The Link Between Food Addiction and Body Image
Do you often find yourself eating way past the point of fullness? Do you continue to overeat despite negative health consequences? Do you use food to numb painful emotions? Have you tried diet after diet, unsuccessfully attempting to control what you eat?
If you answered “yes” to any of these questions, you may be wondering whether you are addicted to food.
You are not alone.
In a 2017 study of 658 university students and 614 adults, 52 percent of students and 40.6 percent of adults perceived themselves as addicted to food. Although food addiction is not a formal diagnosis listed in the DSM-V, standardized measures, such as the Yale Food Addiction Scale (YFAS), have been developed to assess it (Penzenstadler et al., 2019).
As with other addictions, the YFAS defines food addiction as a loss of control, inability to quit despite repeated attempts to do so, increased tolerance, withdrawal symptoms when cutting down calorically dense foods, and significant distress and impairment. The YFAS criteria for food addiction are more stringent and, therefore, less common than self-perceived food addiction.
What Does Food Addiction Mean to You?
If after reading the above, you are inclined to call yourself a food addict, let's try the label on and see how it suits you. Say the phrase aloud “I am addicted to food” and notice how you feel. Do you feel understood and validated, like your challenges now have a name? Or do you feel judged, broken, and out of control? Do you feel empowered to seek out support? Or do you feel helpless? Do you feel compassion towards your body and what it has been through? Or do you feel critical of your weight and a desire to restrict and control what you eat?
Beyond its diagnostic implications, the term “food addiction” can carry a strong emotional charge. This is because in our thin-obsessed, weight-stigmatizing society, food is about so much more than health, sustenance, and even enjoyment. It is about social standing, appearances, relationship desirability, and self-acceptance. If you have been teased as a child, advised to lose weight by a pediatrician, or told to avoid the foods that other kids were allowed to enjoy, the term “food addiction”, though resonant for many, can harp on a lifetime of complicated and very painful messages about food.
For this reason, food addiction is highly controversial among therapists and within the scientific community, so much so that it was the topic of heated debate at two of the largest eating disorder professional conferences (Hudnall, 2013).
To better understand whether food addiction is a helpful construct for you, let's take a deeper look at this model and its opposing counterpart, the food neutrality model.
The food addiction model highlights strong parallels between the intense cravings, loss of control, and reward sensitivity present in substance use and those associated with binge eating. Both substances and food can be used to numb pain and cope with challenging emotions. Both can become overwhelming preoccupations. Both can have negative effects on health and quality of life. Both can form habits that are difficult to break. Neurologically, similar parts of the brain are activated in the presence of palatable foods as are with substances (Adams et al., 2019; Fletcher & Kenny, 2018). Loss of control around food can feel a lot like other addictions.
Furthermore, although there is a strong overlap between food addiction and binge eating disorder (BED), the two are not one and the same. Fifty percent of individuals with BED do not meet the criteria for food addiction (Davis et al., 2011), indicating that the latter requires an intervention distinct from traditional eating disorder treatment and perhaps more aligned with addiction recovery processes.
The food neutrality model, in contrast, emphasizes the damaging impact of societal weight stigma and the ways in which pathologizing pleasurable food contributes to it (Cassin et al., 2019). Research demonstrates that restrictive dieting not only fails to facilitate long-term weight loss, but also contributes to disordered eating (Neumark-Sztainer et al., 2007). Self-perceived food addiction is associated with negative body image and harmful eating behaviors regardless of a person’s actual weight (Meadows et al., 2017).
Labeling calorically dense or highly processed foods “addictive” can contribute to the many ways in which food and weight are stigmatized in our society. Furthermore, it ignores the key role that food restriction often plays in compulsive overeating and might instead exacerbate judgments around food. Food neutrality is often associated with body positivity and Health at Every Size, both of which focus on decreasing weight stigma and embracing all body types.
Which Approach is Right for You?
Whether you believe in food addiction or food neutrality, if your eating habits feel harmful and out of control, you likely want to do something about it. The question is “What?”
The answer depends on which treatment model you follow.
Generally speaking, the food addiction model tends to encourage abstinence from the addictive substance, in this case, trigger foods (generally those with a high fat and refined sugar content) (Adams et al., 2019). The food neutrality model, in contrast, emphasizes body attunement and letting go of “good food” and “bad food” judgments (Hudnall, 2013).
Overeaters Anonymous (OA) is an example of abstinence-based recovery. In many OA programs, you would be encouraged to follow a prescribed meal plan eliminating your trigger foods (ie., the foods that frequently cause you to binge). A parallel might be drawn between the alcoholic’s requirement for complete abstinence from alcohol and your need for consistent meal plan adherence. OA meetings can also help you fill the emotional/spiritual void you may have been using food to numb while connecting you with a community that helps support your recovery.
Intuitive Eating (IE) represents the food neutrality model. When practicing IE, you would learn to tune in to your hunger and satiety signals and adopt a non-judgmental attitude towards food and body weight. You would also be encouraged to reject intentional weight loss diets and moral judgments around food, instead giving yourself permission to find pleasure and joy in food (Tribole & Resch, 2003). Paradoxically, a neutral, non-restrictive attitude towards food can actually decrease urges to overeat by removing the appeal of “forbidden foods” and allowing you to eat all foods in a balanced way.
There is another important psychological principle worth noting regardless of which model you follow. Bear with me through a bit of jargon which we will then ground using a tangible example.
Classical conditioning refers to the process that occurs when a trigger (such as high fat/refined sugar content foods) is repeatedly linked to a particular response (binge eating/ compulsive overeating), causing the brain to learn that the trigger necessitates the response. The only way to change this association is by repeatedly encountering the trigger without engaging in the response. We call this process exposure response prevention.
For example, let’s say your brain has learned that each time you eat one cookie you wind up eating the entire box. Now, whenever you eat a cookie, you have strong urges to binge. This association cannot be changed if you avoid eating cookies altogether. This means, so long as you follow an abstinence-based approach, the association between trigger foods and binge eating will remain intact, making moderate consumption of trigger foods impossible.
To change the cookie=binge association, you would need to eat a cookie while preventing a binge over and over again until your brain learns that cookie does not equal binge.
My Personal Experience with Food Addiction
My perspective on food addiction is influenced by three encounters with the term:
The first was while I sat in my dorm room feeling helpless and sick after one of many uncontrollable food binges. At that time, I did not need any academic articles to jump to the natural conclusion that I was addicted to food. My own recovery was in large part abstinence based. The clarity of articulating what, when, and how much I ate made it much easier to recognize and resist urges to binge. As my recovery progressed and my appetite regulated, I began to decrease the structure and food rules. I now eat completely intuitively and have zero eating disorder symptoms.
The second time was when, on an online group for eating disorder professionals, a therapist posted asking about resources for a client with food addiction. The average post in that group received between zero and ten comments. On that post, the comments rapidly climbed upward of one hundred as one member after the next accused the OP of fat phobia, questioned her validity as a treatment provider, and informed her of the reasons that food must never be demonized. Presumably feeling attacked, the OP deleted the thread and left the group.
The third was during orientation for a clinical internship at an agency that treats eating disorders and addictions side by side on the premise that beneath the behaviors, they share underlying patterns. In the PowerPoint presentation, slides about food addiction were juxtaposed with those explaining the Health at Every Size model. Food can be an addiction AND we will never recommend that clients go on a weight loss diet. Perhaps the body positivity and food addiction models are not mutually exclusive.
Reconciling Food Addiction and Body Positivity
Although food addiction and food neutrality are often presented as contradictory viewpoints, each model contributes important insights into different components of recovery, which, when properly understood, can coexist.
Let’s sum up the contributions and pitfalls of each:
On the side of food addiction, the reality is that as with addictive substances, food is often used to cope with pain (Masheb et al., 2020). Thus, distress tolerance, emotional processing, and spiritual connection can help facilitate recovery. Additionally, for many people, intuitive eating is not immediately accessible. A structured meal plan can regulate appetite and reduce binge urges. It is often easier to eliminate a food group entirely than it is to eat it in moderation.
However, if your recovery is entirely abstinence-based, you will never be able to enjoy your trigger foods in moderation.
On the side of food neutrality, the negative effects of diet culture and weight stigma are impossible to ignore. The high overlap between food addiction and binge eating disorder shows the critical importance of emphasizing body positivity over food restriction.
Most importantly, removing the judgment from food can allow you to enjoy food rather than fearing it, and trust your body instead of trying to control and suppress it. However, although body positivity is important at all stages of recovery, intuitive eating may be impossible when you are first beginning. How can you follow hunger and satiety signals when you are overwhelmed by emotions and urges?
In order to find peace and balance around food, a combination of the two approaches is needed.
We can see this as a three-step process:
First, when you are still actively struggling with binge eating or compulsive overeating, use a clear, balanced meal plan to guide what and when you eat. Consulting with an eating-disorder-trained dietician can help you create a meal plan that meets your body’s needs. At the same time, begin to process the discomfort and emotional experiences that fuel urges. Attending therapy can help. This is the abstinence phase of recovery.
Second, once hunger and satiety cues begin to regulate and you have less frequent or intense urges, use gradual exposure to trigger foods to modify the trigger food/binge association. If you have been avoiding foods for a long time, this can be scary. Once again, consult a therapist and find the support you need to tolerate and process the initial discomfort. With time and repeated practice, your brain will learn that “trigger foods” are safe and no longer cause you to binge. This will also lessen the likelihood of relapse and make intuitive eating possible. This is the exposure phase of recovery.
Thirdly, once your appetite is fairly regular, trigger foods have lost their power, and you are able to process painful emotions without using food to numb, you can begin to decrease structured meal planning and instead follow your body's natural signals.
Cultivating body positivity will allow you to enjoy food again. Tuning into your body, rather than ignoring or controlling it, will help you find real and lasting peace around food. This is the intuitive eating phase of recovery.
Choose the Best Support for You
Ultimately, the meaning we attach to words is the product of very personal and subjective experiences. If the term “food addiction” helps you feel validated and hopeful, use it. If it conjures up shame and stigma, discard it. Either way, when seeking out treatment, consider asking yourself the following questions:
Is my compulsive overeating preceded or followed by food restriction?
To what extent do shame and weight stigma influence my relationship with food?
Do I use food to cope with pain or fill an emotional/spiritual void?
What stage am I at in my recovery and how much structure do I currently need in order to find balance?
How do I envision a healthy relationship with food, and what would help me get there?
It is more important to understand the processes that underlie your distress than it is to use the appropriate label. Reflecting on the above questions will help you identify the type of support you need, whether with body image, emotional processing, distress tolerance, or balanced eating.
It’s OK to ask for help.
If you’re interested in learning more about psychotherapy for yourself or a family member, please contact us through this online form or call us at 847-729-3034. We’ll be happy to answer any questions you might have.