How Widespread Is Food Addiction?

IMG_0145 Wurzburg, Germany

“How prevalent is “food addiction?” is the title of a paper written by Adrian Meule, a doctoral student with the Department of Psychology at Germany’s University of Würzburg. In his introduction, Meule harks back to Dr. Theron Randolph, who recognized food addiction in 1956. Since then, as Childhood Obesity News has remarked, quite a number of other doctors have declared that food addiction is real.

The full disclosure here is that Meule speaks of Dr. Pretlow’s qualitative study of overweight-to-obese children and adolescents, but that’s not the only reason for paying attention. Even more interesting is the sentence that comes just before the reference to Dr. Pretlow’s work, a reminder that aside from his,

Only two studies examined food addiction symptoms in children and adolescents.

Isn’t that amazing? There is a general scarcity of studies investigating addictive eating, not only in children and teenagers, but even in adults. The science of assessing food addiction is in its infancy, and there is plenty of scope for additional research.

For instance, Meule writes:

… the prevalence of food addiction is increased in obese individuals and even more so in obese patients with binge eating disorder… Conversely, an arguably high prevalence of food addiction can also be found in under-, normal-, and overweight individuals. Future studies may investigate which factors are associated with addictive eating in non-obese individuals.

He looks at the many instances where “parallels have been drawn between substance dependence and excessive consumption of such hyperpalatable foods” — the various rat experiments, and the human studies showing that binge-eating disorder, bulimia nervosa, and obesity have something in common, namely that the patients “experience behavioral symptoms and neurochemical changes that are highly comparable to other addictive behaviors.”

Meule talks about the work of Ashley Gearhardt and the Rudd Center for Obesity Research and Policy, originators of the Yale Food Addiction Scale, and will have much more to say about it in a forthcoming publication (with A. Kübler), described as “a German translation and validation of the Yale Food Addiction Scale.”

Meule mentions various studies that have made interesting connections and suggest intriguing clues to the entire food addiction puzzle. For instance, it appears that patients with bulimia nervosa and with binge-eating disorder are also drawn to addictive drugs, while patients with anorexia nervosa are not.

Also, Meule writes,

In recent years, neuroendocrine pathways have been identified that are involved in both drug-and food-seeking behaviors. Specifically, appetite-regulating peptides like ghrelin, neuropeptide Y, orexin, or leptin have also been associated with craving for alcohol… On a neurochemical level, reduced striatal D2 receptor availability has been found in obese patients similar to patients with substance use…

What Dr. Pretlow has learned from the young people self-reporting on their conditions is that, out of the several possible diagnostic criteria that add up to addiction, they most usually experience these three: (1) consuming large amounts over a long period, (2) unsuccessful efforts to cut down, and (3) continued use despite adverse consequences. Meule quotes these as the most common food addiction symptoms and adds,

Tolerance and time effort are further, but less frequent symptoms. Withdrawal symptoms and reduction of social, occupational, or recreational activities are rarely reported.

Meule also notes that food addiction is not synonymous with obesity, since there are some normal-weight and even underweight individuals who answer to the description of food-addicted, without their body mass index being affected. This brings up another difficulty, that studies based on questionnaires place a different emphasis on questions, or phrase their questions differently. Use of a standardized measuring tool, such as the Yale Food Addiction Scale, can’t help but bring more accuracy and clarity into future studies.

Dr. Pretlow points out some of the problems with getting to the behavioral truth when patients are interviewed or asked to complete questionnaires:

Overweight individuals are embarrassed about their problem and also are concerned that they may lose their ‘drug.’ Further, although only 29% of children in my study felt they were addicted to ‘most’ foods, 37% felt they were addicted to ‘certain’ foods. If food addiction questionnaires focus on most or all food, prevalence rates of food addiction may appear erroneously low. Also, a lot of food-addicted individuals appear to exhibit compensatory behaviors that prevent significant weight gain, such as dieting, purging, and excessive exercise.

Another thing Meule points out is that the prevalence of food addiction is not sufficient to account for the current obesity epidemic. Yes, there is such a thing as addictive eating, but the epidemic can’t be fully attributed to that alone. This is where the Perfect Storm comes into the picture.

As Dr. Pretlow has written in Overweight: What Kids Say,

If kids truly become dependent on the comfort and stress relief of highly pleasurable foods, comparable to an addiction, and become overweight and obese because of this, why is this happening now? Pleasurable, comforting food has long existed. Why is the childhood obesity epidemic occurring today? Several extraordinary factors, which alone would not produce the childhood obesity epidemic, appear to have come together at the same time to produce the epidemic, in the same manner as unusual weather conditions occurring together produce a ‘Perfect Storm.’

Your responses and feedback are welcome!

Source: “How prevalent is “food addiction”?,”, 11/03/11
Source: “Overweight: What Kids Say,”
Image by Craig Wyzik, used under its Creative Commons license.

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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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