I am not a scientist and I am not a physician, psychologist or therapist. I am, however, a food addict who has suffered from and recovered from binge eating. (Like alcoholism, my food addiction has been arrested, but not cured.) I know firsthand how my body responds to certain substances, primarily sugar and highly refined flours. Once ingested, these “drugs” trigger behaviors (consumption of massive quantities of similar foods), thoughts (primarily of the suicidal variety) and feelings (panic, rage, despair, depression) that I do not experience when not consuming these foods.

It took a long time for me to recover, primarily due to the lack of understanding of Binge Eating Disorder and food addiction among the helping professionals I turned to, as well as to the absence of available resources, e.g. treatment centers similar to those for alcoholics and other addicts. I cannot help but believe the current epidemic of obesity (one, but only one, of the symptoms of Binge Eating Disorder and food addiction) in the United States is connected in some way to this lack of recognition for this disease.

My associations with hundreds of other food addicts, my reading of current literature reviewing the scientific evidence establishing Binge Eating Disorder and food addiction as valid clinical diagnoses, and my ongoing layperson’s interest in public policy regarding eating disorders diseases have more than convinced me that these are real conditions of the mind and body that warrant recognition and treatment. The first steps must be increased awareness and acceptance of their reality.

Thank you.

P.S. For your information, I a 57-year-old woman. I have lost and kept off approximately 80 pounds for more than 25 years by accepting my disorder as an addiction. I was lucky enough to receive eight weeks of inpatient help in this process in 1986 at Glenbeigh Hospital in Tampa, Florida. At that time, this now-defunct facility was staffed and financially supported by professionals who translated their belief in the reality of Binge Eating Disorder and food addiction into effective methods of treatment.

Mary Foushi
Executive Director
ACORN Food Dependency Recovery Services
941-378-2122
www.foodaddiction.com

1. Given that there is now conclusive evidence supporting the hypothesis that food is a not only a substance that can be abused but to which people can become physically as well as psychologically addicted, failure to identify food addiction and the criteria for identifying it as such in the DSM5 will interferes with the process of helping healthcare professionals learn how to be as effective as possible in their work with patients suffering from food related conditions whom they serve.

2. More specifically, failure to distinguish between a client being

a. overweight
b. eating disordered and
c. chemically dependent on food in some fashion

or some combination of these when working with clients suffering from food related conditions reduces the ability of the healthcare professional to properly understand, accurately diagnose and effectively treat these clients.

3. Criteria for identifying physical addiction to food should include evidence of 3 or more of the following:

a. Physical craving
b. Loss of control
c. Physical withdrawal
d. Tolerance
e. Addictive denial
to include:
Denial as Distortion of the Hunger Instinct
Denial as Distortion of Conscious Thoughts about Food
Denial as Distortion of the Will
f. Food dependency

[In eating disorders added: I would also like to express my explicit support for the addition of Binge Eating Disorder as a category.]

As an Independent Social Worker I have treated overweight clients who presented with depression but in actuality were depressed due to their weight. They had tried multiple times to control their weight but to no avail. Their weight affected their relationships and their self esteem not to mention their medical health. As a nation with millions of people with diagnoses of obesity, it is time we look at the addiction of sugar and other substances as a disorder. There is research that addresses the food addiction. A good web site with a research review is www.foodaddictioninstitute.org. There are millions of people who are searching for some treatment that works and are willing to pay good money to find it. You have the opportunity to add Food Addiction to the DSM-5 to enable these people to get treatment for their addiction.

I support adding Binge Eating Disorder to the DSM 5. And it is much more important for me and fellow food addicts to have food addiction recognized as a Substance Use Disorder. I see there is now science which supports my experience.

Please include food as a Substance Use Disorder in the DSM-5. This will allow many more food addicts to get the medical treatment and support they need.

Treatment is simple but not necessarily easy, and like other addictions and chronic diseases, there is no permanent cure. It is possible however, to put food addiction in physical remission and then slowly to repair the psychological, social, economic and spiritual damage it has caused. The principles of recovery are simply to: 1) completely eliminate specific binge foods and compulsive eating behaviors; 2) develop feeling skills to deal with difficult emotions without using food; 3) ask for help, especially in identifying and making decisions about chronic irrational thinking about eating, body image and food; and 4) effectively break biochemical denial regarding food addiction.

What one needs to do varies in difficulty as the disease of food addiction progresses.

• In early stage food addiction, recovery begins by identifying potentially toxic foods and abstaining from them. Considerable education about food addiction is often needed to do this. The following questions should be addressed: What is the difference between physical craving and hunger? Why will such a radical step in the short term prevent much more serious problems in the long term? Why is it that some need to abstain completely while others can eat the same foods safely in moderation?
• In middle stage food addiction the distortion of instincts has usually distorted conscious thinking and it is often important to ask for help. This might mean asking a sober friend, a counselor, a minster or even a level-headed family member for help. One might also consider attending a meeting of a food-related 12-Step fellowship. The advantage of a food-related 12-Step organization is that you can usually find others who have similar problems with food and are working together toward a solution. In some of the stronger meetings, you may also be able to find a person to serve as your mentor. In 12-step jargon, this person is known as a “sponsor.”
• In late stage food addiction there is often a need for more structure and support. This might mean going to more 12-Step meetings, joining the more structured programs for critical level food addicts – OA HOW, OA 90 Days, FAA, FA, RFA, CEA HOW or GRS, or seeking professional treatment. The week-long residential workshops of ACORN, Kay Sheppard, and Shades of Hope are often a good place to get help.
• In final stage food addiction, residential treatment, halfway houses and long term-care are appropriate. We recommend the following: Milestones in Recovery, Turning Point of Tampa, and Shades of Hope. We will add others as we learn of them and evaluate their success. When residential treatment is too expensive or when primary hospital-based treatment is needed, there are currently very few options.

© Philip Werdell, 2011

There are a number of other lines of scientific investigation which could illuminate the complexity of food addiction: discovery of several other gene markers associated with obesity and digestive disorders, studies showing the role of leptin deficiencies in problems with satiation, the phenomenon of some celiacs craving gluten-based foods which keeps them from digesting food, the possibility that some with Praeder-Willi Syndrome have a form of addiction to large volumes of food, and many more. It is now clear that clinicians view food addiction as not just as one bio-chemical illness but rather as a cluster of several different chemical dependencies and other disorders.

Each of these lines of research have produced scientific evidence about food addiction from a different angle; combined, the research to date provides a confluence of informed scientific opinion confirming the existence of food addiction but also, in substantial detail, how a number of the chemical dependency processes regarding food work. There is now more scientific evidence establishing food as a chemical dependency, and a more complete understanding of the disease of food addiction as a whole than there was for alcoholism and other drug addictions when they were confirmed as substance use disorders by the medical establishment.

In 2009, the Food Addiction Institute created a bibliography of 2,733 peer reviewed studieson aspects of food addiction from over one-hundred different scientific journals. There have been hundreds of more research studies published since then. The Refined Food Addiction Foundation (ReFA) has a summary of thirty-four science review articles forming a consensus about one of the parts of this body of research. One can view streaming video of the Seattle Summit on the Obesity Crisis and Food Addiction where a number of the most prominent international researchers on food addiction summarize their work and its implications for clinicians and recovering food addicts.

More recently, members from the Institute’s International Advisory Board published “Physical Craving and Food Addiction” a science review article on the key question of whether or not there is a biochemical basis for some binge eating and obesity. (Cheren, et al, 2010) The conclusion is that some people can be addicted to a specific food, to several foods or to overeating on large volumes of almost any food. Another group from the Advisory Board is now working on a scientific review of research on “Loss of Control and Food Addiction.” These are the pivotal issues which establish chemical dependency on food as a disease that is distinctly different from obesity and other eating disorders.

Genetic Evidence: In the early 1990’s, Dr. Earnest Noble led a team of researchers at the Medical School of the University of California at Los Angeles in identifying a marker on the D2 Dopamine Gene associated with alcoholism and drug addiction. In 1994, the UCLA team published an article in the International Journal for the Study of Obesity showing that some obese adults who binged on dense carbohydrates and who showed no symptoms of alcoholism or drug addiction also had the same gene marker. (Nobel et al, 1994) In the article this was called the obesity gene, but at the First International Conference on Food Addiction in 1996, Dr. Noble clarified that it was more reasonable to think of the D2 gene marker as evidence of food addiction underlying some cases of obesity. (Summary of Proceedings for Food Addiction 2000, 1996). This research has since been replicated dozens of times leaving undisputed proof that some obese people carry a gene distinction statistically associated with chemical dependency and substance use disorders.

More recently, there has been research (not yet published) showing that some obese adults who have been clinically diagnosed as late stage food addicts do not have the D2 dopamine gene marker. One theory is that those food addicts without the marker are what the DSM 4 designates as “abusers” and those with the marker are “addicts.” In preparing for the DSM 5, the Substance Abuse Disorder Committee of the APA found that very few alcoholics or drug addicts have been diagnosed as abusers, (add comma) and that both abusers and addicts have been successfully treated in the same way. As a result, they are considering eliminating the “abuser” diagnosis. There is no reason to believe that this would be different for food addicts, but there is no formal study of this matter to date.

Another theory about this new research showing food addicts both with and without the D2 gene marker is that, as with diabetes, there are two types of food addicts. Type I food addicts, those with the gene marker, are genetically predisposed to food addiction from birth, and the potentiality for the disease will continue to be passed down genetically. Type II food addicts, those without the gene marker, develop a Substance Use Disorder from intensively eating chemically addictive foods over time. There is substantial research suggesting that prolonged, intense, gluttonous overeating can produce the brain biochemistry of addiction. Great increases in the consumption of sugar, flour, excess fat, salt and artificial sweeteners in recent decades, could reasonably account for some of the parallel increases in obesity and other related secondary diseases. If so, it would mean that in these cases, food addiction is the primary cause of obesity and related diabetes, high blood pressure, cancer and heart disease.

The genetic causes of obesity as a whole are quite complex. Two genes definitely needing further study regarding craving and loss of control are the ob gene, sometimes called the obesity gene, and the gene identified with a deficiency of the chemical leptin and problems with satiety. (Shell, 2002) The latter is a marker for some of those with out of control eating and a diagnosis of Prader Willi Syndrome. (Deneen et al, 2009) Another area where further research is needed is with celiac disease; in this disease, the ingestion of gluten causes a malfunction of the celia in the intestines and nutrients are not digested. In advanced stages, some celiacs experience a feeling of starvation even when eating great amounts of food. This is similar to the clinical experience of food addicts who are addicted to volume, and the fact that some food addicts are only able to achieve food abstinence after they eliminate wheat, the common grain in bread and processed foods with the most gluten. (Celiac.com 2008)

It is problematic that many scientific discussions of the genetics of obesity do not even include the research on the D2 dopamine gene or discuss the other genes which may be responsible for loss of control. (Beales, et al, 2009)

Evidence from Controlled Animal Studies: There is a long tradition of using carefully bred strains of mice in highly controlled animal studies and, in particular, there is an experimental methodology for determining whether a substance is addictive. These animal studies, the same type used to pretest medical drugs for safety in humans, have been highly reliable in predicting the results of addictive substances on humans. Over the last decade, Dr. Bart Hoebel, Chairman of the Department of Psychology and director of the animal research laboratory at Princeton University, led a research team in systematically testing for the addictive properties of sugar. In a review published in 2008 of all the research on sugar addiction to date, including that of the Princeton team, it was found that rats in carefully controlled experimental conditions show physical craving, loss of control, withdrawal, tolerance and chemical dependency for sugar; in summary, “some animals can become addicted to sugar”. (Averna et al, 2008).

Research by noted French psychologist Dr. Serge Ahmed took this one step further. Using artificial sweeteners in a different type of comparative research methodology, he found that “sweet taste” could be more addictive than cocaine. In mice already addicted to cocaine, he had them choose between sweetener and cocaine. They always chose the sweet substance. Even when it was made four times more difficult to choose sweet over cocaine, the animal chose the sweetener (Ahmed, 2009). Then at the Scripps Research Institute in Florida, researchers found that a wide range of high-calorie “junk food” was just as addictive to animals in a controlled setting. Reviewed in Childhood Obesity News, Pat Hartman concluded, “The studies involving rats conclude that over-consumption of high-calorie food can trigger an addiction response in the brain and high-calorie food can turn rats into compulsive eaters in a laboratory setting….Junk food may just be the socially (sic) acceptable form of drug dealing.” (ChildhoodObesityNews.com)

Brain Imaging Evidence for Humans: The relatively new technologies of CAT and PET scans of the human brain have provided a way to identify with precision the areas of the animal and human brain affected by addictive substances. Dr. Mark Gold, Distinguished Professor and Chair of Psychiatry, University of Florida College of Medicine in Gainesville, did the primary research to establish that cocaine is addictive and to place it on the registry of narcotic substances for humans. Over the last decade Dr. Gold turned his attention to the issue of sugar addiction, publishing a number of papers showing that people who binge on sugar develop brain images similar to those addicted to alcohol, cocaine and methamphetamine. As early as 2004, he edited a full volume of the Journal of Addictive Medicine devoted to the research on food addiction at Harvard University, Yale University, and the University of California at Los Angeles, University of Iowa, the Pennsylvania State University, the McKnight Brain Institute, Brookhaven National Laboratories, and the U.S. Department of Health’s National Institute for Drug Abuse. His conclusion: “Over a decade ago, we reported on the similarities of (some) overeating…to classic addictions. Since that time, neurological studies have supported the hypothesis that loss of control over eating and obesity produces changes in the brain which are similar to those produced by drugs of abuse… Overeating and obesity may be readily included in the DSM-5 by simply considering food as a substance in Substance Use Disorders. Loss of control, use despite diabetes and other consequences, changing priories” would fulfill the American Psychiatric Association’s diagnostic criteria. (Gold, 2004).

Evidence of Endogenous Opioids. One of the frequent secondary observations in the animal research is the bio-chemistry of addiction appearing in the brains of animals especially when they maintain a cycle of overeating and restricting. It is often observed that this pattern is frequently present in humans who binge and then restrict. In an effort to understand this, researchers have examined the blood chemistry of obese adults who diet and then regain their weight. In the general text The Way We Eat: a Six Step Path to Weight Control, Dr. David Katz, Director of the Center for Preventive Medicine at the Yale University School of Medicine, noted that in the process of digesting fats, there were opioid-like proteins produced in the human body. There was nothing the individual could do about these chemicals by conscious choice, and they were either “addictive or something very similar.” (Katz and Gonzales, 2002)

That same year, Dr. Carlo Colantuoni at Princeton University, reported on the findings of over a hundred peer reviewed studies on this subject and found “evidence that intermittent excessive sugar intake causes endogenous opioid dependence.”(Colantuoni et al, 2002) Dr. Neil Bernard, noted nutritional scientist at George Washington University, flushed out the implications for the lay person. Food “contains chemical compounds no one ever suspected were there – mild opiates that are released during digestion. Other researchers have added evidence that there is really something about sugar, chocolate, cheese and meat and certain other foods which set them apart. They don’t just tickle the taste buds. It appears they actually stimulate the brain in such a way that it is easy to get hooked and tough to break free, even if you find yourself gaining weight or lapsing into other health problems.” (Bernard, 2003). Simply stated, some animals and humans on the “yo-yo” cycle of overeating and dieting can be triggering a process in their body that releases the same narcotic chemical which causes people to become addicted to cocaine, morphine and heroin.

Interestingly, it was an ingenious experiment at the University of Wisconsin in 1992 that showed the implications of endogenous opioid creation in humans. Dr. A. Drewnowski set up two groups of students: one group was given a chemical opiate blocker called naloxone and the other control group was given a placebo. Both groups were then brought into a large room with lots of food high in sugar, flour and fat. The control group ate freely of the treats at the same rate as previous test groups. The group given naloxone ate almost nothing. Those with the opiate blocker were just not interested; those in the control group were. (Drewnowski, et al, 1992) This was one of the early scientific indications that a proclivity for what we now know are potentially addictive foods could be inhibited by the same opiate blocker that was being used in some treatments of addiction to narcotics. It can now be seen as a confirmation that there is some sort of endogenous opioid in play regarding human interest in eating – and potentially overeating –highly palatable foods.

Many will ask: why don’t we use this as a medication for those with obesity caused by food addiction? In fact, there have been a number of recent experiments with this idea. So far, the “obesity drugs” using naloxone have had one of two problems: 1) they have either had secondary complications with consequences that the FDA decided were too dangerous for general use (dosages of naloxone that had any effect on weight loss at all had to be very much higher than dosages for blocking effects of external drug addiction) or 2) they produced little or no weight loss –- no more than ten pounds per person –which is not sufficient to justify the risk involved. In short, naloxone has the same problem as most other obesity drugs to date: too much risk and/or too little payoff. There is not yet a medicine truly helpful for obesity in general or the obesity caused by food addiction in particular. (Druglib.com, 2011) Those with knowledge of current research and what is in the pipeline of major pharmaceutical companies say it is very unlikely that a new experimental pill will be approved for human use until at least 2015.

Other Biochemical Evidence. There are several other lines of scientific research which point to food addiction:

1. The information above has dealt with only research on the dopamine receptor biochemistry of food addiction. This focuses on the pleasure center of the brain. There is also substantial evidence of an obesity, eating disorders and food addiction relationship to the serotonin receptors. This focuses on the pain reduction function of the brain.
2. A very different biochemical explanation of loss of control over food is the research on leptin deficiencies. Leptin is essential for a person to experience satiation. Some Praeder Willi Syndrome patients with extreme leptin deficiencies experience insatiable desires for food. Though not the conventional biochemistry of addiction, this could explain what many self-assessed food addicts call addiction to volume, i.e. overeating or bingeing on all foods.
3. There is a great deal of research showing that the physical cravings of some people increase when foods are higher on the glycemic index. Experienced clinicians working with food addicts have suggested that spiking low blood sugar might create an experience of “false starving” in some overeaters.

More detail about these and other parts of the body of scientific knowledge about food addiction can be found in the Food Addiction Institute’s scientific review paper on “Physical Cravings and Food Addition.” (Cheren, et al, 2009) The conclusion of this research is a scientific consensus that people can become chemically dependent on certain foods just as they can become addicted to alcohol and drugs. (Volkow, et al, 2005)

Evidence of Outcomes for 12 Step and Professional Food Addiction Treatment: Medicine is a pragmatic science: if the treatment works, the disease exists. There is much we do not know about the biochemistry of cancer, for example, but we have cures that work for specific kinds of cancer, and we use them because there is evidence that they work. This is true in the area of food addiction, too. Long before most of the current scientific research was even contemplated, there were thousands of self-diagnosed and professionally diagnosed food addicts who have applied the addictive symptomology with some cases of obesity and eating disorders. They applied the addictive model of treatment, and it worked. This was sufficient evidence for the food addicts and the clinicians who have served them. There are tens of thousands of these cases; this can be seen as possibly the most important evidence that food addiction or something very much like it does truly exist.

Evidence from Food-related 12-Step Fellowships: In 1960, a suburban housewife in California, learned that a compulsive gambler had found relief from his destructive behavior by applying the principles of Alcoholics Anonymous. She decided to apply this method to her continual struggle with her eating and weight. The program she developed, Overeaters Anonymous, suggested complete physical abstinence, asking for help in a community of peers, and treating the underlying emotional, mental and spiritual problems with the 12-Steps. Over time, Overeaters Anonymous (OA) expounded upon its definition of abstinence and has supported its members to use a food plan tailored to each individual’s particular needs. From the beginning, some members of OA saw themselves as chemically dependent on specific foods, and the principle of “putting down one’s binge foods a day at a time” became widely accepted. Research on OA commissioned by the organization itself found that:

• In 1992, 81% of a sample group reported “an improvement regarding preoccupation with food” and the group as whole lost an average of 40.8 pounds and kept it off to date for an average of 3.97 years. (OA, 1992).
• In 2004, a larger and more rigorous OA self-survey, managed by members of the Southern Methodist University School of Business, found that 33% were abstinent at the time of the survey and another 45.6% reported significant improvement in eating behaviors; 56% reported “food obsessions had been lifted”; and 46% achieved a healthy body weight since joining OA. (OA, 2004)
• In 2010, a third survey – with a return rate of 36% and a margin of error of 4.09% – found that 82% of respondents came to OA overweight; 69% lost weight so far (with an average loss of 45 pounds); and 51% were maintaining a healthy body weight; a large majority found that they had “significant improvement” in daily functioning, overall physical health, mental/emotional health, spiritual connection, and relationships as well as weight issues. In fact, a slightly lower percentage described success with physical recovery – 75% – than with inner recovery – 79-91%. (OA, 2010)

Members of OA are people who have usually tried many diets and failed. Seventy-four per cent (74%) had tried therapy but failed to find help for their food and eating problems before joining OA. The OA success rate is impressive considering the fact that most diets have a success rate of only 10-30% in the first yearTens of thousands of people have been recovering in OA for over fifty years, and most of these people have never had the opportunity to benefit from professional treatment using the addictive model as our counterparts in NA and AA have. OA certainly provides an effective solution for some obese and eating disordered adults, and this makes a strong case that compulsive overeating and food addiction are diseases that exist and can be treated successfully.

Within OA, there are “movements” for those who identify as “food addicts” and not just “compulsive overeaters” or “eating disordered.” Because their disease with food has advanced to a more critical level, they embrace a stricter program to deal with it. Some sub-groups within OA that have developed to suit the needs of critical level compulsive overeaters and food addicts are: OA-HOW, OA-90 Days, and former OA Grey Sheet. Since the turn of the century, substantial groups in each of these movements have created whole new fellowships where everyone identifies as a food addict and where community support is focused on the needs of those in the late and final stages of the disease. These new fellowships include: FAA, FA, CEA-HOW, RFA, and GSA. While there is not yet any self-initiated research from these sub-groups and new organizations, it is commonly known within the food recovery community that these disease-model recovery sub-groups and fellowships are generally more structured, more demanding and more successful with advanced food addicts. The percentage of members who are food abstinent, the amount of weight lost and the stability of recovery seems to be higher in many of these groups than in the rest of OA.

There is one independent academic study of OA in a geographical area where OA HOW is particularly strong. In her doctoral thesis at Virginia Polytechnic Institute, Dr. Kriz did a rigorous study of the effectiveness of 12-Step recovery for obesity and eating disorders. The findings included:

• 68% of 162 respondents said they adhere to a food plan daily;
• 70% were abstinent more than 30 days at the time of the survey;
• 46% said they weighed and measured their meals 75-100% of the time;
• 46% reported never or rarely relapsing;
• 62% had completed a Fourth Step self-inventory;
• 21% had completed making Ninth Step amends to others they had hurt; (Kriz, 2002)

Although Dr. Kriz did not make the distinction between those with eating disorders, food addiction or both, the large percentage who weighed and measured their food suggest many were using a more structured program designed for those with chemical dependency on food. There were no questions comparable to the OA surveys on weight loss.

Evidence from Professional Food Addiction Treatment Program: During the 1980’s and 1990’s there were over a hundred hospital-based treatment programs for food addiction using the medical model. Many did outcome research but did not publish it. There is one independent academic study of Glenbeigh Psychiatric Hospital of Tampa’s Residential Eating Disorder and Food Addiction Treatment Program. It is a doctoral dissertation by Dr. M. Theodora Carroll for the Department of Psychological and Social Foundations of the University of South Florida. The focus of the thesis is on evaluating the predictive value of the Eating Disorder Inventory in an inpatient treatment program for the bulimic and obese employing an addiction paradigm. More importantly perhaps, is the rigorous outcome survey done within the research to establish a basis for evaluating the testing instrument. It is the outcome data which provides evidence supporting the disease concept of food addiction:

• 1/3 of the sample group had maintained rigorous and stable abstinence for at least a year, some up to five years; this entire group was maintaining or moving towards a healthy weight loss.
• 1/3 had had at least one relapse for weeks or months, but each had regained their abstinence, and they too, were moving towards a healthy weight.
• 1/3 had relapsed and was still in relapse at the time of the survey; most did not have an appreciable weight loss, but almost all were thankful for the experience of treatment and for the knowledge that they were chemically dependent on food.

Over 8,000 clients had participated in the six to eight week residential food addiction treatment program at Glenbeigh, and the research studied a random sample of alumni. The outcomes compare favorably with outcomes of drug and alcohol treatment and very favorably with outcomes of commercial weight loss programs.

When health insurance companies stopped reimbursement for all hospital-based primary treatment programs for food addiction, a new model of professional service was developed by private practitioners (e.g., Kay Sheppard, Judy Hollis and Anne Katherine) and private treatment programs (e.g., Shades of Hope and ACORN Food Dependency Recovery Services). Outcome research on the ACORN program was presented at the first “Promising Practices” conference of the International Association of Food Addiction Professionals in 2009. As of 2006, over 1,200 self-assessed food addicts had participated in the five day ACORN Primary Intensive – a residential workshop modeled after the program at Glenbeigh Hospital of Tampa. The samples in the study included 250 alumni of the Primary Intensive and 40 members of Overeaters Anonymous who were in long-time recovery and had not attended ACORN or other professional treatment programs.

Of the ACORN alumni sample, 95% identified themselves as food addicted and were not able to successfully diet, deal with their eating problems through therapy or to achieve and maintain food abstinence with the help of food-related 12-Step programs. Surveyed between one and five years after attending their first ACORN workshop: (add colon, remove comma)

• Over two-thirds said that food addiction had had a strongly negative effect on their physical, emotional and spiritual lives prior to the workshop.
• On the day they responded to the survey, most (76%) were abstinent; they had honestly committed to what they were going to eat that day and then followed through with it.
• About one-third had been stably abstinent since treatment, and another third had relapsed but found their way back to abstinence and recovery on their own.
• On average the ACORN group had lost 50 pounds from their highest weight. They had relief from secondary medical problems, and they judged their mental and emotional health to have improved.
• Those in the ACORN group had similar recovery profiles to the non-ACORN long-timers from OA: a peer support group, a mentor or a sponsor, a spiritual practice of prayer and meditation and/or the 12-Steps.
• None rated their overall ACORN experience negatively; 20% said “it helped a lot,” 59% said “it changed everything,” and 96% said they would “recommend ACORN to other food addicts.”

One of the most interesting outcomes was that all but six of the 1,200+ ACORN participants had become rigorously abstinent during the Primary Intensive, showing that this is a lower cost alternative to a treatment centers and a highly effective way of supporting detoxification for chronically relapsing food addicts. These findings also suggest that short-term residential detox for those chemically dependent on food(s) might make a substantial intervention in the obesity crisis.

Many of the most difficult cases of adult obesity and eating disorders can and do respond favorably to an addiction model of treatment, thus corroborating the scientific evidence for food addiction. The effective treatment for food addiction behooves us to make use of a diagnosis of chemical dependency on food, i.e., food as a substance use disorder. (Cheren, et al)

Obesity is entirely a physical disease. It is caused by excessive calorie intake and/or not using enough calories – and, occasionally, by a metabolic or other medical dysfunction.

Using Body Mass Index (BMI) and established medical standards, the Center for Disease Control has found that a third of the U.S. population is obese and another third is overweight. (CDC, 2010) Historically, between 10% and 30% of overweight and obese adults are able to lose substantial weight and keep it off by dieting either on their own or with the help of commercial diet programs. Since being able to control one’s weight in a healthy manner generally disqualifies a person from being diagnosed with an Eating Disorder or a Substance Use Disorder on food, this shows that there are a substantial number of overweight and obese people who are not food addicted.

Eating Disorders are a psycho-social disease. It is caused by early family dysfunction, trauma and/or unhealthy social norms for body weight and beauty. Using the characteristics established by the American Psychiatric Association, a recent Harvard University study found that 1.8% of the U.S. population is Anorexic, 2.6% is Bulimic, and 3.8% had Binge Eating Disorder. (Hudson et al, 2007)

Food addiction is a chemical dependency. It is caused by the changes in the brains of some people in reaction to the biochemistry of a specific food, several foods or volume of food in general. Using the American Psychiatric Association’s criteria for Substance Use Disorder, Dr. David Kessler, former Commissioner of the U.S Food and Drug Administration and Dean of Yale University Medical School, found that 50% of the obese, 30% of the overweight and 20% of the normal weight adults in a randomized sample were food addicted. (Kessler, 2007) If this initial study represents the U.S. adult population, there are 70 million food addicted adults.

The most difficult cases are those who are food addicted and eating disordered – or have some other addiction or mental illness coexisting with chemical dependency on food. About 80% of the tens of thousands of Overeaters Anonymous members say that they have blood relatives with alcoholism or some other substance addiction, and about the same number say that they have a history of physical, emotional or sexual abuse. This suggests that a very large number in the fellowship – and probably many more outside the fellowship – have both a chemical dependency on food and a trauma based eating disorder. In this case, recovery is possible, but only if both problems are effectively addressed.

Hudson JI, Hiripi E, Pope HG Jr., Kessler RC, The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1; 61(3):348-58. Pub 2006 Jul 3.

Kessler, David The End of Overeating: Taking Control of the Insatiable American Appetite, Rodale Books, 2007.

© Philip Werdell, 2011

• Anorexia and Food Addiction
• Bulimia and Food Addiction
• Binge Eating Disorder and Food Addiction

There are a number of tests and questionnaires for assessing food addiction. Many of the food-related 12-Step programs – OA, FAA, FA, RFA, CEA-HOW and GSA – have a list of self-assessment questionnaires on their websites. There are a number of excellent self-help books on food addiction – by Hollis, Sheppard, Katherine, Danowski, and Ifland – all dealing with the issue of self-assessment. Click here for recommended reading. The best established treatment programs for food addiction–Renaissance Nutrition Center, ACORN Food Dependency Services, Milestones in Recovery, Turning Point of Tampa, Shades of Hope – have assessment information on their websites and they will also do an assessment by phone. Click here for links. The Yale Food Addiction Assessment Instrument is the first assessment tool which has begun the process of standardized testing. Click here to open.

Another good way to determine whether someone might be a food addict is to have them talk with someone else who has identified their own chemical dependency on food and is in stable recovery. Let them talk about what it feels like when they really want to eat or believe that they “have” to eat. Is this hunger or something else, e.g. physical craving? Let them see if they are powerless not to overeat after they have decided not to eat something or to eat moderately. Does it seem as if another person takes over with an entirely different point of view? Let them talk about their sense of self when they overeat: is it their highest and best self that is making food so important or is it a distorted and false self?

If the possible food addict is skeptical, it is sometimes a good idea to suggest an experiment in controlled eating, usually more than one.

• One experiment is to start eating a common personal trigger food and stop right in the middle of a binge. Is there a compulsion to keep going?
• A longer experiment might be a new diet or one that has “worked” in the past. Is it getting any harder to lose weight? This time, is it possible to maintain a healthy weight?

Any food addict is likely to notice problems staying in control. A critically advanced food addict may not even be able to complete the experiment or they will not need to try because they already have done this many times, and they know the answer.

For those who already know they have a problem, an important question is: at what stage are they in the progression of the disease? This makes a difference in terms of what they might have to do to recover.

• In the early stage, food addicts are often unaware that they have a problem; food often seems more like the solution than the problem. The main problem usually begins with a lack of good education about food addiction.
• By the middle stage, food addicts have tried a number of diets or other more extreme strategies to control their eating; they are suffering negative consequences – being overweight, depressed, leading a secret life, feeling guilt or shame about both – but the consequences do not seem severe enough to justify giving up entirely the foods they like the most, much less asking for help to do this.
• In late stage, food addicts know their problem is critical but they find their situation hopeless; they know that they are powerless to stop by themselves, but commercial weight loss, therapy on underlying issues, and sometimes even 12-Step programs alone are not sufficient to get them abstinent and in stable recovery. Most food addicts at this stage need professional treatment.
• In final stage there are usually very serious medical complications. This could be morbid obesity, failing joints, advanced diabetes, progressive heart disease, and much more – including a desire for death. Paradoxically, eating has often become the most important thing in their lives, and while it is causing an early and painful death, it can also be the only thing that they believe makes life worth living. Treatment at this stage must often be primary, follow the addiction model and be hospital-based. There currently are no such programs.
• The last stage of food addiction is death. The death rates for food addicts are probably similar to those for obesity: statistically, active food addicts can expect to die five to ten years before their healthier counterparts, and more importantly, the last stages of life for the active food addict can be very painful physically, emotionally and spiritually.

Tragically, knowing that food addiction is a serious, progressive disease is often insufficient to break food-addictive denial.

In early stage food addiction, the outward behavior of a food addict can be quite similar to a normal eater who occasionally overindulges; the internal experience might involve feeling guilty after eating, feeling preoccupied before eating and the urge to lie about it to others. For example, the early stage food addict often remembers their first binge; they often try to recapture that experience again and again. The food addict is also more likely to have more than one blood relative that is alcoholic, drug addicted or eats out of control. Normal eaters are more likely to be willing to eliminate a food they really like if given good reasons to do so; a food addict may say they are willing to abstain but then sneak the food and lie about it anyway. Lying, sneaking or stealing food over and over is a tell-tale sign. Physical craving has begun to make them do things for the food(s) they want that violate their personal value system.

Middle stage food addicts will likely have the experience of gaining unwanted weight, dieting to take it off, and then gaining the weight back again. Most will have done this more than once. Having dieted successfully in the past, they learn that they can control their eating if they want to by reason and willpower. The fact that they then put their unwanted weight back on – even though they had strong personal, social, economic and medical reasons for keeping it off – is not sufficient to convince them that they are losing control. They experience euphoric recall, remembering the highs of eating but not the negative consequences. Physical craving has begun to distort their unconscious thinking; they have mental obsessions about food before, during and after eating.

At this stage doctors, dieticians, and counselors have told them that they need to lose weight –or stop restricting and purging – or there could be severe medical consequences. They know this is true and that they should stop, but they cannot bring themselves to think of themselves as food addicts, entirely eliminate their binge and trigger foods, and/or ask for the support needed to do this.

Middle stage food addicts often have many of the same external characteristics as those with eating disorders; in fact, many food addicts are also anorexic, bulimic and/or out of control bingers. However, there is a subtle difference between the internal experience of an eating disorder and a chemically based food dependency. Those with eating disorders are primarily emotional eaters, often consciously using food as their main coping mechanism to deal with unwanted feelings. Food addicts will often be aware that they are craving a specific food or foods whether or not they are experiencing difficult feelings. For food addicts, they may also be emotional eaters, but they progressively overeat even when they stop receiving emotional benefits from the food.

In late stage food addiction, the person knows that they are powerless over food and believes the situation is hopeless. For some, when they are told that they are probably food addicted and that there is a solution, they are grateful. Others choose therapy – often for many years – to deal with their weight and eating issues, to no avail. Some try Overeaters Anonymous or one of the other food–related 12 Step programs, but they are not able to achieve and maintain food abstinence and recovery. Many need professional help and treatment for their food addiction, and either they do not know it is available, their health insurance does not cover it, and/or they do not have the financial means to pay for it.

In final stage food addiction, treatment is often not possible without hospital support. The person may be morbidly obese and have needs beyond that of workshop based and free standing treatment programs. They may need doctors to monitor late stage secondary illnesses like high blood pressure, diabetes, and heart disease; they may have an advanced co-existing mental health illness. Strangely enough, they may refuse appropriate treatment because they are certain they can deal with their problems on their own.

© Philip Werdell, 2011

In Early Stage food addiction there is moderate, often infrequent, loss of control. This could express itself in occasional food binges, a slight increase in volume of food eaten, or snacking more frequently. Externally, it can look almost identical to the behavior of a normal healthy eater indulging in occasional excesses. Internally, the early-stage food addict can be lying, isolating and/or feeling guilty. At this stage, the food addict could stop the progression of the disease simply by no longer eating the offending foods, but the negative consequences at this time are seldom sufficient to justify such radical action.

By the Middle Stage of the disease, most food addicts will have gained unwanted weight, dieted, and then regained the weight. Some will have done this more than once. Many find themselves hoarding particular foods, taking others’ food, stealing money to buy food, or outright lying about food – not their normal behavior in other matters. A few begin deliberate periods of restricting, over-exercising or purging. There is often a sense of guilt or shame about not being able to control their weight and treating food like a drug stash, though they may not think of it in this way. Some join a food-related 12-Step group and find this to be the right solution, but others are unwilling to completely abstain from binge foods or do the internal work suggested. As with alcoholics at this stage, these food addicts often “want to want to stop.” They are in denial that they are really food addicted or that a chemical dependency on food actually exists. They remember the times they were able to diet at least temporarily, or they simply cannot accept the idea that they cannot control something as basic as food.

The Late Stage food addict is usually quite clear that they have no control over food. While still experiencing deep shame, they often see any attempts to diet as hopeless – even though they might continue to try. Many have tried therapy to deal with their weight and/or eating disorder – some for many years. While there are often many emotional and spiritual benefits from talk therapy, they find that learning to control their eating is not one of them. Others are so ashamed of their lying about food or so accustomed to doing so that they do not tell their doctor, dietician or therapist the full truth about their eating. They may be unable to tell the full truth about their behavior with food because they are in deep biochemical denial. In late stage food addiction, there are major medical consequences and serious psychological, social, economic and spiritual losses. Besides obesity or an advanced eating disorder, they often have high blood pressure, diabetes, heart disease, depression, anxiety and other serious issues. Frequently, the medical professional will treat the secondary problem because that is what they know how to do, but the underlying substance use disorder with food is completely neglected, and the food addict just lives to overeat again. The diabetes, heart disease, depression or other secondary medical illness returns, often growing worse.

There are now a growing number of food addicts in the Final Stage of the disease. This includes many in the new medical category of Extreme Morbid Obesity. Also included are many anorexic and bulimics who have been in treatment several times, but have not yet been diagnosed as also being chemically dependent on food. In final stage food addiction, secondary medical diseases are often so advanced that treatment is only possible in a hospital where the food addicted patient’s problems can be monitored and treated. It is not unusual for food addicts at this stage to be too overweight for some residential treatment programs which are able to treat food as a substance use disorder. (Tragically, there currently are no primary hospital- based treatment programs for food addiction.) Bariatric surgery can be helpful to many who are extremely obese, but if their food addiction is advanced, they are likely to start overeating again within a year, often losing surgery’s benefits as they regain the weight. All obese people are in danger of dying five to ten years earlier than they would have if they had been at a normal weight. Those who are morbidly obese and in the final stage of food addiction can expect an even earlier death or a very painful life if their chemical dependency is not effectively treated.

© Philip Werdell, 2011

I have always known I was a competent person. I am a graduate of an Ivy League university, earned two graduate degrees with honors, and serves capably as one of the nation’s first women ministers with her own congregation. So, it was confounding to me that I could not control my eating or my weight.

I wasn’t overweight as a child, but once in college I became morbidly obese. I tried diet after diet – always succeeding at first, then gaining it all back and sometimes more. Some of the therapy approaches I tried also worked temporarily, but I gained this weight back too. I tried Overeaters Anonymous, but could never achieve a stable abstinence.

So, at my doctor’s urging, I elected bariatric surgery. This, too, was successful at first. I lost more than 100 pounds, felt better, and my blood test results started pleasing the doctor. Then I started overeating, just a little at first, then wildly out of control. I was very confused and really depressed.

Someone told me about her success with ACORN’s (Food Dependency Recovery Services) primary intensive for food addicts. I was skeptical that it would work for me, but I had to try it.

By the end of the five-day workshop, I was “rigorously abstinent” from all my binge foods. I had a few difficult days of detoxification, but then I knew that something was different. My food Craving disappeared and my crazy thinking about food lessened incredibly. That was almost two years ago. I haven’t picked up any of my binge foods and I’ve found an inner peace. I am maintaining a 220-pound weight loss with ease. I’ve never felt or looked better.

I may have had to fail after the bariatric surgery to fully break my denial that I am food addicted. I have no regrets, and I am grateful to be learning how to work a daily recovery program as a recovering food addict.

In 1990, after deciding I would eat myself to death because I could not stop bingeing on sugar and flour products, I went to treatment for food addiction.  I learned that I am a food addict and that I cannot eat certain foods without creating cravings that I am unable to resist.

Now, I have maintained a 200 pound weight loss for 19 years. I have not binged since 1990 and no longer experience cravings.  I have a normal size body.  I am healthy.  I have not had any form of bariatric surgery.  Rather, I treat myself as a food addict.

They followed the suggested steps which included elimination of sugar, chocolate, cheese, and fatty meats, and replaced these and other foods they craved with a primarily vegetarian diet.  Several months later Miki wrote to Dr. Bernard and told them they were both feeling “wonderful.” Not only was her husband much better, so was she!  Here is part of her story:

The most amazing things have resulted from this endeavor. I have enjoyed the new foods and wonderful tastes, but also a marked improvement in my health.  I have lost sixty-seven pounds in one year.  For the first time in my life I was not on a diet. I was able to increase my exercise regimen due to the weight loss.  My cholesterol is under control (having dropped significantly in the last year).  One of the most amazing results for me has been the disappearance of all diabetic symptoms. My blood sugar measurements have decreased, on the average 185 points without medication.  I feel fantastic, and, for the first time in a long time, I have a clean bill of health from my annual checkup.  We started these classes for my husband; however, I have gained as many benefits along the way as he has.  You have my profound gratitude.  (Bernard, 2003)

(Comment: Miki hadn’t called herself a food addict but she likely was in an early or middle stage of chemical dependency on food.  When she treated herself as if she was food addicted, it worked.)

A 365-pound guy walks into a sub shop, with or without mustard stains on his sweater, and orders a couple of foot-longs. Anyone in the place is going to think they’re all for him, no matter what he does.

That’s why, sometimes, I’d just go in and order, and let them think what they wanted. But sometimes I’d go with the list.

I’d grab a scrap of paper off the floor of my car and scribble on it, or write it out as if it were real, in case the clerk grabbed it to check for grammar or something. Then I’d roll out the driver’s side door and roll on inside.

In the mid-‘80s, friends and colleagues at work suggested he wasn’t very happy and urged him to seek counseling, a path that led to suggestions that he might be a food addict, rather than just a weak, lazy slob. It wasn’t welcome news by far, but it eventually opened a range of changes in attitude, practices, and treatments that are sustaining a 155-pound weight loss for two decades.

Over the next several years, my life would head in beneficial directions I had neither expected nor even contemplated: Relationships, work performance, and personal productivity all began to improve; I was able to take on challenges and expand creatively; I grew willing to see the world in new ways and to take responsibility for my actions. I started dating successfully.

And that doesn’t even broach what most people would consider topic No. 1: I lost weight in a balanced, sane, and healthy manner and kept it off.

Recovery didn’t arrive on a straight path, but it did arrive, and continues to.

The Fat Boy Thin Man book is available on this website, The e-book is available at smashwords.com.

Both Amber and her colleague Dr. Vera Tarman agree that weight loss is only one result of the recovery process for the food addict. Amber went from sneaking food and staying away from public interactions to becoming an advocate for food addiction in the public eye, truly a real life success story.

“The process of surrendering to addiction is difficult for most people,” said Dr. Vera, Canada’s foremost food addiction expert. “For those people like Amber who embrace the science behind food addiction and the need to change the way they think and act, the results of recovery can be remarkable.”

Today Amber has lost over 150 lbs and more importantly is totally committed to the recovery process, including abstinence from sugars and starch. “It’s one day at a time for me, like it is for most people recovering from addiction”, noted Amber. Amber has taken control of her life and her story is one of breaking through the denial of her addiction and developing a passion for living life to the fullest.

In the popular language, the term “food addict” can mean anything from eating a lot of packaged snacks – as in “junk food junkie,”- to having a really a serious disease like alcoholism or addiction to other drugs. However, unlike for those with alcohol and other addictive drugs, there are very few places that can help you get through a one-week chemical detoxification and even fewer places to receive treatment in the way you can for other chemical dependencies. Health insurance usually does not cover the programs that do exist unless you enter via some other diagnosis. In fact, most health professionals have no formal training and little experience in supporting food addiction recovery. As of 2009 there is nothing taught about food addiction in most medical or nursing schools, graduate schools for dietitians or social workers or in the advanced training of most therapists. Even the required reading list for the certification exam put out by the International Association of Eating Disorders Professionals does not contain a text on food dependency. There is no reference to food addiction in the Merck Manual of Medical Information, the world’s most widely used medical reference, nor in the American Psychiatric Association’s Reference to the Diagnostic Criteria for mental health. In the last few years there has been new scientific research that establishes that food should be listed as a substance use disorder.

There are tens of thousands of people just in the United States who assess themselves as food addicted. Many of these are in the membership of food-related Twelve Step fellowships: Overeaters Anonymous (OA), Food Addicts Anonymous (FAA), Compulsive Eaters Anonymous-HOW, Anorexics and Bulimics Anonymous (ABA), Eating Disorders Anonymous (EDA), Grey Sheet Anonymous (GSA), Overcomers Anonymous (Overcomers) and Food Addicts in Recovery Anonymous (FA). How is someone outside one of these fellowships – much less those without such support – able to assess whether or not they are food dependent?

(Note: if you try any of the self-assessment procedures which include major changes in the way you eat, our strong recommendation is to do this in consultation with a doctor, dietitian and/or therapist. Even if these professionals don’t have a lot of experience with food addiction, they will be able to help you spot and deal with secondary problems that are often revealed as food addicts begin to look at recovery. They can also help you monitor whether a food plan is at all dangerous because of specific medical issues which might be complicated by a change in diet.)

Here are some of the most common methods of assessment used by those in recovery and by health professionals who have experience serving them:

If you don’t know if you are a food addict, an initial suggestion is to try some controlled eating. The most common way to do this is to take on the discipline of a formal diet. If you are able to lose weight (or in some cases, gain weight) and then maintain a healthy weight, you may be a “normal eater.” If you cannot, you may be an “emotional eater” (with an eating disorder), or a “food addict” or both.

For most food addicts this will mean trying another formal diet. The fact that they could not control their eating (bingeing, purging or restricting) is what brings them to the question of whether or not they are chemically dependent on a specific food or food in general.

The idea of “trying some controlled eating” may seem a bit reckless considering the dangerous consequence of being food dependent, but this is exactly what the basic text of Alcoholic Anonymous suggests for alcoholics. It helps to have a confrontation with reality. Those whose food addiction is relatively advanced may not be able to keep to a diet for even a day, much less the weeks, months and years necessary for long-term health.

If you already are pretty sure what will happen with another diet experiment, you may be ready for a more conclusive test: try eating like you would if you were a food addict in recovery. The simplest way to do this is to eliminate your binge foods, then eat moderate meals, nothing in between, one day at a time. Another simple way to try to be food abstinent is to use the food plan of one of the Twelve Step fellowships related to food. If you are unable to do this for even for a day or two, you are probably food addicted.

Try this way for a week. Do you experience symptoms of detoxification, such as: Headaches? Anxiety? Strong food cravings? Drowsiness? Irritability? Insomnia? If by the end of a week of abstaining from your binge foods these symptoms disappear or are significantly reduced, this is a good indication of chemical dependency. Note: if the symptoms do not go away or there are still strong cravings to eat, you still may have foods you are addicted to in your food plan, e.g. “hidden sugars” like dextrose, fructose, barley malt or food starch; it would be wise to take these out and start the test again.

If you are looking for a paper and pencil test, try the self-assessment questions below:

While on a diet, do I “lose it” after a few days?

When I lose weight, do I gain back even more?

Do I obsessively calculate the calories I’ve burned against the calories I’ve eaten?

Am I thinking about food or my weight all the time?

Do I have physical problems resulting from the way I eat, or don’t eat?

Do I eat large amounts of food in a short period of time?

Do certain foods trigger binges?

Do I weigh myself once or twice (or more) a day?

Do I eat differently in front of people than I do when I’m alone?

Do I have emotional problems resulting from the way I eat or don’t eat?

Do I find it difficult to stop eating without a struggle after one or two sweets?

Have I done serious work in psychotherapy only to find my “food problem” was unaffected?

Answering one or more of these questions with a “yes” could indicate a food addiction.

There are also simple sets of questions in most of the introductory literature of food-related Twelve Step organizations.In the CEA-HOW and in the HOW meetings of OA, there is a list of 30 pre-commitment questions which you can do one day at a time with a peer sponsor.

Another more thorough instrument is PROMIS Addiction Assessment. These are questions developed by Dr. Robert LeFevre for an addiction treatment center in Great Britain. This is a set of questions not just for food but for a dozen other substance and process addictions. You can test for food and also compare it to your experience in – and in recovery from – other dependencies.

If you would like a professional opinion, make an appointment for an assessment with a doctor, dietitian, therapist or recovery counselor who has been successful in helping food addicts achieve and maintain abstinence. The difficulty here will be in making a judgment about their experience and ability to evaluate and treat food addiction. If they say, “There is no such thing as food addiction,” this is not a good sign. One good sign is if they recommend you check out one of the food-related Twelve Step fellowships.

What will professionals doing an evaluation do? Most will ask you to describe your experience overeating in some detail. Michaelanne Fultz, Director of the Louisville Center for Adult Children (LCAC) and Executive Director of the Kentuckiana Foundation for Eating Disorder Recovery (KFEDR), says that when she does an assessment, she listens for “powerlessness and unmanageability regarding food.”

Personally, when I do an initial assessment, I listen for out of control eating, for the most commonly addictive foods and for a history of addictive behavior about food – lying, stealing, denial, etc. Of course, if you are not able or willing to tell the truth about your eating to a counselor, that is a sure sign that you have a serious problem.

If you are looking for a way to distinguish between a psychologically-based eating disorder and a food addiction, H.Teresa Wright, a registered dietician with over a decade of experience working with both, often suggests a client read two books or take two assessments, one focused on Emotional Eaters and one on Food Addicts. As a book focused on emotional eating, she would suggest Geneen Roth’s Feeding the Hungry Heart or Breaking Free of Compulsive Eating. For a book focused on addictive eating, she would suggest Kay Shepard’s Food Addiction: the Body Knows or Anne Katherine’s Anatomy of a Food Addiction. She lets the client decide in which modality they would like to start.

Three assessments ACORN uses are in my latest book, Bariatric Surgery and Food Addiction: Pre-Operative Considerations.

There are a number of tests about eating disorders that could be matched up with the food addiction assessments above. The most common professionally developed instrument is The Eating Disorder Inventory, often used in conjunction with the Beck Depression Inventory. If the client or the professional thinks that there might be both a trauma disorder and a chemical sensitivity to particular foods – and this is very common, then it is wise to begin with the addictive concept of food addiction: it is not possible to do effective therapy while still medicating the feelings you are trying to work on with food.

If you are pretty sure that you are food addicted, the best way to do an assessment is to start working a program of recovery. This might be on your own, with a counselor or with one of the Twelve Step fellowships. The truth is that no one can ever be 100 percent certain that they are or are not food addicted, but if you work a food addiction recovery program and your weight, mental health and spirit improve, what does it matter if you know exactly whether or how you are chemically dependent on food? Many recovering food addicts will say, “The only way I’m sure that I’m a food addict is that when I treat myself as if I am chemically dependent on food, I get better.”

Any of the growing number of self-help books on food addiction would be helpful if you want to proceed on your own. The original book is Judy Hollis’s Fat as a Family Affair, and it is still one of the best. The most current books are Why Can’t I Stop Eating? by Debbie Danowski, Ph.D. and Pedro Lazaro, M.D and Sugars and Flours: How They Make Us Crazy, Sick and Fat and What to Do About It by Joan Ifland Ph.D (candidate.)

For those looking for free support for this effort, the oldest and most diverse fellowship is Overeaters Anonymous (OA). The fellowship most focused on food addiction is Food Addicts Anonymous (FAA). The organizations where there is often the most structure and tough love for food addiction recovery are Compulsive-Eaters Anonymous-HOW (CEA-HOW), Food Addicts in Recovery (FA), and Grey Sheet Anonymous. For an explicitly Christian context for Twelve Step work, there is Overcomers Anonymous.

For those looking for professional support, there is ACORN Food Dependency Recovery Services. We have an introductory evening seminar, “The Power of Surrender” which is an overview of the disease, an opportunity to do some self-assessment and some guidance about what exactly it means to “surrender” to recovery. ACORN’s best program is the five day residential Primary Intensive©. We also have regularly scheduled workshops and retreats for those needing more support. These are fee-based workshops and usually not covered by health insurance.

While there is no longer a primary hospital-based treatment program for food addiction recovery, there are a few treatment programs with a track record of supporting food addiction recovery. Some health insurance programs still support such treatment.

An important thought about assessment for food addiction: food addiction is a disease of denial. If you have read all this because you are wondering whether or not you are yourself chemically dependent on food, this is something you might want to consider.

Most people who are not food addicted do not spend much time wondering whether or not they have this disease. Many for whom the disease is actually quite advanced spend a lot of time putting off recovery by continuing to stay focused on the question of whether or not there is such a thing as food addiction – or whether or not they are themselves really addicted, rather than taking an action.

If you fit this characterization, here a couple of question for you:

o Are there foods that you don’t think you can live without?

o Are there things you absolutely do not want to do to recover if by some chance you are food addicted?

o Do you sometimes think you will die if you have to abstain from your favorite binge foods for the rest of your life?

If you answer yes to any of these questions, you do not think like a normal eater. And these are not the main ways that Problem Eaters with eating disorders think about food; they just want to be able to eat foods that will help them numb or medicate certain feelings. So, what does this say about you?

? Without doubt the most effective way to assess whether or not you are a food addict is to do an in-depth history of your own experience of being powerless over food. In the Twelve Step fellowships, this is called a First Step, and it is important to do this work while practicing surrendered food abstinence.

The reason this is the most effective way of answering this question is because true food addicts need to admit – and accept at the core of their being – that they are addicted to food. This means breaking the food addict’s denial. Once the disease has progressed, this is often much more than just an analytical and rational process that one can do by oneself. The process of describing specific incidents of powerlessness over food helps break food addictive denial. Most people find they need the help of a community to help them break through their own denial.

© Philip Werdell, M.A.

Recognizing that a slip begins long before the food is eaten, this tool will help you identify what happened at each stage, so that you can learn to back out of relapse.Of course, if you don’t do your Step work, the food slips will continue to happen until you are in full relapse.
This is not a program of slip inventories!

If you are in full relapse, you need to do First Step writing.
It’s important to do this within the first 24/48 hours of the slip. Otherwise, details that are already difficult to recall will disappear entirely into the food addict’s thinking. The longer you wait, the more blurry the details become. This is part of a food addict’s “strange mental blank spots.” It’s easier to slip into denial when we don’t remember what we were thinking and how we felt.

1. Select lined paper and write on every third line. You will be putting in other details later. Write a story of what happened leading up to your slip, starting at least four hours before it happened.

2. Write about the slip as if you were holding a movie camera on yourself. Your actions, thoughts and feelings should be included, right up to “and then I ate…”

3. Identify where the “emotional relapse” happened. When did you get angry, start obsessing, try to control a situation, feel overwhelmed by fear. Write the feelings on the empty lines. You may need another food addict to help you with this.

4. What were the lies you told yourself so that you could eat? “It’s only one bite.” “I’ll start tomorrow.” “It’s my last chance to eat something yummy.” “Oh, screw it; I’m going to have what I want.”

5. After that, identify the spiritual disconnection. Did you have a connection to your Higher Power that morning? How long ago did you lose it? That’s when your slip really began.

6. Read this inventory to two other abstinent food addicts, in addition to your sponsor. You need abstinent people to help you through the blank spots and denial. People that are still in the food are not clear enough to help you.

7. Write out your plan for how to address the situation the next time it happens (AND IT WILL.)

8. Finally, what is the spiritual lesson in your slip?

© Phil Werdell & AEH 2008

In the long term, diets do not work for compulsive eaters and food addicts, but we still need a way to give structure and support to our physical recovery. Since we have become powerless over food, a food plan must be used in a spiritual context. Thus, a food plan is a spiritual tool; it is an instrument for implementing “surrendered” food abstinence.

Everyone’s nutritional requirements are subtly different, but there are general principles and patterns which work for most people. When the food addict is looking for an effective food plan, the situation is similar. Every food addict must look to his or her own food history and be rigorously honest about what has worked and what has not worked. Each of us must check out for ourselves whether a particular food plan works for us in practice. Yet there are principles and patterns which have developed in our collective experience and these provide a helpful guide to compulsive eaters wanting to choose the best food plan for their recovery program.

Issues of Nutrition and General Health vs. Issues of Compulsion and Addiction

It is helpful first to see that we can separate the important issues about nutrition and general health from the issue of compulsive eating and food addiction. While these two types of issues can often over lap, it is practical to consider them separately. Nutrition is an evolving science, and there is still much controversy about basic questions like – What is a healthy weight? What food groups are essential and in what balance? What are the most effective strategies for weight loss (or gain) and long term maintenance? How is diet best supplemented by exercise?

The compulsive overeater needs to answer these questions just as much as the normal eater does. We recommend consulting a doctor, dietitian or other trained health professional regarding these matters. However, as compulsive eaters and food addicts we have an additional question: What do we do when we have a healthy diet to follow and cannot do it? Or when we cannot maintain a healthy eating process and weight over time?

If we are powerless to eat in a basically healthy way – much less in a manner conducive to optimal health, we obviously need help beyond ourselves, and it is in this area that a fellowship – and most importantly the Twelve Step Program – provide real practical experience, strength and hope. As is often mentioned, though, the problem of “putting down” food is different, and more complicated, than putting down alcohol or another addictive drug. The decision regarding exactly how we should abstain and/or from what specific foods we should abstain must be considered in the context of what food we do need and want to eat. This is where a food plan becomes most helpful.

Detoxification

If you are chemically dependent on specific foods or food in general, you are likely to have to go through a period of detoxification. There is no choice here either. Some compulsive eaters will experience immediate relief when they find an abstinent food plan that works for them. This sometimes last several months or even years, though at one point almost all compulsive eaters need to learn to be abstinent when the going is really rough. For many food addicts, however, it gets worse before it gets better. The symptoms of physical detoxification can be very subtle but they can also be quite severe.

Withdrawal symptoms may vary from subtle anxieties to strong physical cravings. Other symptoms of detoxification can include headaches, irritability, fatigue or insomnia. Withdrawal varies for different foods and from one food addict to another Most of all it is possible to have the thought that you have to eat or that certain feelings will be unbearable without food. It is always good to remember that no one has yet starved to death between meals and that feelings any particular feeling is not dangerous in itself… If we don’t eat, any feeling will eventually pass.

This is simple to say but often quiet difficult to do. Food addicts often need increased structure and support for their recovery in the first week to as long as a month because of going through detoxification. Some need extra structured support for much longer.

Similarly, most of us were eating over our feelings, using food essentially to medicate or numb our feelings. We needed to find and use other ways of dealing with even the most difficult feelings if we wanted to stay abstinent and recover. The most common way for food addicts to begin dealing with new and difficult feelings is to surrender to more structure and support: talk more with other food addicts, go to meetings, and use the tools. For long term recovery, this means a thorough working of the Twelve Steps.

It is in this context that we can look at the basic principles of choosing a food plan. Some compulsive eaters need to follow only one or two of these principles in order to discover a food plan that works. Others have to use almost all of these principles. Here again, it is important to base our choice on our best understanding and acceptance of what may be necessary to recovery from this disease. Many of us find it useful, even necessary, to make our choice of food plan with the help of other compulsive eaters or food addicts who are abstinent and who have a food plan that works for them.

Why Use the Term “Food Plan”?

Since most of us have been unable to eat or diet like normal eaters, we choose not to use the word “diet”. To us, diets mean something we can follow by reason and will power alone. We have come to accept that we cannot manage our food by self-control alone. Willpower failed us utterly, so we surrender to our powerlessness over food. The purpose of the food plan is to make this surrender more specific.

Few compulsive eaters chose a food plan because this is always the way they want to eat the rest of their life. Rather, we chose to surrender to a specific food plan because we have surrendered to the fact that we are powerless over food. There is real choice in deciding to use a food plan and what specific plan to use, but the first and most important decision is choosing to use a food plan – and practice surrendering to it – that works for the specific ways we are addicted to food.

There are some choices which are not available to each of us.

Most abstinent food addicts have an abundance of choice regarding what they eat. There are over two hundred different foods in most grocery stores, and only a handful are foods most of us find addictive. However, there is no choice about which food plans or principle will work and which will not. If you are addicted to a specific food, for example, it is not likely you will be able to include this food in your plan and have an abstinence that works.

Most compulsive eaters would like to be able to eat everything they want, exactly the way that they want, and suffer no consequences. Most of us would like to eat like normal eaters, but this choice is simply not available to us if we also want recovery. There is no such thing as surrendered food abstinence without giving up foods and ways of eating that your disease has long been wanting dearly.

© Phil Werdell, M.A.

A. Physically, it means – A surrender of one’s specific binge foods, i.e.foods to which you are addicted. If one is addicted to volume, surrender to weighing and measuring or to some other external form of portion control.

This is most commonly done by surrendering to a food plan. A food plan defines the general content of abstinence. Food addicts need to be specific about what it means to be abstinent. What foods can you eat? What foods can you not eat? How much do you eat? How do you determine nutritional balance? It is common for food addicts who are new to recovery or are having difficulty getting abstinent to make this decision with someone who understands food addiction. If this person is not medically trained, it is also important to consult with a doctor, dietitian, or other health professional.

It also may mean to surrender to more structure and support until you are able to be food abstinent and stay abstinent. This might mean physically being in meetings, physically eating with other recovering food addicts, even staying with other abstinent food addicts 24/7. It might also mean putting oneself in a professionally-led recovery group, workshop, or in-patient treatment.

B. Mentally it means – Surrendering to not making decisions about your food by yourself. Since most food addicts are not able to do this alone, it is common to make day-to-day decisions with a food sponsor. In the 12-Step fellowships, this is called committing your food to a sponsor. It also means accepting direction and support to surrender your food specifically one day a time.

In practice, the most common way of surrendering with a sponsor works like this:

1) Write down your food before you eat it. This means you let go of or surrender spontaneity regarding food. You have to plan ahead. There is a slogan that goes with this principle, “Failing to plan is planning to fail.”

2) Read what you wrote to your sponsor. This means you give up or surrender self-sufficiency and making decisions about your food alone. It means you give your word regarding your food. The slogan is, “Commit what you eat, and eat what you commit. Nothing more, nothing less.”

3) Don’t change your commitment (unless there is a health emergency). This means let go of or surrender grazing or snacking between meals. It means let go of or surrender making decisions about food impulsively.

4) Afterwards, be rigorously honest with your sponsor. This means let go of or surrender of your self-sufficiency and pride. If you are abstinent, say to your sponsor that you are. If you are not abstinent, i.e., made changes, eaten something you didn’t commit to eat, skipped a meal or forgot to eat something, be rigorously honest about how you are not abstinent and develop a surrender plan for the next day. The principle is again summarized in a fellowship slogan, “You are as sick as your secrets.”

This practice of rigorously surrendering one’s food daily with a fellow recovering addict may sometimes seem drastic, but it also seems to be what works for most of the thousands of food addicts who have found abstinence and recovery in the various food 12-Step fellowships. A common response about committing one’s food and/or weighing and measuring is as follows: “No, while I sometimes don’t want to do it, I no longer see it as a burden. It gives me a freedom regarding my food and my life that I never had before.”

C. Spiritually, it means – Surrender your food and your will to the care of a Power greater than yourself. This usually means surrendering to the practice of making conscious contact with God (as you understand God). This might be as simple as praying for help with your abstinence and life each morning, and saying” Thank You” at the end of the day. It might mean taking time each day for spiritual reading and/or silent meditation.

For someone having trouble with the God idea or with having a personal relationship, it means surrendering to work through the Twelve Steps rigorously from beginning to end (or some other effective spiritual practice).This is best done with a sponsor – or in a group. The bottom line is to have an effective spiritual awakening; a change in personality that enables us to live soberly without using food addictively.

Finally, the ultimate spiritual act for a food addict is surrendering to regularly helping another food addict. This is at once the most practical way to stay food abstinent when all other things do not work and the best way to assure there will continue to be a spiritual community to help you if and when you need it. In the end, often in spite of themselves, abstinence is a way of life for food addicts in that they surrender to being with and serving God.

There are, of course, as many ways of looking at surrendering one’s food as there are paths to God. This is just one that works for many food addicts. Thank God.

© Phil Werdell, M.A.

Common denial occurs when someone tells a conscious lie. For example, I ate the rest of the ice cream in the freezer, and then I told someone in my family that I was not the person who ate it.

Normal eaters may have done something like this once or twice in their lives. Food addicts do it all the time. I have done it much less in recovery, but I still find myself considering lying about food quite often. Occasionally, I still lie about food. I haven’t binged on ice cream for a long time, so my food lies are now likely to be about whether or not I am rigorously abstinent. When I do notice that I have lied, I acknowledge my lie and correct it quickly. (Thank you, God). While normal eaters may lie about other things, they seldom experience such pervasive lying or common denial about their food.

Psychological denial occurs when the mind represses a prior experience because of some form of overload. For example, before I got into recovery, I used to tell people that I was never physically abused as a child. I thought this was true. Then one day as a part of my deep work (i.e. being with emotions and letting move through and out of me), I was feeling afraid, and, as I stayed with the experience, the memory returned of my father striking me in the face.

When I asked my father if this could ever have happened, he admitted that it was a frequent occurrence when I was young until our doctor told him that this was an inappropriate way to “discipline” a child. When I talked about these “spankings” with my mother, she said that once she had been fearful that my father would kill me. In short, I was physically abused as a child.

Unresolved psychological traumas from childhood are often underlying problems in serious eating disorders. There is usually some form of physical, emotional, sexual or spiritual abuse, though it is not always repressed. When the feelings are acknowledged and felt, the eating problem often goes away; the problem eater slowly returns to being a normal eater.

In my case, I did work through the feelings and the psychological denial faded, but I continued to have a very serious problem with my food. I was confounded by this experience until I learned that I was a food addict.

Addictive denial is not normal, and it is not caused by psychological repression. Rather, it is a biochemical phenomenon that is an integral part of the addictive process.

For example, before I got into recovery, I lived with frequent, strong urges to eat large volumes of food, especially foods that I had binged on previously. As this problem progressed, I developed what seemed to me to be uncontrollable urges to eat before and after I had finished a large meal, even when I was so stuffed that knew it would be very uncomfortable to eat any more. At the time, I thought that this was hunger, but now I know was not normal hunger.

Further, when I considered putting down my binge foods, I really believed that I could not live without them. When at the suggestion of other food addicts I did put all my binge foods down (and went through a period of physical detoxification), my food cravings diminished almost completely and the thought that, “I will die if I don’t eat,” also went away. I continued to have difficult feelings come up from time to time, but I now see my food addiction as separate from and primary to these trauma-based feelings.

Similarly, I see my addictive denial as interrelated with common denial and psychological denial but also distinct and primary.

© Phil Werdell, M.A.

A normal eater gets hungry when it is time to eat. It is a body signal like a sense of being too hot or too cold. If you do not eat when you are hungry, it feels uncomfortable – just like a person is uncomfortable when the room temperature is too hot or too cold. An important difference between hunger and craving is that the normal eater can live with the discomfort of being hungry just like most people can live with the temperature being a little too cold or a little too warm.

Craving has an urgency to it. When craving strikes food addicts they have to eat. It is like a drowning person under water struggling for breath; there is a sense that one might die if one does not get to the surface and get some air. Food addicts frequently report they have a feeling that they will die if they don’t get to their binge foods. Craving is a distortion of the mind at an instinctual level. The food addicts’ impulse to eat their addictive foods is crossed with a survival impulse: “This has to be done now!”

We call the physical craving of the food addict “false starving.” Unlike hunger, there is this deep urgency and sense of impending danger if craving is not responded to. But when the food addict eats this often does not satisfy the hunger. Rather the craving continues – sometimes even intensifies. It isn’t a real body message, because the person has usually eaten fairly recently and shouldn’t even be hungry, much less starving. The fact that it is a false starving is emphasized by the fact that eating itself can often trigger the craving.

When truly starving people are interviewed, they report a preoccupation with thoughts of food, a compulsive drive to have one or more particular foods, and a willingness to abandon civil and moral rules to obtain food. When food is delivered to true starving communities, there is often a need for police or army guard to keep the starving people from hurting, even killing, each other for food – even when there is obvious assurance that there is enough food for everyone.

Food addicts report lying to parents, close relatives and friends about their eating. Like with alcoholics and other drug addicts, there is a impulse to”protect their stash” at a deep instinctual, often unconscious, level. Food addicts have stolen food as children they have been told not to touch, as babysitters from the family’s home, as school children out of other’s pockets, and as adults off other’s plates. They have eaten possibly spoiled food, food off the floor, food out of the garbage can. They have stolen money from their parents and others to buy food.

Food is so plentiful that these crimes of food addicts are not seen as being as serious as those of drug addicts and the lengths they go to – like holding up a store or stealing a relative’s TV – to get money for their drugs. But the feelings and thoughts inside the minds of food addicts in later stages of the disease can be just as strong, intense and serious to the food addict as ithey are for the heroin or crack addict.

One way to look at this is that there is a simple but important disconnection between the nervous system and the brain like in the experience of dyslexia or being colorblind. A person who is dyslexic sees a word in their mind the opposite way it is printed on the page. The word “was” is seen as “saw” or the word “raw” is seen as “war.” There is nothing that can change this misperception. It has to be identified, accepted and adjusted to. Colorblindness is the same; the colorblind person sees both the color red and the color green as green, for example. This is a reason why we always put the red light on top of the green on traffic lights; people who are colorblind can tell whether ort not to go by checking if the light that is shining is on the top or on the bottom. As with dyslexia, color blindness is sometimes a nuisance, but other times it is really dangerous, and there is not much you can do about it except learn to compensate.

The phenomenon of craving in the food addict is exactly like that. The food addict will really believe s/he is hungry – or, closer to the point, often think s/he is really hungry –when, in fact, his/her body needs little or no more food at all. If s/he is not aware of this, s/he will eat more, often a lot more, than is needed, and, while this might not be much of a problem if it occurs very infrequently, if it becomes more frequent or pronounced it can cause a lot of problems. The first, obviously, is that s/he puts on unwanted weight, and has trouble keeping it off even after serious dieting. Second, the obesity – and often the shift away from good nutrition – put him/her in danger of lots of other health problems over time: diabetes, high blood pressure, joint and back problems, strokes and heart attacks to name just a few. Third, problems with weight can affect one’s self-esteem; repeated failure at dieting can lead to guilt, shame and/or depression. Finally, experiences of eating out of control can negatively affect one’s deepest attitudes and spirit.

For the food addict, all this comes from simply not knowing that you get a “false starving,” i.e. that you often think that the most important thing in life is to eat when your body is not even hungry. This is an experience that normal eaters or emotional eaters do not have.

© Phil Werdell, M.A.

1. Weighing and measuring simplifies portion control. There is no question of how much of each food to eat.

2. For the food addict who is weighing and measuring, it is always clear exactly what surrender means.

3. If the amount of food in your plan has the amount of calories to be your ideal weight, you will eventually reach it and maintain this weight.

4. For those who sometimes – or always – have a distorted concept of food volume, weighing and measuring is like wearing glasses with the corrected prescription.

5. Weighing and measuring is a gentler and a much less expensive alternative to intestinal bypass surgery.

6. For volume addicts – who almost always want more food – weighing and measuring assures that you are getting enough to eat.

7. Weighing and measuring eliminates the need for all the head talk about “how much is enough today?”

8. Being committed to weighing and measuring assures that you know there is one important way you are remembering that you are a food addict.

9. No one gets hurt– including the food addict – by a practice of weighing and measuring.

10. When a food addict weighs and measures in public, there is always the chance another food addict will be helped by seeing and talking about this practice.

©Phil Werdell 2010

There are two schools of thought about the strategy for surrendering to a food plan. One says that it is best to proceed incrementally. The other says that it is best eliminate all dangerous food and triggers at once. There is an abundance of experience that both of these strategies work well for some people, and many “true believer” arguments that their way is the only way among those for whom their food plan or their strategy has worked.

There are many old–timers who will say very truthfully and helpfully that their abstinence evolved. Maybe they were only willing and able to give up “junk food” or eating between meals at first, but they did, and this showed them both that abstinence worked and that there were further issues of abstinence to which they needed to attend.

Also, there are people who were able to use certain foods in early recovery, e.g., diet drinks, but later the caffeine or the NutraSweet or some other ingredient was something they could not handle; as they would say the disease progresses even while we are in recovery. On the other hand, recovery is also progressive; what we could tolerate physically in early recovery becomes a problem as we recover more mentally, emotionally and spiritually.

There are also old-timers who will say that until they put down all their major addictive foods, they were not able to maintain their abstinence from any of them. They found that when they put down ice cream, they eventually picked up bread, and bingeing on bread brought them back to the sugar. Others found that though they appeared to have control regarding a particular food, e.g. wheat or a sugar-free desert, it was giving them low-level cravings which in the long run made it impossible for them to sustain their abstinence over their major binge foods, or they started overeating with volume.

To the newcomer, all these details frequently appear very confusing. This is especially true because for many compulsive eaters, there are food plans and approaches to food abstinence that work for them but not other food addicts. And, of course, there are often food plans which will not work for them no matter how much other food addicts say that this is the only way. It is clear that while recovering food addicts have a lot to share with each other, we are only human, and this means that we all need a Power greater than ourselves.

We have this piece of advice: action is usually better than inaction. After consultation with those we most trust – and, if we choose, a period of prayer, it is always useful for the food addict to practice surrender. Even if there are ways that we are unwilling to surrender, it is helpful to practice going to the lengths that we can. Even if a particular surrender plan is not exactly the one that will work, it is worth exercising our spiritual muscles. In the matter of food plans, act boldly that learning and grace may abound.

© Phil Werdell, M.A.

Smokers and Food

A very common issue of cross-addiction that is usually not talked about in these terms is “shifting” from nicotine to food as a drug of choice. We see it all the time. Someone works hard to put down cigarettes. It might take more that one, maybe as many as a dozen attempts. As soon as there is a period of abstinence from cigarettes, though, the prior smoker starts to gain weight. Some go back to smoking to keep cigarettes as a part of their weight control regime. If they have a commitment to their health that moves them to stop smoking again, then their weight becomes a problem again.

While there was still an argument about whether or not cigarettes were addictive – much less dangerous to your health, almost no one noticed the cross addiction “shift” from nicotine to food. With the major changes in consciousness and in public health policies about smoking, there are more and more people getting the support they need to stop smoking. Health professionals working in chemical dependency treatment are more likely to be conversant with the addictive nature of nicotine. We can now see that the weight gain that sometimes follows abstinence from cigarettes may be a cross addiction.

One small fact that is seldom mentioned is that tobacco is often cured in sugar. This makes it a natural entry-level drug for sugar addiction.

Alcoholics who are also Food Addicts

There are many who come to Overeaters Anonymous from other 12 Step programs, especially Alcoholics Anonymous, that have substantial time sober from alcohol and other addictive substances. In fact, they often come to OA or one of the other food–related 12 Step fellowships because they find themselves reacting to food just like they had reacted to alcohol or their drug of choice many years before. In early recovery, many AA’s are often counseled by their sponsors to not worry if they are craving sugar or gaining weight. In fact, the recovery text, Alcoholics Anonymous suggests that a newly sober drinker carry come candy in their pockets to help relieve urges to drink. Especially if their chemical dependency on alcohol or drugs had been progressing for years, it certainly looked like drugs and alcohol could killed them long before food.

Food addiction also progresses as a chemical dependency, so the dangers of addictive eating can easily increase over time. Many recovering alcoholics first try to work on their eating within A.A. just as they work on other life problems using the 12 Steps, and many are successful.

Many are not. Often they will identify sugar, flour or fat as a substance that is acting in their bodies like a narcotic. They do this just because of their long time experience using and recovering from alcoholism and/or drug addiction. However, when they decide to abstain from their self-assessed food addiction, they are not able to do it. It is difficult to move from the “all or nothing” model of no alcohol to a structured eating plan. This is doubly a problem for those who have already decided to recover from nicotine addiction.

This group has special problems, some of which are addressed in Judi Hollis’s excellent publication When AA’s go to OA. It is humbling to come into a new fellowship with years of sobriety in AA and have to start recovery over from the beginning in OA. It is confusing when the AA newcomers observe a large variety of food plans and perspectives on abstinence in OA.

We think there is another problem: for many alcoholics: food is an earlier and primary addiction. What is alcohol but grain and a form of sugar? The most common addictive foods are sugar and flour. A majority of these sober alcoholic food addicts can quickly remember using and abusing food years before they picked up alcohol.

Not only does this mean that their detoxification from food is likely to be worse than their detox from alcohol, it means that they have to deal on a whole new level with mental-emotional and spiritual developmental problems that began earlier.

It is often said that emotional development stops – or is at least serious curtailed – from the age that a person begins using a substance addictively. Thus, early developmental issues such as trust vs. mistrust must be revisited as one begins to recover, and there are often very basic emotional skills which were stunted in infancy and now must be developed as an adult. When raw emotions came up in early alcohol recovery, one could still use food to cope. Now, for many, there is nothing.

It is true that when the alcoholic says they don’t drink, they do drink water, fruit juice, coffee, tea and other beverages. This is more like the food addict’s abstinence: no binge foods, but other foods are OK. However, the person addicted to food in volume does have a qualitatively different problem being abstinent. This is why many food addicts commit their entire meals daily – sometimes even meal by meal – to their sponsors.

Food abstinence is different from abstinence from other substances in that the food addict still needs to eat several times a day. It is not possible to just “not be around food” the way it is possible to avoid alcohol or smoking.

Drug Addicts who are also Food Addicts.

Some alcoholics put on a “beer belly,” but there are few heroin or cocaine addicts who are overweight. So, it is often a surprise to a recovering drug addict when they cross over and start eating and putting on weight out of control. As we shall see, foods can break down in the digestive symptom into bio-chemical compounds that are similar to the opioids in narcotics. The dosage and effect of using morphine, heroin or cocaine is much stronger, but once these are out of their blood, some physically sober drug addicts can get high and chemically addicted just by using more and more food.

Not all narcotics users get hooked on food when they become drug free. In fact, a majority do not, at least at first. For those who do, though, this is a very serious problem. Not only do they then engage all the medical risks of obesity – and of bulimia and anorexia with they try to purge or restrict to control their weight, but active food addiction can be a trigger back into hard drugs.

Then there is the case of marijuana. While there is an argument yet about whether or not this drug is physically addictive, it clearly can be psychologically addictive, and for many it triggers the well known “munchies” and minimizes resistance to a variety of acting out behaviors. For the food addict whose disease is advanced, this is a serious problem. Often they cannot stay food abstinent unless they abstain from marijuana, too. For those unwilling or unable to do this, this means they are likely to eat, and addictive eating for a food addict means to die.

Food Addicts Not Yet Abstinent in Another Addiction

There is a different – and equally important – set of problems that occur when a food addict is actively using other substances or processes while being abstinent from food.

For some food addicts, this is not a large issue. For example, many food plans ask for abstinence from alcohol or caffeine. There are food addicts who can tell immediately that they are not normal drinkers of alcohol or caffeine, but they are not as important “food drugs” for them as, possibly, sugar, flour, fat or volume. So, these food addicts are quick to accept abstinence from liquor and coffee.

Other food addicts are much more attached to these other edible addictions. They are, at first, not willing to even consider putting down alcohol or caffeine. As they do consider the possibility, they are in the stage of bargaining. “I’ll just have an occasional glass of wine with diner.” “I need my cup of coffee in the morning.” If and when they do become willing to abstain, they fall off the wagon on this one food substance over and over.

For some food addicts this is a grave problem because alcohol or caffeine – another addiction – can turn into a “gateway drug” leading to serious food bingeing and long periods of relapse.

© Phil Werdell, M.A.

Bulimia is a psychological illness, a mental-emotional problem usually rooted in unresolved trauma from before the earliest incident of purging.

It is fairly straight forward to know if you are bulimic. Do you binge and purge?

Do you keep doing this after you decided to stop? More specifically, do you physically vomit food that you have eaten when you are not sick? Or do you use pills, ipecac, laxatives or diuretics to try to take off weight? Or do you exercise excessively – sometimes to the point of hurting yourself – to try and control weight? Do you use highly restrictive dieting over and over again? These are the most common physical symptoms of bulimia. If you are not sure if you are bulimic, you can ask a doctor or eating disorder specialist for a diagnosis.

How does a bulimic know if they are food addicted? One simple indication is if they were obsessing about and/or bingeing out of control on commonly addictive foods before they started purging. The “food drug” to which people most often become addicted is sugar in one of its myriad forms. The second most common “food drug” is flour and other refined carbohydrates which metabolize quickly into simple sugars. Further addictive food substances may include: chocolate, excess fat, wheat, artificial sweeteners, salt, caffeine and a large volume of any food.

Sometimes addiction to volume is simply another form of sugar addiction, but there is also a separate process in which people do not have the normal bio-chemical sensation of satiation.

If someone was binge-eating before they became bulimic, it is usually clear that this is a primary mental-emotional complication of bulimia nervosa. But is this binge-eating due to psychological problems? Or is it the beginning of chemical dependency? Or is it both?

This is sometimes less easy to discern. One possible indication of food addiction is that there are symptoms of detoxification when specific binge foods are completely eliminated. If the person has food cravings soon after abstaining and wants to eat to deal with the cravings, this is an even stronger sign of addiction to that particular food.

Not all bulimics are food addicted, but, for the many who are, understanding and treating their chemical dependency on food is essential to long term recovery from bulimia. Abstinence and recovery helps develop better emotional skills and enables healing of primary trauma.

If you do not want to abstain from all binge foods completely, there is another way of seeing if you are food addicted. When you try to eat all foods in moderation and find that you still want to binge even when you work at dealing with underlying feelings, this could be because you are also chemically dependent on food. It will take some time to be sure about this, of course, for it can take months or years of intensive work to develop strong emotional skills and work through all unresolved trauma.

One test: have you been doing therapy for a year or more for your eating disorder and are you still bingeing and purging? If so, it might be useful to look more seriously at food addiction, because you may not just be medicating feelings; you may also be biochemically addicted.

To treat food addiction, it is important to begin by detoxifying from all binge foods and eliminate the physical cravings for them. This means abstaining from all trigger foods completely. You can identify the foods you are addicted to and get support for detoxification exactly like other food addicts, though the bulimic often commits to abstaining from purging as well as specific foods. The Twelve Step fellowships (such as Overeaters Anonymous and Food Addicts Anonymous) are excellent support programs for this process. ACORN workshops are designed to help those who need additional professional help.

We have a number of people working in ACORN who are bulimic and have spent a year – sometimes several years – in therapy for their eating disorders. These bulimics said that although they had been helped in dealing with their feelings, their eating was still out of control. Often their therapist had said that they “should” be able to eat in moderation or that the rigor of committing food to a sponsor every day and weighing and measuring was “too rigid.” However, when they tried treating themselves as if they were addicted, their cravings diminished. They were better able to deal with difficult feelings, and they came to see that they had a food addiction.

There is a lot of misunderstanding about food addiction – even in the medical community. It is not taught at all in many medical schools or graduate programs for dieticians and the differences between bulimia and food addiction are seldom clarified for counselors and therapists.

A question bulimics can ask themselves is: do I ever think of purging without bingeing first? If you always plan on bingeing – especially if the binge is on addictive foods – before you purge, then the primary problem may be the food, and the underlying problem may well be chemical dependency. Food addiction is a primary disease, just like addiction to alcohol or drugs. If someone is drinking out of control and depressed, the alcoholic must begin by putting down the drink and accepting that he or she is an alcoholic. If one is medicating feelings with pot or some prescription medication, the drug addict must first put down the drug. For most, there is usually much more emotional and spiritual work to do, but this is not possible while still self-medicating with an addictive substance. It is the same with food addiction.

One basic question helps you see the difference: would you suggest to an alcoholic or drug addict that they work on underlying therapeutic issues while they are still using alcohol, cocaine, or some other drug of choice? Well, some foods have exactly the same opiates as in these more socially identified addictive drugs.

The best way for you to tell if you are addicted to food is to treat yourself as if you are food addicted for six months to a year. First, look at your own eating experience and identify foods and eating behaviors to which you may be addicted. Second, get the support – from peers and or professionals – to eliminate those foods entirely and to make abstinence the number one priority in your life. Third, continue to work on any difficult feelings, irrational thoughts and deeper spiritual issues that pull you back to the food.

If you are able to stay abstinent – or, if you make substantial improvement in dealing with food – it’s likely that you are food addicted. If you are not, you are still making progress.

© Phil Werdell, M.A.

How can an anorexic know if they are food addicted? One obvious sign of food addiction is a history of out of control eating – usually bingeing, sometimes purging and almost always becoming overweight by traditional medical standards. Restricting food begins as a way of compensating for a binge. Then regular fasting becomes a strategy for periodic weight loss after gaining by overeating. It is only as the anorexia progresses that such a person stays thin – and then becomes unhealthily thin – and begins to “look like an anorexic.”

A second indication that an anorexic is also chemically dependent on food is a desire to eat a lot more than they are eating – especially sweets and “junk foods” – as well as the strong desire to control their weight and body size by undereating. If there is a history of craving sugar, flour, and fat, this is a reason to consider the possibility of food addiction as a second diagnosis. These cravings can be current, but do not have to be.

All anorexics obsess about their bodies and greatly fear getting fat. It is less known that many anorexics also obsess about food. This often manifests as calorie counting, a list – often quite long – of “bad food” and a preoccupation with eating in a way that they can control what they do – and more importantly, do not – put in their mouths. What is less common is a constant or frequent obsession about wanting to eat sweets, snack foods or just “more” of any food. Especially if this sometimes gets so strong that it seems like “I just have to have it,” there is good reason to assume this person is food addicted as well as anorexic.

Of course, anorexics should use the whole range of diagnostic indicators of food addiction to ascertain if they are chemically dependent on food. There are the traditional indicators of food addiction denial: lying to others and themselves about what they eat, breaking their own moral code – e.g. stealing food or stealing to get food, seeing their powerlessness over food progress over time, feeling numb or high or drugged after eating, experiencing symptoms of detoxification – e.g. anxiety, depression, sleepiness, inability to sleep – when eliminating a binge food altogether. Few food addicts have all of these symptoms; at least they are not able to see them in their own experience at first. So, just one or two obvious signs of food addiction are enough to at least investigate further.

Anorexia is traditionally understood as a psycho-social disorder. It is now also being treated effectively as an addictive disease. (See the text of the ABA fellowship. Anorexics and Bulimics Anonymous at www.anorexicsandbulimicsanonymousaba.com.) In this view of anorexia, the drug which becomes addictive is the illusion of control. Whether being treated as a primarily psychological problem or a more complex addictive illness, the anorexic needs to learn to counter irrational thinking about body image and food and address unresolved trauma from the past. Many – if not most – anorexics that are treated in either modality are not food addicted.

Those who are chemically dependent on food can best be seen as having more than one illness. Those who are addicted need to abstain from their food drug(s) of choice as well as become willing and able to eat more food and often a wider variety of foods. If they have a history of bingeing on sugar, it is questionable for them to try to learn to eat sweets in moderation.

On the other hand, many anorexic food addicts who were addicted to fat, go to the extreme of not eating anything with fat in it at all. Since everyone needs some fat in their diet to enable them to digest other foods, these food addicted anorexics do need to learn to eat fat in moderation. The recovery of those with both food addiction and anorexia can be quite complicated and difficult.

In general, it is our experience that people with advanced anorexia and food addiction need more time and support in recovery than those who are only chemically dependent on food. Anorexia has its own denial, and the food addicted anorexic can have special problemS breaking food addictive denial. The illusion of control in anorexia – and often bulimia – makes it doubly difficult to accept real powerlessness over food. There are also many cases of people who were anorexic and bulimic in their youth and then became compulsive overeaters. If they are food addicted, they often need a great deal of help to break through their biochemical food dependent denial.

There are mutual support fellowships for pure anorexics. There is also a growing welcome for anorexics and bulimics in the oldest and largest food related 12 Step fellowship, Overeaters Anonymous (OA) There are also Twelve Step fellowships separate from OA that focus just on people with eating disorders; besides Anorexics and Bulimics Anonymous (ABA), there is the newer Eating Disorder Anonymous (EDA).

All of these fellowships tend to suggest food plans which include all food in moderation, though ABA very specifically supports those who abstain from specific foods, i.e., food addicts.

This is the key to those who are dually diagnosed with anorexia and food addiction: they need to surrender control of both their obsession with not “getting fat” and their specific food drugs. They need to learn to not restrict and to not overeat. They need to eliminate and detoxify from food(s) upon which they have become chemically dependent and deal with unwanted feelings and irrational thoughts that lead them to starve themselves. Moreover, as physical recovery begins, there are always deeper emotional and spiritual issues which, if not dealt with thoroughly, can lead to relapse down the line.

Food addicts come to ACORN because they are aware of their food addiction and know ACORN’s history of support for food dependency recovery. Some are often surprised when they discover they are also anorexic. It is hard for this group to understand that all anorexics are not dangerously thin. In fact, we find that there is at least a little bit of anorexia under most progressed food addicts. It is the part of their illness in which they have spent so much time trying to control their eating. It is the part of their recovery which stays rigid and perfectionistic long after the first year of abstinence. The lack of joy and true happiness in this “controlled physical recovery” leads many to relapse after a few years.

More difficult is the anorexic food addict who is dominated by the restrictive side of their eating disorder. For some it takes much longer than five days – the length of the ACORN residential Primary Intensive© – to be able eat a healthy amount and mix of food. If they are willing to try, we will often accept them and support them as long as they do not need hospitalization or direct medical supervision.

One suggestion we have for those who think they might fit into this category is to read the first 137 pages of Anorexics and Bulimics Anonymous; if you are willing to try this approach to dealing with your anorexia and abstain from your likely addictive foods, the Primary Intensive© will probably be helpful.

© Phil Werdell, M.A.

At ACORN, we have come to use the terms “compulsive eating” and “addiction to food” to define two distinctly different problems. We use the term “compulsive overeating” to identify what is now called “binge eating disorder” by psychologists. This psychological disorder derives from unresolved trauma and family dysfunction as well as a lack of cognitive feeling and behavioral skills to deal with difficult emotions.

We use the term “food addiction” to refer to biochemical dependency on food. This problem is described as a person relating to specific food(s) or food in general in a different way than normal people. Food addicts experience physical craving, mental obsession, and a distortion of basic instincts and will.

Ten years ago there was little scientific research proving that food addiction actually existed, much less any research explaining a biochemical basis. Today, because of new genetic science, advances in brain scan research and billions of dollars invested in finding a medication that addresses the obesity epidemic, there is an abundance of studies in a wide variety of academic and medical fields that support a diagnosis of food addiction.

These studies overwhelming support the theory that many of the severely obese and those with advanced eating disorders are also chemically dependent on food. In fact, as a substance disorder, food addiction could be the primary medical problem in those cases.

The amount of specialization in scientific research and the fact that professional journals didn’t allow the use of the term “food addiction,” (because it was not yet confirmed as a medical or mental health disease) has made it difficult to assemble all the research and correlate all the data about chemical dependency on food across sub-disciplines of science. Still, there are peer-reviewed professional journal articles establishing:

1. A sample of obese people who were not alcoholic or drug addicted and who binged on dense carbohydrates had the same D2 dopamine gene marker as is found in alcoholics and drug addicts.

2. Dozens of PET scans of binge-eating obese people show the exact same brain image problems as alcoholics and drug addicts.

3. Definitive research that animals in experimental studies can become addicted to sugar.

The question is, what are the differences between these two food-related problems, binge eating and food addiction? Is the treatment for these two issues the same or different?

It is probably helpful to begin by saying that in many of cases of food addiction there may also be an underlying psychological eating disorder based on unresolved trauma. Moreover, there is often a misdiagnosis by a health professional, usually because they do not recognize the symptoms of, or are unwilling to identify, a real chemical dependency on food.

The vast majority of those we see in ACORN were either given diets by professionals who did no follow-up to confirm the effectiveness of the diet and/or were treated therapeutically for psycho-dynamic eating disorders. Usually, professionals have not considered whether their client needed to completely abstain from certain food(s).

One of the most effective ways of determining if someone is food-addicted is to take a “food history.” Does the person have a history of dieting, then gaining back the same amount of weight, or more? Has the person done serious work in psychotherapy, only to find that their bingeing was unaffected? Are there foods that the person feels they cannot live without and are unwilling to forego? Are there foods that the person is unable to stop eating, even though they may have tried many times?

These questions are remarkably similar to many that are asked of alcoholics and drug addicts at the beginning of treatment. As most alcoholics and drug addicts are frequently unable to disentangle themselves from their substances without help, many people that are food-addicted require additional medical assistance and Twelve Step support to withdraw from their “drug of choice.”

© Phil Werdell, M.A.

My food addict’s mind is endlessly creative. It will tell me that changing my diet, arguing with my sponsor about food amounts, thinking I need to lose more weight, and impulsively trying a new food are all perfectly reasonable.

My thinking is my problem.

I used to “think” that if I just found the right diet, the right sponsor, the right medication, did enough therapy, lost enough weight, that I would stop having “problems with food.” I didn’t want to be a food addict. I lived my life by what I wanted, or didn’t want to do; what I felt like doing, in the moment. If I think it, then it’s right.

I would plan to eat abstinently, and then change my mind.

Because I thought all those things, I believed I was right. I would run ideas by myself, and of course “my self” would agree. I spent endless hours counting calories and planning what I would do when the weight came off. Meanwhile, being fat was depressing, so I told myself it was “OK to have just a little,” which would invariably lead to a binge.

I tell myself a lie, and then I eat.

I spent 10 years in and out of relapse with food addiction. I didn’t “think” I needed to stop eating flour and sugar. I didn’t “think” I should have to ask another food addict for decisions about my food. I didn’t “think” I needed to commit my food on a daily basis, and keep my commitment. And I certainly didn’t “think” I needed to do those Steps exactly the way they were written. I did them “my” way, the way I thought “worked for me.”

I utterly believe my own lies.

I felt vaguely offended by Step Two. “Restoring me to sanity?” I wasn’t insane! I told myself “I just have a problem with food.” Insane people are those drug-addict homeless people lounging on the street talking to themselves, not me. As a therapist, I told myself that “insane people” have fixed delusions and problems with reality. I didn’t “think” I was anything like them.

And yet I kept eating. My best efforts would provide me with a day or two of “abstinence,” clenching my teeth all the way through. What was I doing wrong? I tried everything, I “thought.” But I didn’t want to admit what I wasn’t willing to try. Which was most of the program.

I (the big I) was trying to do it by myself, my way.

Finally, I gave up. I gave up trying to do it my way and became willing to follow directions. I committed my food every day to a sponsor and ate only what I committed. Another food addict “held” my food plan, and I agreed not to make changes without talking to her first. If she didn’t think it was a good idea, I didn’t do it.

I stopped lying to others about my food.

But after 2 1/2 years of clean abstinence, I was still obsessed with food. Candy in the drugstore would “sing” to me. I knew everything that was in the vending machines at work, even if I didn’t want to. I knew what everyone else was eating, all the time. Going to the grocery store was still torture. I had to stare at the floor when I walked down the aisles. Hearing others talk about food could trigger a food obsession I would have to talk about for days in order not to eat it. I hated watching normal eaters have dessert and other things I told myself I “couldn’t have.” I was still lying to myself about food.

Food was not my problem.

I wasn’t eating compulsively any more, I was a normal weight, but my thinking about food was making me crazy. I started to wonder if I hadn’t always been this crazy. I still believed that food would make me feel better, even though I had enormous evidence that it never had. That actually qualified as a “fixed delusion,” now didn’t it? I believed I had to do food a certain way, with very strict rules, in order to stay abstinent. I “thought” it was my abstinence.

My thinking about food is fatally flawed.

I finally knew I really was insane. It was my thinking that kept taking me back to the food, over and over. But how could I possibly change my thinking with my thinking? Simple answer: I can’t. But God can. I didn’t believe that God (or whatever) cared about me or my food problem. I was so busy living life my way, “thinking” that my way was the right way. Finally, I heard the question: “What if my way is wrong?”

Being “right” and doing it “my way” is playing God.

I didn’t think I was egotistical; I just had to do it my way, and things would be fine. Except that it never worked out. I finally understood about the actor in the Big Book of AA in Step Three, the one who keeps trying to be a director and get everyone to perform his way. I was selfishly chasing after what I wanted all the time.

What if abstinence was a gift from God? A gift I could take really good care of and return, with thanks, at the end of each day? I didn’t have to be “in charge” all the time. I could practice trust. I could turn my thoughts and my actions over to the care of God.

Making that Third Step decision meant I was no longer running my life based on what I wanted; the four-year-old inside of me was no longer in charge.

According to the dictionary, what does restore” mean?

• to return to its original or usable and functioning condition;

• to regenerate: return to life; get or give new life or energy;

• to give or bring back

• to repair: restore by replacing a part or putting together what is torn or broken

After doing the work in the 4th and 5th Steps, I could truly see how insane my thinking was, not only about food, but about life. The lies I told myself built an enormous tower of resentments I could have never dismantled without the help of God and a wise sponsor. Before every slip or binge was a resentment. Under every resentment were lies and fears.

I have only one “problem:” being separated from God.

If I am practicing rigorous honesty and a daily spiritual life (Steps 6-12), I am not obsessed with food. It no longer calls to me, or bothers me. I can focus on being of service, being happy, joyous and free. This freedom is more wonderful than I could ever have imagined with my limited thinking.

The problem has been removed.

© Arian Eigen Heald, M.Div.

First Step writing is about admitting powerlessness over food. If there was something else that a person could do in a particular situation to have control over their eating, then they would not be powerless. That is obvious.

So, First Step writing is subtly but importantly different than inventorying a situation in which one was not food abstinent and figuring out what could have been done differently. In the arena of food addiction recovery, this distinction is fundamentally important because most food addicts who have gone over the line of biochemical dependency are not able to find long-term recovery without completing the First Step 100 percent.

When a food addict puts down their binge foods completely – and goes though a period of detoxification, she/he finds that their physical cravings are greatly diminished or completely removed. If the progression of the addictive disease has advanced to seriously affecting the mind, however, they are still likely to eat addictively again. Put most simply, they are in exactly the same state of mind in which they began eating out of control in the first place. They still have euphoric recall, still have and believe a rationalization for eating, still have a tendency to minimize the seriousness of the disease, and still are prone to “mental blank spots” where they simply don’t remember that food is a problem for them at all.

It is the inherent nature of the food-addicted mind that it cannot be changed by understanding or by force of will. These efforts sometimes work in the short run, but inevitably, diseased thinking and/or lack of thought returns so powerfully that the food addict is eventually back in the food and bewildered by how this could have happened again. Not seeing that this is a biochemical disease that has taken over the mind, the food addict is typically filled with guilt and shame.

If food addicts are this powerless over their disease, what can they do? Well, food addicts are indeed powerless, but not helpless. There is one thing that they can do, and that is to work on a spiritual basis to become more willing and able to fully accept their powerlessness. This is truly paradoxical: in seeing more completely how powerless they are food addicts become open to the only answer possible – a power greater than themselves.

The most immediate and practical question of a food addict in this position is: just exactly what can I do to pursue taking a food First Step? Here we have a lot of experience, and we think many readers will find it quite valuable.

To put the material of this essay/chapter in proper context, it is important to say that there are many different ways to do First Step work on food and other addictions. Each of these is effective if done as a spiritual practice. That is to say, as with the more commonly known spiritual practices of prayer and meditation, the food addict needs to do the spiritual practice of First Step work without an expectation of when or how these efforts will bear fruit.

We offer the ACORN approach to doing First Steps because it is a process which has been very effective for food addicts who have not been able to take a spiritual food First Step alone, with the help of a therapist, or even by pursuing one of the many routes offered in food-related Twelve Step fellowships. This is the most rigorous approach to food First Step work with which we are familiar, and it compliments an experiential educational process about food abstinence and learning alternatives to food as coping mechanisms for dealing with difficult feelings.

Food First Step Preparation Assignments

There are eight basic questions which can help a food addict better write a rigorous story of their powerlessness over food.

1) What are your secrets about food? Be as specific as possible.

2) What are other secrets? Again, be specific.

3) What is it that convinces you that you are powerless over food? (Some find it helpful to also write about what convinces them that they are not food addicted.)

4) What convinces you that your life is unmanageable?

(Also, possibly, what convinces you that that it is not unmanageable.)

5) Make a list of all the foods you have binged on, and any other out of control eating behaviors. Be specific.

6) Make a list of all the diets you have tried, and everything else you did to try to control your weight or eating.

7) Make a list of 15 specific times when you were powerless over food.

8) Make a list of at least 30 negative consequences of being powerless over food – some physical, some mental-emotional, and some spiritual.

It helps to read each of these assignments, one at a time, to another food addict in recovery and get feedback. It is best to read to a whole group of recovering food addicts including ones who have done this type of rigorous food First Step work.

Secrets. The first two assignments are about secrets – the first about food and the second about the rest of one’s life. From a worldly perspective, this is just a way of getting rigorously honest. If you are willing to self-disclose information that you don’t want to share, then you are on the track to being rigorously honest.

There is also a spiritual dimension to telling “secrets” in food First Step work. Secrets tend to be the information that we are unable or unwilling to tell others. It is information about which we lie to ourselves, and is information we often want to try and keep from God. The primary spiritual problem of addiction is often named “self-will run riot.” This is just as true for chemical dependency on food as it is for alcoholism. Telling secrets is thus a spiritual practice in which a food addict develops the spiritual muscle of willingness by telling others exactly what he/she doesn’t want to reveal.

Twelve Step spiritual fellowships put a great deal of emphasis on “rigorous honesty.” In practice, this means, at least in part, being as specific as possible. What follows is a list of increasingly specific ways of reporting one particular break in abstinence:

- “I had some problems with my food.”

- “I wasn’t abstinent – ate something not on my food plan.”

- “I ate some sugar.”

- “I ate some ice cream.”

- “I gulped down a quart of ice cream.”

- “I ate two separate pints of Haagen-Das Chocolate Chip. I ate so fast the cold of the frozen ice cream gave me a headache, and I kept eating anyway and dripped ice cream all over my shirt and pants.”

A food addict can often tell if they are being sufficiently specific by noticing if sharing that the details cause embarrassment. Embarrassment is one of the many signs of false pride.

Response to secrets and other First Step writing. In responding to secrets – and any First Step work – the most helpful information is often when other food addicts share ways that they have done the same or similar things with food. This type of sharing begins to relieve some of the original food addict’s embarrassment. As these feelings bleed off, it also has a way of breaking denial. A food addict often sees themselves as guilty, shameful or just a “bad” person because they are not in control of their food. When they learn that someone else – who they do not see as shameful or bad – has done the same thing, they can often see the other person was actually powerless, and this helps them begin to separate themselves from the disease of food addiction.

© Phil Werdell, M.A.

Since most of us have been unable to eat or diet like normal eaters, we choose not to use the word “diet”. To us, diets mean something we can follow by reason and will power alone. We have come to accept that we cannot manage our food by self-control alone. Willpower failed us utterly, so we surrender to our powerlessness over food. The purpose of the food plan is to make this surrender more specific.

Few compulsive eaters chose a food plan because this is always the way they want to eat the rest of their life. Rather, we chose to surrender to a specific food plan because we have admitted we are powerless over food. There is real choice in deciding to use a food plan and what specific plan to use, but the first and most important decision is choosing to use a food plan – and practice surrendering to it – that works for the specific ways we are addicted to food.

There are some choices which are not available to each of us.

Most abstinent food addicts have an abundance of choice regarding what they eat. There are over two hundred different foods in most grocery stores, and only a handful are foods most of us find addictive. However, there is no choice about which food plans or principle will work and which will not. If you are addicted to a specific food, for example, it is not likely you will be able to include this food in your plan and have an abstinence that works.

Most compulsive eaters would like to be able to eat everything they want, exactly the way that they want, and suffer no consequences. Most of us would like to eat like normal eaters, but this choice is simply not available to us if we also want recovery. There is no such thing as surrendered food abstinence without giving up foods and ways of eating that your disease has long been wanting dearly.

By Phil Werdell, M.A.

After making a list of our binge foods, we can identify the substances that we are addicted to in order to surrender them to our Higher Power so that we don’t have to eat them anymore.

“Surrender,” in this context, means doing something we don’t want to do in order to recover. Many of us are not able to surrender our binge foods without the structure and support of other abstinent food addicts.

Despite what we are doing to our bodies because of our food addiction, many of us are unable to remember what the addiction is actually doing to us. We can only remember how “good” it tastes. This is called “euphoric recall,” and is a classic symptom of addiction.

How do you know if you are addicted to flour or sugar? The simplest way is to use the test provided by the book Alcoholics Anonymous, written eighty years ago. We can just change the text from using “alcohol” to using “food:”

Try some controlled eating. Step into a bakery and have one piece of candy, one donut, one piece of binge food, and then stop. Stick to a diet and maintain your weight loss.

Try it more than once. If you are like us, you will no more be able to do this than an alcoholic can step into a bar and have one beer.

Check out our page of questions, “Am I a Food Addict?” and also read about different kinds of “eaters,” so you can come to your own conclusions.

If you think you might be a food addict, then you need to know a lot more about what foods are the most likely to be addictive, even though you may not want to give them up. Most food addicts don’t want to give up their binge foods; they just want to avoid the consequences of eating.

For the purposes of this article, we will address sugar and flour, the two most common substances that food addicts become addicted to. Although some food addicts report addictions to fatty, salty and volumes of food we will address those substances in a later article.

“SUGAR”

Sugar is a carbohydrate, and we often think of it only as the white or brown stuff, but sugar is also a natural part of many other foodstuffs such as lactose in milk, maltose in grain, fructose in fruit, sucrose (refined sugar), and more.

The simple refined carbohydrate, crystalline table sugar, is first extracted from sugar cane with the bulk and fiber being left behind. It is then purified, filtered, concentrated, and boiled down to sugar crystals produced out of the syrup. Substances such as sulfur dioxide, milk of lime, carbon dioxide, charcoal from charred beef bones, and calcium carbonate are used in this industrial refining process as purifying agents.

Flour is also a refined carbohydrate, and for many of us who are addicted to sugar, we find that flour acts in our bodies the same way sugar does: it gives us a “high.” Often flour and sugar come together in a food package – equivalent to high-quality crack cocaine to a food addict.

Brown sugar is simple white sugar with a bit of molasses added back in, or colored with caramel.

The food industry has developed enormous sidelines of “diet” food, usually labeled “Sugar-Free” and “Fat-Free.” Given the many different varieties of sugar, derivations of sugar such as Splenda, sugars formed from alcohol (not surprisingly, these can be very addictive), chemical sweeteners, (the “polys”) artificial sweeteners such as aspartame, saccharine, etc., the label “Sugar-Free” usually means the food industry is simply using a different kind of sugar. For some food addicts, these non-sugars can have the same impact as refined sugar: the inability to eat reasonable amounts.

Conversely, it is worth noting that many of the foods labeled “Fat-Free” are loaded with sugar. And “Fat-Free” certainly doesn’t mean calorie-free.

Sugar is rapidly converted in the blood to fat (triglycerides), which increases obesity, heart disease, and diabetes. It is devoid of vitamins, minerals, or fiber; it is an empty food. Its main purpose in the food industry is a stabilizer, flavor enhancer and appetite stimulant.

In 1973, the per capita consumption of sugar and other highly refined sweeteners (such as high-fructose corn syrup) was 126 pounds a year. Today, it’s 158 pounds – an increase of 26 percent. During the same time period, the percent of overweight Americans increased by nearly 20 percent.

Here is a list of types of sugar that are commonly found in foods we find in most grocery stores. Many labels list more than one kind of sugar; only the total grams of sugar give a true idea of how much is actually in the package. Although some artificial sweeteners have no caloric value, their impact on our bodies can be just as deadly as those with calories, if we cannot stop eating it.

• amasake
• apple sugar
• Barbados sugar
• bark sugar
• barley malt
• beet sugar
• brown sugar
• brown rice sugar
• buttered syrup
• evaporated cane juice, or cane-juice crystals (non-FDA approved terms for sugar)
• cane sugar
• caramel
• carob syrup
• chicory syrup (non-FDA approved terms (non GRAS and non-CFR compliant) for high fructose syrup)
• corn sweetener
• corn syrup
• corn syrup solids
• date sugar
• dextrin
• dextrose (refined corn sugar)
• diatase
• diastatic malt
• Diglycerides
• Disaccharides
• D-tagalose
• ethyl maltol
• Florida crystals
• fructan
• Fructooligosaccharides (FOS)
• fructose
• fruit juice
• fruit juice concentrate
• Galactose
• Glucitol
• Glucoamine
• Gluconolactone
• glucose
• glucose solids
• Glucose polymers
• Glucose syrup
• Glycerides
• Glycerine
• Glycerol
• Glycol
• Hexitol
• golden sugar
• golden syrup
• grape sugar
• high-fructose corn syrup
• honey
• inulin syrup (non-FDA approved terms (non GRAS and non-CFR compliant) for high fructose syrup)
• inversol
• invert sugar
• isomalt
• invert sugar
• karo syrup
• lactose
• lactitol ++
• levulose
• malt syrup
• malted barley
• maltodextrin (derived from the corn “wet refining” process)
• maltose ++
• malitol ++
• mannitol ++
• maple syrup
• microcrystalline cellulose
• molasses
• Monoglycerides
• Monosaccarides
• Nectars
• Pentose
• Polydextrose++
• Powdered sugar
• Raisin juice
• Raisin syrup
• raw sugar
• refiner’s syrup
• rice malt
• rice syrup
• saccharides
• sorbitol ++
• sorghum
• Sorghum syrup
• Sucanat
• Sucanet
• sucrose (from cane or beet)
• sugar cane
• trisaccharides
• turbinado sugar
• xylitol ++
• yellow sugar
• zylose

++ Sugar alcohols aren’t sugars or artificial sweeteners. The name “sugar alcohols” comes from the fact that their structure resembles sugar, and they’re chemically similar to alcohol. They’re typically genetically modified from corn or wheat.

Those food addicts who are also addicted to or have an allergy to wheat receive a double impact from sugar alcohols.

Experts say that sugar alcohols can cause stomach cramps, bloating, diarrhea, and anal leakage, because our bodies poorly absorb them. In large quantities, they’re non-GRAS (Generally Recognized As Safe) and some research shows that they can cause cancer.
Foods with average added sugars

• Applesauce contains 11 g
• Peanut Butter contains 18g
• Flavored Yogurt contains 23g
• Fruit drinks contain 40g

A single can of soda contains 12 teaspoons of added sugar. That’s 120 percent of the USDA’s recommended daily intake of sugar.

In 2005, researchers examined the impact of sugar on the immune system. A published study at the National Institute of Health documented the impact of sugar intake on the immune system: Sugar steals the ability of white blood cells to destroy bacteria. White blood cells are known as “phagocytes” and phagocytic tests show that a couple of teaspoons of sugar can sap their strength by 25 percent. A large helping of pie and ice cream renders your white cells 100 percent helpless. This effect lasts from 4 to 5 hours. Consider a 900 ml serving of processed and packaged orange juice or one 683 ml of cola—either of these will depress the immune system by 50 percent, 30 minutes after ingestion and this will last for hours! Consider if you have sugar at every meal, which many do by eating processed foods alone, that the immune system is constantly ineffectual.

For food addicts, who binge on enormous amounts of sugar, eat meals consisting of large amounts of processed food, or diets consisting almost totally of binge foods, the impact could be exponential. For us, to eat this way is to die.

The Problem is Physical:

• Excess Weight

The Problem is Physical and Emotional:

• Binge eating, restricting, and/or purging over feelings
• Unresolved trauma
• And possible weight issues (either over-or- underweight)

• Abnormal response to specific foods
• Physical craving (false starving)
• Mental obsession (false thinking)
• Self-will run riot (false self)
• And often trauma and weight issues

• Medically approved diet
• Moderate exercise
• Support for eating, exercise and lifestyle change

• Develop skills to cope with feelings other than with restricting, purging or bingeing
• Resolve past emotional trauma and irrational thinking (healing trauma)

. . . and Physical

• Include solutions to the left

• Abstinence from binge foods and abusive eating behaviors
• Rigorous honesty about all thoughts and feelings
• A disciplined spiritual program, e.g. the 12 Steps

. . . and Emotional and Physical

• Include all those applicable to the left

• Willpower

• Moderation (along with expressing feelings)

• Surrender, i.e., deep acceptance

CHART EXPLANATION

NORMAL EATERS may have problems with weight (even obesity) if they do not eat the appropriate number of calories (and exercise moderately) to maintain an ideal, healthy weight. The problem for normal eaters is primarily physical: If they choose to eat a balanced diet, exercise moderately, and get support for lifestyle changes, they can lose unwanted weight (or gain weight) and keep their weight in a normal range. Basically, willpower works; just put down the fork and push away from the table.

EMOTIONAL EATERS often have similar problems with weight but find themselves powerless to follow directions to lose (or gain) weight and restore their health even when they want to. For those with diagnosable eating disorders – i.e., anorexia, bulimia or binge-eating disorder – the underlying problem is mental-emotional: It’s not what you are eating but rather what is eating you. Problem eaters use food to numb or medicate their feelings. What works for problem eaters are a moderate food and exercise plan, as well as developing skills to cope with feelings.

FOOD ADDICTS become chemically dependent on specific foods or on food in general. The way their body processes food is bio-chemically different that that of normal eaters and emotional eaters. Many food addicts are predisposed to becoming addicted to food – especially to sugar, flour, wheat, fat, salt, caffeine, and/or excess volume to any food – just as alcoholics are predisposed to being chemically dependent on alcohol and drug addicts to heroine, cocaine or prescription drugs. As the disease of addiction progresses, food addicts become powerless over physical craving and develop distortions and obsessions of the mind that keep them in denial.

SO, WHAT WORKS FOR FOOD ADDICTS?
Diets alone don’t work. Simple therapy alone does not work. What works for food addicts is surrender. Surrendering, through physical abstinence, the foods to which they are chemically dependent. Surrendering to rigorous honesty with all their thoughts and feelings about food. Surrendering to whatever structure and support is needed. Ultimately, surrendering to the process of a spiritual experience, i.e., the type of psychic change that has given relief and healing to thousands of chemically dependent individuals.

Most food addicts have weight problems – the majority are obese, though some are a normal weight or may even be dangerously underweight. Many also have unresolved emotional trauma similar to those who are diagnosed with eating disorders, e.g. anorexia, bulimia, binge-eating disorder. In short, most food addicts have problems similar to those of normal eaters and problem eaters, but for food addicts, their addiction to food must be the primary focus.

If food addicts just diet, they may lose some weight but inevitably will gain it back. If food addicts do not commit to being rigorously honest – preferably with another food addict or with a healthcare professional that understands food addiction – they may make some gains in therapy, but will eventually relapse into the food; this will make them even more anxious or depressed. To be successful in healing from food addiction, one needs to first accept that they are food addicted and then, once again, deal with this first.

Most successful, long-term recovering food addicts approach their physical abstinence and deeper internal healing as a spiritual discipline. One simple approach to this concept is to study and practice the Twelve Steps. While this clearly is not the only way – as there are an endless number of spiritual paths that will work – the Twelve Steps are a spiritual practice specifically designed for those who suffer from addiction.

© Copyright Phil Werdell and Mary Foushi, 2007