Dear Dr. Goldman & the White Coat, Black Art team:

As a registered dietitian, certified Intuitive Eating counselor and CBC fan, I listened to the season premiere of White Coat, Black Art with interest. “Food addiction” is indeed a controversial topic, and I was hoping that more airtime could’ve been given to arguments against food addiction as a diagnosis and an abstinence-based treatment.

Hearing Annie’s and Dr. Tarman’s stories brought me deep sadness. Though they were no longer eating their “trigger” foods, you could sense that they had a lot of mistrust – in the food industry and more importantly, in themselves. It was clear that they felt that they could lose control and “relapse” at any moment, and that this would be a battle they’d have to fight for the rest of their lives. They blamed their weight concerns on their “addiction”, when in reality, the concept is shaky at best.

The Yale Food Addiction Scale (YFAS) was created by adapting screening tools for drug and alcohol addiction to food. Critics argue that this is problematic – first, the obvious: we can live without drugs and alcohol, but we can’t live without food. As such, while the addictive agents and mechanism of addiction for drugs and alcohol have been proven, the same cannot be said about food. Everybody eats, so why do some people become “addicted” to food and others don’t? What makes food addictive? Without proof that food itself is addictive, it’s possible that the YFAS is not picking up “food addiction” but simply describing disordered eating behaviour.

Proponents of food addiction argue that foods high in sugar, fat and salt activate the same reward centres in the brain as drugs and alcohol, but so does music or mothers seeing their babies smile, yet we don’t see the same problematic behaviours or calls for treatment associated with these “triggers”. Even the “rat study” that is referenced in the episode shows that there may be a disconnect between brain activity and behaviour – when the researchers tried to trigger compulsive eating behaviour in the rats by injecting a virus that decreased dopamine receptors in the brain (thereby requiring more stimulus to “feel good”), the compulsive eating behaviour was only triggered in some, not all, of the rats.

More importantly, why an abstinence-based treatment program is problematic for “food addiction” is because restriction might have been what caused these behaviours in the first place. Some of the statements in the YFAS include, “Not eating certain types of food or cutting down on certain types of food is something I worry about”, or “I have found that I have elevated desire for or urges to consume certain foods when I cut down or stop eating them,” which really describes anyone who has been on a weight loss diet.

Again, the “rat study” shows that restriction could be the culprit as well – in the study, the rats were actually divided into three groups – one group was fed chow (regular boring rat food) only, one group was allowed the “cafeteria” diet (which included cheesecake, chocolate, bacon, sausage, pound cake and frosting) for an hour per day (“restricted access”) and the last group was allowed the cafeteria diet for 18-23 hours per day (“extended access”). All groups had unlimited access to chow.

The researchers found that “restricted access rats obtained only < 33% of their daily calories from chow, suggesting that they developed binge-like feeding behaviour and consumed ~66% of their daily caloric intake during their 1 h access session to the cafeteria diet” and that “there was a tendency for consumption of the cafeteria diet to decrease over time in the extended access rats.” If food was truly addictive, wouldn’t it be predicted that the extended access rats would continue the same level of intake?

One theory of why the rats may have decreased their intake is habituation, and it is one of the concepts used in Intuitive Eating, which encourages people to give themselves unconditional permission to eat all foods and use their hunger and fullness cues to help guide their eating habits. While there is often an initial phase where people feel compulsive around eating foods that they’ve restricted for so long, over time, the food loses its power. It stops feeling novel or exciting. Instead of always living in fear of a relapse, food becomes “just food”.

Studies show promise – whereas Dr. Tarman says that her program has a 20% success rate, a 2013 study of a 10-week program incorporating intuitive eating and mindful eating concepts found that 73.5% of participants reported that they were asymptomatic for disordered eating after the treatment (an increase of nearly 40% from baseline)

I hope that a follow-up episode with Annie will cover more of the concerns surrounding a food addiction “diagnosis”, as well as talk about Intuitive Eating and Health At Every Size as an alternative to helping people manage their problematic behaviours and thoughts around food.

Best regards,

Vincci Tsui, RD

Additional Resources

My blog post, Help! I’m Addicted to Sugar!

Eating disorder dietitian Marci Evans tackles this topic in a recent episode of the BodyLove Project Podcast with registered dietitian and personal trainer Jessi Haggerty.

Josée Sovinsky, a fellow HAES dietitian based in Toronto, has rounded up a fantastic list of resources on the subject, filled with blog posts, podcasts, books and webinars on this topic.

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