by Kristina Lewis, MD, MPH, SM
Although most people will admit to a small sweet tooth, for some, the craving for sweets or other unhealthful foods leads to disordered eating and obesity. The term “food addiction” has been coined to describe the pattern of behavior observed in these individuals, and researchers at Yale have developed a questionnaire to look for these problem behaviors, just as a physician might screen for drug or alcohol abuse. The research has generated controversy, with many critics who argue that “addiction” is a concept that cannot be applied to food. Despite the criticisms, it is increasingly clear that for some patients with obesity, addictive behavior plays a role. Recent estimates suggest that up to 15% of adults seeking treatment for obesity may display behaviors that meet Yale’s criteria for food addiction.
Identifying patients who are food addicted doesn’t yet have implications for tailoring the treatment of obesity, however, unique approaches for this population may not be too far off. The FDA recently approved a weight loss medication (Contrave) in which a key active ingredient is naltrexone – the same drug that is used to block reward pathways in recovering opiate addicts. In Contrave, naltrexone is combined with bupropion, an antidepressant also used to curb tobacco addiction. Preliminary research on Contrave suggests that it diminishes food cravings and enhances the ability to control caloric intake, resulting in significant weight loss. Moving forward, it will be important to explore how this and other drug therapies, as well as known behavioral approaches to treating obesity, may differentially impact individuals with food addiction. Food addiction appears to be real, and we should take it seriously in our treatment approaches.