When Food Behaves Like a Drug: Rethinking Overeating Through the Food Addiction Lens.

In recent years, scientists have increasingly questioned whether overeating—particularly of highly processed, calorie-dense foods—may share key features with substance use disorders. Adams and colleagues examined this possibility in their review on food addiction and its implications for diagnosing and treating overeating, noting that behaviours such as craving, continued use despite harm, and loss of control resemble diagnostic criteria for substance use disorders in the DSM-5 (1). Although some parallels are compelling, the model does not apply equally to all individuals, suggesting that only a subset of overeating cases might be accurately described as food addiction (1).

The neurobiological evidence strengthens this argument. Highly processed foods rich in sugar, salt, and fat activate dopamine-based reward pathways in the brain in ways comparable to drugs of abuse, which may explain why some individuals find them so difficult to resist (2,3). A growing body of research suggests that these foods can drive compulsive consumption patterns, leading to health outcomes similar to those observed in addictive disorders (4). For example, Gearhardt and colleagues argue that ultra-processed foods show many of the hallmarks of addictive substances, including high reinforcing value, loss of control, and continued use despite negative consequences (5).

One of the key tools used to study food addiction is the Yale Food Addiction Scale (YFAS), which adapts substance dependence criteria for eating behaviours. Individuals may be classified as meeting “food addiction” if they endorse at least three criteria alongside significant clinical impairment (6). Meta-analyses have found prevalence rates of up to 20% in adults, with higher levels in clinical populations struggling with obesity and binge-eating disorder (7). However, the overlap between food addiction and recognised eating disorders complicates diagnosis, since many symptoms—such as bingeing and loss of control—occur across both conditions (8). Critics argue that this raises concerns about pathologising normal eating behaviours or duplicating existing diagnoses (9).

Despite these challenges, framing overeating as an addictive-like behaviour has prompted exploration of new treatment strategies. Adams et al. highlight cognitive intervention tasks, which train individuals to inhibit responses to food cues, and neuromodulation approaches such as transcranial direct current stimulation, which aim to alter neural activity in reward-related brain regions (1). Systematic reviews of interventions for food addiction suggest that behavioural and psychological approaches, particularly cognitive-behavioural therapy (CBT), show the most promise, though evidence remains limited by small samples and short follow-ups (10,11). In practice, experts recommend prioritising evidence-based treatments for comorbid eating disorders, especially CBT for binge-eating disorder, while continuing to investigate novel therapies specific to food addiction (12).

The broader implications extend beyond clinical care. If certain foods possess addictive properties, this challenges the view of overeating as purely a matter of willpower. Instead, it frames susceptibility as a product of neurobiology interacting with an environment saturated with hyper-palatable products. Epidemiological studies suggest that around 14% of adults and 12% of children worldwide may meet criteria for food addiction, particularly in contexts where ultra-processed foods dominate the diet (13). Public health experts argue that strategies used to curb tobacco or alcohol consumption—such as warning labels, taxes, and marketing restrictions—may be necessary to reduce exposure and harm (14).

Still, the concept of food addiction remains controversial. Some researchers caution that overuse of the term may stigmatise individuals or oversimplify complex eating behaviours driven by emotional, cultural, and social factors (9). Others counter that acknowledging addictive-like responses to food may help validate patient experiences and open new therapeutic pathways (2,5). What is clear is that overeating is not solely a matter of personal responsibility, but an intricate interplay of neurobiology, psychology, and environment.

Taken together, the evidence suggests that food addiction is a useful framework for understanding compulsive overeating in at least a subset of individuals. The model highlights similarities to substance use disorders, provides tools for identifying at-risk individuals, and points towards innovative treatment options, even if definitive interventions remain under development. At the same time, caution is needed to avoid overextending the diagnosis or ignoring established treatments for eating disorders. Ongoing research will be crucial in clarifying how best to integrate the food addiction concept into clinical and public health practice, striking a balance between recognising biological vulnerabilities and empowering individuals to regain control of their eating behaviours.

References

1. Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS. Food Addiction: Implications for the Diagnosis and Treatment of Overeating. Nutrients. 2019;11(9):2086.

2. Volkow ND, Wise RA, Baler R. The dopamine motive system: implications for drug and food addiction. Nat Rev Neurosci. 2017;18(12):741-752.

3. Kenny PJ. Reward mechanisms in obesity: new insights and future directions. Neuron. 2011;69(4):664-679.

4. Pursey KR, Stanwell P, Gearhardt AN, Collins CE, Burrows TL. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients. 2014;6(10):4552-4590.

5. Gearhardt AN, Corbin WR, Brownell KD. Food addiction: an examination of the diagnostic criteria for dependence. J Addict Med. 2009;3(1):1-7.

6. Gearhardt AN, Corbin WR, Brownell KD. Development of the Yale Food Addiction Scale. Psychol Addict Behav. 2009;23(2):193-205.

7. Meule A, Gearhardt AN. Ten years of the Yale Food Addiction Scale: a review of version 2.0. Psychopharmacology (Berl). 2019;236(1):1-12.

8. Davis C. Compulsive overeating as an addictive behaviour: overlap between food addiction and binge eating disorder. Curr Obes Rep. 2013;2(2):171-178.

9. Hebebrand J, Albayrak Ö, Adan R, et al. “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behaviour. Neurosci Biobehav Rev. 2014;47:295-306.

10. Leary M, Pursey KM, Verdejo-Garcia A, Burrows TL. Current intervention treatments for food addiction: a systematic review. Behav Sci (Basel). 2021;11(6):80. doi:10.3390/bs11060080.

11. Schulte EM, Potenza MN, Gearhardt AN. A commentary on the “eating addiction” versus “food addiction” perspectives on addictive-like food consumption. Appetite. 2017;115:9-15.

12. Fairburn CG. Cognitive behavior therapy and eating disorders. Guilford Press; 2008.

13. Pivarunas B, Conner BT. Impulsivity and emotion dysregulation as predictors of food addiction. Eat Behav. 2015;19:9-14.

14. Gearhardt AN, White MA, Potenza MN. Binge eating disorder and food addiction. Curr Drug Abuse Rev. 2011;4(3):201-207.