Addictions
July 30, 2023
I became interested in ultra-processed food addiction when I learned that food companies were using the neuroscience of eating behavior to maximize addiction and profits. In full disclosure, I have researched ultra-processed food addiction, but my personal relationship with food did not drive my interest. While I have some addiction history, I was more interested in the social justice and health equity implications. When I learned that food companies were engineering food for maximum profit at the expense of public health, it made me angry.
I'm interested in conflicts of interest, and that's how I landed on this touchy subject. Ultra-processed food addiction and conflict of interest go hand in hand. I'm interested in public-private partnerships and what goes on “behind the scenes.” It's been known that the food and pharmaceutical industries are in cahoots- putting private profits ahead of public health. This isn't necessarily a non-specific problem; it’s called capitalism. Corporations have a fiduciary responsibility to their shareholders and have incredible resources to influence public discourse and control narratives around health.
I learned about discipline bias- where people's perspectives are colored by their field and the training they received. It made sense to me that people in the addiction field were more likely to see food as having potentially addictive properties than those in the eating disorder field treating anorexia nervosa and other restrictive eating disorders. They often treat people who thought they had a food addiction but had more restrictive psychopathology. It also made sense that dietitians seemed the most opposed to ultra-processed food addiction (because these professionals work with eating disorders and the discourse in the field is heavily influenced by industry). It doesn't seem as debated in psychiatry and neuroscience as in nutrition.
My career has been dedicated to teaching the eating disorder community about food addiction and teaching the food addiction community about eating disorders. It does seem like both camps pretend like the other group doesn't exist, and I'm trying to bridge the gap. I've proposed new models of conceptualizing and treating eating disorders that incorporate recent data on food addiction [1–6].
Defining Ultra-Processed Food Addiction
Ultra-processed foods are defined using the NOVA Classification's four categories:
1. Unprocessed and minimally processed foods.
2. Processed culinary ingredients (e.g., sugars, oils, salt, flavors).
3. Processed foods (combination of category one and category two foods).
4. Ultra-processed foods are formulations of ingredients primarily for industrial use. Consider the constituents of food typically manufactured by industrial practices, such as soda, snack cakes, reconstituted meats, etc. These are foods that you could generally never make at home.
Some data suggest that over half of the calories in the United States come from ultra-processed foods [7].
Ultra-processed foods are consistently linked to [8–16]:
· Poor mental health (depression, anxiety)
· Irritable bowel
· Elevated cardiometabolic risk
· Cerebrovascular disease
· Elevated inflammatory markers
· All-cause mortality
Weight Stigmatization
Another criticism of food addiction is that it's thought to perpetuate stigma- a stigmatizing label since there's a stigma associated with addiction. There may be some truth to that for some, but if you look at substance use disorder- once we understood the neurobiology of the condition, it reduced stigma. In our society, people assume that everyone should be able to manipulate their body weight through food and exercise and that they should be able to weigh what they want. If they can't, they have problems with control and personal responsibility. The science of ultra-processed food addiction pushes back on those assumptions.
We know that weight stigma is a serious problem. It's exciting to see this emerging as the next social justice movement. We have terms like sizeism, and it’s a problem at a societal level, and it often gets internalized. I've argued that internalized weight stigma is a form of stress, trauma, and adversity [4]. It creates a vicious cycle. We know some adverse effects of stigmatization at the biological level, such as cortisol, which can sensitize the reward system and increase oxidative stress [17,18].
A Public Health Perspective on Ultra-Processed Food Addiction
Ultra-processed food addiction can be an individual-level problem, but it's a collective problem that should be addressed on a societal level [4,5]. I've always focused on the potential harms of the food addiction construct- while individualized treatment can be helpful, what would be more helpful is targeting the food environment through public health interventions. That would be the best way to reduce addiction-like eating, chronic dieting, and eventually reduce eating disorder incidence.
I’ve tried to bring ultra-processed food addiction into the context of psychosocial adversity and think about how stress, trauma, and adversity increase susceptibility to addictions, including addiction-like eating. Putting it into the context of the more extensive social and environmental system, we can go beyond just looking at ultra-processed food addiction as a driver of BMI. I see it as a function of stress, trauma, and adversity and how it can become biologically embedded [2,4,19].
When we think about stress, trauma, and adversity, we must look at the upstream drivers, such as socioeconomic status. We also must think about how that affects the food environment that someone lives in and how that can also contribute.
What’s The Real Problem with Food Addiction?
The real problem with food addiction: is it the sugar, salt, and fat added to foods, or is it the fact that once these foods predominate, most people are not eating a lot of blander foods? It's an exciting way to look at it, especially for the youth- we have kids mainly eating ultra-processed foods. Maybe it isn't the ultra-processed foods that are most harmful to their health, but the lack of all the other health-promoting foods.
Recommendations for Ultra-Processed Food Addiction Recovery [6]:
1. Meal timing strategies: three meals plus snacks. I like three meals and two snacks.
2. Eat from all the food groups daily.
3. Food should be consistent in nutrients yet varied in experience. I'm big on incorporating hot, cold, crunchy, creamy, savory, sweet, etc. (all sensory and tactile experiences).
4. Emphasize lower glycemic carbs.
5. Identify known trigger foods (which can change over time). Some foods can be problematic for someone, and that could change over time.
6. Switch the goal from weight loss to improving mental health.
7. Cook more at home and use mindful eating practices.
Target impulsivity through mindfulness and mind-body practices.
9. Develop emotional regulation skills.
10. Recruit social support.
Potential Solutions to the Crises in the Nutrition Field:
1. Don't participate in Diet Wars. Instead, be curious about people and groups that might differ from you.
2. Investigate your biases and blind spots and be curious about the information that makes you uncomfortable. Read more scientific papers.
At a minimum, I hope we can agree that:
✔ Ultra-processed food addiction overrides consumer sovereignty.
✔ Corporate greed is a real problem in our world.
✔ Orthorexia nervosa is a real problem, but it shouldn't invalidate our research on ultra-processed food addiction.
✔ We have a long way to go for improved mental health and eating disorder treatment outcomes.
Are you here for it?
References
1. Wiss DA, Brewerton TD. Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG). Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2017;22(1):49–59.
2. Wiss DA, Brewerton TD, Tomiyama AJ. Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding. Eat Weight Disord - Stud Anorexia Bulimia Obes. 2021;1–19.
3. Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients. 2020;12(10):2937.
4. Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients. 2020;12(11):3521.
5. Wiss DA, Avena NM. Food Addiction, Binge Eating, and the Role of Dietary Restraint: Converging Evidence from Animal and Human Studies. In: Frank KW, Berner LA, editors. Switzerland: Springer Nature; 2020. p. 193–209.
6. Wiss D. Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective. Curr Addict Reports. 2022;1–13.
7. Baraldi LG, Steele EM, Canella DS, Monteiro CA. Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. Bmj Open. 2018;8(3):e020574.
8. Martins GM dos S, França AKT da C, Viola PC de AF, Carvalho CA de, Marques KDS, Santos AM dos, et al. Intake of ultra-processed foods is associated with inflammatory markers in Brazilian adolescents. Public Health Nutr. 2022;25(3):591–9.
9. Ferreiro CR, Arroba CMA, Navia PC, Pablos DL, Cámara AG de la. Ultra-processed food intake and all-cause mortality: DRECE cohort study. Public Health Nutr. 2022;25(7):1854–63.
10. Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Brit J Nutr. 2021;125(3):308–18.
11. Faisal-Cury A, Leite MA, Escuder MML, Levy RB, Peres MFT. The relationship between ultra-processed food consumption and internalising symptoms among adolescents from São Paulo city, Southeast Brazil. Public Health Nutr. 2022;25(9):2498–506.
12. Mazloomi SN, Talebi S, Mehrabani S, Bagheri R, Ghavami A, Zarpoosh M, et al. The association of ultra-processed food consumption with adult mental health disorders: a systematic review and dose-response meta-analysis of 260,385 participants. Nutr Neurosci. 2022;1–19.
13. Lane MM, Lotfaliany M, Forbes M, Loughman A, Rocks T, O’Neil A, et al. Higher Ultra-Processed Food Consumption Is Associated with Greater High-Sensitivity C-Reactive Protein Concentration in Adults: Cross-Sectional Results from the Melbourne Collaborative Cohort Study. Nutrients. 2022;14(16):3309.
14. Lane MM, Gamage E, Travica N, Dissanayaka T, Ashtree DN, Gauci S, et al. Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients. 2022;14(13):2568.
15. Taneri PE, Wehrli F, Roa-Díaz ZM, Itodo OA, Salvador D, Raeisi-Dehkordi H, et al. Association Between Ultra-Processed Food Intake and All-Cause Mortality: A Systematic Review and Meta-Analysis. Am J Epidemiol. 2022;191(7):1323–35.
16. Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-Processed Foods and Health Outcomes: A Narrative Review. Nutrients. 2020;12(7):1955.
17. Tomiyama AJ, Epel ES, McClatchey TM, Poelke G, Kemeny ME, McCoy SK, et al. Associations of Weight Stigma With Cortisol and Oxidative Stress Independent of Adiposity. Health Psychol. 2014;33(8):862–7.
18. Hunger JM, Smith JP, Tomiyama AJ. An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Soc Iss Policy Rev. 2020;14(1):73–107.
19. Wiss DA, Brewerton TD. Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies. Physiol Behav. 2020;223:112964.
