York University researchers have published a qualitative study examining “how obese women with and without binge eating disorder (BED) experience overeating in relation to the DSM-5 [Diagnostic and Statistical Manual] symp- toms of addiction.” Claire Curtis & Caroline Davis, “A Qualitative Study of Binge Eating and Obesity From an Addiction Perspective,” Eating Disorders, January 2014. According to the study, the recently-published DSM-5 includes a new category for “Addiction and Related Disorders” that addresses “both substance use disorders (SUDs) and non-substance addictions” in addition to providing new diagnostic guidelines.

Using these expanded criteria, the authors interviewed 12 obese women with BED and 12 without BED, concluding that “both groups of women endorsed DSM-5 SUD criteria (in relation to food) in their narratives,” although there were “visible qualitative differences in how the women experienced these symptoms.” More specifically, Curtis and Davis reported that while both groups expressed a desire to reduce their food intake, participants with BED “focused on the uncontrollable aspect of binge eating” and were more likely to describe their symptoms as a “craving,”“urge,”“desire,” or “constant thought.”

“Except for one person in the non-BED group, all participants in our study met two or more criteria for a substance-use diagnosis (with food as the substance) as specified in the DSM-5,” the study suggests. “All those who self-identified as ‘addicted’ to food emphasized that it was only the highly palatable ‘junk food’ to which they felt dependent. The sweet foods they craved the most included candy, chocolate, cookies, brownies, ice cream, and cakes. Given that many of these foods are also high in fat, it may not be sugar alone that is driving their addictive feelings, but especially when it occurs in combination with fat.”

In a related development, University of California, San Francisco, pediatric endocrinologist Robert Lustig discusses the concept of food addiction in a January 2, 2014, Atlantic article titled “The Sugar Addiction Taboo.” In particular, he wonders whether food can truly be addictive “in the same way that alcohol, tobacco, and street drugs are,” raising questions about the necessity of fructose in the diet in addition to examining research focused on sugar’s effects on the brain. “The concept of sugar addiction will continue to evoke visceral responses on both sides of the aisle,” opines Lustig in the end. “One thing most agree on is that sugar should be safe—and rare… The industry feeds our sugar habit to the detriment of our society. We need food purveyors, not food pushers.”