Background: This presentation will focus on genetic evidence, brain imaging, neurological similarities. cross addiction, DSM-V, and animal studies to elucidate whether or not food is addictive. The emphasis will be on how to design therapeutic guidelines that will not only stop the binge eating, but also demonstrate long term relapse prevention.
Introduction: Can you be addicted to food?
Definition of food addiction & ADA guidelines
Arguments for and against food addiction: genetic evidence; brain imaging; opioid dependence; neurological similarities; cross addiction; serotonin malfunction; DSM-V; animal studies; Physiological and biochemical support
Exploring which components of food are addictive: : sugar, fat, sugar and fat combined, salt, refined starches, highly palatable foods, processed foods, gluten, chocolate, fast foods, trigger foods, excess volume or all the above
Validating measurements of food cravings: Yale Food Addiction Scale (YFAS) (Gearhardt ‘08).; Three Factor Eating Questionnaire (TFEQ) (Stunkard ‘85); Food Preference Questionnaire (FPQ) (Geiselman ‘98); Food Craving Inventory (FCI) (White ‘02); State Food Cravings Questionnaire (FCQ-S) (Rodríguez ‘05) and the Power of Food Scale (PFS) (Lowe ’09)
Dichotomous way of solving problem eating. Is this practical? The abstinence model lends itself to black and white thinking (success or failure) which locks one into absolute standards
The addiction trap: What to do if and when abstinence fails. This potentially can set the person spiraling into believing they have failed miserably and there is no hope. Outcomes should be focused not just on abstinence but also include quality of life, interpersonal relations, healthy food choices, heightened activity levels, vocational performance, emotional stability, improved self-worth, increased self-efficacy and reducing insomnia
The concepts of unmanageable and control. The concepts of unmanageable and control. It would be hard to be passionate and motivated about helping those who suffer with binge eating disorder if a cure (permanent recovery) were not possible.
Support systems: Design and Focus
Abstinence as an impediment to behavioral change
Changing the way we think and applying self-monitoring skills
Solutions: What treatment is best?
Assessment and an integrated model
Therapeutic resources: cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), exposure response therapy (ERT), or dialectical behavioral therapy (DBT).
Summary and conclusion
A controversy beings when the question arises as to whether or not binge eating should be labeled as an addiction? If it is categorized as an addiction, then it is critical to acknowledge how this diagnosis drives treatment which ultimately includes abstinence. It is imperative that science and research explore the advantages and disadvantages of the two approaches: abstinence or non-abstinence. To date there is no comparative data available to substantiate claims of either model. The heterogeneous nature of the disorder and the varying layers of severity should be examined to address the improbability that any single form of treatment will prove superior for all patients. Good recovery and not so good recovery has been observed in both approaches. Eventually it may be necessary to match patients with the strategies that fit their individual characteristics and circumstances. There might be an advantage to advocating a window of time whereby an individual temporarily eliminated foods identified to be triggers. A trial period of elimination might be appropriate in order to turn down the overwhelming impulses to eat highly palatable foods, a time to engage in the appropriate decision making skills and the opportunity to develop a strong support system. Perhaps this could be analogous to the detox period that drug addicts submit to after they crash. This transitional period would be followed by exposure response therapy to gain trust that the unmanageable component of the craving is not permanent. The aim is “to show patients that they don’t gain weight when they eat trigger foods in reasonable amounts. The other goal is “to show patients that they can eat reasonable amounts of trigger foods when they eat regularly rather than in a chaotic or binge eating pattern.” A check-list of specific skills with measurement of mastery of those skills should be ongoing. Continuous throughout this recovery process will be addressing the underlying causes, be they emotional, habitual, innate or circumstantial.
Dr. Carson has been involved in the clinical treatment of obesity, addictions and eating disorders for over 35 years. Dr Carson graduated from Duke and Duke University Medical School and received his doctorate at Auburn University. He is currently the Executive Director of FitRx, an intensive outpatient treatment program addressing people of size located near Nashville, TN. Dr Carson is an active Board member of iaedp and the Binge Eating Disorder Association (BEDA). He is the author of "Harnessing the Healing Power of Fruits" and the recently published "The Brain Fix: What’s the Matter with Your Gray Matter?"
