If you’d lived in the 1880s, you could’ve walked into a pharmacy, laid a quarter on the counter, and asked for a gram of pure cocaine. A wonder drug, cocaine came in medications from throat lozenges to hemorrhoid creams. When concerns about cocaine dependency started to surface, the top medical minds of the day dismissed them, likening a cocaine habit to one developed drinking coffee or tea.
“The history of addiction is riddled with controversies,” says Ashley Gearhardt (A.B. ‘03), assistant professor of psychology. “Smoking couldn’t be addictive because it didn’t intoxicate you. Gambling couldn’t be addictive because it was a behavior. But over time research showed that in each case, for some people, addiction’s mechanisms were in play.” It’s a useful history for someone like Gearhardt, who’s conducting her own controversial research: exploring similarities between addiction and people’s behaviors around food.
Not a Piece of Cake
As a graduate student, Gearhardt helped to develop the Yale Food Addiction Scale (YFAS), which uses the gold standard in addiction diagnosis to identify addictive eating behavior and food.
The YFAS asks 25 questions, including these: How often do you eat more of certain foods than you mean to? Do you eat them even when you’re not hungry? Have you tried to stop eating them, but can’t? Are there particular foods that give you problems?
When people who meet YFAS addiction criteria look at pictures of problem foods, functional magnetic resonance imaging shows a great deal of activity in brain areas linked to craving and motivation. It also shows that when they actually consume the foods, the brain areas related to self-control go quiet.
The debate about food addiction has received a lot of attention in scientific literature, but scientists have not reached consensus on how to define it or on whether food can even be addictive at all. “But ask someone off the street if they believe sugar is addictive, and they’re likely to say, ‘Yeah of course it is,’” says Gearhardt. “Polls clearly show people believe sugar is addictive. It’s much more controversial in science."
“Generally, our lab finds that people who report addictive-like eating have reward systems in their brains that are more reactive to food cues than people who don’t. This is one of the main markers of addiction: a strong reactivity to environmental cues. The mechanisms involved in addiction are clearly implicated in problematic eating patterns. Whether that meets the criteria for an actual addiction remains an open question, but it’s obvious that they’re involved.”
Gearhardt’s lab explores multiple areas of food addiction, including highly processed foods themselves: How do foods engineered to be particularly rewarding impact our brains? How do they affect the way we feel and think? Have they become so intensely rewarding that—for some people—they’ve become potentially addictive?
“Obviously not all foods are addictive,” says Gearhardt. “What sets those particularly problematic foods apart?”
The Terrible Ten
The 10 most problematic foods identified by Gearhardt’s research subjects might be a good place to start. Reviewing the list of familiar culprits—chocolate, French Fries, pizza, and ice cream—you might understandably mutter, “Well, duh. Who’d make a late-night grocery run for brussel sprouts?” Gearhardt thinks there’s more than the foods’ deliciousness in play.
Hyper-palatable foods have a high glycemic load: When we eat them, they deliver a fast blood-sugar spike—more like a shot than a beer. Addictive drugs are similar, and if you can refine the drugs to hit your system faster, they become even more addictive. Chew a coca leaf and you probably won’t become addicted to it. Refine it into cocaine and it becomes a different story. Gearhardt thinks the same mechanism is at work in really rewarding, processed foods.
“Hyper-palatable foods don’t exist in nature,” says Gearhardt. “They’re designed in a lab to be as rewarding as possible by adding refined carbohydrates—chiefly sugar—and fats. These foods have exploded in the last few decades, and they are the foods people struggle most with.”
As with other addictive substances, not everyone is equally susceptible. Ninety percent of us drink alcohol, but only 5–10 percent of us become fully addicted. Yet alcohol remains a leading cause of preventable death because alcohol’s tug is strong enough to impact people's health and safety, even if their response doesn't rise to the level of a diagnosed addiction. Gearhardt believes addiction to hyper-palatable foods works the same way.
“A narrow band of people can become fully addicted to these foods and need treatment to address it,” says Gearhardt. “But the vast majority will have a subclinical response. They feel a real pull that might not require treatment, but causes them to eat an extra 200 calories per day. That’s enough to lead to obesity over time. It's significant from a public health perspective: Most people will struggle to stop at just one because this food is engineered to pull you back.”
Everyone agrees addicted people play a role in seeking treatment and getting better. But Gearhardt thinks resisting addictive foods is harder when the environment is stacked against you. “We’re bombarded by ads promoting these foods,” says Gearhardt. “We all have to eat, and it’s cheaper and more convenient to eat these foods than to go home and prepare a meal.”
Stigma and shame have always been the first tactics we use to make people stop. Try harder. Put down the bottle. Stop smoking. “It just doesn’t work,” Gearhardt says. “If people were getting better it might be a different story, but they aren’t. The obesity epidemic is astronomic, and we’re unfortunately finding hyper-palatable foods have an even stronger effect on kids.
“It’s very possible our next study will produce findings that contradict the data we’ve seen,” Gearhardt concludes, “But so far the evidence connecting addiction to certain foods keeps building. And because most people believe food addiction is a real thing, we need to do the science to understand it.”
Hungry for Change?
Gearhardt has some practical, take-home advice to help you stay—or get back—on track with your food choices.
- Know Your Cues
Cues are very powerful, and they can prime us biologically—especially when we’re not aware of it. Try to pay attention to your own cues. Do you get the urge to grab potato chips from the pantry a few minutes after you see a fast-food commercial on TV? Figuring out what activates you—and being aware of it—can help you distinguish if you’re actually physiologically hungry or if a cue revved up your system.
- Eat High-Quality Foods
Choose high-quality, less-processed foods that you find delicious and aren’t triggering. Everyone has certain classes of foods that are risky or safe. Make sure your safe foods are on hand. If you get that impulse and craving, it’s easy to turn to junk food because it’s so convenient. Keep quality foods in your bag, pre-prepped in your fridge, or have a bowl of fruit that’s enjoyable and visual.
- Don’t Go on a Crash Diet
It’s the worst thing you can do. When you’re not eating enough calories, you not only feel deprived, but your brain is also much more reactive to the cues in your environment.
- Be Prepared to Go Through Withdrawal
The first week or so after you stop eating triggering foods, you may feel an intensity of cravings and preoccupation with food, and maybe even feel a little anxious or dysphoric. If you can ride out that week, the feelings will fade, and your system will recalibrate.
- Make Sure You're Doing Things to Take Care of Yourself
People who struggle to regulate their emotions are more prone to using hyper-palatable foods to soothe or distract themselves. Feeling financially strapped, like it’s hard to get back into the swing of things, or like the weather's simply lousy can make you more vulnerable. Making sure that you’re making time for things like sleep, exercise, meditation, and talking to friends can set you up with more resources to succeed.