DiFeliceantonio, an appetitive neuroscientist at Virginia Tech, answers questions for Scientific American. Some excerpts:

SA: What does it mean to have a “food addiction”?

DiFeliceantonio: “When we’re thinking about food addiction and looking qualitatively at what people are eating when they are saying that they can’t stop eating, we have to put it in the framework of a substance use disorder. These disorders affect life in an untenable way. Food addiction isn’t in the Diagnostic and Statistical Manual of Mental Disorders (DSM) like substance use disorder is, but there is a proposal to have it put in the DSM.

“We typically look to the Yale Food Addiction Scale for clinical evaluation. … If we accept that food addiction exists—if you give the Yale Food Addiction Scale to large population-level studies and do it across multiple countries internationally—we generally find that around 12 percent of people [experience] it.

A combination of factors can lead to an addictive behavior. And the most common is the addictive potential of the substance combined with the vulnerability of the person. We think about both of those things with food, too: ingredients that could have addictive potential and the people who could be most vulnerable. …”

SA: Why does “food addiction” ignite debate?

DiFeliceantonio: “One pushback I hear is we don’t want to overpathologize everything. But I think that if about 12 percent of a population is telling you that they have a problem, maybe we should look at it, or we should at least give it some concerted study and determine what it is. People also say it’s a behavioral addiction — you are not addicted to food as a substance; you are addicted to the act of eating. But that argument falls down pretty quickly when you look at what people are eating. If you were addicted to the act of consuming, you would be eating things that were hard or crunchy or that required a lot of work to consume. And that’s not really what we see. We see people losing control over intake for items that are high in fat and sugar — refined carbohydrates.

“I also think a lot of the pushback is a moral tie — if you’re addicted to food, you’re a bad person. For the most part, a lot of people have let this go. We understand that alcohol use disorder, for instance, isn’t caused by a failing of willpower. [People with the disorder] cannot overcome it, and we have to help them. I’m always bringing that level of compassion to food addiction, too.”

SA: If ultraprocessed foods are truly “addictive,” what are some treatments? How should those treatments be tackled on a societal and individual level?

DiFeliceantonio: “When someone has a substance use disorder, part of the treatment is for them to avoid the cues and context in which they use that substance. … Addiction is societal and behavioral. We decide what drugs are illegal. We decide at what age people have access to potentially addictive substances. Artificial refinements of foods — so pure sugar, fat, combinations of fat and sugar that don’t occur in nature—also activate our reward system. At what level is a rewarding substance one that we are willing to regulate as a society? … You need to eat to survive, but you don’t need the majority of ultraprocessed foods for human survival, food security and national security.”