The concept of food addiction has never sat particularly well with me, even more so after coming to the realization that we can risk damaging ourselves by calling our overeating an addiction.
Through looking at the definition of addiction and comparing the treatment for overeating with the treatment for over-consumption of alcohol, I want to explore how labeling struggles with food as an addiction can actually hinder our ability to heal. There are also considerations which I believe separate food from being an addiction.
When it comes to addiction, I naturally want to put on my medical hat and so thinking back to being in medical school, we were taught that addiction is defined as requiring four elements: 1) compulsion, 2) negative consequences, 3) symptoms, and 4) development of a tolerance to the object of addiction.
It’s important to understand how each one of these requirements plays into addiction, whether it’s alcohol, gambling, shopping, social media, drugs, or anything else we latch onto to numb uncomfortable emotions.
This is the pull you feel towards doing the impulsive action and you feel you don’t have much control over this.
For example, this could be the negative consequences for your relationships, your ability to perform at work, or the health consequences of overeating or overdrinking.
What happens when you take away the substance or the behavior? This is easier to see with the withdrawal symptoms that show up when an addict stops taking substances like drugs and alcohol. In terms of food or behavior addictions rather than substances, you can look at emotional consequences like anxiety and agitation when not engaging in the behavior.
An example of this would be the amazing high you might feel after the first time you take a drug, but the more you take, the more drugs you will need over time to feel that same effect.
It’s fairly easy to see how these four elements apply to drug and alcohol addictions, but these are present with behavioral addictions too.
When we look at overeating, people do experience the compulsion to binge, the negative consequences of obesity or other weight-related health issues, and may feel a sense of anxiety if they’re not able to have the food they are craving.
What causes addiction?
When it comes to exploring why we get addicted to certain things, we can first look to the reward systems in the brain and the dopamine system that act to keep you in the cycle of consuming your substance. When we look at what happens in the brain’s reward systems, all of that is very much the same across the board. But then the question is what starts the addiction in the first place? We also find commonalities here too.
A podcast guest once told me that “addiction is the absence of connection to yourself” and while people talk about addiction in different ways, when it comes to the cause of it, you often hear two reasons that drive us to addictive behaviors.
One thing that drives us to addictive behavior is an attempt to regulate a dysregulated nervous system. When we are talking about a dysregulated nervous system, we are talking about being stuck in a fight, flight or freeze response. This conversation is often happening in circles discussing traumas from childhood that we bring forth into adulthood, and don’t have another way to heal. The drugs, alcohol, food, or whatever substance or behavior it is, is meant to bring our nervous system back into the present moment to feel safe.
I definitely see this at play with women who overeat and for me personally, I have come to understand that the root of my overeating is a negative self worth and feeling that I have to overachieve to get the rewards and accolades and external validation to feel worthy. This leads to anxiety and overwhelm which causes me to overeat.
The second cause that drives us to engage in addictive behaviors initially is the desire to escape from uncomfortable emotions. We grow up as children without the good modeling of how to express and live through our emotions and so when we grow into adults and have really big emotions that are uncomfortable, we don’t know what to do with it. That often means we turn to these behaviors or substances to numb ourselves out or to self soothe. For me, it’s food, or sometimes online shopping. For others it’s having a drink or scrolling on social media. Most of us have some way that we choose to self soothe.
We have established the similarities that drive us to addictive behaviors, whether it’s an attempt to regulate our nervous system, or to self soothe from uncomfortable emotions, but should these addictions be managed in the same way?
The key difference is that we can not escape from food. When people talk about healing alcohol addiction, they might refer to 12 step programmes and complete abstinence. But we can’t do that if we’re addicted to food because we need fuel for our body.
So if we go back to the idea that the food addiction started from either attempting to regulate our nervous system or to self soothe a negative emotion, we have to bring a level of awareness into our eating. We have to understand when we are eating because we’re physically hungry and when we’re eating to calm ourselves down. However, because the behavior itself is so compulsive, it’s not always so easy to differentiate. If you do have a tendency to overeat, there’s a good chance that you’ve lost that ability to actually tell if you’re physically hungry versus if you’re emotionally hungry. At some point, those things just start to feel the same.
Therefore, the treatment is not necessarily abstinence. There is a huge ‘no sugar, no flour’ following in the weight loss world at the moment which I do take issue with. If you are over consuming sugar and flour to self soothe or to regulate your nervous system, you will not solve the problem by cutting them out. You will simply turn to something else to fill the gap. And so turning to weight loss programs is a broken strategy because you're not targeting the right thing.
This is why I have a little bit of discomfort talking about food addiction and sugar addiction because I think it puts you into a brain space where you’re not primed to actually heal the addiction. You’re just putting a bandaid on the symptoms, you're just temporizing things, and you're not healing the wounds underneath.
Traditional 12-Step Programs versus Therapy
There is a 12-step program called Overeaters Anonymous that will treat people with binge eating disorder and people who self identify with being overeaters. Whereas if you look at binge eating disorder as a subset of people who overeat, there is actually a very high cure rate with therapy. CBT (cognitive behavioral therapy) is the specific type of therapy shown to be effective. I want to compare the traditional 12 step program to treat addiction versus what happens in CBT to describe where the problem lies for me.
- One thing that always comes up inside 12-step programs is that addiction is an illness you have forever and there is no cure. However, we know that recovery is well within the reach of most people. My concern is if you’re taking on that mentality that you can’t be cured, it doesn’t set you up in the right frame of mind to heal from overeating, which absolutely can be done and I see it all the time with my clients.
- Recovery using the 12-step programs is often based on immediate abstinence. So you would stop binge eating as soon as possible, attend group meetings and have sponsors to help you never binge eat again. To me, this is not a great idea because we have to eat anyway. What happens when we tell ourselves that we can’t? It’s neither reasonable nor realistic to never eat. For many, the difficulty lies in distinguishing whether you’re eating for physical or emotional reasons, and so that makes abstaining from binge eating difficult in itself.
- In this program, the abstinence is not just from binging but also from problematic food groups. However, the CBT approach takes the stance that restrictions and the diet brain do not go well together. The problem is that most people who have binge eating disorder or who overeat also have a weight problem. We know that restricting food groups when dieting changes the chemistry in your brain and becomes problematic for us. The CBT approach is that food avoidance should not be encouraged and instead, we bring in other ways to relate to those food groups in a way that is healthier.
- The 12-step approach essentially says that you’re either in control or you’re out of control. You’re either abstinent from food groups or not. It’s a very black and white, ‘all or nothing’ way of thinking, which can be very dangerous when combined with a diet mentality. An ‘all or nothing’, perfectionistic way of thinking could even be a cause for the binge eating, stemming from a lack of self worth. Therefore the last thing we want to do is put binge eaters in a program that will perpetuate that type of thinking.
The main reason I feel so unsettled about calling the compulsion to overeat or the need to use food to self soothe an addiction is because it sends us down the wrong path in terms of getting treatment. The way that we heal overeating in an effective way that we know is sustainable over the long term is completely at odds with the way that we successfully treat an addiction for substances like alcohol.
Everybody has to find a way to heal their relationship with food in a way that makes sense to them. For some, it might be helpful to label it as a food addiction, but for others the shame that our society often attaches to the word ‘addiction’ may not be helpful for their healing journey.