AJCN’s Great Debates in Nutrition series applies scientific evidence to argue the pros and cons of viewing overeating and obesity as symptoms of food addiction
Summary: AJCN’s Great Debates in Nutrition series provides a venue for rigorous debates about nutrition, emphasizing topics that affect patient care and public health. The latest debate published in The American Journal of Clinical Nutrition explores whether the concept of food addiction enhances our understanding and treatment of overeating and obesity. Dr. Ashley N. Gearhardt argued that overeating and obesity should be viewed as symptoms of addiction, whereas Dr. Johannes Hebebrand made the counter-argument.
- Edited by Dr. David Ludwig, AJCN’s Great Debates in Nutrition presents scholarly debates on pressing topics in the field of nutrition, with an emphasis on questions that directly affect patient care and public health.
- The most recent debate published in The American Journal of Clinical Nutrition explores whether the concept of food addiction enhances our understanding of overeating and obesity.
- Dr. Ashley N. Gearhardt argued that highly processed foods have many of the attributes of addictive substances such as tobacco and alcohol.
- Dr. Johannes Hebebrand countered that the concept of food addiction has not led to clear-cut improvements in the treatment of individuals who are obese or who overeat.
- Both authors agreed that further research is needed to fully address this complex question.
Rockville, MD – Launched in 2020, The American Journal of Clinical Nutrition’s Great Debates in Nutrition series has created a venue for rigorous, scholarly debates on pressing topics in the field of nutrition, with an emphasis on topics that directly affect patient care and public health. These debates aim to reinvigorate the time-honored academic principle that scientific advancement rests upon the constructive dialogue between opposing viewpoints.
According to the Centers for Disease Control and Prevention (CDC), obesity affects more than 40% of Americans, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain types of cancer. The most recent debate published in The American Journal of Clinical Nutrition explores whether or not the concept of food addiction could help us both better understand and better treat obesity and overeating. Dr. Ashley N. Gearhardt, Associate Professor of Psychology at the University of Michigan, took the position that, yes, the concept of food addiction does help us better understand and treat overeating and obesity. On the other hand, Dr. Johannes Hebebrand, Professor of Psychiatry at the University of Duisburg-Essen, took the opposing position, arguing that the concept of food addiction has not led to novel and successful treatments for overeating nor obesity.
Highly processed foods, including white bread, cookies and potato chips, represent the majority of the United States food supply. According to Dr. Gearhardt, these foods have many of the attributes of addictive substances such as tobacco and alcohol. They are created by combining refined carbohydrates and fat, often along with sodium and food additives, at levels that far surpass the levels found in naturally occurring foods such as fruits, vegetables, and meats. “Like addictive drugs, highly processed foods are complex, man-made substances designed to effectively deliver reinforcing ingredients (e.g., refined carbohydrates, fat).”
We humans have been designed by evolution to crave carbohydrates and fat; however, as the carbohydrate and fat content of food increases due to processing, these highly processed foods can become more and more enticing to the point of addiction. Highly processed foods, like addictive substances, are more effective in activating reward-related neural systems than minimally processed foods. As a result, despite widespread knowledge of the potential health consequences, most people consume excessive amounts of highly processed foods. Moreover, most people’s attempts to reduce highly processed food intake fail: “This chronically relapsing pattern of excessive highly processed food intake despite clear adverse health consequences bears a striking resemblance to the intake of addictive substances.”
“As we did with cigarettes,” Dr. Gearhardt noted, “misclassifying highly processed foods as non-addictive would allow the industry to continue to create new addictive highly processed foods, market these products to vulnerable populations, and blame those who overconsume them as lacking personal responsibility.”
On the other hand, Dr. Hebebrand argues that the concept of food addition “has not led to novel and successful treatments for overeating and obesity.” Moreover, he argued that “the concept of food addiction has the potential to distract from the need to focus on environmental influencers to combat the obesity pandemic.
According to Dr. Hebebrand, the rapid increase in the prevalence of obesity is a reflection of dramatic environmental shifts. Over the past few decades, for example, physical activity has declined and sedentary behavior such as screen time has increased. Profound changes in the global food system, which produces more processed, highly palatable, cheap, and effectively marketed foods, has contributed to an increase in the average daily energy intake. Through this lens, “obesity can be viewed as a somewhat predictable outcome of market economies being predicated on consumption-based growth.”
Dr. Hebebrand further noted that among people with obesity, only a minority exhibited food addiction symptoms, as defined by the Yale Food Addiction Scale. Interestingly, he also noted that food addiction occurs at higher rates among patients with anorexia nervosa, casting doubt on applying the concept of food addiction to explain high BMIs. In summary, Dr. Hebebrand argued, “addiction can at best explain obesity in a fraction of people, and many differential diagnoses would need to be considered. The concept of food addiction has, as of today, not led to a clear-cut improvement in the treatment of subjects who overeat.”
In addition to writing their individual arguments, Drs. Gearhardt and Hebebrand collaborated on a consensus article, highlighting areas of agreement and disagreement. Both researchers agreed that “addictive-like eating exists, mechanisms implicated in substance-related and addictive disorders contribute to overeating and obesity, and food industry practices are also a key contributor to this phenomenon.” In contrast, the authors remained in disagreement over the strength of evidence underlying the assertion that highly processed foods are addictive, the appropriate framework for conceptualizing addictive-like eating, and the implications of identifying unhealthy, highly-processed foods as addictive. Looking to the future, both authors believe that further research is needed, most notably to determine what measures should be used to evaluate whether highly processed foods are addictive.
Great Debates in Nutrition is edited by David S. Ludwig, Co-director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School.
Gearhardt AN and Hebebrand J. The concept of ‘food addiction’ helps inform the understanding of overeating and obesity: YES. Am J Clin Nutr 2021 Jan 15 (Epub ahead of print; DOI: https://doi.org/10.1093/ajcn/nqaa343).
Hebebrand J and Gearhardt AN. The concept of ‘food addiction’ helps inform the understanding of overeating and obesity: NO. Am J Clin Nutr 2021 Jan 15 (Epub ahead of print; DOI: https://doi.org/10.1093/ajcn/nqaa344).
Gearhardt AN and Hebebrand J. The concept of ‘food addiction’ helps inform the understanding of overeating and obesity: Debate Consensus. Am J Clin Nutr 2021 Jan 15 (Epub ahead of print; DOI: https://doi.org/10.1093/ajcn/nqaa345).
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About the American Society for Nutrition (ASN)ASN is the preeminent professional organization for nutrition research scientists and clinicians around the world. Founded in 1928, the society brings together the top nutrition researchers, medical practitioners, policy makers and industry leaders to advance our knowledge and application of nutrition. ASN advances excellence in nutrition research and practice through its publications, education, public affairs, membership programs, and annual meeting, Nutrition. Visit ASN online at nutrition.org.