How do you determine if someone is food addicted?

If someone eats when they really do not want to or if they persistently eat more food than their body needs, or eat in a way that they know is not good for them, they may be a food addict. It is certainly worth investigating the matter further.

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

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