Do you have an overweight or eating disordered patient who resists treatment?
Read on for some life saving information about food addiction.
Dear Physician, Dietitian, or Therapist,
- Do you have a patient who is obese and cannot lose weight through diet and exercise alone?
- Do you have a patient who has tried many diets and also tried therapy to deal with their overeating– all unsuccessfully?
- Do you have a patient for whom neither weight loss medication nor psychotropic medications have helped them to maintain a healthy weight over time?
- Do you have a patient who is considering bariatric surgery but cannot meet the requirements for the operation? Do you have a patient who has lost weight with bariatric surgery and gained most of it back? Do you have a bariatric surgery patient who has lost weight and then become addicted to alcohol or drugs?
It is possible that your patient has become addicted to food.
As Jan Wilson wrote in the Food Addiction Newsletter, “I believe there is a physical addiction that happens at the biochemical, neurotransmitter level, and this imbalance can be triggered by certain allergenic foods in fairly small quantities, by sugars and sugar-fat combinations in medium quantities, by almost any foods in excessive quantities, by starving, by purging or even by thinking yourself into a binge.” When Wilson wrote this in 1989, there was almost no scientific, peer-reviewed research which would prove the case of food addiction to a skeptical physician, dietitian or therapist. Twenty-one years later, as is documented in Physical Craving and Food Addiction, the first scientific review paper of the Food Addiction Institute, there is more evidence for the scientific basis of chemical dependency on food than there was regarding alcohol and other addictive drugs when dependency on them was formally declared Substance Abuse Disorders by the medical profession.
This letter is to bring you up to date on the overwhelming scientific case for food addiction and offer basic practical suggestions regarding how you can help potentially food addicted patients at each of the progressive stages of this disease. We include one or two references related to each point in order to point you in the direction of the best current research.
- The d2 dopamine gene marker for alcoholism and drug addiction has been found in overeating obese adults who are not alcoholic or drug addicted. Noble, et al, “D2 Dopamine Receptor Gene and Obesity,” International Journal of Eating Disorders, 15:205-219, 1994.
- Animal research in the model used to test for alcoholism and drug addiction has shown that some animals can be addicted to sugar, other sweeteners, and excess fat. Avena, et al, “Evidence of Sugar Addiction: Behavioral and Neurochemical Effects of Intermittent, Excessive Sugar Intake,” Neuroscience and Biobehavioral Reviews,” 20-39, 2008; Leibowitz, “Over Consumption of Fats: A Vicious Cycle from the Start,” Summit on Obesity Epidemic and Food Addiction, 2009.
- Brain imaging research on humans has found similar changes in pet scans of highlighted dopamine of obese, binge eating adults as are found in diagnosed alcoholics and drug addicts. Gold (Ed) Eating Disorders, Overeating, Pathological Attachment to Food: Independent or Addictive Disorder? Haworth Medical Press, 2004 (co-published as The Journal of Addictive Diseases, 23:3, 2004).
- There is scientific consensus that some humans who binge on food, then restrict and then continue this binge/restrict pattern produce endogenous opioids. Drewnowski, et al, “Taste Response and Preference for Sweet, High-fat Foods: Evidence of Opioid Involvement,” Physical Behavior, 51:371-9; Colantuoni, “Evidence That Intermittent, Excessive Sugar Intake Causes Endogenous Opioid Dependence,” Obesity Research, 10: 478-88, 2002.
- There is evidence that markers on the ob gene and deficiency in the chemical leptin are related to disorders in satiation and to problems self assessed food addicts call addiction to volume eating of all foods. Shell, The Hungry Gene: the Science of Fat and Future of Thin, Atlantic Monthly Press, 2002; Deneen, Gold and Liu, “Food Addiction and Cues to Prader-Willi Syndrome,” Addictive Medicine. 3:11, 2009.
- There are professional journal articles showing from clinical experience chemical dependence on food is different from simple obesity and different from traditional eating disorder. Werdell, “Food Addiction: Beyond Ordinary Eating Disorders,” The Clinical Forum, International Association of Eating Disorder Professionals, 1994.
- There is research showing that some overeaters have all the characteristics of food as a Substance Use Disorder. Ifland, et al, “Refined Food Addiction: A Classic Substance Use Disorder,” Medical Hypotheses, 518-526, 2009.
- There are thousands of anecdotal case studies of individuals becoming addicted to food. Danowski, Locked Up for Eating Too Much: the Diary of a Food Addict in Rehab, Hazelden, 2002; Bullitt-Jonas, Holy Hunger: A Woman’s Journal from Food Addiction to Spiritual Fulfillment, Vintage, 1998; Prager, Fat Child, Thin Man, 2010.
- There are case studies of obese patients who for years could not diet, but after treating themselves as food addicts and eliminating all binge foods completely from their food plan, they were successful in losing and keeping off the weight. Dufty, Sugar Blues, Warner Books, 1975 Appleton, Lick the Sugar Habit, Avery, 1988; Overeaters Anonymous, OA World Service. I, 1980 and Vol. II, 2002; theconnection, Journal of Food Addicts in Recovery Anonymous, 2004.
- There is outcome research showing that some members of a food related 12 Step fellowship are successful when treating themselves as food addicted. Overeaters Anonymous (OA), Membership Survey Report, Overeaters Anonymous, Inc. 2004; Kirz, The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-eating Disorder and Bulimia Nervosa, Virginia Polytechnic Institute, 2002.
- There are case studies of obese patients who could not stay on traditional diets and are now being treated successfully by doctors using an addiction model. Kline, The Junk Food Withdrawal Manual, Total Life, 1978; Bernard, Breaking the Food Seduction: the Hidden Reasons Behind Food Craving – and 7 Steps to End Them Naturally, St. Martin’s Press, 2003.
- There is outcome research showing the success of residential treatment for food addiction in a psychiatric hospital setting and of workshop based treatment for those not needing direct medical supervision using the same addiction model. Carroll, The Eating Disorder Inventory and Other Predictors of Successful symptom Management of Bulimic and Obese Women Following an Inpatient Treatment Program Employing an Addictions Paradigm, Department of Psychological and Social Foundations, University of South Florida, 1993.
The scientific studies above are just a small selection of the best research. For an excellent online overview of the current state of the field, go to www.foodaddictionsummit.org : there is a streaming video of the presentations of top scientists and clinicians at the Summit on Obesity and Food Addiction, Bainbridge, WAS, 2009. For a summary of 34 science review articles showing areas of consensus regarding food addiction, go to the Refined Food Addiction Research Foundation – www.refinedfoodaddiction.org. And on this site, you can find a bibliography of 2,733 science books and articles documenting food addiction in over 100 different scientific journals.
So, what do you do if you encounter a patient who might be food addicted?
First, tell them that science has now documented that some people can become chemically dependent on food. You might give them a copy of this letter, refer them to this website, or suggest one of the many good self-help texts on food addiction: Hollis, Fat is a Family Affair, Hazelden, 1985; Sheppard, Food Addiction: The Body Knows, Health Communications, 1989; Danowski and Lazaro, Why Can’t I Stop Eating?, Hazelden, 2000; or Ifland, Sugars and Flours: How They Make Us Crazy, Sick and Fat and What To Do About It, First Books Library, 2000. See recommended reading on this site. If your patient would like to do research on the internet, you might suggest they start here.
Second, suggest that they make a detailed list of binge foods and foods that trigger overeating. The most commonly addictive foods are sugar, flour, excess fat, caffeine, and alcohol. There are also millions who are addicted to wheat, salt, artificial sweeteners and other food substances. The secret of dealing with food addiction is to begin by eliminating entirely the foods you personally abuse. In early stages of food addiction, people can often do this on their own; the problem is that the consequences in early stages often do not seem harsh enough to demand such drastic action. For an individualized food plan, see a physician, dietitian or therapist who understands food addiction or obtain Theresa Wright’s (RD) Your Personal Food Plan: A Basic Food Plan for Recovery from Addictive and Compulsive Eating Behaviors, Renaissance Nutrition Center, 2004 at http://www.sanefood.com/
Third, provide a list of food addiction peer support groups and, if needed, referrals to professionals who have had success in working with food addicts. There are eight places to find free support for food addiction recovery:
- Compulsive Eaters Anonymous-HOW (CEA-HOW)
- Food Addicts Anonymous (FAA)
- Food Addicts in Recovery Anonymous (FA)
- Greysheeters Anonymous (GSA)
- Overcomers Outreach (OO)
- Overeaters Anonymous (OA)
- Recovery from Food Addiction Inc, (RFA).
OA is the oldest, most diverse and largest by far; it contains support for compulsive eaters who are not food addicted and it has special groups within which are primarily for late stage food addicts: OA-HOW and 90 Day Meetings. A short history and description of each, along with recommendations for professionals, can be found in Werdell, Bariatric Surgery and Food Addiction: Preoperative Considerations, pp 185-218, Evergreen, 2009. Health professionals need to research local groups to find out where food addiction is best understood and where there is the best support for food abstinence and recovery.
Fourth, if your patient is not able to achieve a stable food abstinence and recovery with your help and by working a 12 Step program alone, the rule of thumb in addiction recovery applies: help them surrender to more structure and support. In food addiction recovery – like in alcoholism and drug addiction recovery – the simplest and least expensive ways of doing this are within the 12 Step fellowships: find a sponsor and do what they say; go to more meetings, and if this doesn’t work, go to even more; attend workshops and retreats, and become more involved by doing service. The other option is to seek out professional help; if individual counseling is not enough, find a food addiction recovery group; if weekly meetings are not enough, try intensive out-patient treatment or a residential workshop; if this is not enough, enroll in in-patient treatment, and if it takes more structure and support live in a food addiction friendly recovery house or halfway house for an extended period. For the standards by which you can evaluate professional food addiction services, see Werdell, “From the Front Lines: Best Practices in Treatment for Late Stage Food Addicts,” Brownell and Gold (ED), The Food Addiction Handbook, Oxford, forthcoming.
And finally, physicians, dietitians and therapists can help their food addicted patients by voting that their professional associations recognize food addiction as a medical disease and that the American Psychiatric Association add “food addiction” as a Substance Use Disorder in the DSM 5.