Is Food Addictive? Nicole M. Avena, Ph.D.

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1 Is Food Addictive? Nicole M. Avena, Ph.D.

2 Obesity in the US ~69% of adults in the U.S. are overweight, of which ~36% are obese. Being obese or overweight is associated with multiple comorbid health concerns (e.g., heart disease, diabetes). Increased body weight can also have psychological, economical, and social consequences.

3 Why are so many people overweight or obese?

4 Obesity is an endpoint, with multiple contributing factors Sedentary lifestyle Genetic disorders (Prader- Willi syndrome) Genetic vulnerability Increases in portion sizes Obesity Food accessibility Food Reward/Hedonics (addiction?) Stress and endocrine factors Social norms regarding food

5 Food Acquisition is Easier Than it Used to Be

6 Portion Size and Portion Creep

7 Types of Food Cues People frequently think of food cues as advertisements or savory smells, but they can also come in more subtle forms. Food cues can be divided into two categories: those that are sensory (i.e., smell, taste, etc.), and those that are normative (i.e., cues that signal how much is appropriate to eat). One example of a normative food cue is portion sizes.

8 Hunger- vs. Hedonically-driven Eating

9 Hunger- vs. Hedonically- driven eating People sometimes eat because they want to eat, not because they have to eat (people may eat because of boredom, stress, etc.) Foods that are rich in fats and sugars, and consequently calories, often taste good. Palatable food is ubiquitous for most people in our society. Food is a part of our social lives.

10 Added Sugar Consumption in the United States Added sugar, as measured here, includes: white, brown and raw sugar, syrup, honey, and molasses that were eaten separately or used as ingredients in processed or prepared foods such as breads, cakes, soft drinks, jams, and ice cream. The National Cancer Institute (2010)

11 How Much Sugar is Too Much Sugar? The New Dietary Guidelines for Americans recommend NO MORE than 10% of daily caloric intake come from added sugar If you are on a 2,000 calorie diet, no more of 200 of those calories should come from added sugars (50 grams or 12 teaspoons). Currently people eat ~ 355 calories from added sugar per day! Added Sugars DO NOT include foods and beverages that NATURALLY contain sugar, such as fruit, vegetables and milk

12 Examples of Foods With Lots of Added Sugar 16 oz Starbucks Caramel Frappaccino: 64g of sugar (128% of DV) 1 Classic Cinnabon Roll: 59g of sugar (109% of DV) 1 Dunkin Donuts Reduced Fat Blueberry Muffin: 40g (80% of DV) 1 pack of Pop-tarts: 28g of sugar (56% of DV) 1 Dannon Fruit on the Bottom : 24g of sugar (48% of DV)

13 Some Sources of Hidden Sugars Flavored and fruited yogurts Meal replacement bars and protein shakes Pasta sauce, BBQ sauces, salad dressings and ketchup Many hot cereals, cold cereals and granola Flavored tea and coffee drinks, energy and sports drinks Breads, crackers and kettle corn

14 What is a food?

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17 Does processing matter?

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22 What happens in reward-related parts of the brain when we eat? Drugs that are abused act on brain systems that evolved to reinforce natural behaviors (e.g., sex, feeding). There are overlaps in the brain pathways activated by palatable foods and drugs of abuse. Tulloch, Murray, Vaicekonyte, & Avena, 2015

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24 How Do We Define Addiction? The DSM-5 describes a substance use disorder as a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.

25 Assessing Addiction Using Animal Models BINGEING CRAVING WITHDRAWAL Enhanced locomotion Cross-sensitization Increased Consumption

26 Evidence for Sugar Addiction in Animal Models Increases in dopamine release wane with repeated exposure to chow; however, these increases continue in response to sugar (Rada, Avena and Hoebel, 2005) Sugar bingeing rats show signs of anxiety when given an opioid antagonist (naloxone) or when fasted from all food for 36 hours (Colantuoni et al, 2001). Rats that overeat sugar daily show increased responding for sugar following a period of abstinence (Avena et al, 2005).

27 Assessing Food Addiction In Clinical Samples

28 The Yale Food Addiction Scale (YFAS) has been created to study food addiction in clinical samples by applying the DSM-IV criteria for substance dependence to eating behaviors. Questions are answered using a Likert-type scale (i.e., Never, Once a month, 2-4 times a month, 2-3 times a week, 4 or more times or daily). Sample items: Yale Food Addiction Scale I find myself continuing to consume certain foods even though I am no longer hungry I eat to the point where I feel physically ill I find that when I start eating certain foods, I end up eating much more than planned

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30 Most Problematic Foods Other Problematic Foods French Fries Popcorn (Buttered) Cheeseburger Breakfast Cereal Soda (Not Diet) Cake Cheese Bacon Fried Chicken Rolls (Plain) Factors Associated With Problematic Eating Large Positive Predictors Processing Fat Glycemic Load Small-to-Moderate Positive Predictors BMI YFAS Symptom Count Schulte et al., 2015

31 Summary Avena et al. (2012)

32 Thank you! Contact: DrNicoleAvena.com