Are You a Food Addict?

(This excellent article on food addiction was written by Kevin Helliker and was originally published in the Wall Street Journal.)

A new study suggests that people who struggle to say no to chocolate, french fries or other junk food suffer from something more insidious than lack of willpower: They may actually have an addiction.

Using a high-tech scan to observe the brains of pathological eaters versus normal eaters, the study found that showing a milkshake to the abnormal group was akin to dangling a cold beer in front of an alcoholic.

Previous studies have shown that food photographs can activate the brain’s reward centers in much the way that booze imagery does for alcoholics. This study from Yale University researchers purports to be the first to distinguish so-called food addicts from overeaters.

Beyond a Craving

Study subjects who scored high on the Yale Food Addiction Scale had addict-like neural responses to food during an MRI. Before the MRI, they answered questions including this one, with 26 foods to choose from.

Please circle ALL of the following foods you have problems with:

Before subjecting 39 women to magnetic resonance imaging scans, researchers asked them to complete the 26-question Yale Food Addiction Scale, a two-year-old test designed to identify pathological eaters. Fifteen of the women scored high on the test for addictive-like eating behaviors. When placed inside an MRI machine, those 15 women had dramatically greater neurological responses to the image of a milkshake than the others, according to the study, published online this week in the Archives of General Psychiatry.

Just as most people who abuse alcohol or smoke marijuana aren’t addicts, this study suggests that no single explanation or solution exists for overeating. In cases where the underlying problem is addiction, psychiatrists say that neither gastric-bypass surgery nor lifestyle changes are likely to prove effective. Among addicted eaters, “the current emphasis on personal responsibility…may have minimal effectiveness,” concluded the paper.

Ashley N. Gearhardt, lead author of the study, said that those who score high on the food-addiction scale report needing to consume greater and greater quantities of food to achieve the same earlier emotional effect. For some, thinking about anything other than food becomes difficult, she said.

“Some of them actually stop socializing because it gets in the way of their eating,” said Ms. Gearhardt, who is a doctoral student in clinical psychology at Yale University who was involved in devising the food-addiction scale.

The study suggests that food addicts could benefit from a checklist akin to those that exist for measuring alcoholism and drug addiction.

“It’s the first study to ask whether a paper-and-pencil checklist for food addiction correlates with brain regions known for drug reinforcement,” said Mark Gold, University of Florida chairman of psychiatry and a prominent addiction researcher who wasn’t involved in the study.

Dr. Gold said such a checklist could be valuable for individuals considering gastric bypass.

The publishing of the study comes at a time when American psychiatry is wrestling with whether to regard pathological eating as an addiction akin to alcoholism.

Skeptics note that the brain’s reward centers are designed to light up at the promise of food, because food is necessary for survival. Those centers also brighten in some cases at the thought of whiskey or cocaine, they said. Moreover, skeptics note that food addiction less commonly results in the consequences that characterize drug addiction—stealing, negligent parenting and deteriorating workplace performance.

“The skeptic’s position is that drugs are uniquely powerful reinforcers that hijack the brain’s reward center,” says Michael M. Miller, a Wisconsin psychiatrist and board member of the American Society of Addiction Medicine.

Calling himself “middle-of-the-road” on the issue of food addiction, Dr. Miller said ASAM will vote this month on a policy change that would embrace food addiction—among other compulsions—as a genuine addiction.