Stories abound about overeating during the stress and hardship of the COVID-19 pandemic. But, before COVID-19, obesity was already at epidemic levels in developed nations. Here in Canada, almost two-thirds of the population is overweight or obese, similar to the United Kingdom. In the United States, nearly three out of four people are overweight or obese. These high rates are unfortunately not new, but what is gaining increasing recognition is that many people report a compulsive relationship with food akin to drug addiction: food addiction.
Previously, research on food addiction tended to focus on specific sub-populations, like individuals awaiting bariatric surgery, but we recently investigated food addiction in a large number of adults from the general population. We examined its prevalence and links with obesity, quality of life, and psychological measures of self-regulation. Overall, nearly one in 10 met criteria for food addiction and the prevalence was double among obese individuals. In both obese and non-obese individuals, food addiction was associated with a sizable reduction in quality of life, overall and specifically for psychological, physical, and social functioning. Finally, food addiction was associated with psychological measures of self-regulation that are commonly correlated with drug addiction, especially problems with emotional regulation and cognitive control.
What are the causes of food addiction? Quite simply, the same as drug addiction. Drugs are addictive in part because they potently stimulate ancient neurobiological circuits that underlie drives for food and sex. In the modern world, the food industry has effectively engineered hyperpalatable foods that are similarly potent, to disastrous ends. These hyperpalatable foods are highly processed products containing high levels of sugar, salt and fat that act synergistically to promote overconsumption. Rather than being a single type of food, hyperpalatable foods fall into three categories, those combining fat and salt (e.g., bacon), those combining fat and sugar (e.g., ice cream), and those combining sugar and salt (e.g., potato chips). The common factor is that these foods are potent stimulators of the same neurotransmitters that are affected by psychoactive drugs. Indeed, an increasingly large scientific literature of animal and human studies suggests parallel processes in the brain for hyperpalatable foods and addictive drugs. Hyperpalatable foods are remarkable both in their composition — the density of sweetness, saltiness, fattiness, and, ultimately, caloric impact — and in their manufacturing for rapid ingestion and absorption. They are deliberate feats of food engineering to maximize consumption. Critics disingenuously reject the concept of food addiction because food is a biological necessity, but hyperpalatable foods are engineered to be supernormal stimuli that affect the body and brain with extraordinary intensity. Our bodies have no innate requirement for McDonald’s, Doritos, or Ben & Jerry’s. Moreover, the alarming thing is just how widespread these foods are: nearly two-thirds of the items in a widely used food database were classified as hyperpalatable. It’s not just traditional notions of “junk food,” but aisle after aisle of heavily processed foods in the grocery store.
So what needs to be done? We need a co-ordinated multi-pronged approach to transform the dietary landscape. This includes strategies to reduce consumption of hyperpalatable foods, including marketing restrictions, especially to children, and supplemental taxes, such as the so-called “soda tax,” but to hyperpalatable foods more generally. In essence, we need to apply the strategies that have been successful in tobacco control to hyperpalatable foods. Perhaps even more important are strategies to promote consumption of healthy foods, those that are highly nutritious, high in fibre, and low in calorie density (i.e., the ratio of calories to food weight), such as fruits and vegetables. This includes agricultural subsidies and consumer incentives to make healthy food available, affordable and accessible. Quite simply, we need to make healthy foods as cheap and ubiquitous as hyperpalatable foods currently are.
These are Pigouvian strategies, named for economist Arthur Pigou, who proposed regulatory remedies for downstream effects that are not factored into product prices. In other words, we need to change the contingencies of the food landscape using both sticks and carrots (sometimes literally, in the case of carrots). Critics will reject these recommendations as being too costly, but the reality is that, beyond the human toll, the current inaction imposes vast economic health-care costs. Indeed, by not pricing hyperpalatable foods to reflect these downstream consequences (and subsidizing access to healthy foods), we implicitly permit the food industry to privatize profits and socialize the costs of food overconsumption. Beyond the marketplace, making evidence-based prevention and treatment for obesity universally available is essential and developing interventions for food addiction is warranted. One natural strategy would be adapting effective drug addiction treatments, such as such as motivational interviewing and cognitive-behavioural therapy, for food addiction also.
The COVID-19 pandemic has caused astronomical levels of disruption, stress, and pain, so, of course, many are finding solace in comfort foods. As a psychologist, it’s hard not to feel this commentary is clueless, tone deaf, or both. But the health consequences of overconsumption of food — obesity, diabetes, heart disease — are indeed part of the burden of COVID-19; they are major risk factors for the worst outcomes from the disease. Now is not the time to be blinkered about our toxic eating environment. We need to overhaul a food system that is poisoning us.