Original Research Article
Eating ourselves to death: How food is a drug and what food abuse costs
Matthew Robinson
Abstract
Drug Science, Policy and Law Volume 8: 1–21
© The Author(s) 2022
Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/20503245221112577 journals.sagepub.com/home/dsp
The objective of this paper is to examine definitions of the terms “drug,” “drug use, “drug abuse,” and “addiction” to determine if the most commonly consumed foods in America are similar or consistent with drug use, abuse, and addic- tion. The methodology consists of reviewing published studies in the “food addiction” literature to determine if any con- sensus on the issue is achieved. Further, the author analyzes research on harms (including illness, death, medical costs and productivity losses) of illicit drugs, licit drugs, and foods. The author finds evidence that some food consumption is con- sistent with drug use and drug abuse, and that food addiction is real. Further, the harms caused by the unhealthy foods we eat dwarf those caused by crime and illegal drugs combined. Based on the data, the author suggests we reprioritize what we believe to be dangerous and “criminal” as well as rethink the “war on drugs.”
Keywords
food addiction, food crime, drug use, drug abuse, drug misuse
Introduction
Crime is generally understood to refer to violations of the criminal law. Yet, people often feel like crime victims whenever they are intentionally harmed by another (or even harmed by another with any form of moral culpability, whether illegal or not) (Robinson, 2002). Much research in the social sciences shows clearly that the crimes considered serious by the police and citizens alike are not the most fre- quently occurring and harmful acts faced by citizens. Stated simply, the behaviors that are most likely to harm us—both physically and financially—are either not illegal (even when committed with moral culpability) or are illegal but are not the focus of criminal justice intervention. Consider, for example, the numerous forms of white-collar-, corporate-, state-, state-corporate-, and other forms of crime and elite deviance that are harmful yet legal (Barak, 2017; Brickey and Taub, 2017; Buell, 2016; Michalowski, 2006; Robinson and Murphy, 2008; Simon, 2018).
One set of deleterious outcomes now being considered to some degree within criminology and related disciplines are those associated with the foods we commonly consume (Robinson, 2017). Recent papers examined the culpability of the actors in the conventional food system for the health outcomes of obesity (Schrempf-Stirling and Phillips, 2019; also see Stanish, 2010) and type 2 diabetes (Robinson and Turner, 2019). Housed in the context of
the “food crime” literature (Croall, 2007; Gray and Hinch, 2018), these papers show that culpable acts of global food companies lead to far more death, illness, and financial loss annually than all street crimes combined. Stated simply, global food corporations grow, process, advertise, and sell the foods eaten by people all over the world. Changes in dietary patterns from 1970 to 2010, such as increases in consumption of unhealthy oils and fats, as well as corn-based sweeteners, have led to increases in obesity and diabetes across the globe (Robinson and Tauscher, 2019). Yet, none of the foods responsible for these outcomes are illegal, nor are the behaviors that get these foods into the hands of consumers.
The term “Food Crime” was first used by Croall (2007: 206) to describe the “many crimes that are involved in the production, distribution, and selling of basic foodstuffs.” Gray and Hinch (2018: 12) note that food crime includes “illegal, criminal, harmful, unjust, unethical or immoral food-related” behaviors and omissions of behavior. As of now, work has focused on issues such as food insecurity and famine (Howard-Hassman, 2016) as well as food
Appalachian State University, USA
Corresponding author:
Matthew Robinson, Department of Government and Justice Studies, Appalachian State University, Boone, NC 28608, USA.
Email: robinsnmb@appstate.edu
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fraud (Leon and Ken, 2019). Additional research has focused on issues related to food poisoning, misleading advertisements, exploitation of labor including low pay as well as child & slave labor, control over farmers by large agribusiness, land grabbing, hazardous working conditions, inequality of food availability, food waste, unethical trade policy, illegal trade & pricing in the food industry, various forms of environmental degradation, genetically modified foods (GMOs), faculty farming, and animal cruelty (Beirne, 1999; Boone, 2013; Coe and Coe, 2013; Croall, 2013; Culp, 2005; Del Prado-Lu, 2018; Fairley, 1999; Fatka, 2013; Goodman, 2011; Gray and Hinch, 2015; Hinch, 2018; Lawrence, 2004, 2008; Leighton, 2018; Long and Lynch, 2018; Morgan and Goh, 2004; Mugni et al., 2012; Nottingham, 2003; Satre, 2005; Schrage and Ewing, 2005; Smith et al., 2017; Walters, 2006; White, 2012, 2014; White and Yeates, 2018).
While the food crime literature is growing and especially focused on harms associated with various foods, one aspect of food crime is largely being ignored within disciplines such as criminology and criminal justice. That aspect is food as a drug. In this paper, the author examines food as a “drug” because it can lead to unhealthy use, addiction, and even abuse, often interfering with adaptive functioning in school, work, and personal relationships. The novelty of the paper is its focus on food as a drug and its relationship to the literature on food crime.
The paper then compares and contrasts the harms asso- ciated with food, legal drugs, and illegal drugs. Based on the numbers, the author suggests that criminologists con- tinue to study not only criminal behaviors but also other harms excluded from the criminal law. Based on the data, the author suggests we should re-examine what we believe to be dangerous and “criminal” and reconsider the national policy of a drug war. That is, there are many harms associated with food addiction that suggest the “war on drugs” might be focused on at least some of the wrong things.
Metholodogy
This is a review paper with an analysis of the literature on drugs, drug use, drug misuse, drug abuse, addiction, sub- stance use disorders, and ultimately food addiction. The author examines published studies in each area, and reviews the diagnostic guidelines related to many of these terms, as established by scientific and medical societies such as the American Psychiatry Association (APA), National Institute on Drug Abuse (NIDA), and American Society of Addiction Medicine (ASAM). The author then compares studies of food addiction with definitions of the terms above, in an effort to establish the evidence with regard to whether food is addictive in any way. He also reviews studies using the Yale Food Addiction Scale,
measuring the nature and prevalence of food addiction in the United States.
Then, the author attempts to compare harms associated with food with those caused by both licit and illicit drugs in the US, as well as with street crimes such as murder. Here, he uses data from the Federal Bureau of Investigation and the US Department of Justice, Bureau of Justice Statistics, with regard to the frequency and costs of street crime.
A major limitation to any review paper pertains to avail- ability of sources. Though every effort was made to locate all studies on food addiction, it is not certain that every study published on this subject was reviewed. This could ultimately impact the conclusions of this author, though it is unlikely given the amount of studies reviewed in this article.
Drug use versus drug misuse and drug abuse
Drug use refers to any ingestion of a drug into the body. A drug is generally understood to be any substance, that, when ingested into the body, produces a physiological change. Although food would clearly fit this definition, scholars generally point out that the definition of drugs does not include food. Further, the Food, Drug, and Cosmetic Act (21 US Code Section 321) specifies:
The term “drug” means (A) articles recognized in the offi- cial United States Pharmacopoeia, official Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them; and (B) arti- cles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and (C) articles (other than food) intended to affect the structure or any function of the body of man or other animals; and (D) articles intended for use as a compo- nent of any article specified in clause (A), (B), or (C)….A food, dietary ingredient, or dietary supplement for which a truthful and not misleading statement is made in accord- ance with section 343(r)(6) of this title is not a drug under clause (C) solely because the label or the labeling contains such a statement (Cornell, 2020).
Interestingly, the federal law noted above states that foods and dietary supplements are not considered drugs even though research shows that, in some cases, they are.
An example of drug use is drinking a cup of coffee in the morning, having a beer after work, or drinking a glass of wine with dinner. Drug misuse refers to “improper or unhealthy use” rather than proper medical use, or overuse of a drug (including alcohol) rather than use in moderation. Drug misuse includes “repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other
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than prescribed or using someone else’s prescription” (National Institute of Drug Abuse, NIDA, 2020, emphasis in original). One can envision the inclusion of food when it comes to misuse, given the realities of overeating, binge eating, obesity, and so forth. In fact, even in the absence of physical dependence, Ziauddeen and Fletcher (2013: 21) suggest an alternative to the term food addic- tion—“food abuse or misuse.” This issue is revisited later in the paper.
Why do people use drugs?
According to the National Institute on Drug Abuse (NIDA), people use drugs to feel good (e.g. feeling of pleasure or a “high”), to feel better (e.g. relieving stress), to do better (i.e. improving performance), out of curiosity, and because of peer pressure. The “feeling” of course occurs in the brain. Hartney (2019) notes: “While the pharmacological mechan- isms for each class of drug are different, the activation of the reward system [in the brain] is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a ‘high.’” It is important to note that some foods are used by people to feel good or better and that they activate the same regions of the brain as drugs. This will be addressed later in the paper.
How the brain is involved. The brain is involved in drug use, because drugs “directly or indirectly target the brain’s reward system by flooding the circuit with dopamine” (NIDA, 2020). Dopamine “is important for reward-related processes driving substance-seeking behavior” (Wiss and Brewerton, 2020: np). NIDA notes that “Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and reinforce- ment of rewarding behaviors. When activated at normal levels, this system rewards our natural behaviors. Overstimulating the system with drugs, however, produces effects which strongly reinforce the behavior of drug use, teaching the person to repeat it.”
This same outcome occurs with food, especially those foods that taste good and consist largely of sugar, salt, and fat (Breslin, 2013; Drewnowski and Almiron-Roig, 2010; Jabr, 2016; Moss, 2013; Pollan, 2006, 2008). Eordogh et al. (2016: np) confirm that “neurobiological cir- cuits involved in the development of drug addiction also play a role in food consumption.” Other scholars agree: “Drugs and food both exert a rewarding effect through the firing of dopamine neurons … resulting in the release of dopamine …” (Lindgren et al., 2018: 811). This issue will be the focus of much of this paper.
In fact, all reward responses occur in the same areas of the brain, whether you are talking about drugs, food, or something else, including, for example, gambling. Thus, it makes sense the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes drug use disorders
but also includes Gambling Disorder and Internet Gaming Disorder. Each outcome may reflect a Reward Deficiency Syndrome, whereby low levels of dopamine are ultimately caused by excessive engagement with drugs, food, or gam- bling over time. This leads to greater use or participation to experience the desired effect due to increased tolerance over time, where more of a substance (or experience) is needed to achieve the desired effect. Withdrawal, a key sign of drug abuse, also happens with low dopamine; in this case, people seek out substances to deal with negative physical symptoms emanating from not being fulfilled. As will be shown later in the paper, the same finding occurs with certain foods (Pursey et al., 2014).
What is addiction?
There are numerous definitions of addiction available. The American Psychiatry Association (APA, 2020) defines addiction as a “brain disease that is manifested by compul- sive substance use despite harmful consequence.” APA adds that addiction involves an “intense focus on using a certain substance(s) … to the point that it takes over their life.” That is, drug users will continue to use even knowing it will likely lead to problems in relationships at work, home, and/or school.
APA (2020) lays out that outcome of substance use dis- orders, as well as others:
• Social problems: substance use causes failure to com- plete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.
• Impaired control: a craving or strong urge to use the sub- stance; desire or failed attempts to cut down or control substance use.
• Risky use: substance is used in risky settings; continued use despite known problems.
• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance) (APA, 2020).
The American Society of Addictive Medicine (ASAM, 2020) defines addiction as “a treatable, chronic medical disease involving complex interactions among brain cir- cuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often con- tinue despite harmful consequences.” Those harmful conse- quence include not only potential physical withdrawal and possible overdose but also interferences in relationships, as noted above.
NIDA (2020) defines addiction as a “chronic, relapsing disorder characterized by compulsive drug seeking, contin- ued use despite harmful consequences, and long-lasting changes in the brain.” NIDA goes on to point out that
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addiction “is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances” (NIDA, 2020).
Addiction is characterized by “distorted thinking, behav- ior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control” (APA, 2020). NIDA (2020) adds that addiction changes brain function in the areas of “natural inhibition and reward centers.”
For food to be considered addictive by these definitions, it must have the potential to produce outcomes like those identified above. A review of the literature on food addic- tion, provided later in the paper, shows that some foods do produce at least some of these outcomes.
Addiction versus substance use disorder. In spite of NIDA’s assertion that addiction is a mental illness, addiction is not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Rather, the DSM includes “substance use disorder,” a replacement of the previous cat- egories (from DSM-IV) of substance abuse and substance dependence. Substance use disorder has three subclassifica- tions of mild, moderate, and severe based on the number of symptoms identified (two to three symptoms is considered
Table 1. Indices of addiction and substance use disorders.
Social problems: persistent or recurrent social or interpersonal problems caused by use; use interferes with work, school or home; failure to sustain obligations; social, work or leisure activities are given up or cut back (APA, DSM, ASAM)
Impaired control, compulsive use: cravings or strong urges to use; desire to or failed attempts to reduce use; using more than intended (APA, DSM, ASAM, NIDA)
Risky use: use in risky or hazardous settings; continued use despite known problems; continued use despite knowing one has a persistent or recurrent physical or psychological problem caused or exacerbated by the substance (APA, DSM, ASAM, NIDA)
Drug effects: tolerance; withdrawal symptoms (APA, DSM)) Brain disease: causes physical problems in the brain; drive to
use based on neurotransmitters (APA, ASAM, NIDA)
Time usage: large amount of time is spent in activities necessary to obtain the substance, use the substance, or recover from
its effects (DSM)
Key:
APA: American Psychological Association.
DSM: Diagnostic and Statistical Manual for Mental Disorders. ASAM: American Society of Addictive Medicine.
NIDA: National Institute on Drug Abuse.
“mild,” four or five is considered “moderate,” and six or more is “severe”). NIDA (2020) explains: “The new DSM describes a problematic pattern of use of an intoxicat- ing substance leading to clinically significant impairment or distress with 10 or 11 diagnostic criteria (depending on the substance) occurring within a 12-month period.”
The diagnostic criteria include:
1. Thesubstanceisoftentakeninlargeramountsorovera longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving,orastrongdesireorurgetousethesubstance, occurs.
5. Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home. 6. Use of the substance continues despite having persist- ent or recurrent social or interpersonal problems
caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activ- ities are given up or reduced because of use of the
substance.
8. Use of the substance is recurrent in situations in which
it is physically hazardous.
9. Use of the substance is continued despite knowledge of
having a persistent or recurrent physical or psycho- logical problem i.e. likely to have been caused or exa- cerbated by the substance.
10. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the sub-
stance to achieve intoxication or desired effect
(b) A markedly diminished effect with continued use
of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for that
substance (as specified in the DSM-5 for each
substance).
(b) The use of a substance (or a closely related sub-
stance) to relieve or avoid withdrawal symptoms (Hartney, 2019).
According to Hartney (2019), the DSM acknowledges that substance use disorders can emerge from numerous classes of drugs, including alcohol, anxiolytics (i.e. anti-anxiety medicine), caffeine, cannabis, hallucinogens, hypnotics, inhalants, opioids, sedatives, stimulants (including amphe- tamines and cocaine), tobacco, and other or unknown sub- stances. Hartney notes that “the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.” This could presumably include food. In fact, research into food addiction does show
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many of the above diagnostic criteria are in fact met when it comes to use of some foods, suggesting the possibility of even a “severe” substance use problem. This review is pre- sented later in the paper.
Table 1 illustrates the varying conceptions of addiction and substance use disorders. These are taken from the def- inition above, offered by APA, ASAM, NIDA, and from information within the DSM. Later in the paper, this table will be revisited to see which of these conceptions of addic- tion and substance use disorders apply to food.
Interestingly, a scale of food addiction—the Yale Food Addiction Scale (YFAS)—has been developed based on similar measures. This is a 25-point self-report question- naire meant to discover the impact of addictive behaviors related to food, based on substance dependence criteria from the DSM. Table 2 shows this scale. The survey exam- ines eating habits in the past year, and asks questions related to eating more than one plans, eating when no longer hungry, eating to the point of feeling ill, eating in spite of worrying about foods being consumed, various negative health outcomes resulting from eating, interferences in quality of life due to food, food cravings, as well as phys- ical, emotional, and psychological outcomes consistent with withdrawal, and more. The YFAS allows us to get a sense of the prevalence of food addiction; those data are shared later in the paper.
Importantly, the YFAS doesn’t just measure eating behaviors but is meant to measure eating that significantly impairs and distresses people (Moss, 2021: 21). An example is eating too much when you do not want to. According to Cohen (2014: 129): “Most people cannot rou- tinely control how much they eat in the face of excess avail- ability of food.” Accessibility of food is the most significant change in the conventional food system in the past fifty years: food is available nearly everywhere, all the time, and it is major food corporations who are responsible for this reality. This raises the issue of culpability in the food industry for outcomes such as obesity, a topic to be addressed later in the paper.
Is food addictive?
Before considering whether food is addictive, it is first important to differentiate between two types of hunger. “Metabolic hunger” or “homeostatic hunger” is feeling a need to eat that is “driven by physiological necessity and is commonly identified as the rumbling of an empty stomach” (Jabr, 2016: np). This is regulated by the hypo- thalamus in the brain. After eating, hunger is normally sup- pressed by hormones produced by the hypothalamus as well as by the stomach. “Hedonic hunger” is understood to mean “a powerful desire for food in the absence of any need for it,” as in the case of continuing to eat when you are already feeling full. It is “the yearning we experience when our stomach is full but our brain is still ravenous”
(Jabr, 2016: np). It is hedonic hunger that is relevant for this paper, for it is eating to satisfy hedonic hunger that is most consistent with the idea of food addiction. Everyone eats; some peole eat too much and/or too often.
The first scholar to introduce the term food addiction (FA) was Randolph (1956), who defined it as “a common pattern of symptoms descriptively similar to those of other addictive processes.” More recently, Soto-Escageda et al. (2016: 175) claim: “There is physiological and behav- ioral evidence that some people may develop a true addic- tion to food.” Yet, there is not universal agreement that FA is real. For example, a review of the evidence by Ziauddeen and Fletcher (2013: 19) concluded that FA is merely “a phenotypic description, one that is based on an overlap between certain eating behaviours and substance depend- ence.” They explain: “While work on animals supports the argument that the combination of high fat and high sugar, prevalent in modern processed foods, produces an addiction-like phenomenon in rodents…the FA concept in humans rests on a less well-explored extrapolation: namely that certain highly processed foods are addictive” (p. 20).
Schulte and Gearhardt (2017: 112) disagree, writing that “studies in animals and humans have demonstrated biobe- havioural indicators of addiction in response to foods high in fat and/or refined carbohydrates” making it “akin to a substance-use disorder.” Additionally, Corwin and Grigson (2009: np) argue that “both behavioral and neuro- biological evidence support the conclusion that food, under [certain] conditions … can induce and addiction-like state in subjects” (also see Pelchat, 2009).
According to Meule (2019), there are at least three major positions when it comes to the issue of FA:
1. Certain foods have addictive potential, consistent with substance use disorders (e.g. see Corsica and Pelchat, 2010; Ifland et al., 2015; Schulte et al., 2017).
2. No specific additive substances have been identified in food (e.g. see Hebebrand et al., 2014; Ruddock et al., 2017).
3. Food addiction is not a valid concept since it overlaps with at least one eating disorder—binge eating—and is thus unneeded (e.g. see Finlayson, 2017; Ifland et al., 2015; Long et al., 2015; Schulte et al., 2017).
Similarly, Fletcher (see Fletcher and Kenny, 2018: np) claims that “the addictive substance [in food] remains undiscovered”; there is significant overlap between food addiction and binge eating disorder, suggesting the concept is not valid; “there remains no convincing demon- stration in humans that … neurobiological changes … underlie … food addiction behaviors”; and even convincing evidence from animal studies may not be applicable to humans. This paper reviews the evidence and finds more support that food is addictive than that it is not.
6 Drug Science, Policy and Law Table 2. Yale food addiction scale, version 2.
This survey asks about your eating habits in the past year. People sometimes have difficulty controlling how much they eat of certain foods such as:
– Sweets like ice cream, chocolate, doughnuts, cookies, cake, candy
– Starches like white bread, rolls, pasta, and rice
– Salty snacks like chips, pretzels, and crackers
– Fatty foods like steak, bacon, hamburgers, cheeseburgers, pizza, and French fries – Sugary drinks like soda pop, lemonade, sports drinks, and energy drinks
When the following questions ask about “CERTAIN FOODS” please think of ANY foods or beverages similar to those listed in the food or beverage groups above or ANY OTHER foods you have had difficulty with in the past year
IN THE PAST 12 MONTHS:
Never Less than monthly Once a month 2-3 times a month Once a week 2-3 times a week 4-6 times a week Every Day
1. When I started to eat certain foods, I ate much more than planned. 01234567
2. I continued to eat certain foods even though I was no longer hungry. 01234567
3. I ate to the point where I felt physically ill 01234567
4. I worried a lot about cutting down on certain types of food, but I ate them anyways. 01234567
5. I spent a lot of time feeling sluggish or tired from overeating. 01234567
6. I spent a lot of time eating certain foods throughout the day. 01234567
7. When certain foods were not available, I went out of my way to get them. For example, I went to the store to get certain foods even though I had other things to eat at home.
01234567
8. I ate certain foods so often or in such large amounts that I stopped doing other important things. These things may have been working or spending time with family or friends.
01234567
9. I had problems with my family or friends because of how much I overate. 01234567
10. I avoided work, school or social activities because I was afraid I would overeat there. 01234567
11. When I cut down on or stopped eating certain foods, I felt irritable, nervous or sad. 01234567
12. If I had physical symptoms because I hadn’t eaten certain foods, I would eat those foods to feel better. 01234567
13. If I had emotional problems because I hadn’t eaten certain foods, I would eat those foods to feel better. 01234567
14. When I cut down on or stopped eating certain foods, I had physical symptoms. For example, I had headaches or fatigue. 01234567
15. When I cut down or stopped eating certain foods, I had strong cravings for them. 01234567
16. My eating behavior caused me a lot of distress. 01234567
(continued)
Robinson 7 Table 2. (continued)
17. I had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family, or health.
01234567
18. I felt so bad about overeating that I didn’t do other important things. These things may have been working or spending time with family or friends.
01234567
19. My overeating got in the way of me taking care of my family or doing household chores. 01234567
20. I avoided work, school or social functions because I could not eat certain foods there. 01234567
21. I avoided social situations because people wouldn’t approve of how much I ate. 01234567
22. I kept eating in the same way even though my eating caused emotional problems. 01234567
23. I kept eating the same way even though my eating caused physical problems. 01234567
24. Eating the same amount of food did not give me as much enjoyment as it used to. 01234567
25. I really wanted to cut down on or stop eating certain kinds of foods, but I just couldn’t. 01234567
26. I needed to eat more and more to get the feelings I wanted from eating. This included reducing negative emotions like sadness or increasing pleasure.
01234567
27. I didn’t do well at work or school because I was eating too much. 01234567
28. I kept eating certain foods even though I knew it was physically dangerous. For example, I kept eating sweets even though I had diabetes. Or I kept eating fatty foods despite having heart disease.
01234567
29. I had such strong urges to eat certain foods that I couldn’t think of anything else. 01234567
30. I had such intense cravings for certain foods that I felt like I had to eat them right away. 01234567
31. I tried to cut down on or not eat certain kinds of food, but I wasn’t successful. 01234567
32. I tried and failed to cut down on or stop eating certain foods. 01234567
33. I was so distracted by eating that I could have been hurt (e.g. when driving a car, crossing the street, operating machinery). 01234567
34. I was so distracted by thinking about food that I could have been hurt (e.g. when driving a car, crossing the street, operating machinery).
01234567
35. My friends or family were worried about how much I overate. 01234567
Source: Food and Addiction Science & Treatment Lab (2020). Yale Food Addiction Scale. Downloaded from: https://fastlab.psych.lsa.umich.edu/yale-food- addiction-scale/.
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Some have suggested the term “eating addiction” rather than FA (Jabr, 2016). For example, Novelle and Dieguez (2018: np) write: “Although eating behaviour cannot be considered ‘addictive’ under normal circumstances, people can become ‘addicted’ to this behaviour, similarly to how some people are addicted to drugs. The symptoms, cravings and causes of ‘eating addiction’ are remarkably similar to those experienced by drug addicts, and both drug- seeking behaviour [and] eating addiction share the same neural pathway.”
Schulte et al. (2017: np) agree, noting that “eating may be a behavioral addiction that can trigger an addictive-like response in susceptible individuals. One major rationale for the eating addiction framework is that the assessment of food addiction is based on behavioral indicators, such as consuming greater quantities of food than intended and eating certain foods despite negative consequences.” Lennerz and Lennerz (2018: 68) concur, writing that “food addiction may be a behavioral addiction, analogous to gambling disorder, which was recently included among addiction disorders in the DSM-5 catalog.” Hunt (2020) agrees, calling food addiction “a complex condition that has similarities to other types of addiction, such as drugs, alcohol, shopping or gambling.”
Other scholars also agree, claiming “animal and existing human data [are] consistent with the existence of addictive eating behavior … eating can become an addiction in … predisposed individuals under specific environmental cir- cumstances” (Hebebrand et al., 2014: np).
Interestingly, one can be diagnosed with substance dependence even in the absence of physiological depend- ence—which requires evidence of tolerance and with- drawal—so being dependent or addicted to certain foods “can be diagnosed using entirely behavioral criteria” (Hebebrand et al., 2014: np). But, Morris et al. (2018: np) disagree, writing: “food addiction symptoms more closely resemble[] those of a substance use disorder due to the necessary consumption of a substance (food) and the inapplicability of certain behavioral criteria (e.g. monetary loss: DSM-5 criteria 1, 6, and 5).”
Still, given the foods regularly identified as relevant for addiction, perhaps the more specific concept of “refined food addiction” or “processed food addiction” would be more precise (Ifland et al., 2008, 2015; Manso, 2008). The types of foods that may be addictive are discussed later in the paper.
As will be shown below, food addiction is consistent with most of the definitions of addiction and substance use disorders discussed earlier in the paper. First, food changes the brain by altering neurotransmitter levels such as dopamine and serotonin. Further, the same areas involved in drug misuse and abuse and also involved in food misuse and abuse. Second, some foods produce intense cravings. Third, those foods also can produce toler- ance. Fourth, discontinued use of some foods may lead to
withdrawal (although this is less clear). Fifth, some people misuse food (e.g. compulsive eating) despite appar- ent harms to their well-being. This includes overeating even when people don’t want to, suggestive of impaired control. Sixth, misuse of food leads to numerous social problems including enormous costs to health and other costs to society; some forms of food misuse also lead to significant interference in quality of life. Each of these issues is addressed below.
Before turning to these points, a meta-analysis of 52 studies published in 35 articles between 1999 and 2017 (20 articles on 22 studies were with humans and 15 articles on 30 studies were with animals) found support for “the fol- lowing addiction characteristics in relation to food: brain reward dysfunction, preoccupation [with food], risky use, impaired control, tolerance/withdrawal, social impair- ment…Each pre-defined criterion was supported by at least one study” (Gordon et al., 2018: 477). That six differ- ent indicators of substance use disorder appear to be found in the literature suggests the possibility that some foods lead to “severe” substance use problems in at least some people.
The most supported indicators of addiction were brain reward dysfunction (n = 21 studies) and impaired control (n = 12 studies), but risky use had the least support (n = 1 study). Overall, 21 of the 25 articles and 47 of the 52 studies found support for the idea that certain foods are addictive, two studies more were mixed, and only three were unsupportive. The scholars conclude that “findings support food addiction as a unique construct consistent with criteria for other substance use disorder diagnoses” (Gordon et al., 2018: 477).
Changes in the brain
The foods we eat impact our brain chemistry. Studies show that eating certain types of foods under certain circum- stances impacts the pleasure centers of the brain in the same way that drugs do. Research on both humans and animals show highly palatable foods (i.e. foods that are highly pleasing or satisfying) impact the brain in similar ways to addictive drugs like heroin and cocaine. Specifically, “highly palatable foods trigger feel-good brain chemicals such as dopamine. Once people experience pleasure associated with increased dopamine transmission in the brain’s reward pathway from eating certain foods, they quickly feel the need to eat again” (WebMD, 2020). Studies find the same areas of the brain involved in alcohol addiction and FA (De Ridder et al., 2016). More discussion on highly palatable foods follows later in the paper.
An extensive review of the literature by Lennerz and Lennerz (2018: 64) focuses on the importance of brain changes related to food addiction. They note that: “Three lines of evidence support the concept of food addiction: (a) behavioral responses to certain foods are similar to
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substances of abuse; (b) food intake regulation and addic- tion rely on similar neurobiological circuits; (c) individuals suffering from obesity or addiction show similar neurochemical- and brain activation patterns.”
With regard to the latter point, Leigh and Morris (2018: 37) claim: “There is a growing body of evidence that a subset of individuals with disordered eating display addiction-like beha- viorurs in response to foods.” Indeed, neuroimaging studies in obese subjects provide evidence of altered reward and toler- ance. Once obese, many individuals meet criteria for psycho- logical dependence. Stress and dieting may also sensitize an individual to reward (Garber and Lustig, 2011: 146).
Lindgren and colleagues (2018: 817) add that: “Numerous functional and structural MRI studies have elu- cidated neurobiological correlates between drug addiction and obesity. Compared to healthy individuals, obese and drug addicted subjects show differences in reward and attention regions in response to cues and tasks as well as in a resting state.” Similarly, “there is considerable overlap in the behaviours associated to food addiction and binge eating disorder, and food addiction measures correl- ate highly with measures of binge eating.” Drugs that are typically used to help with drug dependence also help address binge eating (Leigh and Morris, 2018: 31). Binge eating is a disorder where people frequently eat more than they need and are unable to stop. Symptoms include eating a lot of food in a short amount of time, eating rapidly, eating when you are already full or not hungry, feeling that your eating is out of control, eating alone or in secret, and “feeling depressed, disgusted, ashamed, guilty or upset about your eating” (Mayo Clinic, 2018: np). People with binge eating disorder also frequently diet but typically do not lose weight.
Yet, it’s not just with obesity or binge eating that similar- ities between food and drugs are seen. Even hedonic eating is similar to drug use and abuse. Zhang et al. (2011: 1149) provide a possible explanation for this, focused on the brain:
Many of the brain changes reported for hedonic eating and obesity are also seen in various types of addictions. Most importantly, overeating and obesity may have an acquired drive similar to drug addiction with respect to motivation and incentive craving. In both cases, the desire and contin- ued satisfaction occur after early and repeated exposure to stimuli. The acquired drive for eating food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation.
Indeed, research shows that “overconsumption of palatable foods triggers” a reduction in dopamine receptors “in the same way that drugs do” (Lerma-Cabrera et al., 2016: np).
One area of study in the brain is the nucleus accumbens. This is a small region just in front of the limbic system by
the hypothalamus, and “neuroimaging studies show that our brain response is similar in the presence of food and drug abuse: increased cell activation” in the nucleus accumbes —“the brain’s pleasure center” (Lindgren et al., 2018: np).
Moss (2021: xxiii) reviews what he calls a “wealth of sur- prising evidence” and concludes that “food, in some ways, can be even more addictive than alcohol, cigarettes, and drugs” (emphasis in original). This is, in part, due to the fact that the same parts of the brain involved in drug abuse are involved in outcomes associated with eating, such as obesity (p. 18). Moss (2021: xxiv, 47) attributes a new meaning to the term fast food as “nothing is faster than pro- cessed food in rousing the brain” in terms of addiction. This matters because the quicker a substance can get into the bloodstream and ultimately the brain, the more addictive it can be (p. 24). As food is digested, it is converted into glucose—the brain’s fuel—and the glycemic index refers to how quickly foods raise sugar in the blood. Highly refined or processed foods raise the glycemic index the fastest, and “the faster it soars, the faster it hits the reward system in the brain” (p. 50). Blood sugar also drops more quickly, prodding the brain to make more dopamine and an urge to take in more food (p. 51). Dopamine is tied to our natural opioid system, and is linked to pleasure and well-being (Cohen, 2014: 50).
Moss (2021: 99) seems to conclude, however, not that food per se is addictive, but rather, that eating is addictive. He blames processed foods for causing people to lose control, not any particular ingredient in it. Moss even notes that processed food companies have ultimately con- ceded addiction as a problem related to their foods (p. 187). This should not be surprising given that these com- panies literally use brain scan technology “to study how we react neurologically to certain foods, especially to sugar” (Moss, 2013: xxvii). According to Moss: “They’ve discov- ered that the brain lights up for sugar the same way it does for cocaine.” In fact, cocaine, narcotics, and “super- sweetened foods” stimulate the brain (Fuhrman, 2017: 22). They all trigger the release of dopamine in the brain in the nucleus acumbens, as do fatty foods (Herz, 2018: 8, 43). This is known even to the National Institute on Drug Abuse (Cohen, 2014: 128).
Soda and fast food companies even speak in terms of “heavy users” of their products (i.e. those who drink two or more cans a day or eat at an establishment at least three times a week) (Moss, 2013; Schlosser, 2012). Appropriately, since sugar is known to ease withdrawal symptoms of opiates, giving people naloxone—a drug used to get people off of heroin—is found to curb appeal for snacks high in sugar and fat (Moss, 2013: 132); the same is true for chocolate which “can elicit a narcotic-like bliss that makes us feel better inside and out” (Herz, 2018: 240). This is likely because both narcotics and some foods “race along the same pathways, using the same neurological cir- cuitry to reach the brain’s pleasure zones, those areas that reward us with enjoyable feelings” (Moss, 2013: 276).
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Others, such as Fuhrman (2017: 65) allege that eating certain kinds of foods such as fast food “can lead to changes in brain chemistry that can increase addiction and drug-seeking behavior later.” Fuhrman even claims that high sugar and fast food consumption can act as gateway drugs to harder substances. Similarly, evidence suggests malnourishment can lead to problems with addictive drugs. Fuhrman’s review of the evidence shows that highly palatable foods have addictive properties, including eliciting cravings, that people can develop tolerance to certain foods, people often unsuccessfully attempt to cut back on foods they deem problematic, and they continue to eat them despite negative consequences.
Cravings
Fletcher (see Fletcher and Kenny, 2018: np) claims that “there are patterns of behavior and subjective experiences related to food consumption that bear a resemblance to [substance use disorders], most notably the strong urge to consume, which can become more powerful with abstin- ence and override personal desires to limit consumption.” Part of the strong urge to consume comes from cravings related to past food experiences.
Even when foods do not immediately elicit cravings, over time with repeated exposure to foods, physical changes occur in the brain, and cravings are elicited that lead to food seeking behaviors. Over time, habitual and compulsive consumption can result (Lennerz and Lennerz, 2018: 67). One possible outcome of this is obesity. That unintended, negative outcome of poor nutri- tion is discussed further later in the paper.
All addictions include symptoms such as “craving, impaired control over the behavior, tolerance, withdrawal, and high rates of relapse.” Lennerz and Lennerz (2018: np) also note that “commonly suspected problem foods share nutritive properties, suggesting a chemical or meta- bolic link rather than a mere behavioral phenomenon.” That is, there are substances in the foods we consume that lead to cravings and ultimately addiction.
There appear to be several biological and psychological similarities between food addiction and drug dependence, including both craving and loss of control (Fortuna, 2012). This is partly due to the nature of some foods. According to Ziauddeen and Fletcher (2013: 24), certain foods impact brain wiring and behaviors “in ways that can be compared meaningfully with alterations produced by drugs of abuse.” So, just as some drugs elicit cravings, so too will some foods. Some example include sugar and fat (Hunt, 2020), to be discussed further later in the paper. Incredibly, though major food companies do not tend to openly discuss addiction when it comes to their foods, they do regularly and openly talk about their efforts to increase the “craveability” of their products (Pollan, 2006, 2008).
Another way that cravings are involved with food per- tains to the issue of nutritional value of foods we eat. For example, when people eat foods with lower levels of nutri- ents, they tend to crave more calories (Fuhrman, 2017: 11). According to Fuhrman, this is one way that nutritional inad- equacy “magnifies food addiction and the desire to overeat. It makes the craving to eat too frequently and too much feel overwhelming” (p. 179). Further: “The faster the calories of a food enter the bloodstream, the higher the release of fat storage hormones and the greater the increase in dopamine (a driver of addiction in the brain). Because of these hormo- nal effects [for example, insulin], fast foods initiate and per- petuate food addiction and cravings” (p. 18). With rushes of sugar into the bloodstream, the more the brain’s “pleasure center gets stimulated and trained to direct more sugar- seeking behavior. Eating sweets and high-glycemic carbo- hydrates enhances the desire and craving for these foods.” Eating too much of these foods can also result in diminished dopamine function, as noted earlier (Fuhrman, 2017: 59), an issue related to tolerance.
Tolerance
Research shown above illustrates that certain foods can produce effects consistent with tolerance. Pursey et al. (2014: 4581) explain the Reward Deficiency Syndrome—dis- cussed earlier—writing that “an addiction to food could act in a similar way to other substance addictions, with repeated exposures to pleasurable food diminishing the dopamine brain response. This would lead to larger quantities of food consumed in order to feel satisfied, subsequently perpetuat- ing overeating.” This occurs when more of certain foods are needed over time to achieve the desired levels of satisfac- tion, caused by alterations to dopamine levels in the brain. One outcome is likely to be overeating, meaning eating more food than is needed due to an increased tolerance for certain foods (Pursey et al., 2014). Recall that neuroimaging studies in people suffering from obesity show evidence of altered reward in the brain, leading to possible tolerance (Garber and Lustig, 2011: 146).
The meta-analysis by Morris et al. (2018) reviewed a study that measured tolerance in bariatric surgery candi- dates who reported needing increasing amounts of food to reach satisfaction (Lent and Swencionis, 2012). It also reviewed a study of women craving carbohydrates who reported dispelling of negative moods upon drinking swee- tened carbohydrate beverages; that effect diminished over time, consistent with tolerance (Spring et al., 2008). Further, another study found tolerance effects for high-fat, sweet foods as well as high-fat, savory foods (Markus et al., 2017).
Hunt (2020) lays out the relationships between cravings for certain foods, and tolerance: “Highly palatable foods often contain unnatural substances or higher-than-normal levels of natural substances that your body and brain
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can’t process. This results in your body being flooded with ‘feel-good’ chemicals.” In order for people to maintain or re-experience good feelings resulting from the ingestion of certain foods, people “will begin to crave highly palat- able foods.” Over time, a person’s brain “will adjust its receptors to compensate for the rush of chemicals” and they will “eventually need to consume increasing quantities of highly palatable foods to get the same feel-good reac- tion,” consistent with tolerance.
Withdrawal
Since food does produce cravings and tolerance, symptoms associated with cessation of ingestion of certain foods may lead to withdrawal symptoms (Lennerz and Lennerz, 2018). Not eating foods that you crave and develop a tolerance for can lead to “withdrawal symptoms such as cravings, head- aches, irritability, and restlessness” (Hunt, 2020). Kenny (see Fletcher and Kenny, 2018) agrees, writing that evi- dence supports the idea that certain foods can produce with- drawal symptoms. Corwin and Grigson (2009: np) also concur, claiming that “withdrawal from a high-fat diet leads to neurochemical responses comparable to those induced by withdrawal from drugs” (Corwin and Grigson, 2009: np; also see Lutter and Nestler, 2009). Fuhrman (2017: 28) also agrees, claiming that “withdrawal symp- toms from unhealthy foods, especially excess sugar and fat, can sometimes be severe. Fatigue, headaches, itching, low-grade fever, sore throat, and mild anxiety are common.”
The meta-analysis of studies by Morris et al. (2018) dis- covered that, among bariatric surgery candidates, those with the highest addictive personality scores reported feeling most anxious when not around food (Lent and Swencionis, 2012). This is consistent with withdrawal. Two studies of chocolate addicts determined that exposure to chocolate led to changes in anxiety and restlessness that is often seen in those suffering from substance addiction (Tuomisto et al., 1999). Another study found that people with at least one YFAS symptom reported some physio- logical effect of withdrawal from high-fat, savory foods, high-fat, sweet foods, low-fat, sugary foods, and low-fat, savory foods, in that order of magnitude (Markus et al., 2017). These findings are consistent with the idea of withdrawal.
Compulsive use despite harms, lack of impulse control
According to Lerma-Cabrera et al. (2016: np): “The most common symptoms of food addiction are loss of control over consumption, continued use despite negative conse- quences, and inability to cut down despite the desire to do so.” Generally speaking, the loss of control in eating is easily demonstrated by one simple fact: people “chronically
eat some foods in amounts larger than needed for staying healthy” (Lerma-Cabrera et al., 2016: np).
Further, both hedonic and compulsive overeating are suggestive of spending too much time with food, consistent with one aspect of addiction (Jabr, 2016: np). When people eat too much and/or spend too much time with food, it is strongly supportive of a lack of impulse control.
Fletcher (see Fletcher and Kenny, 2018: np) also writes that substance use disorders are identified by “a manifest- ation of a behavioral abnormality that negatively impacts their life: specifically, the failure to control consummatory behavior despite repeated attempts to do so.” This, too, is consistent with a lack of impulse control.
According to Kenny (see Fletcher and Kenny, 2018): “Overweight individuals who experience real or perceived social, emotional, or health consequences because of their body weight will often express a desire to lose weight and will repeatedly attempt to do so, but limiting their food intake or the types of food over the prolonged time periods necessary to achieve and maintain a healthy body weight is notoriously difficult. Further, even people who lose weight tend to gain it back, demonstrating “remarkably high rates of recidivism.” Thus, “overweight individuals who are unable to exert control over their consummatory behavior, despite awareness of the negative consequences, demonstrate the same core failure to control consumption as those suffering from [substance use disorders].” Kenny cites an enormous amount of research on both adolescents and adults in support (see, e.g. Booth et al., 2008; Puhl et al., 2008; Saunders, 2001; Small et al., 2001; Stice et al., 2008; Stice et al., 2011; Yokum et al., 2014).
Individuals with FA are also more likely to be impulsive (Davis et al., 2011; Maxwell et al., 2020), similar to sub- stance users. They tend to be characterized by “emotion dysregulation,” or how well an individual is able to notice their own emotions and properly respond to them. This is likely to result in compulsive use, even with the knowledge that it can be harmful. Harfy et al. (2018: 368) note: “Individuals with poor emotion regulation abilities often have poorer decision-making, that is, a reduced ability to limit impulsive behaviors and adaptively handle unpleasant feelings.” This is important because people who cannot control their emotions at times turn to drugs or food to make themselves feel better. One possible outcome is over- eating and binge eating. Recall that drugs typically used to help with drug dependence also help people deal with binge eating (Leigh and Morris, 2018: 31).
This makes sense given the brain chemistry involved in both, as noted earlier. Loss of control is logically caused by a reduction in striatal dopamine receptors, reducing metab- olism in the prefrontal and orbitofrontal cortex, which nor- mally exerts “inhibitory control over consumption” (Lerma-Cabrera et al., 2016: np).
The meta-analysis by Morris et al. (2018) examined studies that looked at the following indicators of poor
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impulse control: substance use in larger amounts or over a longer period of time than intended, spending a great deal of time obtaining and using substances, and having cravings or strong urges to use substances. Here, studies found that people meeting FYAS measures of addiction, as well as obese people, had more cravings for food, hedonic eating, snacking on sweets (Davis et al., 2011, 2014; Tuomisto et al., 1999), and difficulty controlling their eating (Burmeister et al., 2013).
The meta-analysis by Morris et al. (2018) also looked at studies that examined the following measures of social impairment: continued use despite social or interpersonal problems caused or exacerbated by use, and reductions in important social, occupational, or recreational activities due to use. Here, one study found that bariatric surgery can- didates tended to choose spending time eating over other social and recreational activities, a behavior the authors referred to as maladaptive (Lent and Swencionis, 2012). Hardy et al. (2018: 367) explain: “Individuals with food addiction exhibit classic symptoms of addiction, such as a preoccupation with obtaining the desired substance, exces- sive ingestion of the substance and continued, excessive use, despite adverse biological consequences.”
According to Jabr (2016: np), “people who are addicted to food will continue to eat despite negative consequences.” This is consistent with one aspect of addiction. In fact, having trouble with stopping eating is measured in FA surveys with questions dealing with going out of one’s way to obtain foods, food interfering with life activities, problems with normal daily functioning, and physiological withdrawal symptoms (Jabr, 2016: np).
Social problems
Social harms associated with food are enormous and they rival those of drug abuse. Studies show the costs of drug abuse to society are about $740 billion per year, though this includes indirect costs such as losses of productivity. In 2016, drug overdoses killed more than 63,000 people. Another 88,000 died from excessive use of alcohol, and 480,000 died from ill- nesses caused by tobacco use (NIDA, 2020).
Poor diet is also responsible for very large financial losses as well as a large number of deaths. For example, dia- betes was associated with $245 billion in losses (in 2008 dollars), while obesity was associated with $147 billion in losses (in 2008 dollars); both these figures also include indirect costs (Robinson and Tauscher, 2019). Additionally, 75% of all health care dollars spent in the US are used to treat chronic diseases and medical condi- tions that are preventable, caused by things such as poor diet and lack of exercise (Nesheim et al., 2015).
In terms of death, poor dietary intake killed approxi- mately 395,000 people in the US in 2012 (Micha et al., 2017). This can be compared to only about 42,000 deaths caused by drug overdoses in the same year (Robinson and Tauscher, 2019). Table 3 illustrates the specific culprits responsible for those deaths, according to the authors.
Additionally, FA can lead to numerous other significant negative health outcomes. Outcomes of food addiction identified in studies include sluggishness and fatigue,
Table 4. Outcomes of food addiction.
Physical effects
• Heart disease
• Diabetes
• Digestive Problems
• Malnutrition
• Obesity
• Chronic fatigue
• Chronic pain
• Sleep disorders
• Reduced sex drive
• Headaches
• Lethargy
• Arthritis
• Stroke
• Kidney/Liver Disease • Osteoporosis Psychological effects
• Low self-esteem
• Depression
• Panic attacks
• Increased feelings of anxiety
• Feeling sad, hopeless, or in despair
• Increased irritability, especially if access to desired food is
restricted
• Emotional detachment or numbness
• Suicidal ideation
Social effects
• Decreased performance at work or school
• Isolation from loved ones
• Division within family units
• Lack of enjoyment in hobbies or activities once enjoyed • Avoidance of social events or functions
• Risk of jeopardizing finances or career https://www.eatingdisorderhope.com/information/food-
addiction
Table 3. Sources of death in the American diet. High sodium
Lack of nuts/seeds Processed meat
Lack of omega-3 vitamins Too few vegetables
Too few fruits Sugar-sweetened beverages
66,508 deaths 59,375 deaths 57,766 deaths 54,626 deaths 53,410 deaths 52,547 deaths 52,547 deaths
Source: Micha, R., Penalvo, J., Cudhea, F., Imamura, F., Rehm, C., & Mozaffarian, D. (2017). Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. Journal of the American Medical Association, 317(9), 912-924.
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declines in healthy functioning, efforts to avoid socializing with others, continuing to eat unhealthy food even after suf- fering from unhealthy outcomes, tolerance for foods in the form of not reducing negative emotions or increasing posi- tive emotions with the same amount of food over time, and withdrawal symptoms after stopping eating certain foods (Arumugam et al., 2015). Such outcomes are consistent with the idea that some foods are addictive, as these are similar outcomes in drug abuse. Table 4 illustrates other deleterious physical, psychological, and social outcomes.
Which foods may be addictive?
Now that the similarities between drug addiction and food addiction have been revealed, it is useful to identify the spe- cific types of foods that may be associated with the out- comes consistent with addiction. Part of the overlap between food and drugs is due to what is in the foods people consume. Westwater et al. (2016: 56) claim that FA “is similar to substance addiction” and that “certain ‘addictive agents’ within food produce neurochemical effects in the brain similar to drugs of abuse.”
According to Pursey et al. (2017: np): “Based on the current evidence base, highly processed, hyper-palatable foods with combinations of fat and sugar appear most likely to facilitate an addictive-like response. Total fat content and glycemic index also appear to be important factors in the addictive potential of foods.
The YFAS specifically lists sweet foods including ice cream, chocolate, doughnuts, cookies, cake, candy, carbohy- drates like white bread, rolls, pasta, crackers, chips, pretzels, French fries, and pizza, but also steak, hamburgers, cheese- burgers, bacon, apples, bananas, broccoli, lettuce, straw- berries, and even soda pop. And scholars suggest that: “Energy dense foods, including sugary drinks like beverages, cakes, biscuits, and various salt and savoury snacks are the foods that are the most typically associated with reports of food craving and food addiction” (Avaz et al., 2018: np).
Gearhardt et al. (2011a: 1208) agree, writing: “Foods, particularly hyperpalatable ones, demonstrate similarities with addictive drugs. This is likely due to the nature of the food itself. For example, Pursey et al. (2017) write: “Functional neuroimaging studies have … revealed that pleasant smelling, looking, and tasting food has reinforcing characteristics similar to drugs of abuse.”
Garber and Lustig (2011: 146) also agree that certain foods are more addictive than others: “Studies of food addic- tion have focused on highly palatable foods.” In some indi- viduals, palatable foods have palliative properties and can be viewed as a form of self-medication (Fortuna, 2012). According to Gordon et al. (2018: 477), “certain foods, par- ticularly processed foods with added sweeteners and fats, demonstrate the greatest addictive potential.” Other research supports this idea, finding that at least four out of the 11 DSM substance use disorder symptoms apply to highly palatable
foods (Meule and Gearhardt, 2014). Recall that, if true, this would make food addiction consistent with a “moderate” substance use disorder problem, although other studies noted earlier are more supportive of being a “severe” substance use disorder problem. Processed foods and foods high in carbo- hydrates are the ones most identified as being most likely to lead to addictive-like eating among survey respondents (Schulte et al., 2015).
Moss (2021: 19) points out that addictive foods include sweets, white bread and pasta starches, salty snacks, fatty foods, as well as sugary drinks. These foods do not even have to be consumed to impact the brain; merely thinking about them, talking about them, and smelling them will light up the brain in the same way other addictive drugs do (p. 25). Even cues related to foods, like images of foods and the logos of companies that sell them, impact the reward centers of the brain (p. 52). Part of why this is true is because thoughts trigger memories and emotions related to past food experiences (Herz, 2018: 117).
An interesting link between hyperpalatable foods and addiction is that these foods are literally designed to be eaten without thought, so it tends to be consumed mind- lessly while being engaged in other activities such as watch- ing TV, reading, texting, answering emails, and so on (Moss, 2021: 26). Different parts of the brain are activated when eating purposefully (e.g. the hippocampus) versus eating without purpose, or eating by rote (e.g. the striatum) (Moss, 2021: 63).
These foods include many fast foods. Fast food “has several other attributes that may increase its salience.” It is high in fat, salt, and sugar, as well as other additives that might lead to dependence. Additionally, “fast food advertisements, restaurants and menus all provide environ- mental cues that may trigger addictive overeating … these findings support the role of fast food as a potentially addict- ive substance that is most likely to create dependence in vulnerable populations (Garber and Lustig, 2011: 146).
The logic of why these foods are addictive is because they act on the same areas of the brain and in the same ways as addictive drugs. As noted by Hunt (2020: np): “Consuming ‘highly palatable’ foods, or foods that are high in carbohy- drates, fat, salt, sugar or artificial sweeteners, triggers the pleas- ure centers of the brain and releases ‘feel-good’ chemicals such as dopamine and serotonin. These foods affect the same area of the brain as drugs, alcohol and behaviors such as shopping or gambling,” as noted earlier.
So-called “palatable foods” also increase dopamine. For example: “High-glycemic-index carbohydrates elicit a rapid shift in blood glucose and insulin levels, akin to pharmoki- netics of addictive substances. Similar to drugs of abuse, glucose and insulin signal to the mesolimbic system to modify dopamine concentration” (Lennerz and Lennerz, 2018: 64). Highly palatable foods impact the “mesolimbic dopaminergic circuit, the primary component of the reward system” in the brain (Leigh and Morris, 2018: 31). This
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system “is involved in a large number of behaviors including reward processing and motivated behavior” (Lerma-Cabrera et al., 2016: np). These foods would include, for example, white breads, potatoes, rices, pastas, many cereals, and snack foods such as chips, pretzels, and crackers. Any drug of abuse tends to “increase the extracellular concentration of dopamine (DA) in the striatum and associated mesolimbic regions” (Lerma-Cabrera et al., 2016: np). Palatable foods also increase glucose levels which catalyze absorption of tryptophan, and this is converted into serotonin, which can elevate mood (Fortuna, 2012).
Sweet, fatty, and salty foods also activate the same che- micals in the “reward circuits” of the brain that are linked to addictive drugs and gambling behaviors. The so-called “hunger hormone”—ghrelin—is released by the stomach, increasing dopamine in the brain’s reward circuit with con- sumption of these foods, triggering the “feel good” effects we experience while and after eating these foods. Continued eating comes from a dependency on the good feelings people get from food (Jabr, 2016: np).
Overeating highly palatable foods “saturates the brain with so much dopamine that it eventually adapts by desen- sitizing itself, reducing the number of cellular receptors that recognize and respond to the neurochemical” (Jabr, 2016: np). This is the Reward Deficiency Syndrome noted earlier. In essence, the brain demands more sugar and fat to reach the same level of pleasure as was once experienced with smaller amounts of food, consistent with tolerance. Overeating thus becomes a way of “recapturing … or main- taining … well-being” (Jabr, 2016: np).
Normally, leptin and insulin—produced by caloric con- sumption—suppress the release of dopamine. According to Lerma-Cabrera et al. (2016: np): “Leptin infusion into the tegmental ventral area, a reward system brain area, decreases food intake and inhibits the activity of dopamine neurons.” Yet, as fatty tissue increases in the body, it does not respond to signals such as fullness and satisfaction; dopamine can override them, as well (Jabr, 2016: np).
Wiss and Brewerton (2020: np) write: “The mesolimbic dopaminergic circuit is clearly affected by both highly pal- atable foods and diet-induced obesity similar to exposure to drugs of abuse. Recent review articles have discussed highly processed foods (often high in glycemic index) as impacting neurohormonal and inflammatory signaling path- ways in ways that create a vicious cycle of impulsivity, compuslvity, FA, and [eating disorders].” Consumption of fats and sugars can increase dopamine in the brain, “produ- cing good mood effect” (Avaz et al., 2018: np). Overconsumption of these foods, especially repeatedly, conditions the brain to expect high levels of dopamine, and not getting that will “ultimately promote depressive or anxious responses when those foods are no longer avail- able or consumed” (Avaz et al., 2018: np; also see Rodin et al., 1991). Again, this is consistent with the Reward Deficiency Syndrome.
Interestingly, in the short-term, these foods are thought to relieve anxiety and temporarily lesson symptoms of depres- sion among people with FA, who tend to have higher inci- dence of anxiety and depression (Benzerouk et al., 2018; Burrows et al., 2017; Fonseca et al., 2020; Linardon, 2018; Nolan and Jenkins, 2019; Spettigue et al., 2019; Tomiyama et al., 2011; Wiss and Brewerton, 2020). Perhaps this is why they are known as “feel good foods” or “comfort food” (Wiss and Brewerton, 2020). Still, low quality diet is related to increased depression over the long-term (Gomez-Donoso et al., 2019). This suggests a feedback loop between food consumption and mental illness.
Lindgren, Gray et al. (2018: 811) concur with the idea that certain foods such as sugar are linked to food addiction: “Certain foods, especially those high in sugar and fat, act in a similar way to drugs, leading to compulsive food consump- tion and loss-of-control over food intake.” Lennerz and Lennerz (2018: 69) assert: “Sugar elicits addiction-like craving, compulsive food seeking, and withdrawal in rats and has therefore been used in substance abuse models for some time.” Sugar causes the “release of endogenous opioids in the [nucleus accumbens] and activates the dopamin- ergic reward system” (Lerma-Cabrera et al., 2016: np). It also increases the neurotransmitter acetylcholine, possibly explain- ing the sign of dependency of “increased intake of sugar after a period of abstinence” (Lerma-Cabrera et al., 2016: np).
Yet, at least one study concludes that sugar is not addict- ive. Westwater et al. (2016: 55) write: “We find little evi- dence to support sugar addiction in humans, and findings from the animal literature suggest addiction-like behaviors, such as bingeing, occur only in the context of intermittent access to sugar.”
Studies of salt show it can lead to cravings, physical dependence, and tolerance (Soto-Escageda et al., 2016). Soto-Escageda and colleagues (2016: 180) conclude that “salt is categorically an addictive substance just as psycho- tropic drugs, as they share cerebral pathways that perpetuate their excessive consumption.”
So, it may not be surprising to learn that people with high FA scores have significant brain responses to images of hyperpalatable foods similar to people with drug depend- ence who view images of drugs. These responses are found both in reward areas of the brain (i.e. striatum, anterior cin- gulate cortex, dorsolateral prefrontal cortex, and amygdala) and an area known to inhibit unhealthy behaviors (i.e. the prefrontal cortical regions and medial orbitofrontal cortex) (Gearhardt et al., 2011b; Fletcher and Kenny, 2018; Holsen et al., 2005; Killgore et al., 2013; Lee and Dixon, 2017; Scholtz et al., 2014).
Prevalence of food addiction
Studies vary on how prevalent FA is within the US, but average of studies is about 10–25% of the population (Leigh and Morris, 2018), with other scholars claiming
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20% of the population (Pursey et al., 2014). Rates of FA are found to be highest among binge eaters (more than 50%), followed by obese people (nearly 25%), and then other members of the general population (about 11%) (Gordon et al., 2018).
There is clearly a correlation between food addiction and binge eating, in particular (Leigh and Morris, 2018). Recall from earlier that some scholars thus question the need for the FA concept. Yet, it is logical that FA is separate and dis- tinct from binge eating, and is likely its source!
Studies also show that the likelihood of scoring high on the YFAS and thus showing symptoms of food addiction are related with ingestion of certain foods, including more calories, fat, saturated fat, and trans fats, carbohydrates, as well as sugars (Schulte et al., 2018). This is consistent with the argument of scholars that hyperpalatable foods are the most problematic.
What does it all mean?
While FA might not meet all the acceptable definitions of addiction that are used when considering drug addiction, there are clear parallels between drug addiction and FA. That is, some foods may be considered addictive in some very important ways, including that they produce changes in the brain (including in areas and ways related to drug addiction), produce cravings, lead to tolerance, lead to com- pulsive use in spite of harms and intentions to stop, lead to withdrawal under certain circumstances, and produce sig- nificant social problems that rival all illicit drugs combined.
Taken together, it is not unreasonable to conclude that some foods may be considered drugs and that their use may be considered drug use, misuse, and abuse. Table 5 revisits Table 1, with regard to which components of addic- tion are found with food. This review illustrates that most of the criteria for addiction are met when it comes to food,
Table 5. Degree of support for indices of food addiction.
Social problems: moderate for obesity and overeating (persistent or recurrent social or interpersonal problems caused by use; use interferes with work, school or home; failure to sustain obligations; social, work or leisure activities are given up or cut back)
Impaired control, compulsive use: high for obesity and overeating (cravings or strong urges to use; desire to or failed attempts to reduce use; using more than intended)
Risky use: low (use in risky or hazardous settings); high for obesity and overeating (continued use despite known problems; continued use despite knowing one has a persistent or recurrent physical or psychological problem caused or exacerbated by the substance)
Drug effects: high for hyper-palatable foods Brain disease: low, but high for brain changes Time usage: low
especially with regard to obesity and overeating (such as binge eating). Specifically, there is a high level of support for impaired control and compulsive use for obese indivi- duals and people who overeat, a moderate level of support for social problems caused by food and interference in life from food issues, and a high level of support for drug effects on the brain and tolerance and withdrawal, espe- cially for hyper-palatable foods. To repeat, this would make FA a “severe” substance use disorder problem, fol- lowing the logic of the DSM.
Given this reality, the comparative harms (including illness, death, medical costs and productivity losses) asso- ciated with licit & illicit drugs and food become increas- ingly relevant for academic disciplines such as criminology and related fields. This paper demonstrates that the foods we consume lead to incredible financial and physical harms that rival those associated with both licit and illicit drugs. It is therefore not unreasonable to assert that we ought to reprioritize what we believe to be danger- ous and worthy of the “criminal” label and to suggest that perhaps the “war on drugs” might be focused on at least some of the wrong things. That is to say, if the fundamental purpose of the criminal law is to protect us from harmful acts, particularly those committed against us by other people, one could at least argue that legislatures ought to reconsider what “drugs” are legal and which are illegal.
Of course, an obvious difference between food and drugs is that food is nourishing and thus has important value to humans in terms of functioning and surviving. So, no one will argue that food should be illegal. Yet, most of the hyperpalatable foods discussed in this paper are better described as “pseudo foods,” as they are often human creations and have little to no nutritional value what- soever. Moreover, studies from all over the world show that ultra-processed foods are inversely related to nutrition (Elizabeth et al., 2020; Monteiro et al., 2019).
Further, much of the foods that we eat are actually quite dangerous, especially in the long-term. Studies from across the globe show positive relationships between consumption of ultra-processed foods and deleterious outcomes includ- ing obesity, diabetes, hypertension, cancer, sickness, and death. There are clear relationships between ultra-processed foods, unhealthy diets, and poor health outcomes. For example, one review of 43 published studies found that 37 studies indicated intake of ultra-processed foods were associated with at least one poor health outcome (Elizabeth et al., 2020). These included being overweight, being obese, diabetes, heart disease, as well as all causes of mortality. Not a single study was found that demon- strated positive health outcomes associated with ultra- processed foods.
Ultra-processed foods tend to contain high amounts of sodium, sugar, fat, and saturated fat and generally do not contain whole grains, fruits, vegetables, or micro nutrients needed for good health. Ultra-processed foods are defined
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as “formulations of ingredients, mostly of exclusive indus- trial use, that result from a series of industrial processes … many requiring sophisticated equipment and technology” (Elizabeth et al., 2020: 2). Incredibly, studies find that more than 50% of energy intake in high-income countries like the US comes from ultra-processed foods, with up to four separate servings per day, so it’s no wonder we have epidemics of obesity, diabetes, heart disease, and cancer. Importantly, such studies remind us that ultra-processed foods are really not foods at all, but rather industrially pro- duced food stuffs that contain high amounts of chemical additives meant to increase palatability and shelf life. That these products are also likely addictive calls into further question their utility.
Monteiro et al. (2019: 3) echo these findings, noting: “Reports issued by [United Nations] agencies and other authoritative organisations…list a number of commonly con- sumed processed foods and drinks as certainly or probably implicated in obesity and various chronic non-communicable diseases.” Among the food products they discuss include fast foods, convenience foods, soft drinks and other sugary drinks, refined starchy foods, and processed meats, as well as a wide variety of snack foods that are “extracted from foods or derived from food constituents” (p. 5). Also included are candies, breads and buns, cookies, pastries, cakes, sweetened breakfast cereals, margarines, energy drinks, cheeses, pastas, pizzas, chicken and fish nuggets and sticks, sausages, hamburgers, hot dogs, instant soups, noodles, and more. Many of these ultra-processed foods are “never or rarely used in kitchens,” a sign that they are not actual food products (p. 10), and they are found to be inversely related in a person’s diet to the amount of protein, fiber, and many micronutrients including vitamins A, C, D, E, and more. These foodstuffs also comprise the list of potentially addictive foods studied in the FA literature.
If the purpose of the criminal law is to protect us from harms, government interventions into the conventional food system in the interest of public health are warranted. For example, Meule (2019: np) argues that, “if certain foods have an addictive potential, policy regulations may be implemented to limit advertising, increase the price of, or restrict access to such foods, similar to alcohol and tobacco regulations” (also see Pomeranz and Roberto, 2014).
At the same time, drug use is considered normal as it has been found through nearly all societies in human history, and it also serves adaptive functions for humans (e.g. enjoy- ment, relaxation, socialization, religion, etc.) (see, e.g. Crocq, 2007; Lyman, 2016). So, the differences between drugs and food are thus smaller than they have been made out to be.
Finally, like with any drug, licit or illicit, the foods we consume of our own “free will” are also provided to us by “dealers” (in the case of the foods we eat, this is typically very large multi-national corporations that are the dealers). Walker (2019: 243) concludes that “the modern food
system is designed to stimulate reward pathways in the brain, conditioning people to crave more.” If so, this makes actors in the food system culpable for our eating pro- blems. Moss (2013: 277) characterizes convenience stores as “the dealer of the fix” when it comes to foods high in sugar, salt, and fat.
Yet, as noted by Cohen (2014: 78): “The food industry is not putting a gun to our heads to make us eat too much. It doesn’t have to. It is simply taking advantage of our natural interest in food and our innate instincts to survive.” Simon (2006: 28) concludes the same thing, writing:” They’re not holding a gun to your head (but almost).” She notes that major food companies are responsible for making the least health foods the cheapest, and making them readily available and convenient. Simon says they are also culpable for heavily marketing these foods in every avenue available to them, using the most sophisticated means of advertising known to humans. Simon also alleges that major food com- panies “hijack the scientific process, suppress the truth about good nutrition” (p. 29).
As an example of such advertising behavior, Chandler (2019: 175) notes that “fast-food companies rely on intri- cate, genius gimmickry and wacky marketing, jingles and slogans, baseline appeals to id and comfort, a hucksterism both grand and unflinchingly American.” CEOs of major food corporations even admit to being in the business of temptation, and knowing that 60% of trips to fast food res- taurants are on impulse, they must be in that business in order to succeed.
The Physicians Committee for Responsible Medicine also reportedly found that food manufacturers “deliberately target consumers who are vulnerable to certain food addic- tions” (Simon, 2006: 283). And thus, while we should “know the effects of eating too much fat, sugar, and salt, we cannot be expected to know that certain combinations of these ingredients are addictive, as mounting evidence seems to indicate” (Kaplan, 2016: 265). Fuhrman (2017: 2, 35) also notes that highly processed foods are actually “designed to hook us” and that “Addiction to fast food is likely the most far-reaching and destructive influence on our population today” (p. 15). Luckily for food manufac- turers, the foods they design to be addictive are the same ones we already want, so we have mass addiction that is legal (Fuhrman, 2017: 21).
All of this raises the issue of state-corporate criminality, harmful acts committed by corporations with the assistance and/or enabling of governments (Kramer, 1994; Kramer and Michalowski, 1991; Kramer et al., 2002; Ross, 2017; White, 2014). Scholars have begun to research “food crimes” in the context of state and corporate culpability (Robinson, 2017).
Incredibly, “Big Food” aims to reach as many people as possible with its unhealthy products even as those very pro- ducts will kill off their own consumers (Leon and Ken, 2019), but not before hooking them like addicts. In the
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past fifty years, there has been a dramatic change in the food environment, with a fundamental shift away from healthy foods towards unhealthy and ultra-processed foods that strip all nutrient value away. This change has led to deadly foodstuffs not really worthy of even being labeled foods. As noted by Avaz et al. (2018: np): “The food envir- onment has changed dramatically with the incursion of hyper-palatable foods that are produced to exceed the rewarding properties of traditional foods (e.g. vegetables, fruits, nuts) by increasing fat, sugar, salt, flavours and food additives to high levels.” We are eating food we do not need and that is dangerous for us. It is predominantly large corporations who produce the food we eat, making the decisions of what to produce and to add to the foods we consume. The results of the review in this paper suggest FA is another likely outcome.
Food addiction and harmful outcomes resulting from it are partially due to the production and sale of addictive foods to consumers by those corporations, enabled by state, national, and international organizations including governments. Leigh and Morris (2018: 31) note that it is “the ready availability of highly palatable foods … increases the incidence of hedonic, non-homeostatic feeding.” That is, part of why there is so much hedonic eating of unhealthy and addictive foods is because they are available everywhere, heavily advertised, and highly affordable relative to healthier alternatives.
This raises the issue of culpability in the companies who produce these foods, as well as in the government agencies that enable it and allow it. Wiss and Brewerton (2020: 2937) argue: “Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity.” Humans have an evolu- tionary need for calorie-dense foods, so cravings for them can be seen as normal. Yet, this drive for certain foods is not healthy in contemporary society when calories are avail- able everywhere and there is no need to hunt or fight in order to eat. The bulk of evidence shows that mere will power is not enough to stop the overeating that leads to obesity and that change in the food environment is needed (Jabr, 2016: np). The highly palatable processed foods that are so highly sought after in contemporary society highly impact the brain and provide nutrients that do not occur naturally. These foods tend to be more addictive when they are blended to combine substances such as carbohydrates and fat, which are directly under the control of the corporations who manufacture our food (Fletcher and Kenny, 2018). Lerma-Cabrera et al. (2016: np) concur, writing: “Manufacturing industries have designed processed foods by adding sugar, salt, or fat, which can maximize the reinfor- cing properties of traditional foods (fruits, vegetables). The high palatability (hedonic value) that this kind of processed food offers, prompts subjects to eat more.” This suggests overeating is an expected outcome of the types of food being used to target consumers by food companies.
According to White (2014: 835), there are also extensive government and corporate security mechanisms that have grown to protect “a platform of state, corporate, organized group wrongdoing and injustice.” Leon and Ken (2019: 25) point out that the “pervasive and increasingly legitimized activity of Big Food relies on a legal, regulatory, and moral framework that allows for the relegation of all non-market oriented value systems to be secondary to a pro-corporatist ideological and moral superstructure.” All of these behaviors are confined in the context of “cheap capitalism,” which is “characterized by degraded business morality, low prices and/or unsafe goods or services, and low-waged labour to maximize profits” (Asomah and Cheng, 2018: 194). In the context of food, the goal of large corporations is to produce foods that sell, and natural as well as artificial flavors (sugars, salts, fats) help them achieve wealth in spite of the costs, which include FA and the harmful out- comes associated with it. Government agencies that enable, empower, and allow the production of harmful foods with no or little nutritional information are responsible for state- facilitated harms resulting from the ubiquitous presence of dangerous foods (Kauzlarich et al., 2003).
All of these behaviors are meant to be studied by the new “Food Criminology” (Robinson, 2017). Food Criminology has a “social harm” focus, thereby not being constrained by the criminal law, which typically benefits the powerful people who write and fund it through political campaigns (Robinson, 2015). This focus encourages social scientists to focus on acts (and failures to act) in the food industry that are “threatening to public health and safety, or has negative consequences on either human or non-human victims, including environmental harms,” whether legal or illegal (Gray and Hinch, 2018: 16) because they are “awful” even as they are “lawful” (Passas, 2005). These outcomes, which include FA, can be traced back to the cor- porations and government agencies that produce and assist in the production of the foods we consume.
Surely, these realities are thus worthy of focus by crim- inologists who study culpable harmful acts, both illegal and legal. To the degree we study these realities, we are likely to promote the ideas that:
1. The things we define as crimes in American society are not actually the most harmful acts committed with culp- ability, and
2. The war on drugs does not target the substances that cause the most harm in society.
These are important lessons.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
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