Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Abstract

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications

“…Furthermore, obesity frameworks should incorporate weight stigma as an important cause and consequence of the epidemic, suggested herein as a form of STA that can also become biological embedded. Finally, the role of dietary restraint has been included as an important psychological factor that should be accounted for when conceptualizing FA and obesity, particularly given the strong relationship between ELA and EDs, as recently reviewed elsewhere [ 46 ].…”

“…A frequent criticism of FA data in clinical settings is that the measure itself does not account for restrained eating [ 46 ] (discussed in Section 5.1 ). Another criticism is that it remains unclear how to intervene once FA has been detected.…”

“…These theories need to be tested in both observational and experimental studies in an effort to better develop the emerging field of behavioral health nutrition. Recently, an 8-step process has been proposed to help clinicians discern FA from dietary restraint in order to inform inclusive vs. exclusive nutrition strategies [ 46 ]. The key discerning factors include the presence of SUD, PTSD, and ELA, which, if all present, can provide more confidence in the strength of an FA signal, particularly in the absence of dieting behaviors.…”

“…Thus, disordered eating characterized by dietary restraint provides important context for FA data. It has been recently suggested that the presence of dieting behavior must be carefully evaluated in order to separate the FA “signal” from the “noise” [ 46 ]. For example, ED research has identified significant overlap between FA and bulimia nervosa (BN), with FA symptoms improving when BN symptoms remit [ 47 ].…”

Editorial: Psychosomatic Aspects of Obesity

“…Results indicate that patients with AUD and BED process disorder-specific stimuli (alcohol and food, respectively) differently as compared to healthy controls and neutral stimuli. Findings address the ongoing debate surrounding the utility of extending the concept of addiction to the treatment of obesity and eating disorders (5,6).…”