Assessing Whether or Not You are Food Dependent
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.