Considering the Role of Food Addiction
By: Susan Branscome, Food Addiction Institute Board Member
Eating disorders (ED) are among the most serious and complex mental health conditions, often emerging during critical developmental years and carrying profound physical and psychological consequences. Over decades, the field has developed a range of evidence-based treatments—primarily psychological interventions such as cognitive behavioral therapy (CBT-ED), family-based therapy (FBT), and other specialized approaches.
And yet, despite this progress, one question remains:
Why are outcomes still only modest?
A recent National Institutes of Health study indicates that remission rates for anorexia nervosa, bulimia nervosa, and binge eating disorder remain modest—approximately 40 to 60 percent, with relapse common and many individuals experiencing only partial recovery. This raises an important question:
What might we be missing?
A Psychological Model—But Is It Complete?
Eating disorders are currently classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, as psychiatric disorders. Treatment has therefore focused on psychological and behavioral factors—distorted thinking, emotional regulation, trauma, and family dynamics. Eating disorder treatment has traditionally focused on the psychological and behavioral aspects of food and eating, rather than framing certain foods as potentially addictive. These ED approaches are essential—and often life-changing. But what if they are not the full picture?
Even the most well-established therapies tend to improve behaviors, such as weight restoration, while deeper symptoms—obsession, compulsion, and intrusive thoughts—often persist. This raises the possibility that, for some individuals, the primary driver may not be disordered eating alone, but a substance-abuse-like response to certain foods, especially ultra-processed foods and sugar. This raises an important clinical consideration: for some individuals. Approaches centered on inclusion of all foods may inadvertently perpetuate symptoms; whereas, an addiction-informed model—incorporating abstinence—may better address the underlying drivers of their condition.
A Blind Spot in the Field?
The concept of Food Addiction—particularly related to sugar and ultra-processed foods—has been controversial within the eating disorder field. Concerns include oversimplification and stigma.
At the same time, emerging research suggests that highly processed foods can activate brain reward pathways in ways that resemble those of addictive substances.
Many individuals report:
- Loss of control
- Cravings
- Continued use despite harm
- Repeated relapse
These are not only psychological features—they are also hallmark characteristics of physical addiction and substance use disorders, similar to alcohol and drug addiction. This distinction becomes more complex when considering the interaction of two powerful forces: the biological, substance-like, addictive effects of certain foods and the addictive behavioral patterns that reinforce their continued use.
Could there be a subset of individuals being treated for an eating disorder for whom food functions, in part, like an addictive substance?
Cravings, Withdrawal, and Abstinence
Some individuals experience symptoms resembling withdrawal when reducing or eliminating certain foods—particularly sugar and ultra-processed foods—including cravings, irritability, and a strong drive to return to use. These patterns are consistent with biological adaptations seen in substance use disorders.
In traditional eating disorder treatment, the message is often that “all foods can fit.” For many, this is appropriate. But for others, especially those with repeated loss of control, this approach may not fully address their experience, and addiction may be present. In substance use disorders such as alcohol addiction, recovery often involves abstinence from the triggering substance. Similarly, some individuals report that abstaining from specific foods stabilizes behavior and reduces cravings and food noise. Removal of these foods may result in early behavioral stabilization, followed by a gradual reduction in obsessive thoughts and compulsive urges. This highlights a critical distinction: while traditional eating disorder treatment often emphasizes flexibility with food, addiction-informed approaches—such as 12-step programs—may require abstinence from specific substances for some individuals to achieve successful stability and relief.
Expanding the Conversation
There is growing international interest in whether Food Addiction, particularly involving ultra-processed foods, may meet criteria similar to other substance use disorders. Efforts are underway to explore recognition within frameworks such as those of the World Health Organization and the American Psychiatric Association.
Where This Leads
This is not a call to abandon current treatment models. It is a call to expand them. For some individuals, integrating an understanding of Food Addiction—including cravings, withdrawal, and, in some cases, abstinence—may improve outcomes. For those who continue to struggle, the question remains:
What are we missing—and how can we better serve them? Is abstinence an answer for those experiencing ED who remain treatment resistant?