A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncrating clinical features
Davis (2017)
Appetite

Abstract

There is accumulating evidence that some vulnerable individuals display addictive symptoms in relations to their consumption of certain highly rewarding foods. Despite a positive relationship between obesity and addictive tendencies toward food, it is over-inclusive to model obesity as an addiction disorder, especially given the multi-faceted etiology and current pervasiveness of weight gain worldwide.

Introduction

The experience of ‘loss-of-control’ (LOC) over food consumption can reflect a clinically significant eating disturnabce irrespective of the amount of food that is eaten. Binge eating is neither a necessary nor a sufficient component of food addiction, and other forms of compulsive intake may also characterize this disorder.

Classification and causality

Obesity is a mutable physical state characterized by higher levels of adipose tissues than are deemed healthy, but which can change relatively rapidly as a result of alternations in energy input or energy expenditure. It is a condition that can only be assessed by proxy in the living organism. Obesity is a condition with multiple causes, which must, prominently, include dramatic changes in food environment during the same time period as tis most prominent increase. In addiction, casual factors tend to function in the form of interactions between our inherited biology and our physical surroundings.

Binge eating disorder has been conceptualized as a psycho-behavioural pathology. The diagnostic criteria include only behavioural and psychological symptoms. There are typically marked feelings of loss of control, and a guilty, disgusted, and depressed mood state. It is a culture-bound syndrome.

Addiction disorder are viewed as a state of developing pathology fostered by excessive motivation of rain reward circuitry, and inferred by symptoms like tolerance, withdrawal, and strong cravings, all of which have an established biological basis. They can be viewed as self-perpetuating clinical phenomena.

Commonalities

There is a strong empirical interconnection between obesity, binge eating disorder and addiction. If binge eating disorder persists over time, weight gain will occur given that the absence of compensatory behaviour is a hallmark of binge eating disorder. There is a comorbidity between binge eating disorder and food addiction. Binge eating disorder and food addiction are greatly over-represented in obese individuals.

Not all individuals with binge eating disorder meet the diagnosis for food addiction, nor vice versa. One viewpoint is that among those with binge eating disorder, food addiction may reflect a more compulsive and more severe form of the disorder.

‘Grazing’ as a compulsive form of overeating

Only a small proportion of obese adults in the general population report engaging in binge eating. Varied patterns of consumption are found in all substance-use disorders. There are various patterns of overeating that are relevant to the study of weight gain and obesity, and each of these may have the capacity to promote addictive tendencies toward food.

Food addiction can reflect different patterns of excessive and compulsive intake. Grazing is relatively continual or repetitive eating throughout the day. It can also be a defining feature of food addiction. It is not always compulsive and out of control.

Two forms of grazing are: 1) Compulsive, this is more frequently associated with eating disorders. The continuous consumption of small amounts of food, or of larger amounts eaten over an extended period of time. This is also the inability to resist such repetitive snacking despite intentions to stop. 2) Non-compulsive

Neuropsychobehavioural associations

The most prominent characteristic that all compulsive forms of overeating have in common is poor impulse control, which often leads to impaired decision making, especially when the outcomes of one’s actions are probabilistic in the future. High reward sensitivity has been associated with the risk of over-eating behaviours. Both poor impulse control and strong reward seeking facilitate the consumption of highly palatable foods.

Both risk factors are influenced by signalling strength in the brain’s mesocorticolimbic pathways. Both dopamine and endogenous opioid neurotransmitters are involved are involved interdependently in regulating responsiveness to reward via activation of this neural circuitry. This relationship appears to be moderated by BMI.

Among those who are obese, binge eating disorder is a biologically-distinct subtype. Adults with binge eating disorder self-reported higher impulsivity. Findings suggest a hypo-functioning in the reward circuitry in those with binge eating disorder.

Obesity and binge eating disorder hare heritable.

There are brain alterations related to high sugar consumption. Like striatal neuroadaptions, a decrease in dopamine concentrations. Such brain alterations might foster the compulsive intake of highly palatable foods.

Fetal brain alterations may occur in utero when mothers consume high-sugar diet during pregnancy, and such changes may produce ADHD-like symptoms in the offspring.