I’m pretty sure I used to be addicted to Wrigley’s Extra gum. I would chew through at least a packet of it every workday. It had to be blue (peppermint) and I would feel a little anxious if I arrived at work without it. When Wrigley’s changed the packet from seven to 14 pieces I didn’t buy half the usual packets per week; I consumed twice as much. In December last year when I decided that my dietary habits needed an overhaul, gum was one of the many things to go. And I’ve not had a piece, nor desired one, since. That’s saved me about $487 (more than the JMC Omniblend I have since purchased.) In fact, my friend Cam says people chewing gum grosses him out and – much like a converted smoker – I can see what he means. I’m all about dental hygiene (and, if I wasn’t a nutritionist then I’d totally be a dental hygenist) – but now I have to say I’m a little repulsed by even the smell of it.
Some might say that I can’t have been addicted to just simply be able to give it up that easily however I disagree. And, after attending New Zealand’s First Food addiction symposium in Christchurch on Friday, hosted by University of Otago’s School of Medicine, I am more inclined to feel that way. We live our own reality and listening to people talk about their own dependence made that clear. One woman talked about consuming a block of chocolate over three days, whereas another described eating food covered in ants, such was the strength of her compulsion to eat. Clearly these two situations are vastly different – however for both women they experienced the same emotion about their relationship with food – and who is to tell either of them that it’s not ‘addiction.’
Currently food addiction is not considered to be like a drug addiction – and therefore is not recognised in the Diagnosis and Statistical Manual (DSM) V criteria for a diagnosis of an addiction. There is a reluctance to psychiatrise a seemingly ‘every day life behaviour’, however many psychiatrists – such as Professor Doug Sellman – one of the keynote speakers at the symposium, would argue that food addiction is less behavioural and is more chemical. He likened it to alcoholism – which wasn’t formally recognised by the disease model of dependency until the 1930s/40s. When that changed it did much for those people who, up to that point, suffered from the pain and emotion of not having their disease recognised or understood. A study conducted by his research group last year, where a fake enquirer called up concerned about her sister who was compulsively overeating, found that less than 10% of the service providers called (both addiction services and overeaters anonymous) would see her sister for an assessment. That’s problematic when the services who could provide some support dismisses the problem, and arguably doing more harm to the person than if no help was sought.
Prof Sellman’s talk was centred around the question “‘how can we have a food addiction if food is essential for life?” which was what he thought 20 years ago before his own weight gain and loss struggle, along with the stories of others, made him think otherwise. How these people described their relationship with food was parallel to that which he counselled those with drug addictions for. Certainly, food in itself is necessary for life, but – like alcohol and cigarettes – the type of foods which people talk about as triggering unhelpful eating patterns don’t typically fall into the ‘must eat for health’ category. Prof Sellman estimated that half of those suffering from obesity had a relationship with food that might fit the description of addiction. The accuracy of that estimate cannot be determined, but is undeniable is that the drive of obesity is often stronger than whatever emotion or pain is felt by the person who is desperately wanting to be a healthy weight.
The DSM-V criteria for an addiction is three or more of the following criteria:
- Consumption is often more than intended (quantity or time)
- Unsuccessful attempts to cut down or control consumption
- Much time is spent in consumption
- Other important activities are given up or reduced
- There is continued consumption despite the knowledge of psychological or physical health problems
- Our tolerance for the substance increases (so we require more)
- Withdrawal if you go without for an extended period of time.
I’m sure other practitioners would agree that when some clients describe their inability to stop at one serving of a ‘trigger’ food, it doesn’t sound too different from the above. While foods high in sugar certainly make up a large proportion of ‘trigger’ foods, savoury foods (such as potato crisps, corn chips, crackers etc) can be an individual’s food ‘nemesis’ too. Prof Sellman talked about these foods being formulated to deliver a certain mouth feel, and to deliver an experience that can trigger the same neurotransmitters in the brain that drugs do.
However while the food industry gets blamed for providing highly palatable, nutrient poor, calorie dense food which leads people to gain weight, that doesn’t explain the overwhelming drive experienced by some people to overconsume these foods. Kelly Brownell, who lead the first international symposium in Food Addiction just six years ago, in his handbook of Food and Addiction describes nutrients such as sugar as hijacking the brain and overriding will, judgement and personal responsibility.
The increasing awareness of food addiction as more than just a behavioural problem is another step closer to understanding the complexities of an individual and their relationship with food. While as practitioners we can guide people to eating foods that will minimise the chemical response in the brain that drives the overconsumption of food, recognising clients that might benefit from services beyond our scope of practice (such as that from a psychiatrist or psychotherapist) is just as important.
(From Prof Sellman’s talk, a version of which can be found here)