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Scientific interest in "food addiction" continues to grow due both to neurobiological and behavioral similarities between substance dependence and excessive food consumption. An important next step is to examine the addictive potential of highly processed foods. In this paper, we explore addiction-related changes in the modern food environment (e.g., increased potency, elevated speed of absorption), examine the historical and modern understanding of addictive substances as applied to hyperpalatable foods, and outline shared factors that increase the public health costs of both addictive drugs and certain foods.
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140 Current Drug Abuse Reviews, 2011, 4, 140-145
1874-4737/11 $58.00+.00 © 2011 Bentham Science Publishers
The Addiction Potential of Hyperpalatable Foods
Ashley N. Gearhardt*,1, Caroline Davis2, Rachel Kuschner1 and Kelly D. Brownell1
1Yale University, New Haven, CT, USA
2York University, Toronto, Canada
Abstract: Scientific interest in “food addiction” continues to grow due both to neurobiological and behavioral similarities
between substance dependence and excessive food consumption. An important next step is to examine the addictive
potential of highly processed foods. In this paper, we explore addiction-related changes in the modern food environment
(e.g., increased potency, elevated speed of absorption), examine the historical and modern understanding of addictive
substances as applied to hyperpalatable foods, and outline shared factors th at increase th e public health costs of both
addictive drugs and certain foods.
Keywords: Food addiction, food environment, high fructose corn syrup, obesity, substance dependence, withdrawal.
Although the concept of food and addiction is receiving
widespread attention from the popular media, and is woven
into popular language and culture as seen with terms such as
“chocoholic” and “carbohydrate craving”, it has become
credible in the scientific community only recently [1-4].
Since 2006 there has been an exponential increase in the
number of academic publications relating to this topic (Fig.
1), due in part to a shift in persp ective to the view that
addictions should be reframed as unusually strong and
maladaptive desires to ingest a substance or engage in a
behavior despite negative consequences [5, 6].
Fig. (1). Number of publications containing the words “food
addiction” obtained from the Web of Science database, and plotted
for the years 2000-2010.
The term ‘food addiction’ might be seen as an oxymoron
since eating is quintessentially necessary for our health and
survival. We argue the opposite - that many of the highly-
processed foods in modern diets that damage health are more
similar to drugs of abuse than to the natural energy resources
people consumed historically (Table 1). Humans evolved to
prefer foods high in fat, sugar, and salt, but in the quantities
*Address correspondence to this author at the Yale University Department
of Psychology, 2 Hillhouse Ave., New Haven, Connecticut 06511, USA;
Tel: 415-265-9484; Fax: 203-432-7172; E-mail:
and availability these ingred ients now occur in processed and
refined foods, they appear to have an abuse potential similar
to addictive drugs like cocaine and alcohol [7-9].
A growing body of research has identified many
similarities between conventional addiction disorders and
excessive consumption of calorie-dense foods. Presently
many of the studies on the additive potential of certain foods
are based on examinations of rats exposed to sugar, fat, or
highly processed foods [3, 10]. The eating behavior of rats
may provide an especially useful analogue for human food
consumption, as both rats and humans are omnivores who
have developed the ability to ingest a diverse array of foods
[11]. For both rats and humans the dopamine and opioid
neural circuitry implicated in drug addiction is also
associated with the motivation for food and food-related
reward [12, 13]. It has also been demonstrated that rats given
sugar, fat, or highly processed foods exhibit reward-related
neural changes seen in drug addiction, as well as the
behavioral signs of withdrawal, tolerance, and continued use
despite negative consequences [3, 10]. Scientific evidence of
the parallels between substance use and food consumption in
humans is also building. For example, drug and food
cravings foster similar patterns of neural activation in the
brain’s mesocorticolimbic pathways [14]. Further, genetic
(i.e., DRD2 Taq1A allele) and personality factors (i.e.,
elevated reward responsivity) linked with addiction have
also been implicated in obesity and binge eating disorder
[15]. Moreover, individuals who endorse symptoms of food
addiction as indicated by the Yale Food Addiction Scale are
more likely to exhibit patterns of craving-related neural
activation in response to food cues and disinhibition-related
neural activation during palatable food consumption [16].
Examining how hyperpalatable substances have addictive
properties is an important next step in evaluating the validity
of the food and addiction construct. This may be especially
true for understanding the utilityof an addiction perspective
in preventing and treating diet-related disease and obesity. In
this paper, we will explore addiction-related changes in the
modern food environment, examine the historical and
modern understanding of addictive substances, and outline
shared factors that increase the public health costs of both
addictive drugs and certain foods.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Yea r
The Addiction Potential of Hyperpalatable Foods Current Drug Abuse Reviews, 2011, Vol. 4, No. 3 141
Table 1. Similarities Between Hyperpalatable Foods and
Addictive Drugs
1. Activate dopamine and opioid neural circuitry
2. Trigger artificially elevated levels of reward
3. Absorbed rapidly into the blood stream
4. Alter neurobiological systems
5. Cause compensatory mechanisms that result in tolerance
6. Combined with additives to enhance rewarding properties
7. Elicit cue-triggered cravings
8. Consumed in spite of negative consequences
9. Consumed in spite of a desire to cut down
10. Impact disadvantaged groups to a disproportionate degree
11. Cause high public health costs
12. Exposure in utero can result in long-term alterations
Prior to examining the addictive potential of food, it is
useful to consider what constitutes a food. A wide-variety of
substances is consumed for sustenance, as well as pleasure,
and definitions of what is considered a food varies based on
cultural definitions. For example, insects are a staple of diets
in some regions (e.g., China) [17], but they are not
commonly eaten in the Western world. Further, the
increasing prevalence of chemicals, flavor enhancers and
lab-developed compounds in the food supply has led to the
question of whether ultraprocessed foods should no longer
be called food and should instead be relabeled as food-like
products [18]. To add another layer of complexity, alcohol
(which is typically considered an addictive substance) is a
natural product of ripe fruits, may be a standard part of a
hunter-gather diet, and provides calories and some nutrients
in a similar manner as substances classified as food [19].
Although no one definition is able to succinctly capture the
complexity of this topic, in the current review we use the
term food to reference caloric items that are consumed as
part of the Western diet (i.e., might be purchased at a grocery
store) with special attention given to macronutrients that are
frequently manipulated during food processing, like fat and
sugar. Although alcohol may fall under this definition, in the
current paper we include ethanol-containing products in the
category of substances traditionally considered addictive.
The food environment has changed drastically, which has
resulted in foods with increasingly addictive-like properties.
In the pre-industrial era humans survived on a diet that was
minimally processed, high in protein, grains, and produce,
and relatively low in salt [20]. Foods that had greater caloric
value through elevated sugar and fat content, such as berries
and animal protein, were relatively scarce. As an adaptation
to motivate consumption of calorically dense foods, we
evolved to find foods high in sugar and fat more hedonically
rewarding than foods low in these substrates [20]. As
industrialization occurred and food-related technology
evolved, the environment changed from one with limited
access to calorie-dense foods to one of abundance with
artificially elevated levels of fat, sugar, salt, caffeine and
flavor enh ancers in the meals we eat [21].
Many highly processed foods have been altered in a
similar manner as addictive drugs. Both the elevated potency
of a substance, and its rapid absorption into the bloodstream,
increase a substance’s addictive potential [22]. Many drugs
of abuse derive from plant materials that are refined into
highly concentrated substances (e.g., grapes into wine; the
coca leaf into cocaine). As a result of processing, these
substances became more potent and the active ingredients is
more quickly absorbed into the bloodstream. For example,
when the coca leaf is chewed or stewed as tea, it produces
only mild stimulation and is thought to have little addictive
potential [23]. Further refinement provides a more potent
drug in the form of cocaine and crack, which is hedonically
very rewarding, quickly absorbed, and highly addictive [24].
Many highly palatable foods follow a similar process that
results in the quicker absorption of sugar and a higher level
of reward. For example, corn is a frequently consumed
starchy vegetable that has been part of the human diet for
centuries. With technological advances, corn was refined
into high fructose corn syrup (HFCS) – a highly
concentrated and very sweet simple carbohydrate, which is
not found in natural foods that comprise most traditional
diets [25].
In the past 40 years or so, HFCS has been added to a
large variety of processed products, such as soft drinks,
baked goods, and cereals. Indeed, our consumption of this
simple sugar has increased exponentially – from about 4 to
12% of our daily caloric intake in a few generations [26]. In
this capacity, the special physiological properties of fructose
render it similar to other drugs of abuse. The most direct
parallels are seen between fructose and alcohol because the
two are biochemically and evolutionarily congruent. Ethanol
is simply the fermented byproduct of fructose [27] and can
have some health benefits when consumed in small doses.
For example, not only is ethanol an energy resource due to
its caloric content, but it may also serve as a stimulant to
further feeding. Given that ethanol is associated with the
valuable nutrients found in ripe fruit, Dudley [19] suggested
that a short-term advantage of ethanol might be to increase
the rate of food intake, which, in turn, would increase blood-
ethanol content and foster further consumption. Similarly,
HFCS provides the body with calories needed to maintain
functioning. Thus, consuming either HFCS or ethanol in
small doses may provide some benefits.
However, as both HFCS and ethanol are legal, relatively
cheap, widely available, and socially sanctioned in most
Western cultures, they are frequently consumed to excess.
When taken in large quantities, HFCS and alcohol may cause
biological changes that encourage further problematic use.
Excessive alcohol consumption causes mesolimbic
dopamine down-regulation, which fosters increased intake,
pronounced cravings, continued use despite negative
consequences and physical withdrawal symptoms during
periods of abstinence [28]. High fructose consumption tends
to promote insulin resistance and chronic hyperinsulinemia,
and this occurs largely through its capacity to induce
increased release of triglycerides in th e liver [29]. We have
142 Current Drug Abuse Reviews, 2011, Vol. 4, No. 3 Gearhardt et al.
also learned that the metabolic impact differs substantially
depending on the type of sugar that is consumed. For
instance, the monosaccharide fructose raises triglyceride
levels and lowers high-density lipoprotein, whereas glucose
does not have these effects [30]. Fructose also blunts leptin
signaling thereby promoting sensations of hunger and
activation of the reward pathways creating a desire for
consumption independent of energy needs [31] – a
phenomenon that is directly comparable to what occurs when
alcohol is used excessively [27]. This seems to occur
because HFCS bypasses the insulin-driven satiety system. In
other words, while glucose stimulates the release of insulin,
decreasing the desire to eat, fructose has this effect to a very
weak degree [31]. Therefore, ingesting elevated amounts of
either ethanol or fructose can result in biological changes
that promote overconsumption.
Another consequence of processing for both food and
drugs of abuse is that the refined substance is combined with
additional products to enhance its rewarding properties. The
tobacco plant, for example, is harvested and processed into a
form that can be either inhaled as smoke, or ingested as a
result of chewing. Although the nicotine in the tobacco plant
is the main active ingredient, the tobacco industry has added
hundreds of additional ingredients to enhance the flavor and
aroma of the product, speed absorption into the lungs, and
increase cigarette shelf life [32]. The resulting tobacco
product is significantly more rewarding and addictive than
unprocessed tobacco.
A similar process occurs with hyperpalatable foods.
HFCS is not consumed on its own, but is combined with
other ingredients, such as sweeteners, fat, salt, flavor
enhancers, and caffeine. For ex ample, a frosted chocolate-
fudge Pop Tart combines HFCS with refined flour, sugar,
oil, salt, cocoa, flavor enhancers, and preservatives. In total,
the resulting product has approximately 37 ingredients.
Thus, similar to cigarettes, the substance that results from
processing is often significantly more rewarding than
minimally processed foods.
In addition to the increased levels of hedonic reward, the
processing of foods may also result in other addiction-related
changes, such as tolerance and cue-reactivity. For example,
individuals have a tendency to consume greater quantities of
foods they find palatable, as evident in the ever increasing
portion sizes of highly processed foods [33]. The
consumption of food, especially in large quantities, increases
the level of glucose into the bloodstream, which disrupts the
homeostasis of the biological system [34]. As a
compensatory mechanism, the pancreas begins to secrete
cephalic insulin in response to food-related cues or at the
beginning of food consumption to allow the body to tolerate
greater levels of food ingestion [34]. Similarly, ingestion of
drugs of abuse also stresses the body and biological
responses occur to compensate for these disruptions, which
increases the body’s tolerance to the addictive substance
[35]. Thus, the body adapts to the ingestion of either food or
drugs of abuse in a manner which results in higher levels of
tolerance. The development of elevated tolerance may then
drive even more problematic levels of consumption.
Addition ally, consump tion of sugar or addictive drugs can
result in elevated dopaminergic activation in response to
related cues, which is associated with an enhanced
motivation to seek out the substance (i.e., wanting) without a
corresponding increase in the hedonic pleasure received
during consumption of the substance (i.e. liking) [36, 37].
The sensitization of dopaminergic activity to cues may result
in cue-triggered cravings playing a large role in both
problematic eating and drug-taking behavior. In summary,
the elevated hedonic nature of highly processed foods may
initially encourage overconsumption, but other factors (e.g.,
increased tolerance, elevated wanting) may also drive
addictive-like eating behavior.
Like the food environment, the conceptualization of an
addictive substance has changed throughout history. In the
19th century, substances that are now classified as addictive
were commonly consumed as a part of daily life. For
example, heroin was an ingredient in over-the-counter tonics
for both children and adults, cocaine was included in Coca-
Cola, and alcohol was consumed as an alternative to
contaminated water [38]. In the late 1800s and early 1900s,
public concern about these substances grew, and some, like
heroin and opium were thought to be a threat to societal and
personal wellbeing [39]. As the impact of these substances
on the body and brain became more evident in the latter part
of the 20th century, the list of problematic drugs increased.
Nevertheless, the classification of what constitutes an
addictive substance has often been controversial. Frequently,
the substance at the center of debate has been associated with
some central features of addiction (e.g., escalating use,
inability to stop despite problems), but lacks other typical
addiction markers. For example, cocaine is associated with
almost no physical withdrawal symptoms, which created
controversy about its addiction potential until the late 1980s
[40]. The addictive nature of tobacco was also the focus of
debate, in part due to its lack of a strong intoxication
syndrome [41].
Hyperpalatable foods are also associated with some of
the factors that once caused cocaine and tobacco’s addictive
nature to be debated. Although there is evidence that sugar
consumption is associated with pronounced physical
withdrawal symptoms in animals [3], evidence of withdrawal
from hyperpalatable foods in humans is largely anecdotal
and based on reports of people experiencing headaches,
elevated cravings, irritability, and temperature dysregulation
while dieting [42]. Like cocaine, the limited exploration of
food-related withdrawal in humans has increased skepticism
about the addictive nature of highly processed foods [43].
Moreover, in a similar manner as tobacco, consumption of
highly processed foods does not result in an obvious
intoxication syndrome. However, the level of intoxication
triggered by an addictive substance does not directly
correlate with the degree of negative consequences. Tobacco
is currently the number one cause of preventable death in the
United States despite the lack of an intoxication syndrome
[44]. The greater public health cost associated with tobacco
is partly because of the ease of accessibility, increased social
acceptability, heavy marketing practices, and low cost [21].
Hyperpalatable foods are also ubiquitous, socially
acceptable, highly marketed, and inexpensive [21] and their
public health consequences are enormous. Furthermore,
despite the lack of an intoxication syndrome, ingredients in
The Addiction Potential of Hyperpalatable Foods Current Drug Abuse Reviews, 2011, Vol. 4, No. 3 143
highly processed foods appear to have reinforcing properties
on par - or possibly exceeding - drugs of abuse. For example,
Lenoir and colleagues [45] found that cocaine-addicted rats
will choose saccharin, a calorie-free sweetener, over cocaine
in a forced choice task, which led to the conclusion that the
rewarding properties of sweetness may surpass that of drug
Although hyperpalatable foods may differ in some ways
from the typical conceptualization of addictive drugs, they
share many features with traditionally addictive substances.
First, highly processed foods and drugs of abuse are both
capable of triggering cravings [14, 46]. Second, consumption
of highly processed foods and drugs of abuse can both be
associated with compulsive overuse in the face of severe
negative consequences [42]. And finally, in some individuals
there is evidence of chronic relapse and an inability to cut
down consumption of both substances [42]. Thus, while
highly processed foods may not be associated with a clear
intoxication syndrome, and evidence of withdrawal is just
now building, there are significant areas of overlap with
conventional addiction disorders.
In addition to nosological debates, the application of an
addictive label has also been mark ed by societal controversies.
For individuals, stigma is often associated with a substance
dependence diagnosis. The stereotype of persons with addiction
as weak-willed and untrustworthy can be a barrier for those
thinking of seeking treatment and may result in occupational
and social discrimination [47]. In contrast, the conceptualization
of addiction as a disease has also led to more widespread
support for those seeking treatment for substance use disorders,
increased insurance coverage for addiction, and greater funding
for addiction-related research [47]. Similarly, applying an
addiction perspective to food may increase weight stigma or
conversely may lead to greater support for the treatment of
eating-related problems. Addictive substances have also been
linked to questions of social justice. Certain addictive
substan ces (e.g., crack-cocaine)have been linked to
underprivileged groups (e.g., urban poor, African-Americans),
which have resulted in stricter legal consequences for the use of
these drugs relative to other substances [48]. Further, at-risk
groups have often been disproportionally targeted for the
marketing of legal drugs. For example, primarily African-
American neighborhoods in metropolitan areas have a higher
density of tobacco billboards and magazines designed for
African-American readers are more likely to contain cigarette
advertisements [49]. Currently, food-related problems, such as
obesity, are impacting minorities and economically
disadvantaged groups in disproportionately high numbers [50].
As with tobacco, advertisements for potentially addictive foods
are specifically designed to appeal to these demographics and
fast-food restaurants are more prevalent in poorer
neighborhoods [51, 52]. The historical relationship of addiction
with social issues may prove informative in considering the
burden of potentially addictive foods on disadvantaged groups.
Although addictive substances appear to be somewhat
heterogeneous in nature (i.e., varying levels of withdrawal,
intoxication, etc.), the addiction rubric has been useful in
identifying substances that are likely to be consumed
excessively despite negative consequences and to result in
clinical levels of impairment/distress. Ultraprocessed foods
appear to share many of the characteristics of addictive
substances and excessive consumption of these foods is
already associated with some clinical disorders (e.g., binge
eating disorder). The consequences of potentially addictive
foods, like drugs of abuse, will also likely extend beyond
clinically significant disorders. Widespread use of addictive
substances often results in steep public health costs due in
part to sub-clinical problematic use. For example, alcohol
consumption is prevalent in America, but only 5-10% of
alcohol users develop alcohol dependence during their
lifetime [53]. Despite the relatively low rates of dependence,
alcohol is the third leading cause of preventable death in the
United States, partially as a result of accidents and health
conditions caused by sub-clinical alcohol use [44]. Highly
processed foods may have a similar impact on public health
by triggering problematic use in individuals that do not
exhibit clinically disordered eating. Moreover, ingredients in
highly processed foods are implicated in health problems
beyond elevated body mass index. For example, research
suggests that HFCS relative to sucroseis more likely to cause
adipose fat in the abdominal region, increase circulating
triglyceride levels, and result in metabolic syndrome [31,
54]. If hyperpalatable foods are capable of driving
widespread overeating and metabolic dysfunction to a degree
that impacts health, this may partially account for the high
public health cost of excessive food consumption [44].
Protective factors against the development of addictive
behaviors are also on the decline in the current food
environment. Addictive substances consumed in the context
of cultural and religious rituals appear to be less likely to be
abused (e.g., [55]). If it is only socially appropriate to
consume a substance in a specific context, social mores may
restrain substance use and only a limited number of cues
may be linked with the substance, which could result in
fewer triggers for use. In a similar vein, food consumption
has traditionally been linked with the experience of eating in
a social or cultural context. For examples, meals were
frequently eaten with family or friends while seated at a table
and snacking between meal times was not a common
practice. The current trends in food consumption find people
eating more frequently in isolation, in a variety of setting
(e.g., the car, at a work desk, in front of th e television), and
snacking regularly between meals [56]. The uncoupling of
food consumption for social/cultural settings may also
increase the likelihood that highly processed food
consumption will result in an addictive behavior.
Additionally, the frequency and the duration of one’s
exposure to an addictive substance, as well as early age of
substance use [57], increases the likelihood of becoming
addicted [58]. There is some evidence that the same dosing
effects may also apply to food high in sugar, fat and salt.
While drug experiences typically begin during adolescence
or early adulthood, direct exposure to processed and highly
palatable food normally begins within the first few years of
life. Indeed, recent research indicates that these influences
can occur in utero and can substantially modify the fetal
genome [59]. For instance, maternal consumption of a high-
fat diet during pregnancy can induce long-term alterations in
dopamine and opioid gene expression and preference for
palatable foods in animal offspring [60]. In addition, there is
144 Current Drug Abuse Reviews, 2011, Vol. 4, No. 3 Gearhardt et al.
evidence that children of obese mothers are at increased risk
for insulin resistance and subsequent obesity and metabolic
dysfunction [61]. Therefore, the early age of exposure to
processed foods and the chronic nature of its consumption
may increase the consequences of potentially addictive
In summary, although highly processed foods differ from
the traditional conceptualization of addictive drugs in some
ways, such as the lack of intoxication, the degree of overlap
is significant and compelling. In addition to neurobiological
and behavioral similarities, hyperpalatable foods and
addictive substances both trigger artificially high levels of
reward, cause biological compensations that result in
tolerance, and become linked with associated cues. Factors
that increase the addictive potential of substances, such as a
lack of cultural context, frequent consumption and early age
of use, are also relevant to highly processed foods. Further,
the components that increase the public health consequences
of alcohol and nicotine are also present in the modern food
environment, such as the ease of accessibility, increased
social acceptability, heavy marketing and lower cost of high-
calorie foods. Due to the similarities between highly
processed foods and addictive drugs, successful policies in
reducing the impact of addictive drugs may also be useful in
combating food-related problems. For example, tobacco
consumption was significantly reduced in the United States
when effective individual treatments were comb ined with
tobacco-focused interventions, such as barring cigarette
machines, increasing taxes and limiting marketing. Similar
interventions have been proposed in response to the obesity
epidemic, such as reducing nutrient-poor foods in school
vending machines, implementing a soda tax and reducing
marketing of high-calorie foods to children [62,63]. Given
the similarities between highly processed foods and tobacco,
these approaches may also prove effective in reducing the
public health consequences of excess food consumption.
Future Research Questions:
It is highly unlikely that all foods are equally capable of triggering
an addictive process. What foods have the greatest addictive
potential? What increases foods’ addictive nature (e.g., elevated
sugar, increased fat)?
Does a reduction in the consumption of highly processed foods
trigger a withdrawal syndrome? Do symptoms of withdrawal from
hyperpalatable foods (e.g., anxiety, agitation, physical symptoms)
increase the risk of weight gain or being unable to adhere to a
healthier diet?
Can the implementation of protective factors against the
development of addictive behaviors (e.g., inclusion of consumption
in social/cultural settings, reduced exposure to advertisements) also
reduce problematic food consumption?
Key Learning Objective:
The food environment has changed drastically in a relatively short
period of time. One cause for concern is that foods are now being
processed in ways that increase both their reward potency, as well as
the speed of absorption of fat/sugar into the system. These are two
factors that increase the addictive potential of other substances (e.g.,
coca leaves). This may have increased the likelihood that certain
foods may be capable of triggering an addictive process.
Labeling a substance addictive has been historically controversial.
For example, the minimal physical withdrawal symptoms associated
with cocaine and the lack of an intoxication syndrome linked with
tobacco led to debates about their addictive nature. Hyperpalatable
foods are associated with similar factors, which will likely lead its
addictive nature to be a topic of controversy.
Despite these differences, hyperpalatable foods and addictive drugs
share a number of characteristics. They are both associated with
loss-of-control, continued use despite negative consequences, high
rates of relapse, public health costs and in utero influences. If
evidence of the addictive potential of highly processed foods
continues to build, effective policies for reducing the impact of other
addictive substances (e.g., increased taxation, restricted advertising)
may prove essential in dealing with the obesity epidemic.
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Received: January 26, 2011 Revised: March 22, 2011 Accepted: April 19, 2011
... Researchers, clinicians, and health bodies unanimously recognise the widespread availability and tenacious marketing of inexpensive energy-dense, nutrient-poor foods and beverages, as a key driver of excessive energy intakes and reduced dietary quality (Drewnowski, 2000;MOH, 2014;Swinburn, 2008). These 'empty calories' are usually highly palatable, and potentially addictive, due to the physiologically reinforcing qualities of added sugars, fats, and salt (Gearhardt, Davis, Kuschner, & Brownell, 2011;Kessler, 2009). When combined, these biological and environmental influences create a 'perfect storm' for obesity to flourish. ...
... Furthermore, in our modern food environment, these 'empty calories' are inexpensive and widely available (Caballero, 2007;Giskes, van Lenthe, Avendano-Pabon, & Brug, 2011;Lake & Townshend, 2006;Swinburn, Egger, & Raza, 1999). Research suggests highly palatable, energy-dense foods may challenge our natural appetite control systems, further encouraging their consumption (Gearhardt, Davis, Kuschner, & Brownell, 2011;Kessler, 2009 (Gearhardt et al., 2011;Kessler, 2009;Liu, von Deneen, Kobeissy, & Gold, 2010). ...
... Furthermore, in our modern food environment, these 'empty calories' are inexpensive and widely available (Caballero, 2007;Giskes, van Lenthe, Avendano-Pabon, & Brug, 2011;Lake & Townshend, 2006;Swinburn, Egger, & Raza, 1999). Research suggests highly palatable, energy-dense foods may challenge our natural appetite control systems, further encouraging their consumption (Gearhardt, Davis, Kuschner, & Brownell, 2011;Kessler, 2009 (Gearhardt et al., 2011;Kessler, 2009;Liu, von Deneen, Kobeissy, & Gold, 2010). ...
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Background: Obesity is a key modifiable risk factor for non-communicable diseases. The modern food environment provides easy access to inexpensive, highly palatable, energy-dense and nutrient-poor foods and beverages, which are associated with increased BMI and reduced dietary quality. The NEEDNT Food List™, comprising ‘non-essential, energy-dense, nutritionally-deficient’ foods and beverages, was developed to help patients and consumers to clearly distinguish non-essential foods from core foods required for good health. In the present study, the original NEEDNT Food List™ was incorporated into preliminary ‘Moderation Guidelines’, which aim to provide quantified guidance for implementing the concept of dietary moderation, in the context of NEEDNT food and beverage intake. Objectives: The aims of the present study were to create a points and quota system for quantifying and monitoring energy intake from NEEDNT foods and beverages; to pre-test preliminary Moderation Guidelines among a representative group of potential users; and to make recommendations to further develop the Moderation Guidelines as a weight loss tool. Design: This study utilised an observational design and qualitative methods to obtain information-rich verbal data from study participants. Twelve people, aged 22 to 57 years, with a BMI ≥30 and a history of repeated weight loss attempts, were selected to pre-test the Moderation Guidelines over a 4-week period, and subsequently participated in one-on-one, semi-structured interviews. Interviews comprised eight open-ended questions, to explore participants’ views and experiences of the Moderation Guidelines, along with information relating to historical weight loss attempts and thoughts on dietary moderation. Interview data were recorded, transcribed verbatim and coded using NVivo software. Coded data were categorised and evaluated by thematic analysis using a general inductive approach. Results: Preliminary NEEDNT Foods Moderation Guidelines were presented in an A5 booklet format, with NEEDNT foods and beverages assigned 1 NEF (‘non-essential food’ value) per 100 kcal portion. Participants were allocated up to 19 NEFs weekly, representing around 1900 kcal. Participants varied in the extent of their previous dieting experiences. All expressed uncertainty around applying personal concepts of dietary moderation. Nine participants found the Moderation Guidelines usable and beneficial. Five participants self-reported weight losses of 2-4 kg during the 4-week period. Three participants found the Moderation Guidelines less appealing, unusable, or incomplete. All participants reported an improved understanding of dietary moderation generally. Seven participants intended to continue using the Moderation Guidelines. Suggested changes to the print booklet included revision of NEEDNT food and beverage categories, modification of terminology, integration of colour and graphics, clarification of serving sizes, and culture-specific versions. Most participants emphasised the need for support from a Dietitian or other health professional, for dietary guidance around core food groups, and behavioural change techniques. Participants said a NEEDNT-based smartphone app would increase functionality and appeal. Māori and Pacific participants requested culturally tailored NEEDNT-based education. Conclusion: Preliminary NEEDNT Foods Moderation Guidelines show potential for assisting obese persons to lose weight by moderating consumption of NEEDNT foods and beverages. Revision and retesting would further develop the Moderation Guidelines, and should incorporate participants’ recommendations, design principles, behavioural change theories, and best practices in nutrition education. An intervention trial is warranted, to evaluate the effectiveness of revised Moderation Guidelines as a dietary quality and weight loss tool. Further research opportunities include the development of a Moderation Guidelines smartphone app and website, tailored adaptation of the Moderation Guidelines for Māori and Pacific individuals and community groups, and a NEEDNT-based public health campaign. Keywords: NEEDNT Food List, NEEDNT Foods Moderation Guidelines, Moderation Guidelines, NEF, NEEDNT-FFQ, dietary moderation, energy density, nutrient density, overweight, obesity, qualitative research, qualitative evaluation, nutrition education.
... The industrial revolution boosted the productivity of the food and beverage industry by changing the food systems and patterns of most developed and developing countries [54]. The food environment changed dramatically, from a diet rich in proteins and grains, and low in sodium, fat, and sugars, to an adapted diet, with a production of artificial foods high in fat and sugars [55]. ...
... The food environment changed dramatically, from a diet rich in proteins and grains, and low in sodium, fat, and sugars, to an adapted diet, with a production of artificial foods high in fat and sugars [55]. From a nutritional point of view, most of these artificial foods have lost the characteristics of food and turned into industrial ingredient formulations that contain little or no whole food [54]. These artificial foods are palatable, fast and practical, and have become the target of a population marked by pressure and lack of time [56]. ...
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Background: Overweight and obesity have increased cases of eating disorders and psychiatric disorders.
... Esto tendría un efecto apaciguador frente a los estados psicológicos negativos derivados de la mala situación económica. Se trata de un efecto a corto plazo similar al que proporciona el consumo de otras sustancias como el tabaco o el alcohol y que también podría desembocar en adicciones con el agravante de que los productos ultraprocesados se adquieren a muy bajo precio (Gearhardt et al., 2011). De manera recíproca, un estudio longitudinal que ha seguido la evolución de quince mil universitarios españoles durante más de 10 años ha mostrado que el consumo elevado de productos ultraprocesados aumenta el riesgo de desarrollar trastornos depresivos y que esto podría estar asociado con ciertas deficiencias de micronutrientes (Gómez-Donoso et al., 2020;Sánchez-Villegas et al., 2015). ...
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El desempleo y el empleo precario son uno de los mayores determinantes de pobreza en España y se han visto agravados con la crisis económica sufrida durante la última década. La falta de recursos amenaza la seguridad alimentaria de las familias que se ven obligadas a adoptar estrategias de compra que conducen a la reducción del consumo de alimentos frescos y al aumento de productos refinados y ultraprocesados. Estas dietas hipercalóricas y de bajo valor nutricional, unidas al sedentarismo, dan lugar a una doble carga de malnutrición donde conviven la obesidad con las deficiencias de micronutrientes. El estado nutricional determina en gran medida la salud física y mental de las personas pero esta relación no es directa y unidireccional. Todos los factores mencionados se retroalimentan entre sí y a su vez están atravesados por otros elementos transversales como son la pobreza energética, la globalización, la inequidad de género o el acceso a la educación y la salud, entre otros. Intervenciones multisectoriales como son los itinerarios de inserción sociolaboral integrales y la colaboración entre entidades públicas y privadas, resultan imprescindibles para poder asegurar la salud y bienestar de los colectivos más vulnerables.
... Besides, multiple unique non-nutritional properties of ultra-processed products have been proposed as the risk factors for increasing odds of obesity [12]. Considered convenient, these products are generally prepared in large portion sizes, and endorsed through media advertising, leading to overconsumption [45][46][47]. Due to minimal required preparation, they may alter eating patterns of individuals in various age groups; these factors may lead to rapid food consumption while involved in alternate routine activities (e.g., eating while watching TV) [18,37]. Thus, rapid and unconscious consumption associated with these intake behaviors can disturb digestive and neural functions that signal satiety and satiation, perhaps, causing overconsumption [48,49]. ...
Numerous studies have reported the association of ultra-processed foods with excess body weight; however, the nature and extent of this relation has not been clearly established. This systematic review was conducted to analyze the currently documented evidence regarding the association between ultra-processed food with overweight and obesity. A literature search was performed using multiple literature databases for relevant articles published prior to November 2019. Random effects model, namely the DerSimonian–Laird method, was applied to pool effect sizes. The potential sources of heterogeneity across studies were explored using the Cochrane Q test. Fourteen studies (one cohort study and thirteen cross-sectional studies) were included in this review. A significant association was identified between ultra-processed food intake and overweight (pooled effect size: 1.02; 95% confidence interval (95% CI): 1.01, 1.03, p < 0.001) and obesity (pooled effect size: 1.26; 95% CI: 1.13, 1.41, p < 0.001). Our findings revealed a positive association between ultra-processed foods and excess body weight. Future studies with longitudinal designs and adequate control for confounding factors are required to clarify whether ultra-processed food intake alters anthropometric parameters and leads to obesity.
... Soft drinks and processed foods are leading risk factors for chronic, noncommunicable diseases (Stuckler et al. 2012), and ultra-processed, long-shelf-life, and ready-to-eat or ready-to-heat foods are associated with weight gain (Hall et al. 2019). Highly processed foods hold addiction potential, similar to other addictive products such as alcohol and tobacco, because of their hyperpalatable nature (Gearhardt et al. 2011). These products are also packaged such that the container contributes to overconsumption (e.g., "super-sizing," multiple servings in single packages ;Rolls 2003;Zlatevska, Dubelaar, and Holden 2014). ...
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Food systems and the ways food products are formulated, packaged, and marketed contribute to obesogenic environments. The current research focuses on products informally referred to as junk food (foods high in sugar, fat, and salt) and how they function as a mechanism in developing taste preferences in children three to five years old. Across two studies, the authors examine how parents’ taste preferences, their lay theories of self-control, and their resulting decisions about foods to provide to their children are associated with their children’s taste preferences and consumption of healthy food. Using a parent survey, Study 1 examines how parent preferences and exposure to junk food contribute to the development of child food preferences. Study 2, which is based on a parent survey and observation of child meals out of home, confirms Study 1 findings. Furthermore, Study 2 shows how parental lay theories and parental decisions regarding junk food provided to a child are related to the child’s consumption of vegetables. Implications for food brands, policy, and parents are discussed.
... The controversial construct of food addiction posits that certain foods (e.g., highly palatable, calorically dense, processed foods) might have addictive properties. Food addiction is not a formally recognized diagnosis within the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases, yet public attention and scientific interest in this construct has increased substantially since the Yale Food Addiction Scale (YFAS) development [1]. Food addiction (as assessed by the YFAS) is related to greater disordered eating, food cravings, impulsivity, body mass index (BMI), and psychosocial impairment in both clinical and non-clinical samples [2][3][4][5]. ...
PurposeFood addiction (FA) is related to greater body mass index (BMI), eating-disorder psychopathology, food craving, and psychosocial impairment. Less is known regarding the utility of the FA severity specifiers, as measured by the number of symptoms endorsed on the Yale Food Addiction Scale (YFAS 2.0).Methods Participants (N = 1854) were recruited from Amazon Mechanical Turk to complete an online survey on eating behaviors. Participants completed self-report measures assessing FA, eating-disorder psychopathology (Eating Disorder Examination Questionnaire), and food craving (Food Craving Inventory). Based on the YFAS 2.0 specifiers, participants were classified into four FA groups: No FA (n = 1643), mild (n = 40), moderate (n = 55), and severe (n = 116).ResultsThere were significant differences found in age, sex, BMI, and frequency of objective binge-eating episodes (OBEs) among the FA groups. Using ANCOVA, adjusted for multiple comparisons and covariates (e.g., BMI, sex, OBEs), the No FA group reported significantly lower levels of shape concern (η2 = 0.05; p < 0.001), weight concern (η2 = 0.04; p < 0.001), eating concern (η2 = 0.15; p < 0.001), and global eating-disorder psychopathology (η2 = 0.06; p < 0.001) than mild, moderate, or severe FA groups. The No FA group reported significantly lower levels of dietary restraint (η2 = 0.01; p < 0.01) than mild and severe FA groups. The severe FA group reported higher food craving scores (η2 = 0.02; p < 0.001) compared to the No FA group.Conclusion Our findings parallel the severity specifiers literature for eating and substance use disorders by also indicating the limited utility of severity specifiers based on symptom count. Future research should investigate alternative targets for discriminating among levels of FA.Level of evidenceLevel V, cross-sectional descriptive study.
... [12] Gearhardt et al. listed the common characteristics of addictive substances and hyperpalatable foods as follows: they increase dopamine and opioid neural system activity, trigger artificially high levels of reward, enter the bloodstream rapidly, stimulate the neurobiological systems, lead to the continued consumption despite negative consequences, and are difficult to quit although the person is willing to quit. [13] Studies suggest that foods containing excess fat/sugar overstimulate reward pathways, and increase dopamine release, which leads to compulsive food consumption, i.e. to food addiction. [9,14,15] The present study aimed to determine the prevalence of obesity among adolescents in different high schools in an urban area and the effect of food addiction on obesity. ...
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Background: People may develop addiction to hyperpalatable foods, which may be a cause of obesity. This study aimed to determine the prevalence of obesity among adolescents and the effect of food addiction on obesity. Materials and Methods: In this cross-sectional study, food addiction and obesity status of high school students were investigated. Among 17,000 10th and 11th grade students, assuming the design effect as 2.0, with obesity prevalence of 10%, with 3% error, and 95% confidence interval, at least 752 participants were included. Obesity was the dependent variable, whereas sociodemographic characteristics, body image, eating habits, and food addiction were the independent variables. Food addiction was assessed using the Yale Food Addiction Scale. Obesity was determined by age- and sex-specific body mass index (BMI) percentiles for adolescents < 18 years of age and BMI ≥ 30.0 for those aged ≥ 18. Data were collected through face-to-face interviews. Statistical analyses were performed using SPSS 25.0. After adjustment for age, sex, and other variables, the effect of food addiction on obesity was determined through logistic regression. P
... 20 However, in today's obesogenic environment, the adverse impact of eating these foods regularly is important to consider when taking into account the research on salt, sugar, and fat consumption, their potential for dependence, and subsequent impact on health. 119,120 Socioeconomic stratification by race is also a likely contributor to greater intake of foods high in sugar, fat, and salt, given differences in the availability of foods that have less of these ingredients by zip code. 121 These socialization factors may contribute to learned preferences for certain highly palatable foods in children, as well as for larger portion sizes and feelings of being quite sated (ie, overfull). ...
Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.
... Although the concept of food addiction is a controversial topic and there is no consensus on whether humans show addictive-like eating [37], previous animal studies indicate that high consumption levels of high-fat and high-sugar foods induce neurobiological changes, such as dysfunction of the reward system and downregulation of dopamine receptors observed in other addictive disorders [37][38] [18]. Human studies have also suggested evidence for the addictive potential of hyperpalatable food via neural activation in addictive-like eating behavior and substance dependence, such as altered activation in the reward circuit [39] [40][37] [19]. ...
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Background: This study aimed to examine whether the frequency of consuming specific foods was associated with smartphone usage time and the problems caused by smartphone overuse in adolescents. Methods: Both routines (food consumption and smartphone use) were investigated in a large sample of Korean adolescents using a nationwide self-report survey. Food intake was assessed using a seven-point scale (“never” to “1, 2, and 3 or more times per day”) for nine items: fruits, vegetables, milk, soda, energy drinks, sweetened beverages, fast food, instant noodles, and snacks. Smartphone usage time and problematic usage were determined using self-report items. The study took place in Korea. In total, 62,276 students aged 12–18 years participated. Results: Most respondents (66.5%) used smartphones for over two hours per day. Higher rates of consuming fruits, vegetables, and milk were associated with significantly lower smartphone usage; in contrast, higher consumption of soda, energy drinks, sweetened beverages, fast food, instant noodles, and snacks was associated with higher smartphone use. Conclusions: Our findings provide useful clinical information regarding adolescents’ mental health. Future studies should investigate underlying mechanisms and examine the efficacy of adopting dietary interventions for adolescents with excessive smartphone use.
Objective To evaluate the state of the literature for whether food addiction may warrant consideration as a distinct psychiatric disorder in the Diagnostic and Statistical Manual (DSM) using Blashfield et al.'s (1990; Comprehensive Psychiatry , 31 (1), 15–19) five criteria. This framework was utilized because it has recently been applied to examine the diagnostic utility of several eating disorder phenotypes. The criteria are: (a) at least 50 journal articles published on the proposed syndrome in the past 10 years; (b) proposal of diagnostic criteria and assessment measures; (c) clinician reliability in diagnosis; (d) cohesiveness of the proposed diagnostic criteria; and (e) differentiation from similar, existing diagnostic categories. Method For each criterion, a literature review was conducted to examine if the minimum qualification had been met, and key findings were discussed. Results Two of the criteria (literature and differentiation) have been empirically supported to extent specified. Two criteria (diagnostic criteria and syndrome) have been partially fulfilled, due to only having self‐report assessment measures and no examination of the odds ratios for meeting more than one symptom, respectively. Clinician reliability has not yet been evaluated. Discussion The existing literature suggests that food addiction may warrant consideration as a proposed diagnostic category in the DSM, though future research is needed to fulfill Blashfield et al.'s (1990; Comprehensive Psychiatry , 31 (1), 15–19) criteria. The development of a semi‐structured interview would be an impactful contribution for addressing these gaps.
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Ayahuasca is a psychoactive beverage used for magico-religious purposes in the Amazon. Recently, Brazilian syncretic churches have helped spread the ritual use of ayahuasca abroad. This trend has raised concerns that regular use of this N,N-dimethyltryptamine-containing tea may lead to the medical and psychosocial problems typically associated with drugs of abuse. Here we assess potential drug abuse-related problems in regular ayahuasca users. Addiction severity was assessed using the Addiction Severity Index (ASI), and history of alcohol and illicit drug use was recorded. In Study 1, jungle-based ayahuasca users (n = 56) were compared vs. rural controls (n = 56). In Study 2, urban-based ayahuasca users (n = 71) were compared vs. urban controls (n = 59). Follow-up studies were conducted 1 year later. In both studies, ayahuasca users showed significantly lower scores than controls on the ASI Alcohol Use, and Psychiatric Status subscales. The jungle-based ayahuasca users showed a significantly higher frequency of previous illicit drug use but this had ceased at the time of examination, except for cannabis. At follow-up, abstinence from illicit drug use was maintained in both groups except for cannabis in Study 1. However, differences on ASI scores were still significant in the jungle-based group but not in the urban group. Despite continuing ayahuasca use, a time-dependent worsening was only observed in one subscale (Family/Social relationships) in Study 2. Overall, the ritual use of ayahuasca, as assessed with the ASI in currently active users, does not appear to be associated with the deleterious psychosocial effects typically caused by other drugs of abuse.
Context While general consensus holds that food portion sizes are increasing, no empirical data have documented actual increases.Objective To determine trends in food portion sizes consumed in the United States, by eating location and food source.Design, Setting, and Participants Nationally representative data from the Nationwide Food Consumption Survey (1977-1978) and the Continuing Survey of Food Intake by Individuals (1989-1991,1994-1996, and 1998). The sample consists of 63380 individuals aged 2 years and older.Main Outcome Measure For each survey year, average portion size consumed from specific food items (salty snacks, desserts, soft drinks, fruit drinks, french fries, hamburgers, cheeseburgers, pizza, and Mexican food) by eating location (home, restaurant, or fast food).Results Portion sizes vary by food source, with the largest portions consumed at fast food establishments and the smallest at other restaurants. Between 1977 and 1996, food portion sizes increased both inside and outside the home for all categories except pizza. The energy intake and portion size of salty snacks increased by 93 kcal (from 1.0 to 1.6 oz [28.4 to 45.4 g]), soft drinks by 49 kcal (13.1 to 19.9 fl oz [387.4 to 588.4 mL]), hamburgers by 97 kcal (5.7 to 7.0 oz [161.6 to 198.4 g]), french fries by 68 kcal (3.1 to 3.6 oz [87.9 to 102.1 gl), and Mexican food by 133 kcal (6.3 to 8.0 oz [178.6 to 226.8 g]).Conclusion Portion sizes and energy intake for specific food types have increased markedly with greatest increases for food consumed at fast food establishments and in the home.
The question of addiction concerns the process by which drug-taking behavior, in certain individuals, evolves into compulsive patterns of drug-seeking and drug-taking behavior that take place at the expense of most other activities, and the inability to cease drug-taking, that is, the problem of relapse. In this paper we summarize one view of this process, the “incentive-sensitization” view, which we e rst proposed in 1993. Four major tenets of the incentive-sensitization view are discussed. These are: (1) potentially addictive drugs share the ability to alter brain organization; (2) the brain systems that are altered include those normally involved in the process of incentive motivation and reward; (3) the critical neuroadaptations for addiction render these brain reward systems hypersensitive (“sensitized”) to drugs and drug-associated stimuli; and (4) the brain systems that are sensitized do not mediate the pleasurable or euphoric effects of drugs (drug “liking”), but instead they mediate a subcomponent of reward we have termed incentive salience (drug “wanting”).
During the past few years there has been a new upsurge of interest in insects as food. One factor that may be responsible is an increasing awareness in the western world that insects are traditional and nutritionally important foods for many non-European cultures. Other factors may be increased pride in ethnic roots and traditions, increased concern about environment and overuse of pesticides, and better communication among scientists who are interested in the subject. Edible insects may be closer now than ever before to acceptance in the western world as a resource that should be considered in trying to meet the world's present and future food needs.
Compares the various modes of cocaine use and their relative dependence producing potential and toxicity. The effects of the dose and route of administration are investigated in relation to bioavailability, tolerance development, and serious toxicity. The impact of crack and the practice of cocaine smoking on compulsive cocaine addiction is examined. Topics of discussion include coca leaf chewing; oral, intranasal, and iv administration; smoking coca paste; cocaine freebase smoking; cocaine doses and toxic reactions; and cocaine smoking disorder. The physical and psychological symptoms and symptom list of 32 freebase users are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Summary  The notion that sweetness is ‘addictive’ endures in the scientific literature and in the popular press. The most common targets of food cravings and addictions are energy-dense foods that are sweet, high in fat, or both. In clinical studies, the consumption of sweet and high-fat foods has been selectively reduced by opiate antagonists, suggesting a link between hedonic pleasure response and the brain systems of reward. Recent brain imaging studies have further implicated the dopamine system in mediating the pleasure response to food as well as a range of addictive behaviours. However, suggestions that sugar and fat have a permanent impact on the neurobiology of food preference are in sharp contrast with the view that the vast majority of food addictions are simply a matter of misattribution. Dietary restraint, coupled with ambiguous attitudes towards good-tasting but energy-dense foods, may lead consumers to claim that some aspects of eating behaviour are beyond their control. This distinction between addiction and attribution has implications for obesity-related lawsuits. The chief attraction of addiction theory for the plaintiff’s counsel lies in the claim of diminished personal responsibility and abrogation of free choice. However, sugar and sweets do not appear to meet the current criteria for substance dependence as formulated in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition. Examining scientific literature on sweet food ‘addictions’ and their putative links to the obesity epidemic is the topic of this review.
The liver is a major regulator of lipid metabolism in the body. It plays a central role in the synthesis and degradation (oxidation) of fatty acids. Fatty acids serve as an important source of energy as well as energy storage for many organisms and are also pivotal for a variety of biological processes, including the synthesis of cellular membrane lipids and generation of lipid-containing messengers involved in signal transduction [1]. Fatty acids can generally be stored efficiently as non-toxic triglycerides (triacylglycerols/fat), which generate more than twice as much energy, for the same mass, as do carbohydrates or proteins. Accordingly, liver is a key player in energy homeostasis: first, as it converts excess dietary glucose into fatty acids that are then exported to other tissues for storage as triglycerides as lipid droplets [2]; second, under conditions of increase in synthesis and decreased oxidation of fatty acids the liver contributes to the progressive accumulation of excess unspent energy in the form of energy-dense triglycerides in adipocytes of adipose tissue, which provide virtually limitless capacity to store energy and finally, under chronic energy over-load situations the liver may serve as a surrogate reservoir for storing considerable quantities of excess fat, leading to the development of hepatic steatosis and steatohepatitis [3].