Some researchers and clinicians have found similarities between binge eating and alcohol and drug abuse. This observation led to the introduction of terms such as “compulsive overeating” and “food addiction”, and to propose specific treatments based on the addiction model. However, if binge eating is not addictive, treatments based on this conceptualization may not be appropriate.
In this article, I will briefly address two questions: (1) Is it fair to think of binge eating as an addiction? and (2) What are the implications for the treatment of binge eating?
Is it fair to think of binge eating as an addiction?
The addiction model argues that binge eating is produced by the same physiological processes operating in substance use disorders. According to this theory, people who overeat are biologically vulnerable to specific unhealthy foods, such as sugar and starches, and as a result, become addicted to them, becoming unable to control the amount they eat. Since they have a biological vulnerability to binge eating, they cannot cure their illness and must learn to accept it and live with it.
The theory of binge eating as an addiction is supported both by the similarities between binge eating and alcohol and drug abuse and by the neurobiological findings.
Similarities Between Binge Eating And Addiction
The proponents of the binge eating addiction model highlight the following key similarities between alcohol and drug abuse and binge eating:
- Desires and desires to engage in behavior
- Feeling of loss of control over behavior
- Recurring concerns about behavior
- Using behavior to modulate negative mood and stress
- Denial of the seriousness of the problem
- Persistence of behavior despite negative consequences
- Repeated failure to stop the behavior
Some studies have found commonalities in the neurobiological reward processes between people with recurrent episodes of binge eating and those with substance use disorders. An increase in dopamine has been observed both in people who use cocaine and alcohol after taking these substances, and in some obese people after taking food. In addition, dopamine D2 receptors appear to be reduced both in people with substance use disorders and in some obese people.
Neurobiological findings have led to the proposition that in healthy individuals the reward system is normally self-regulated so as to allow appropriate inhibitory control of substance use or overeating. On the other hand, in individuals where this system is deregulated, there would be a tendency to have less control over the consumption of substances or food for a deficit of reward.
Differences between binge eating and addiction
Despite the similarities, there are some important differences between binge eating and addiction which can be summarized in the following points, as described by Professor Christopher Fairburn of the University of Oxford in his book, Overcome binge eating:
- People with binge eating do not consume food classes. If binge eating episodes were a form of addiction, they should be characterized by craving and consuming specific foods. However, this does not usually happen in people with binge eating, where the hallmark of binge eating is the amount of food taken, not the type of food eaten.
- People who binge eat have a continued need to avoid the binge eating episode. In contrast, one of the biggest challenges in treating people with substance use disorders is motivating them to try to avoid substance use.
- People who have binge eating often adopt a strict diet to lose weight. Weight loss diets increase vulnerability to binge eating episodes. In contrast, people with substance use disorders and alcohol are not vulnerable to substance abuse when they try not to avoid them.
- People with binge eating often have specific psychopathology. Most people with bulimia nervosa and about half of those with binge eating disorder report “overestimation of shape and weight” (that is, they rate self-esteem almost exclusively in terms of weight, shape and control). This psychopathology plays an important role in maintaining the eating disorder and binge eating. In contrast, people with substance use disorders do not have this psychopathology.
- Binge eating appears to arise from the interaction of several biological, social and psychological risk factors and factors not exclusively associated with diet and food.. This suggests that binge eating episodes are the result of several maintenance mechanisms rather than the consequence of food addiction.
- The relationship between binge eating and substance use is not specific. The rate of substance and alcohol abuse in people who have binge eating is higher than in the general population, but it is similar to that of people with other mental disorders. Likewise, the rate of binge eating episodes is higher in people with alcohol and drug abuse, but it is similar to that of people with other mental disorders. Even the highest prevalence of drug abuse in family members of individuals who force-feed is not higher than that seen in other mental disorders.
- Those who stop binge eating do not replace food with alcohol abuse. Although it has been observed that eating problems precede alcohol abuse (ie.
Moreover, as Professor Paul Fletcher of the University of Cambridge pointed out, the data on neurobiological findings and the reduction of dopamine D2 receptors are inconsistent, as are the data on obese people and brain imaging studies. presenting food stimuli to participants with and without an eating disorder.
Additionally, although some foods activate neural pathways common to drugs, no evidence has yet shown that there is neuronal sensitization to food. In fact, the intense stimulation elicited by the drugs, which far exceeds that obtained from any food, appears to be the cause of the dysfunction of the natural reward system (including the sensitization of the mesolimbic dopaminergic neurons involved in the process. desire), rather than simply activating the pathways of desire. This is why addiction to substances becomes so compulsive and persistent, regardless of the pleasure and damage that its consumption entails. At the same time, this means that a food capable of activating the reward system cannot automatically be classified as an addictive substance.
What are the implications for the treatment of binge eating disorder?
Considering binge eating disorder as an addiction would have inevitable repercussions on its treatment. In fact, the non-pharmacological treatment of food addiction should be based on the approach that Alcoholics Anonymous and other related groups use to help people with alcohol problems: the so-called “12 step” approach.
The 12-step approach, as shown Tcapable 1, differs significantly from cognitive behavioral therapy for eating disorders (CBT-ED), recommended by the 2017 National Institute for Health and Care Excellence (NICE) guidelines for the treatment of bulimia nervosa and disorders of the binge eating disorder. The NICE guidelines reflect substantial new evidence that has emerged over the past decade, has focused on the results of controlled clinical trials, and has taken into account the experience of users, family members, researchers. and doctors.
In addition, there is no data on the long-term effectiveness of binge eating treatments based on the 12-step approach. On the other hand, the results of CBT-ED are supported by several well-designed clinical studies.
Table 1. Main differences between the 12-step approach and cognitive behavioral therapy (CBT) for eating disorders
Source: Riccardo Dalle Grave, MD
Despite the many similarities between binge eating and substance use disorders, there are fundamental differences between the two conditions with respect to psychopathology, epidemiology, and risk factors.
As Professor Terence Wilson of Rutgers University pointed out, nowadays there is a tendency to use the term addiction for virtually any form of repetitive behavior loosely, with some people being said to be sex addicts, media junkies. social, television, shopaholic, etc. Using the word “addiction” in such a broad and comprehensive way, most of us could be considered addicted to something.
The possible adoption of a treatment based on the food addiction model in people with binge eating is of particular concern because, having therapeutic implications that explicitly contradict CBT-ED, the currently recommended treatment for patients with bulimia nervousness and binge eating disorder could turn people away. of therapies with proven effectiveness.
However, it is important to stress that even if we exclude the model of food dependence in the genesis and maintenance of binge eating attacks, it is recommended to encourage the implementation of preventive public health interventions, to create an environment that supports healthy eating for most people. and a flexible diet and an active lifestyle.