FooD Addiction

Is food addiction real?

Yes, it is. Food addiction is often referred to as ultra-processed food addiction (UPFA), carb addiction, sugar addiction or eating addiction. Read my blog What is food addiction.

Food addiction is not recognised in the Diagnostic and Statistical Manual (DSM), or the International Classification of Diseases (ICD), the two manuals that is used to diagnose conditions. But it can be assessed through questionnaires such as the Yale Food Addiction Scale (YFAS). Mounting research shows that food addiction is an experience that many people identify with. There is a really great text book by Claire E. Wilcox MD published in 2021 'Food Addiction, Obesity, and Disorders of Overeating An Evidence-Based Assessment and Clinical Guide'. Dr Vera Tarman's book 'Food Junkies' (2019) and the 'Food Junkies podcast' are also excellent resources that will keep you up to date with what researchers and clinicians have to say about the topic.

In May 2024, the first International Food Addiction Consensus Conference took place in London to bring together professionals to discuss the next steps to ensure ultra-processed food addiction (UPFA) is included  in the ICD and an evidence-base for treatment is established. Even though professionals agree that a person can also engage in addictive eating behaviours with non-ultra-processed foods, it was decided the UPFA label is the most convincing description for food addiction to obtain formal recognition because the detrimental health impact of ultra-processed food is now widely understood and accepted.  

Below are the YFAS questions to help you understand if you may identify with the concept of food addiction.  

Do these food addiction symptoms resonate with you?

In the last year...
• I ate to the point where I felt physically ill.
• I spent a lot of time feeling sluggish or tired from overeating.
• I avoided work, school or social activities because I was afraid I would overeat there.
• If I had emotional problems because I hadn’t eaten certain foods, I would eat those foods to feel better.
• My eating behavior caused me a lot of distress.
• I had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family, or health.
• My overeating got in the way of me taking care of my family or doing household chores.
• I kept eating in the same way even though my eating caused emotional problems.
• Eating the same amount of food did not give me as much enjoyment as it used to.
• I had such strong urges to eat certain foods that I couldn’t think of anything else.
• I tried and failed to cut down on or stop eating certain foods.
• I was so distracted by eating that I could have been injured (e.g., when driving a car, crossing the street, operating machinery).
• My friends or family are/were worried about how much I (over)eat.

Eating Disorders

In my experience, many people who have food addiction will identify as also struggling with some forms of disordered eating or eating disorders such as binge eating disorder, bulimia nervosa, anorexia nervosa or other eating disorders. Obesity is also often present when somebody presents with a food addiction.

Research now confirms that there is a clear overlap between food addiction, eating disorders and obesity, which requires further research. (Claire E. Wilcox, 2021, Food Addiction, Obesity, and Disorders of Overeating An Evidence-Based Assessment and Clinical Guide'). 

Do you identify with having an eating disorder?

Here are just a few questions from the EDE-Q questionnaire which is one of the tools used by clinicians to assess for the presence of an eating disorder. This may help you to identify a possible eating disorder, such as binge eating disorder, bulimia nervosa or anorexia nervosa. Please note this is NOT the full questionnaire. There is also a great amount of resources on eating disorders on the Butterly Foundation's website.

• Have you been deliberately trying to limit the amount of food you eat to influence your shape or weight (whether or not you have succeeded)?
• Have you gone for long periods of time (8 waking hours or more) without eating anything at all in order to influence your shape or weight?
• Has thinking about food, eating or calories made it very difficult to concentrate on things you are interested in (for example, working, following a conversation, or reading)?
• Has thinking about shape or weight made it very difficult to concentrate on things you are interested in (for example, working, following a conversation, or reading)?
• Over the past 28 days, how many times have you made yourself sick (vomit) as a means of controlling your shape or weight?
• Over the past 28 days, how many times have you taken laxatives as a means of controlling your shape or weight?

How do we work with food addiction & how do eating disorders play a role? 

A journey towards sustainable lifestyle shifts…

There are no quick fixes and we focus on steady progress and long-term sustainability. The way we work together will be tailored to what you need. Everyone is different.

Psychotherapy is usually a weekly or fortnightly and long-term process. Or you may just want to start with a few sessions to work through a particular aspect or get you started on your journey. You may have tried different treatments before and your experience of your journey so far will determine your preferences and needs.

A peer support network, such as a 12-step group or SMART recovery can be a great support network outside of therapy. 

Finding your unique recovery truth…

The fields of food addiction (ultra-processed food addiction) and eating disorders are complex and more research is required, as well as more collaboration between the professionals who work in these fields.

There is one crucial difference that I see in my clinical practice regarding food addiction and eating disorders:
Those of us who have food addiction often recover well when abstaining from specific trigger foods and food behaviours entirely. Often sugar, flour and other ultra-processed food substances are the biggest challenges. While this is all but easy, some people know that this is their truth. 

Those of us who have an eating disorder without a chemical dependency may be able to, once inner conflicts have been resolved, eat all foods in moderation. In that case, using an abstinence approach is too restrictive and reinforces the eating disorder.   

Many of us have struggled with both so we explore what came first and take a very nuanced way of addressing recovery. This is a trial and error process which can take months or years as we are embark on a journey towards a peaceful relationship with food. 

 The Key is to stay Patient, open And curious in Finding your own Personal Truth And Recovery Path.

Taking a 'Two Lane Approach'

We might find ourselves working in a ‘two-lane approach’, looking at practical matters and tease out what's biology, and in parallel, the deeper underlying issues around the addiction and/or eating disorder.

Lane One

Considering practical matters is absolutely vital for us when we want to recover from addictive behaviours and/or disordered eating. For example, I can draw on traditional, evidence-based strategies to support you to: 
• Learn about addictive and disordered eating patterns  
• Understand your triggers 
• Establish your own food plan and/or work with other professionals to do so
• Establish accountability and daily recovery actions 
• Learn how to eat mindfully  
• Develop strategies for dealing with cravings 
• Deal with difficult emotions 
• Prevent relapse 
• Establish a support network 
• Consider concerns around body weight, shape and size  

Lane Two

My experience has shown that so many of us already know what to do but are finding it difficult to stick to those ‘healthy habits’ and apply our learnings. That’s where psychotherapy comes in - helping us to go deeper through compassionate inquiry informed by Internal Family Systems therapy, a wonderful modality that helps us meet ALL of the parts of us involved in the addictive process.
Questions we might ask are:  
• What parts of me are needing to eat addictively and for what purpose?  
• What is their positive intention?  
• What other parts are critical of those addictive and impulsive parts?  
• What parts want to eat healthily and what other parts absolutely do not want to give up specific foods?  
• What parts hold what beliefs about what foods and where have they learned those beliefs?  
• What parts feel hopeless and discouraged and exhausted?  
• What parts are unhappy with our body and weight and are seeking to restrict our food?  
• What internal pressures and polarisations are created by all of these warring parts?
• Is there a way we can curiously get to know these parts, and help them meet their positive intentions in other ways?  
• Are there underlying wounds outside of current awareness that might seek healing to ease the addictive processes?
• To what extent is biology involved, and to what extent have my parts learned this behaviour, and what is the best way to move forward based on this learning?  
• Will I need to completely abstain from specific foods and ways of eating?  
• Or will I be able to eat all types of foods in moderation?  
• Is restricting food necessary or harmful for my system?
•What inner pain and burdens are my parts seeking to heal and release?
We will only be able to find those answers by listening to all of our parts, and through trial and error of different eating guidelines. Internal Family Systems is a wonderful approach to explore addictions, disordered eating, and set up food and recovery lifestyles that work for us.

Acknowledgement of Country
I recognise the history, culture, diversity and value of all Aboriginal and Torres Strait Islanders, and acknowledge their Elders past and present.

I acknowledge that sovereignty has never been ceded, and support reconciliation, justice and the recognition of the ongoing living culture of all First Nations people by providing welcoming and culturally informed services. 

Embracing inclusivity and diversity,  I also support a culture of inclusion, respect, choice, voice and diversity and am committed to supporting all people to be mentally well and engaged in their communities.