One of my big heroes in the anti-diet world is Isabel Foxen Duke. She is a bad-ass who doesn’t mince words when it comes to explaining why diet culture is bullshit, eating isn’t the addiction, and why emotional eating might be saving your ass. So when we got to meet over the phone a while back, of course I leaped at the chance to invite her on our podcast.
In this awesome episode of Dietitians Unplugged, Isabel, Aaron and I talk about all stuff anti-diet, intuitive eating, Health at Every Size and yes, even sex (don’t worry, the episode is still by and large PG!).
More About Isabel
Isabel Foxen Duke is the Creator of Stop Fighting Food—a free video training program for women who want to “stop feeling crazy around food.” After years of trying to overcome emotional eating, binge-eating and chronic weight-cycling through traditional and alternative approaches, Isabel discovered some radical new ways to get women over their “food issues” once and for all—not just by shifting the mindsets of individuals, but by challenging the dominant diet culture as a whole.
When my partner and I first moved in together, he – a naturally thin person whose eating is highly internally regulated and who has never restricted any food in his life AND even enjoys guilt-free overeating on occasion – suggested cookies as a grocery item list. I had just regained a few pounds after my most restrictive dieting period ever, and I looked at him like he was crazy. “Uh, NO! I can’t have cookies in the house or I’ll just EAT ALL OF THEM! I’m addicted to those foods!” He looked at me calmly and said, “Well, that won’t happen to me and I want cookies.” It would be four more years before I stopped dieting and the cookie tug-of-war would peacefully come to an end and I would once and for all stop feeling like I was addicted to sweets.
I recently had a conversation with a woman who considers herself a food addict and has been a member of Overeaters Anonymous for 16 years. She manages her self-described addiction by eating no refined grains and no sugar at all. She maintains a high-protein, low-carb diet. After talking a while I found out a few other things: 1. She was criticized for her weight at a young age, 2. She started self-restricting cookies when she was 7 or 8 years old, and 3. She was often a much higher weight, tried all the diets, and this total abstinence regimen is the only one that has “worked” for her in terms of keeping her weight down long-term. She also frequently talks longingly about what she can’t have but would love to eat. She sometimes bakes brownies just to enjoy the smell and gives them away to friends without having any. She said she never stops thinking of herself as fat, even though she is now “normal weight.” If ever there was a person my heart went out to, it was this person.
We hear stuff like this all the time. Sugar is addicting. Fat is addicting. Refined carbs are addicting. Salt combined with any of those foods is addicting. I was once accused of being addicted to cheese, which is ridiculous because anyone who knows me knows chocolate is my drug of choice! (If I thought of it that way, which I don’t)
To learn more, I emailed a colleague who specializes in nutrition for recovering addicts and food addiction. He sent me a paper which apparently is the foundation for food addiction treatment right now, “Understanding and Addressing Food Addiction” by The National Center on Addiction and Substance Abuse. The paper admits little is known about food addiction, which is why they have chosen to look at it through the lens of substance addiction. Food addiction was considered for the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) but rejected, so in the absence of any other diagnostic criteria, the Yale Food Addiction Scale (a scale that is primarily based on the diagnostic criteria for substance dependence) is often used to determine food addiction.
The paper talks about possible risk factors for food addiction including “obesity/overweight”, early exposure to “overeating and unhealthy eating” at a young age through family or peer groups, genetics, personality trait and psychological tendencies, and more. They state that the individual characteristics associated with food addiction are being female, over age 35, and overweight or obese (interestingly, the same people that are often on a diet). It discusses the relationship of food addiction to eating disorders (there is a higher correlation than in non-ED populations). It talks about the similar neurological responses of the brain to highly palatable foods (the aforementioned sugar/fat/salt combo) and addictive substances. And in the end, it concludes:
“The food addiction model, like that of substance addiction, describes the ways in which certain food properties or ingredients can produce addiction in individuals who are susceptible to their effects and who consume them in a manner that induces the addictive process (i.e., eating certain types of highly palatable, calorie dense, and nutrient-poor food on an intermittent but repeated basis). It allows for an explanation and an intervention strategy for those cases of disordered eating that are not adequately accounted for by existing psychological or medical causes.”
In other words, in the absence of psychological or medical reasons for an “addictive” response to food, it blames the food itself.
I find this paper, while highly referenced, problematic. I don’t think it’s asking the right questions.
One major problem is that nowhere does it mention restrained eating or dieting behaviors and their relationship to food-addicted behavior. This is a huge omission because it’s well-documented that highly restrained eaters often have frequent episodes of disinhibition (aka overeating or binge eating), especially with “forbidden” highly palatable foods (read some of that data here and here). Who on a diet hasn’t felt addicted to the very foods they weren’t supposed to eat? It’s no surprise to me that people with eating disorders have experienced more food addiction symptoms; high degrees of eating restraint are common in eating disorders.
I have qualms about treating food the same way as addictive substances. We don’t need addictive substances to live for the most part, and most of us, in our usual activities of daily living, will never come across those substances unless we search them out. They’re easy to avoid (cigarettes and alcohol being exceptions to some degree). Food, on the other hand, is everywhere, and we need it every few hours to achieve nutritional adequacy. One might encounter “trigger” foods multiple times in a day. This puts the onus on the addicted person to try to avoid contact with trigger foods or those who are eating them, and that could lead to extreme social isolation. I had a friend who, once he joined OA, couldn’t eat with me anymore because of potential exposure to all his trigger foods – which was becoming everything except non-starchy vegetables.
Yet another problem is that this paper views highly palatable foods as inherently bad for health; they simply aren’t, and there is no adequate body of evidence to conclusively show this (and we know now that our patterns of eating impact our health much more than individual foods). Many people can incorporate these demonized foods into a balanced diet quite easily without overdoing it or feeling ruled by them (those people all live in France, plus the three I know here. Kidding! I know four here.). In my experience, these are people relaxed eaters who have never dieted and never felt they had to change their body shape or weight.
A lot has been made of the similar ways that highly palatable foods and addictive substances light up certain neural pathways. But guess what – those are pleasure pathways. They also light up when we receive hugs from people we love, hang out with our pets, or have sex. So the lighting up of those pathways alone do not indicate addiction.
There may be truly food-addicted people out there, because anything is possible – but this “addiction” does not happen in a vacuum. If you showed me a food-addicted person who had never dieted, never felt bad about his or her appearance, never been exposed to our pervasive culture of food fear, and never observed or felt weight stigma, I might buy the construct of food addiction in which food is the problem more readily. If that food was broccoli, I’d have no doubt. But it’s never broccoli, and there are few people who meet that criteria.
We’re asking the wrong questions. Based on all I know about dieting, food restriction and disinhibition, food addiction tendencies are more likely driven by high dietary restraint, weight stigma, and a toxic culture of food-fear than a chemical dependency on food. The evidence is the many people who have gotten free of this feeling of food addiction once they healed their relationships to food, eating and their bodies.
So is food addiction a real thing? I think the feeling of addiction to food is a very real thing, yes. But is it the food itself that causes the addiction? In most cases, I don’t believe it is. And I don’t believe more restriction is the answer.
My feelings of addiction to sweet foods went away when I started to feed myself without restraint and abandoned body-shame as a way of life. Once I legalized all foods, the power any one type of food had over me disappeared. I think if we started treating food addiction with liberalization, not more deprivation, we’d quickly see fewer and fewer cases of it.
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