Emotional Eating, Food Addiction, and the Road to Recovery

Written by: Julie Howell 12/5/2024

Abstract

The purpose of this paper was to identify the causes of emotional eating and food addiction and to help find modalities to heal our relationship with food, our minds, and our bodies. Using an EBSCO host search engine, the research on food addiction and emotional eating, at first glance, shows many related articles; however, upon closer inspection, it all circles back to obesity, cardiovascular concerns, and diabetes issues. This paper did identify that obesity and associated comorbidities are symptoms of food addiction but that people with food addiction are not necessarily obese, and obese people may not necessarily have a food addiction. A few articles and studies look into the reasoning behind food addiction and note many different triggers related to food addiction. The reviewed articles noted the need for a more defined diagnosis due to the realization that FA overlaps with addiction and behavior diagnoses. Tools that can be used for diagnosing food addiction were also looked at and verified as functioning and well-translated tools. Some of the articles even looked into gender differences that may play a role in food addiction, but varying results were noted. The research did find that current treatment for food addiction is lacking and recognized the need for individualized treatment that also focuses on the cognitive, emotional, and behavioral aspects of food addiction, which include other complementary therapies in collaboration with diet and exercise. While many different treatments were theorized, no clear treatment approaches for food addiction were identified. The research over the last 5 years has improved. However, more case studies must be completed to provide a clear treatment approach. 

Emotional Eating, Food Addiction and the Road to Recovery

Food addiction is a dysregulated eating pattern and an overlap in the physical and mental correlates of post-traumatic stress disorder (PTSD), such as loss of control, overeating, and other compensatory behaviors (Stojek et al., 2021). Emotional eating and food addiction (FA) to energy-dense foods like sugars, salt, and fatty processed foods have been compared to drug addiction. Professionals say it can be related to the same chemical reactions in the brain, like neural alterations in impulse control, dysfunctional reward-related neural activity, and down-regulation in the dopamine system (Schankweiler et al., 2023). Hauck et al. (2020) say the chemical reaction to these energy-rich foods activates the dopamine reward system.

Food addiction is not yet a medical diagnosis, like anorexia or bulimia; however, studies are working to show it as a legitimate diagnosis and whether or not it is encompassed with current eating disorders or if it should be included under substance abuse disorders (Lacroix et al., 2018). In the general population, the prevalence of FA is 20% (Vasiliu, 2022); however, Praxedes et al. (2022) noted that the prevalence of FA was higher in participants with a binge eating diagnosis. There is concern about creating unhealthy lifestyle habits that may lead to obesity and other medical concerns. While many factors cause someone to be obese, there are links to obesity from FA and emotional eating.

Obesity puts a person at higher risk for other conditions, such as cardiovascular, musculoskeletal, respiratory, sleep disorders, diabetes, and fatty liver disease, to name a few (Vajravelu et al., 2023). Obesity is a symptom or result of FA and emotional eating; however, when it comes to the treatment of obesity, the standard treatment is diet and exercise, with the most intrusive and extreme being medications and surgeries without regard to the emotional and behavioral aspects that cause it.

Obesity has reached epidemic levels in Canada, with 24.5% of the population being obese without a diagnosed psychological reason (McIntosh, 2013). Schankweiler et al. (2023) note that in the last 30 years, obesity has more than doubled worldwide, with 24 % of Germany's population meeting the obesity criteria. Vajravelu (2023) says that it affects one in every five adolescents, and the weight stigma at an early age can exacerbate weight gain. 

With lifestyle modifications and healthier stress management coping techniques, FA and obesity can be treated or even prevented. The concern with traditional treatment with weight loss surgery would be the post-op complications and potential life-long issues, and many of the weight-loss drugs have a large number of side effects. Without effective treatment to address the cognitive reasoning for FA, any attempt at weight loss via drugs, diet, exercise, or surgery would only be momentarily successful and have the potential for rebound weight gain and exacerbated lifestyle behaviors. 

This paper aims to look at emotional eating and FA to help find Complementary alternative medicine (CAM) therapies to heal our relationship with food, our minds, and our bodies. This paper will look at studies that use varying therapies to help with food addiction and emotional eating. Studies like "Impact of a Phone-based Cognitive and Behavioral Therapy on Food Addiction in Patients with Severe or Morbid Obesity" (2023) are looking at cognitive and behavioral therapy. Learning CAM therapies to treat FA will help reduce the incidence of obesity and other comorbidities and help us learn new coping techniques and lifestyle behaviors for healthier physical, behavioral, and cognitive outcomes. 

Methods

An EBSCO discovery search was used to look for primary, secondary, and supporting articles on food addiction and emotional eating. Within the EBCO host, Google Scholar, PubMed, and Science Direct were utilized to find various available articles. The following search terms were used: Food addiction from emotional eating, Food addiction and stress eating, Therapies for food addiction, Obesity complications, eating addiction, addiction to food, treatment for food addiction, food addiction treatment and therapies, and eating addiction treatment.

Inclusion requirements included the studies or articles within the last five years (2019-2024) discussing and defining emotional eating, food addiction, CAM therapies and treatments, and reasons of concern for food addiction and potential comorbidities and complications. Any human, animal, in vitro, and in vivo trials that met the above requirements were also used.

Exclusion requirements were applied if the articles or studies were not relevant to food addiction, emotional eating, and CAM therapies that are used to treat food addiction. Articles were also excluded if they were not within the last five years or if the article was unreliable. Studies or clinical trials were excluded if they were still incomplete, as noted on the clinicaltrials.gov website. No gender, age, or race restrictions were applied to this research paper's exclusion criteria.

Results

FA has a history of being similar to other eating disorders and addiction diagnoses, but it has been long argued as to where it belongs on the diagnosis spectrum. Without a diagnosis, finding a treatment plan is difficult. To learn the triggers of FA would be a considerably large milestone in the diagnosis and treatment. The research has identified several causes, from learned behavior and emotionally induced to maladaptive coping and addiction. Further exploration of these triggers will be helpful to understand the future of FA and to help people on their healing journey.

Triggers of Food Addiction

Traumatic Experiences

Looking at food addiction and emotional eating and what triggers us to have these lifestyle behaviors, many of the research articles link traumatic experiences to maladaptive coping. McMullin et al. (2020) look at life stress, impulsivity, and addiction in their study. With 200 healthy college students, their lifetime stress exposure and self-reported impulsivity and addictive behaviors were assessed. Each experienced stressor was assessed by severity, frequency, time, duration, and psychological characteristics. Impulsivity, FA, alcohol consumption, and consequences were quantified using the self-report. The study assessed whether lifetime stress exposure added to impulsivity and addictive behavior and whether stress and impulsivity predicted addictive behavior to food and alcohol. What McMullin found was that stress exposure in childhood and adulthood leads to food addiction prediction, but adulthood stress exposure only predicted alcohol consumption. Wiss et al. (2020) agreed that adverse childhood experiences (ACEs) can leave a lasting impression on the body and that ACE scores have been used to link to a wide range of adverse health conditions, most notably substance-related disorders and predicted obesity. The results from their assessment concluded that reducing exposure to ACEs improved the food environment and likely eating behaviors. In the cross-sectional study completed by Bou Khalil et al. (2020), they also looked at childhood maltreatment and its relationship to eating disorders and FA and whether it had an impact on symptom severity. The study used 231 participants who had an eating disorder diagnosis and used the Yale food addiction scale, childhood trauma questionnaire, and the eating disorder inventory for assessment. What they found was that childhood maltreatment, especially physical neglect, may induce, maintain, or exacerbate food addiction symptoms. The study by Hazzard et al. (2019) discovered five classes or stages of childhood trauma/maltreatment and found that the class that expressed multi-type maltreatment also reported more binge eating-related concerns than the class that expressed no to low maltreatment, which led to the conclusion that child maltreatment plays a definitive role in eating disorders at varying degrees.

Gender Difference in FA

An imbalance in the brain's reward system may contribute to FA, and Osadchiy et al. (2019) say it is related to changes in the brain's resting state activity, as seen in neuroimaging studies. Osadchiy investigated early life adversity (ELA), the reward system, and FA to see if there were any sex-related differences in 186 participants. Functional resting state magnetic resonance imaging was performed. Using questionnaires and the Yale food scale, participants with high BMI demonstrated an association between ELA and food addiction, with reward regions playing a role. Of these results, women had an increased ELA association with high BMI and increased centrality of the brain's reward and emotion regulation areas. In contrast, Men had somatosensory regions playing a role. Stojek et al. (2021) also looked at gender differences in FA, and out of 214 participants who had a PTSD diagnosis, they did not find any sex, age, or race differences in the prevalence of FA. However, they did find that those with FA also had a higher incidence of depression and a higher BMI. Mills et al. (2020) found that females had a positive correlation between plasma dopamine levels and disordered eating behavior. Anjum et al. (2020) also showed females having lower body self-image and psychological well-being on their study assessments.

Body Self-Image, Weight, and Social Stigma

Some of the other FA-related research looks at the cognitive trends of body self-image, weight stigma, and social stigma as triggers for food addiction. Ruddock et al. (2019) discuss participants who completed questionnaires measuring target-specific stigma (i.e., stigma towards an overweight female), general stigma towards obesity, addiction-like eating behavior, and causal beliefs about addiction and suggest that the food addiction label may increase stigmatizing attitudes toward a person with obesity, particularly among individuals with low levels of addiction-like eating behavior. The longitudinal study by Meadows et al. (2020) explored the contributions of weight-related self-devaluation and fear of social stigma in predicting changes in addictive-like eating behavior over time. 305 Participants completed a questionnaire regarding food addiction, weight-related self-devaluation, and social stigma at two different points, 280 days apart. They found that weight stigma predicted worsening food addiction behavior over time. The cross-sectional study by Anjum et al. (2020) found that body image and psychological well-being were positively correlated, and participants who were addicted to fast food had lower levels of psychological well-being and lower body self-image. Interestingly, they discovered that females had lower results on the body self-image and psychological well-being scales when compared to the male participants.

Stress, Anxiety, and Maladaptive Coping

As discussed above, psychological and cognitive aspects play a role in the development of FA. The following research discusses how maladaptive coping with stress and anxiety adds to poor lifestyle and eating behaviors. Lozano-Madrid et al. (2020) suggested that patients with eating disorders and substance or drug abuse symptoms display characteristics of greater impulsiveness, emotional dysregulation, and issues with executive control and may be at a higher risk of developing substance abuse disorders. Rijkers et al. (2019) suggest that comorbid PTSD patients are at higher risk of more severe eating disorder symptoms and that the maladaptive emotional regulation strategies may be the relationship between PTSD and eating disorders. Nolan et al. (2019) took a look at irrational beliefs that lead to stress, anxiety, depression, problem eating behaviors, and alcohol misuse. Based on the studies analyzed results from 239 participants, indications for irrational beliefs did increase trait anxiety and increased emotional eating, which led to higher FA symptoms. 112 morbidly obese participants were used for the cohort study by Schankweiler et al. (2023) to help further the understanding of FA and find therapies for treatment. The results showed that 25 % of the participants had FA symptoms with dysfunctional emotional coping mechanisms with low stress tolerance, which suggests that these are significantly related to FA. They recommend that behavioral interventions should include a biopsychosocial model for treatment. Longitudinal research is warranted to investigate endocrine dysregulation and excess eating in Major depressive disorder (MDD), which may inform interventions and reduce chronic disease risk in affected individuals (Mills et al., 2020). Mills et al. (2020) looked at 140 participants with MDD in a study to examine biometrics, psychopathology, and plasma dopamine levels and their relationship to FA. Of those 140 participants, 23 met the Yale Food Addiction Scale (YFAS) requirements for FA. Those individuals meeting the YFAS with MDD had greater psychopathology scores for mood and eating when compared to those with MDD and did not meet the YFAS. This study also noted that females' plasma dopamine levels correlate positively with disordered eating behavior compared to males. The exploratory focus group study by Grethe et al. (2021) used 15 inpatients in a psychiatric clinic. They assessed the relationship between traumatic history and its impact on eating behaviors and the possible relationship to the development of metabolic syndrome and type 2 diabetes. Based on the results of the study groups, they were able to identify that traumatic experiences can lead to eating behaviors as coping mechanisms, addiction to food and sweets, eating controlled by stress and emotions, lack of appetite, and no desire to perform meal prepping.

Addictive Problem Foods

There is more to Food addiction than just maladaptive coping from emotional dysregulation. As noted, certain foods are considered addictive. Gordon et al. (2020) noted that high-fat, high-sugar processed foods, like ice cream, pizza, potato chips, and chocolate, are most commonly associated with addiction-like behaviors and neurobiological changes. Concerns for cardiovascular diseases (CVDs) are one of the leading public health problems and represent a greater risk of mortality and morbidity for the world population, as noted by Lopez-Lopez et al. (2021). They completed a study to determine food addiction, saturated fat intake, and body mass index (BMI) in 394 Peruvian adults. Food addiction was assessed using the Yale Food Addiction Scale self-administered questionnaire. A validated food frequency questionnaire was used to measure saturated fat intake. They did not note any difference between genders in food addiction symptoms. They did assess that 62% of participants with high saturated fat intake did have FA. Their suggestion for treatment was to decrease high saturated fat diets to prevent obesity and CVD concerns. Sarkar et al. (2019) also advised that obesity has become a significant public health concern worldwide due to its high social and economic burden caused by its comorbidities that impact physical and mental health. Fat addiction is diagnosable and is similar in the construct of addictive disorders but is distinct from eating disorders or normal eating behaviors. Sarkar notes that fat is an important energy source but that the nutritional recommendations vary from country to country. The dietary reference intake says that fat intake should be no more than 35% of daily calories. The concern is that food rich in fat is hyperpalatable and is easily consumed in excess amounts.

There is also research emerging that suggests people find sugar reduction challenging because of its addictive-like properties, and some people have symptoms similar to addictions to alcohol, tobacco, and caffeine. These symptoms include cravings, using more than intended, eating despite knowledge of the consequences, tolerance (over time, more is needed to get the same effect), repeated attempts to reduce consumption as well as physical withdrawal (Rodda et al., 2020). The consumption of free sugars has been linked to multiple adverse outcomes, including dental caries, type II diabetes, depression, and cardiovascular concerns. Sugar consumption, including sugary drinks, has been identified as a significant factor in weight gain and the risk of obesity. An adult's diet ranges between 13%–25% of daily energy intake, double the recommended 5-10% from free sugars, including any white or brown table sugar, honey, syrup, and juices.

Diagnosing Food Addiction

Reliability of Food Addiction Scales

It is essential to have a functional assessment tool to verify that it is reliable in the diagnosis, and the YFAS is a tool that is frequently used throughout the research. The following articles look at its reliability. The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Linardon et al., 2019). Ghanbari et al. (2022) stated that for things like food addiction to be treated, we need first to be able to assess accurately. They used a cross-sectional descriptive study on 451 college students to determine the Yale food addiction scale and its applicability to Persian translation. They used the Yale food scale, the food craving questionnaire trait reduced, and the depression, stress, and anxiety scale. The results showed that these scales translated well across language and culture. The study by Linardon et al. (2019) was the first to investigate the factor structure, psychometric properties, and clinical significance of YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. They used 220 community-based participants who met "probable BED" criteria based on self-reported symptoms and frequency. Out of the participants, 42% met the classification for FA. Linardon suggests that the YFAS was reliable, stating that it was adequately consistent and displayed a unidimensional structure. Based on their results, they recommend that YFAS 2.0 be used during interventions for the treatment of BED due to its ability to highlight more specific psychopathology.

Difference Between Addiction and Behavior Diagnosis.

Without a diagnosis, treatment is delayed, further exacerbating symptoms and comorbidities. Hauck et al. (2020) stated that food addiction is highly debated within the general public and the scientific communities. Using the term food addiction suggests that individuals may experience addictive responses to food, as seen with substance abuse disorders. They stated that it would be helpful to best define the diagnosis via the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to establish if FA met the criteria for substance-related or non-substance-related disorders. After their review, they felt it was too early, based on the available information, to conclude where FA fit into the diagnostic world. A review by Lacroix et al. (2018) strongly voiced that FA did not fit into a substance use disorder due to a lack of validity in the data. However, in a qualitative study by Paterson et al. (2019), the results showed that FA did not fit into the category and overlapped with both. They also stated that FA had similar qualities to BED but did not completely fit.

Food addiction is considered an essential link for a better understanding of psychiatric and medical problems triggered by dysfunctions of eating behaviors like obesity, metabolic syndrome, binge eating disorder, or bulimia nervosa (Vasiliu et al., 2022). However, at a behavioral level, food addiction is similar to other eating disorders, a phenomenon that creates difficulties in finding specific diagnostic criteria. Vasiliu (2022) states that high-sodium foods, artificially flavored foods, and rich carbohydrate- and saturated fats-containing foods are triggers for activating the same neural pathways. Therefore, food can act similarly to drug abuse and suggested that FA should be considered a disorder based on functional negative consequences, associated distress, and potential risks to both psychological well-being and physical health. During a meta-analysis review by Vasiliu (2022), they found a 20% prevalence of FA in the general population using the YFAS tool but still suggested uncertainty in the pathogenesis of FA. They did recommend that reward dysfunction, impulsivity, and emotional dysregulation be considered as basic mechanisms that trigger eating disorders and addictive behaviors. They believe that genetics play a role in the dependence on foods that are high in carbs and saturated fats and suggest that standard treatment of eating disorders like lorcaserin, antiepileptic drugs, opioid antagonists, and antiaddictive agents could be considered in the treatment of FA. However, more research is needed before treatment can be defined.

In this cluster study of 234 participants, Jiminez et al. (2019) looked at eating disorders (ED) and obesity. The goal was to look at the phenotypical character of FA using the YFAS 2.0. All participants completed many comprehensive questionnaires, and three categories of FA were found: dysfunctional, which had the highest ED psychopathology, and dysfunctional personality traits. Class two had a high prevalence of BED and moderate levels of ED psychopathology, and lastly, adaptive, which had high levels of BED but low ED psychopathology and had more functional personality traits. They concluded that this characterization of FA should be considered when looking at psychopathology, personality, and ED traits for interventions.

Complimentary and Integrative Therapies

Looking at current diet and exercise modifications for the treatment of FA have shown to be futile, and the research has suggested that a more behavioral, emotional, and cognitive treatment approach added to diet and exercise would be beneficial. There is evidence to suggest that food can induce addictive-type behaviors similar to those seen with other substances. The DSM-5 criteria have limited application to overeating, and the term' food addiction' applies only in a minority of cases. Researching the psychological pathology of FA has led to potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove beneficial for intervention development (Addams et al., 2019). Cognitive intervention and neuromodulation techniques should be considered and explored. While this paper aims to look at treatment for FA, obesity is a common link and is frequently discussed. Jebeile et al. (2019) completed a review looking at Obesity treatment related to ED, which included Binge eating and emotional eating, and found that structured and professionally run interventions with a dietary component to treatment in 2589 participants that lasted 1 week to 13 months and followed up from 6 months to 6 years resulted in a decrease in ED prevalence, risk, and symptoms. However, Gordon et al. (2020) conducted a secondary analysis of randomized control trials, evaluating the correlation between food addiction, body weight, and problem foods. This was a 22-month weight loss program with 182 participants. The interventions included exercise, lower caloric intake, and general physical and nutritional education. They noted an initial decrease in Food addiction but noted a sharp rebound over time. According to Rijkers et al. (2019), Two pilot studies provide preliminary evidence that concurrent cognitive behavior therapy (CBT) for PTSD and eating disorders may be beneficial and that repetitive transcranial magnetic stimulation (rTMS) could be helpful in the treatment of PTSD in some eating disorder patients.

Cognitive and Behavior Therapy

With the general treatment of diet and exercise having varying degrees of success based on different diagnoses, it is essential to look at other treatment avenues. Nolan et al. (2019) analyzed the responses of 239 participants who took surveys/questionnaires regarding FA, irrational beliefs (IB), depression, anxiety, and anthropometrics. The results indicated that IB increased trait anxiety, which, in turn, increased emotional eating, which finally led to a higher number of FA symptoms. The results led to the discussion of cognitive behavioral therapy and the relationship between irrational beliefs (IB) triggering stress, anxiety, depression, problem eating, and alcohol misuse. With FA following the diagnostics for substance misuse, they believe that cognitive behavioral therapy and targeting irrational beliefs might be the future of treating FA. Given the high rates of comorbidity between eating disorders (EDs) and substance use disorders (SUDs), it is essential to develop effective treatment approaches for individuals with both an ED and SUD (ED-SUD) (Claudat et al., 2020). In their research study, they found that the results indicated a higher number of psychiatric comorbidities in patients with ED-SUD who were more likely to be prescribed mood stabilizers and were reward-sensitive. There was also difficulty with emotion regulation, including more difficulty engaging in goal-directed activities, lacking impulse control, and displaying limited access to emotion regulation strategies. They recommended focusing on tailored dialectal behavior therapy and targeting emotion dysregulation. With the need for structured treatment, O'Hea et al. (2024) conducted a microscopic pilot study using 2 participants to demonstrate    the use of the Food Addiction Clinical Treatment (FACT) manual in hopes that it will be used for future treatment of food addiction and other eating disorders. The study does note its limitations based on the small sample size and agrees that future studies using the FACT manual would help to obtain treatment viability with its use.

Neuromodulation and Operant Conditioning

Song et al. (2019) say that novel treatment approaches, such as neuromodulation approaches, are urgently needed, as the efficacy of currently available therapeutic interventions in preventing relapse in drug addiction is only 40-60%, with similarly low success rates in eating disorders. They completed a meta-analysis on brain wave stimulation studies on addiction, including food and drugs, since FA has similar characteristics to drug addiction in the brain. They found significant effects of neuromodulation approaches that targeted cravings and consumption. Martin-Garcia et al. (2020) advised that FA is increasing in prevalence worldwide by up to 19% and performed this operant conditioning clinical study on mice. This study of food addiction consisted of three signature behaviors that included the persistence to respond without an outcome, the strong motivation for palatable food, and the loss of inhibitory control over food intake that leads to compulsive behavior in addicted individuals. They describe FA as a complex multifactorial brain disorder resulting from the dynamic interaction between genetics and environmental impact on cognitive and brain development and functioning, leading to differences in FA diagnosis among individuals. They used operant behavior training to create a food addiction in mice to chocolate-flavored pellets. They made sure that the mice met the diagnostic criteria for food addiction that were adapted from cocaine addiction based on the DSM IV. The study tests the mice's persistence in food-seeking, motivation, and compulsivity by using a foot shock as a punishment for getting the chocolate-flavored pellet. The mice were then divided into addicted and nonaddicted categories and ended up with 25% of mice being addicted.

Discussion

This paper aimed to look at FA and find complementary and integrative treatment plans. Looking at Food Addiction (FA) as a diagnosis, the tools to assess FA and confirm a diagnosis, and issues for comorbidities and triggers, including emotional, learned behavior, cognitive, stress-induced, and even foods that are addictive, there was no confirmed treatment. The goal was to look at FA and its triggers to learn how to treat it because of a history of unsuccessful attempts with standard diet and exercise (Gordon et al., 2020). Due to physical comorbidities that result in chronic and lifetime health issues, it is important to curb FA (Vajravelu et al., 2023).

FA has been defined as an addiction to energy-dense foods and can be linked to the same chemical reactions in the brain related to addiction and the dopamine reward system, as pointed out by Shankweiler et al. (2023) and Hauck et al. (2020). FA has also been identified by Rijkers et al. (2019) to be a maladaptive coping mechanism that has been linked to learned behavior and emotions triggered by trauma. Being able to heal our traumas could have the potential to curb FA, which would lead to a final goal of healing our minds, bodies, and spirits.

Not everyone's FA triggers are the same, so the treatment plan should be customized to focus on the triggers depending on whether it is maladaptive coping, learned behavior, or being addicted to foods (Jiminez et al., 2019). Martin-Garcia et al. (2019) have shown that Operant conditioning may just be what we need for the learned behavior aspect of food addiction, while Song et al. (2019) theorizes that neuromodulation would be beneficial for addictive foods and the brain's reward system. 

 Looking at the research, standard treatment of diet and exercise has failed because it did not incorporate the cognitive aspect or individual experiences like trauma and maladaptive coping mechanisms into the treatment plan. All of the research agrees that more studies must be completed to better understand and recommend looking at different cognitive, emotional, complementary, and integrative plans.

Looking at current and potential treatments, there is still a long way to go to find a plan that would act as a treatment protocol, and currently, it appears to be grasping at straws. Based on available treatment therapy, there is speculation about what needs to happen and what might be helpful, but information is lacking. While we have come far in the last five years, there is still a long way to go.

Conclusions and Recommendations

The outcome of the research is that light is being shed on Food addiction and that there are many different reasons for food addiction. The research has shown that maladaptive coping, trauma, emotional mindset, learned behaviors, and actual addictive foods can cause someone to have a food addiction. Without an official diagnosis or knowing the triggers of food addiction, you cannot formulate a treatment plan

Current standards of practice focus on treating the comorbidities and the results of food addiction, such as obesity, diabetes, high cholesterol, etc., with diet and exercise. While one of the studies showed promising results with diet and exercise, the results were short-lived (Gordon et al., 2020). Multiple articles agree that a different approach is needed and that treatments should include individualized, complementary/integrative therapies that include behavior, cognitive, and neuromodulation. The research is promising but still lacks any tried-and-true treatment plans.

References

Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS (2019). Food addiction:           implications for the diagnosis and treatment of overeating. Nutrients.11:2086.      http://doi.org/10.3390/nu11092086 

Anjum, A. & Jahangir, I. (2020). Fast Food Addiction, Body Esteem, and Psychological Well- Being among University Students. Pakistan Armed Forces Medical Journal, 70(4), 11141118. https://doaj.org/article/9989207e38eb47fa9efb030d393babaf 

Bou Khalil, R., Sleilaty, G., Richa, S., Seneque, M., Iceta, S., Rodgers, R., Alacreu-Crespo, A.,    Maimoun, L., Lefebvre, P., Renard, E., Courtet, P., & Guillaume, S. (2020). The Impact of Retrospective Childhood Maltreatment on Eating Disorders as Mediated by Food       Addiction: A Cross-Sectional Study. Nutrients, 12(10), 2969.    https://doi.org/10.3390/nu12102969 

Bryant, E.; Rehman, J.; Pepper, L.B.; Walters, E.R. (2019). Obesity and Eating Disturbance: The Role of TFEQ Restraint and Disinhibition. Curr. Obes. Rep., 8, 363–372.           https://doi.org/10.1007/s13679-019-00365-x 

Claudat, K., Brown, T. A., Anderson, L., Bongiorno, G., Berner, L. A., Reilly, E., Luo, T., Orloff,       N., & Kaye, W. H. (2020). Correlates of co-occurring eating disorders and substance use  disorders: a case for dialectical behavior therapy. Eating disorders, 28(2), 142– 156. https://doi.org/10.1080/10640266.2020.1740913 

Ghanbari, N., Nooripour, R., Firoozabadi, A., Tabassom Saeid, P. V., Wisniewski, P., & Hosseini, S. R. (2022). Psychometric assessment of Persian translation of Yale Food Addiction  Scale Version 2.0 (YFAS 2.0) in Iranian college students. Journal of Eating Disorders, 10,1-9. https://doi.org/10.1186/s40337-022-00689-5 

Gordon, E. L., Merlo, L. J., Durning, P. E., & Perri, M. G. (2020). Longitudinal Changes in Food  Addiction Symptoms and Body Weight among Adults in a Behavioral Weight Loss  Program. Nutrients, 12(12), 3687. https://doi.org/10.3390/nu12123687 

Grethe, E. R., Solbakken, H. H., Abebe, D. S., Aaseth, J. O., Bolstad, I., & Lien, L. (2021).  Inpatients experience about the impact of traumatic stress on eating behaviors: an        exploratory focus group study. Journal of Eating Disorders, 9, 1-12.           https://doi.org/10.1186/s40337-021-00480-y

Hauck, C., Cook, B., & Ellrott, T. (2020). Food addiction, eating addiction, and eating disorders. The Proceedings of the Nutrition Society, 79(1), 103- 112. https://doi.org/10.1017/S0029665119001162

Hazzard, V. M., Bauer, K. W., Mukherjee, B., Miller, A. L., & Sonneville, K. R. (2019).            Associations between childhood maltreatment latent classes and eating disorder     symptoms in a nationally representative sample of young adults in the United            States. Child abuse & neglect, 98, 104171. https://doi.org/10.1016/j.chiabu.2019.104171

Impact of a Phone-based Cognitive and Behavioral Therapy on Food Addiction in Patients with Severe or Morbid Obesity (ADALOB) (2023). https://clinicaltrials.gov/study/NCT04626570 

Jebeile, H., Gow, M. L., Baur, L. A., Garnett, S. P., Paxton, S. J., & Lister, N. B. (2019).   Treatment of obesity, with a dietary component, and eating disorder risk in children and  adolescents: A systematic review with meta-analysis. Obesity reviews: an official journal  of the International Association for the Study of Obesity, 20(9), 1287–1298.  https://doi.org/10.1111/obr.12866 

Jiménez-Murcia, S., Agüera, Z., Paslakis, G., Munguia, L., Granero, R., Sánchez-González, J., &  Fernández-Aranda, F. (2019). Food addiction in eating disorders and obesity: analysis of clusters and implications for treatment. Nutrients, 11(11), 2633.    https://doi.org/10.3390/nu11112633 

Lacroix, E., Tavares, H., & von Ranson, K. M. (2018). Moving beyond the "eating addiction" versus "food addiction" debate: Comment on Schulte et al. (2017). Appetite, 30, 286 292. https://doi.org/10.1016/j.appet.2018.06.025 

Leary, M., Pursey, K. M., Verdejo-Garcia, A., & Burrows, T. L. (2021). Current Intervention   Treatments for Food Addiction: A Systematic Review. Behavioral Sciences, 11(6), 80.     https://doi.org/10.3390/bs11060080 

Linardon, J., & Messer, M. (2019). Assessment of food addiction using the Yale Food Addiction  Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance. Psychiatry Research, 279, 216-221. https://doi.org/10.1016/j.psychres.2019.03.003

Lopez-Lopez, D. E., Saavedra-Roman, I. K., Calizaya-Milla, Y. E., & Saintila, J. (2021). Food  Addiction, Saturated Fat Intake, and Body Mass Index in Peruvian Adults: A Cross  Sectional Survey. Journal of nutrition and metabolism, 2021, 9964143. https://doi.org/10.1155/2021/9964143 

Lozano-Madrid, M., Clark Bryan, D., Granero, R., Sánchez, I., Riesco, N., Mallorquí-Bagué, N.,  & Fernández-Aranda, F. (2020). Impulsivity, emotional dysregulation, and executive         function deficits could be associated with alcohol and drug abuse in eating            disorders. Journal of Clinical Medicine, 9(6), 1936. https://doi.org/10.3390/jcm9061936 

Martín-García, E., Domingo-Rodriguez, L., & Maldonado, R. (2020). An Operant Conditioning  Model Combined with a Chemogenetic Approach to Study the Neurobiology of Food Addiction in Mice. Bio-protocol, 10(19), e3777. https://doi.org/10.21769/BioProtoc.3777 

McMullin, S. D., Shields, G. S., Slavich, G. M., & Buchanan, T. W. (2021). Cumulative lifetime   stress exposure predicts greater impulsivity and addictive behaviors. Journal of Health Psychology, 26(14), 2921–2936. https://doi.org/10.1177/1359105320937055 

Meadows, A., & Higgs, S. (2020). Internalized weight stigma and the progression of food     addiction over time. Body Image, 34, 67– 71. https://doi.org/10.1016/j.bodyim.2020.05.002

Mills JG, Thomas SJ, Larkin TA, Deng C. (2020). Overeating and food addiction in major       depressive disorder: links to peripheral dopamine. Appetite.  https://doi.org/10.1016/j.appet.2020.104586

Nolan, L. J., & Jenkins, S. M. (2019). Food Addiction Is Associated with Irrational Beliefs via   Trait Anxiety and Emotional Eating. Nutrients, 11(8), 1711.    https://doi.org/10.3390/nu11081711 

O'Hea, E.L., Edwards-Hampton, S., Beall Brown, D., L., S., K. R., Z., D. M., &  Gearhardt, A.  N. (2024). The Food Addiction Clinical Treatment (FACT) Manual: A Harm Reduction            Treatment Approach. Behavioral Sciences, 14(7), 557.     https://doi.org/10.3390/bs14070557

Osadchiy, V., Mayer, E. A., Bhatt, R., Labus, J. S., Gao, L., Kilpatrick, L. A., & Gupta, A.                       (2019). History of early life adversity is associated with increased food addiction and sex  specific alterations in reward network connectivity in obesity. Obesity science &        practice, 5(5), 416–436. https://doi.org/10.1002/osp4.362

Paterson, C., Lacroix, E., & von Ranson, K. M. (2019). Conceptualizing addictive-like eating: A  qualitative analysis. Appetite, 141, 104326. https://doi.org/10.1016/j.appet.2019.104326

Praxedes, D. R. S., Silva-Júnior, A. E., Macena, M. L., Oliveira, A. D., Cardoso, K. S., Nunes, L.       O., Monteiro, M. B., Melo, I. S. V., Gearhardt, A. N., & Bueno, N. B. (2022). Prevalence  of food addiction determined by the Yale Food Addiction Scale and associated factors: A   systematic review with meta-analysis. European eating disorders review the journal of  the Eating Disorders Association, 30(2), 85–95. https://doi.org/10.1002/erv.2878    

Rijkers, C., Schoorl, M., van Hoeken, D., & Hoek, H. W. (2019). Eating disorders and   posttraumatic stress disorder. Current opinion in psychiatry, 32(6), 510- 517. http://doi.org/10.1097/YCO.0000000000000545

Rodda, S. N., Booth, N., Brittain, M., McKean, J., & Thornley, S. (2020). I was truly addicted to   sugar: A consumer-focused classification system of behavior change strategies for sugar  reduction. Appetite, 144, 104456. https://doi.org/10.1016/j.appet.2019.104456 

Ruddock, H. K., Orwin, M., Boyland, E. J., Evans, E. H., & Hardman, C. A. (2019). Obesity           Stigma: Is the 'food addiction label feeding the problem? Nutrients, 11(9), 2100.    https://doi.org/10.3390/nu11092100 

Sarkar, S., Kochhar, K. P., & Khan, N. A. (2019). Fat Addiction: Psychological and Physiological  Trajectory. Nutrients, 11(11), 2785. https://doi.org/10.3390/nu11112785 

 Schankweiler, P., Raddatz, D., Ellrott, T., & Carolin, H. C. (2023). Correlates of Food Addiction and Eating Behaviours in Patients with Morbid Obesity. Obesity Facts, 16(5), 465-474.

https://www.proquest.com/scholarly-journals/correlates-food-addiction-eating- behaviours/docview/2900328216/se-2 

Stojek, M. M., Lipka, J., Maples-Keller, J. M., Rauch, S. A. M., Black, K., Michopoulos, V., &            Rothbaum, B. O. (2021). Investigating Sex Differences in Rates and Correlates of Food  Addiction Status in Women and Men with PTSD. Nutrients, 13(6), 1840.    https://doi.org/10.3390/nu13061840 

Song, S., Zilverstand, A., Gui, W., Li, H., & Zhou, X. (2019). Effects of single-session versus

multi-session non-invasive brain stimulation on craving and consumption in individuals  with drug addiction, eating disorders or obesity: A meta-analysis. Brain Stimulation,    12(3), 606–618. https://doi.org/10.1016/j.brs.2018.12.975 

Vajravelu, M. E., Tas, E., & Arslanian, S. (2023). Pediatric Obesity: Complications and Current     Day Management. Life, 13(7), 1591. https://doi.org/10.3390/life13071591 

Vasiliu O. (2022). Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature  Review. Frontiers in psychiatry, 12, 824936. https://doi.org/10.3389/fpsyt.2021.824936 

Wiss, D., & Brewerton, T. (2020). Separating the Signal from the Noise: How Psychiatric         Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients, 12(10), 2937. https://doi.org/10.3390/nu12102937

Wiss, D.A.; Brewerton, T.D. (2020). Adverse childhood experiences and adult obesity: A           systematic review of plausible mechanisms and meta-analysis of cross-sectional            studies. Physiol Behav. 223, 112964. https://doi.org/10.1016/j.physbeh.2020.112964