How was Food Addiction Left Out?

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As Childhood Obesity News has discussed before, the latest edition of the Diagnostic and Statistical Manual managed to omit recognition, in any way, shape, or form, of the reality of food addiction. What causes this ongoing delay? The medical establishment in Great Britain, as in other places, seems to have made up its mind. For a BBC Radio 4 program titled “Constant Cravings: Does Food Addiction Exist?” journalist Frankie Mullin wrote:

Addiction is defined by the National Health Service as “not having control over doing, taking or using something, to the point where it could be harmful to you.” Although addiction is most commonly associated with gambling, drugs, alcohol and nicotine, the NHS goes on to say that it is possible to be addicted to “anything.”

Yes, that word is “anything.” But DSM-5 is strangely silent on the addictive potential of edible products. Its chapter on “Feeding and Eating Disorders” includes anorexia and bulimia, but nothing about the most prevalent eating disorder on the planet, the one that causes millions to morph into grotesque, bloated caricatures of human beings. While anorexia and bulimia are serious and even life-threatening, they affect a very small fraction of the populace compared, for instance, to the devotees of chips or soda.

Maybe that explains the silence. If the Drug Enforcement Agency had to define chips and soda as Schedule I or II substances along with heroin, methamphetamine, and cocaine, it would lead to a legislative nightmare and a great deal of societal awkwardness. For instance, school sports teams, which are not currently allowed to let South American drug cartels pay for their uniforms, would no longer be allowed to accept sponsorship from food and beverage corporations.

The easiest and most superficial reason for the omission of food addiction could be that while experts do recognize the basic phenomenon, they just haven’t been able to classify it to their own satisfaction. Does compulsive overeating stem from the addictogenic nature (either inherent or contrived) of some foods? Or has it really been a behavioral addiction all along? But still — many other disorders are included and acknowledged as illnesses, even though they are not understood in every detail.

Is There Motion? Yes. Is it Body-Focused? Yes. Repetitive? Yes.

Food addiction might have fit into the book under “Obsessive Compulsive and Related Disorders.” Consider a person’s need to repeatedly cut a slab of meat with a knife; or to repeatedly clench a pizza slice between the teeth and sever a bite; or to repeatedly plunge the hand into a popcorn bag and then bring the fingers to the mouth; or to repeatedly chew or swallow. A case could be made that all those things are body-focused repetitive behaviors, or even (in a different chapter) stereotypic movement disorders.

Why not? When someone compulsively bites her or his own lip, cheek, or nails, “These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” That’s according to the book — which, by omitting compulsive eating, seems to imply that the daily habit of robotically ingesting many pounds of food somehow does NOT cause distress and impairment.

But we know that it does — in every possible functional realm, not just occupational and social, but in basic physical health. Indeed, compulsive overeating is so destructive, it could easily fit into the section on “Nonsuicidal Self-Injury” or even make its debut as star of the “Suicidal Behavior Disorder” category. Again — why not?

By the way, anyone who thinks that the newest edition of the Diagnostic and Statistical Manual makes sense, even to professionals, or who believes that the latest set of changes went down easily, is invited to read Dr. Stuart Gitlow’s “DSM-5: New Addiction Terminology, Same Disease.”

Your responses and feedback are welcome!

Source: “Food addiction: know the facts,”, 01/05/2013
Source: “DSM-5 Table of Contents, 2013
Image by Valerie Everett

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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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