In the News

The Missing Piece in Response to the Obesity Epidemic: Diagnosing and Treating Food Addiction

1st Annual Food Addiction Conference
Downloadable / Viewable Reference Documents

UMASS Department of Psychiatry

UMASS Department of Psychiatry

Format for Professional Training Continues to Evolve

The new model for the FAI/ACORN Professional Training, conducted July 19-25, 2013, in Tampa and Sarasota, Florida, was a success. All participants who are food-addicted were rigorously abstinent at the end of the first weekend, which was followed by the new two-day academic component at the Florida School of Addiction Studies.

Phil Werdell taught the two-day course and used material from his Springfield College course on food addiction.

Dr. Vera Tarman lectured on medications for eating disorders and food addiction. (Basically, there is not much that is very helpful yet, but the research underlying these medications helps us understand how chemical dependency on food is kindled.)

Esther Helga Gudmundsdottir and Raja Batarseh, from Iceland and Jordan respectively, presented their innovative models for outpatient education and treatment. (Both have developed ways of working with food addicts not yet in use in America.)

Several participants — including Dana Dixon — supplemented Mary Foushi’s recovery stories which related to theories covered in the class.

There was material on assessment, comparing food-addiction treatment with alcoholism treatment, applications of the American Psychiatric Association’s new Binge Eating Disorder diagnosis for food addiction, information on adjusting food-addiction treatment for different cultures, and new concrete proposals for public health strategies for food addiction.

The next Professional Training intensive will be held in Iceland sometime in early 2014.

Brownell and Lustig Challenge APA on Food Addiction

Kelly Brownell At the recent annual assembly of the American Psychiatric Association, Dr. Kelly Brownell of Duke University and Dr. Robert Lustig of the University of California at San Francisco spoke on how food addiction is affecting the United States.

Brownell remarked that a growing scientific literature indicated that processed foods negatively affect the brain. “This is a game-changing concept… because it’s true that food can hijack the brain, you can imagine how parents are going to feel about this when their children are exposed to these ‘substances’. It could come down to helping us protest children’s food environments, much like we try to do with tobacco and alcohol.”

Brownell suggested that we not focus on food addiction, which is experienced by a small percentage of the population and goes to the morality or pathology of the individual, but instead on ”food and addiction because that destigmatizes the person and puts the focus on the substance(s) instead.” He asked the question, “If there is an addictive impact of food on the brain, what does that say about the accountability of the food industry for intentional manipulation of ingredients, what kind of advertising is permitted, and what products should be permitted for sale in schools?”

Brownell pointed out that food in its natural state has never been known to create a public health hazard, and outlined the criteria to determine whether legal action against some food processors might be appropriate. “A product must be safe with its intended use. When injury occurs, this duty is breached. The liability is enhanced if the product is addictive. Did the manufacturers knowingly modify products? Were the consumers warned?”

The social policy issues outlined by Brownell warrant investigation, but when Brownell implicitly says, “Forget those who are food addicted. We can do more good focusing on those in earlier stages of the problem,” it is a subtle form of food addiction denial. Yes, we want to help people who can still help themselves and their children, but we also must support those who have reached a critical stage of the disease to challenge food addiction denial and get help.

OLYMPUS DIGITAL CAMERALustig, meanwhile, demonstrated how food additives such as refined sugar and high fructose corn syrup increase appetitive hormones and “reward” feedback in the brain while reducing the brain chemicals responsible for controlling food intake. This amounts to creating “craving for more food, while the body’s ability to detect satiety is simultaneously suppressed.”

Lustig said that of the roughly 600,000 food items sold in America, 80 percent have refined sugar, for which there are 56 names. “So how do you reduce consumption if you don’t even know you’re eating it?” Lustig said his data indicate that the additives’ disruption of the brain’s signaling system contribute to rising obesity and patterns of processed-food consumption that “fits the DSM-IV criteria for addiction.”

Lustig concluded that “Medicare in 2024 will be broke if we don’t approach this as a public health crisis.”

Brownell, formerly director of the Rudd Center for Food Policy and Obesity at Yale University, is the author of Food Fight and co-editor of Food and Addiction: A Comprehensive Handbook, the first medical text on the science of food addiction.

Lustig is a pediatric endocrinologist and author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.

DSM-V Acknowledges Food Addiction

DSM-5 CoverThis past May, The American Psychiatric Association unveiled its updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The inclusion of Binge Eating Disorder as a diagnostic category bodes well for the eventual recognition of food addiction as a substance use disorder in future editions of the manual.

The following is an excerpt:

“Binge Eating Disorder:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

a. recurrent episodes of binge eating, in which binge eating is defined as eating in a discrete period of time, (e.g. within a 2-hour period) an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, and

b. a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating.).

B. Three of the following:

a. Eating much more than normal.

b. Eating until feeling uncomfortably full.

c. Eating large amounts of food when not physically hungry.

d. Eating alone because of feeling embarrassed by how much one is eating.

e. Feeling disgusted with oneself, depressed or very guilty afterwards.

C. Marked distress regarding binge eating.

D. The bingeing occurs as least once a week for 3 months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa…..

Specify current severity:

The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

  • Mild: 1-3 binge-eating episodes per week.
  • Moderate: 4-7 binge-eating episodes per week.
  • Severe: 8-13 binge-eating episodes per week.
  • Extreme: 14 or more binge-eating episodes per week.”1

Health professionals familiar with food addiction, as well as self-assessed food addicts, will immediately notice that many, possibly a large majority, of cases of food addiction fulfill all the characteristics of Binge Eating Disorder and that most late- and final-stage food addicts display severity equivalent to “severe” or “extreme” Binge Eating Disorder. In the introduction to the Feeding and Eating Disorder section of the DSM-5, this is acknowledged:

“Some individuals with disorders described in this chapter report eating-related symptoms resembling those typically endorsed by individuals with substance-use disorders, such as strong craving and patterns of compulsive use. The resemblance may reflect the involvement of the same neural systems, including those implicated in regulatory self-control and reward in both groups of disorders. However, the relative contributions of shared and distinct factors in the development and perpetuation of eating and substance use disorder remain insufficiently understood.” (DSM-5, p 329)

This recognition of food as a substance-use disorder in the diagnostic manual is of extreme importance. It gives clinicians encouragement to look for a psycho-socially caused eating disorder, a biochemically caused food addiction, or both. It also means that in the treating of Binge Eating Disorder, both the traditional treatment for eating disorder (i.e. therapy, mindfulness training, and medication) and traditional addictive-,model treatments (i.e., abstinence, education about chemical dependency and preparation for 12-Step-type aftercare) should be covered by health insurance reimbursement as appropriate to the clinician’s diagnosis. This principle obviously applies equally where binge-eating co-occurs with anorexia and/or bulimia. Here too, the binge eating may have psychodynamic roots, be caused by biochemical addiction or both.

These conclusions align completely with the observations of Dr. Charles O’Brien, chairman of the Substance Use Work Group of the DSM-5. As we reported earlier, in his letter to the Food Addiction Institute, Dr. O’Brien wrote:

“We share your interest in understanding how eating behaviors can take on characteristics that strongly resemble the behavior of individuals who abuse substances such as cocaine. It is likely that this resemblance reflects the fact that neurobiological systems involved in processing of reward are disturbed in both disorders. The problem is that, at present, the precise nature of these disturbances and how the neurobiology of eating disorders resembles and differs from the neurobiology of substance-use disorders is unknown. We, and the members of our Work group, wholeheartedly endorse research to understand this important overlap.” ( July 2012)

We replied that The Food Addiction Institute favors introducing food as a Substance Use Disorder on an experimental basis – as Binge Eating disorder was published in the DSM-IV-TR – to encourage clinical and scientific experimentation. Meanwhile, we encourage clinicians to look not only for psycho-social, trauma-based eating disorders but also for biochemical cravings that may be caused by consumption of a specific food or foods. Each needs to be treated differently, and the most complex cases often satisfy criteria for both psycho-social eating disorders and food addiction.

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, pp. 350-352. Arlington, VA, American Psychiatric Association, 2013. []

Food Addiction Treatment for the Impaired Professional

Phil Werdell Presents “Food Addiction Treatment for the Impaired Professional” at the University of Florida

The University of Florida (UF) Gainesville invited Phil Werdell to speak Wednesday, March 20 during their Continuing Medical Education Grand Rounds lecture series at the Florida Recovery Center. Phil’s lecture, “Food Addiction Treatment for the Impaired Professional” was webcast live and we have the opportunity to share the lecture with you.We are sure you will enjoy the presentation and feel free to forward this to those you think may benefit from viewing.

ACORN Professional Training Primary Intensive

New ACORN Professional Training Primary Intensive, July 19 – 25

The intensive will include:

  • 2-day “Introduction to Food Addiction” course worth 10 CEU’s
  • 6 day Intensive instead of 5 days at the same cost
  • Additional faculty member from Iceland’s highly successful outpatient food addiction program and graduate of the ACORN Professional Training program
  • Dr. Vera Tarman, Medical Director of the largest drug and alcohol treatment center in Canada, will speak on medical and scientific aspects of food addiction

This is a wonderful opportunity to further your training!

Adding Food Addiction as a clinical diagnosis in the DSM-5

Gail Marcus, Chair of the Food Addiction Institute, and Phil Werdell, Director of the Food Addiction Professional Training Program, headed up a delegation to the national conference of the American Psychiatric Association May 5th – 9th in Philadelphia. Their focus was to educate psychiatrists about the need to include food as a substance use disorder in the next update of the association’s Diagnostic and Statistical Manual (DSM-5) due out in 2013. They also shared information about the urgent need for food-addiction treatment. Phil Werdell was well received when he spoke to this issue at one of the open forums. Since then, Mr. Werdell has continued communicating with members of the committee explaining in greater detail the importance of the American Psychiatric Association’s recognizing food as a substance use disorder in the DSM-5. Click on a PDF below to read each letter.

Click here to show your support, read other letters, or write your own letter.