Comfort Eating, Food Addiction, and the DSM-V Manual

Light Bedtime Reading

Not long ago we mentioned Jennifer LaRue Huget, the Washington Post reporter who began to take seriously the notion of food addiction after meeting Michael Prager. This is encouraging, because childhood obesity won’t be stopped until food addiction is understood to be as real as addiction to hard drugs, alcohol, and even the range of non-substance addictions like pornography, the Internet, gambling, and so forth.

Huget’s report and remarks about food addiction also attracted the attention of Dr. Kimberly Dennis, of Chicago’s Timberline Knolls Residential Treatment Center. According to information provided by Danielle Bickelmann and Susie Lomelino, Dennis is one of the many eating disorder specialists who view food addiction as a diagnosis that should be included in the upcoming, revised DSM-V Manual.

DSM is short for Diagnostic and Statistical Manual of Mental Disorders, compiled by the American Psychiatric Association. Everybody uses it for something — researchers, government agencies, clinicians, legislators, and pharmaceutical corporations. And, of course, health insurance companies. If a condition is included in the manual as a recognized psychiatric disorder, it is “legitimized,” so its victims can (depending on their particular insurance plan) be reimbursed for treatment. Timberline’s press release quotes Dr. Dennis, who says:

We need to treat these serious diseases whether they are listed in the DSM or not. But not being listed can make getting access to treatment difficult… It is a serious obstacle when food addiction is not included in the DSM Manual, and we must fight for its acceptance as a real mental health disease.

Of course, Dr. Pretlow has been saying all along that obesity needs to be recognized as a brain disorder, and the ability to diagnose food addiction is necessary if the obesity epidemic is to be quelled. This is equally true of adults and children. Comfort eating is a subject that deserves a lot of attention because it can blossom into food addiction.

Comfort eating is not a bad thing in itself. Food and bliss are inextricably linked in humans, it’s a survival trait. Is there any creature more contented than a baby at its mother’s breast? Nature has its reasons for setting things up this way. Sex feels good so the species can continue to propagate, and eating feels good so the individual can thrive.

But just as the procreative urge can go beyond reasonable bounds and become warped into any number of pathological behaviors, eating can take over a person’s life in a most unhealthful way. Comfort eating is one of the childish things we must put away if we want a successful adulthood. Comfort eating is appropriate for babies, not for grownups. To grow up is to know that food is for fuel, and that its quality is measured by standards other than flavor alone.

The appropriate attitude to food is that it is nutrition for the organism, not a reward for getting a good employee evaluation, or a compensation for getting a bad report card. Or a substitute for a missing parent, lover, or friend. Emotional distress needs to be met head-on, not smothered by ingesting half a pound of chocolate-covered bacon. The appropriate attitude for a healthy adult toward food is that it’s fuel for the body, not a band-aid for the psyche. Psychological self-medication with food is a bad path to take, leading to childhood obesity, adult obesity, and a whole slew of medical conditions that threaten the quality of life and even life itself.

When the brain realizes that pain, stress, and boredom are eased by the pleasure of the food, dopamine receptor changes start to take place in that all-important organ. Once significant dopamine changes have taken place in the brain, the person is no longer able to resist the food — he or she is addicted. How does Dr. Pretlow know this? From 10 years of messages, 134,000 of them, written by children and teens who respond to the Weigh2Rock website. He summarizes:

One third explicitly say they turn to food to ease sadness, stress, anger, fatigue, loneliness, and boredom, as well as the pain of being obese itself. For most, this ‘comfort eating’ appears to be unconscious or mindless. The disaster is that they become hooked on this behavior and unable to stop, even when distressingly overweight or obese because of it.

It appears that children initially overeat because “the food is there” — it simply tastes good, and it is comforting. But once their brains realize that pain, stress, and boredom are eased by the pleasure of the food, it becomes a habit. Meanwhile, dopamine receptor changes insidiously take place in their brains. Once significant dopamine receptor changes have taken place in their brains, the children are unable to cease the comfort eating — in other words, it’s no longer a habit but an addiction.

Children and teens have enough problems already just trying to grow up in this crazy world. Once food addiction gets its claws into them, a large portion of their attention, which needs to be on other things, is diverted into the struggle to resist their incessant thoughts about highly pleasurable foods, and their urges to go find something good to eat right now. This is why Dr. Pretlow, along with Dr. Dennis and an increasing number of health professionals, believes that addiction to certain foods should be included as a diagnosis in the next edition of DSM.

Your responses and feedback are welcome!

Source: “Timberline Knolls Responds to Washington Post Article on Food Addiction,” PRWeb, 01/30/11
Image by richardmasoner, used under its Creative Commons license.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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