Guest Post: Treatment For Addictive Eating: Many Shades of Grey

Pam Peeke MD, MPH, FACP
Food, Mood, Addiction Expert and Author

Continuing with the theme of food addiction, here is another guest post – this one by Dr. Pam Peeke, a Pew Foundation Scholar in Nutrition, Assistant Clinical Professor of Medicine at the University of Maryland, and Senior Science Advisor to Elements Behavioral Health, the USA’s largest network of residential addiction treatment centers. She is author of the New York Times bestseller The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction. Her website is http://www.drpeeke.com/

For years, the popular culture has embraced the relationship between food and addiction. It permeates our daily vernacular— “I’m hooked on bread”, “I need a candy fix”, “I can’t get off the stuff”, “I’m a carb addict”. Grocery store shelves are filled with colorful cereal boxes labeled “Krave”, as the food industry capitalizes on the consumers’ never ending hunger for another fix. History was made when a major weight management company aired its first Super Bowl commercial, choosing a “food as drug” theme, narrated by Breaking Bad actor Aaron Paul. Close your eyes, listen to the words, and you’d never guess that food, not drugs, was the focus. Companies and communities, however, cannot validate the phenomenon of addictive eating behavior—only science can do that.

Heeding the call to arms, nutrition and addiction researchers, led by Dr. Nora Volkow, Director of the National Institute of Drug Abuse, have spent the past ten years generating a critical mass of valid and credible science associating specific food products and addictive eating behavior. A tipping point was reached in 2012, when the peer reviewed and edited professional textbook Food and Addiction was published. A month later my consumer book, The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction, was released and the single most common response from my readers was “What took you so long?” We needed, and finally benefited from, new groundbreaking research.

We now know that certain foods, namely the “hyperpalatables”–sugary, fatty, salty food combinations— affect the brain’s reward center in a way identical to drugs and alcohol, triggering an abnormally high level of release of the pleasure chemical dopamine. Repeated hyper-stimulation of these reward pathways can trigger neurobiological adaptations that can lead to compulsive consumption despite negative consequences.

In 2009, Yale researchers developed the first assessment tool, the Yale University Food Addiction Scale, or YFAS, to identify individuals who demonstrated an addictive response to specific foods. Subsequent studies using the scale have shown that there is a wide spectrum of people who present with addictive eating behavior, especially in those who are overweight/obese, female, over 35, or who have existing disordered eating patterns such as binge eating disorder or bulimia. Ongoing investigations have noted that among women, there is a 90 percent association between food addiction and prior history of abuse, especially in childhood and adolescence. As well, the incidence of addictive eating in women increases with post-traumatic stress syndrome.

As scientific evidence continues to mount clarifying the connection between food and addiction, attention is now beginning to focus on treatment options. Treatment for addictive eating behavior is of particular interest to me as a scientist and a clinician. I recall one of my patients, a former alcoholic with a disabling sugar addiction, declaring, “If drinking is black and white – I drink or I don’t– sugar is more shades of grey than there are books.” Indeed, in contrast to drugs and alcohol, treatment for the psychobiological challenges of addictive eating is far more complex. In a prior blog, Dr. Vera Tarman addressed abstinence as one treatment option.

Who is the target treatment population? It’s not just obese, compulsive overeaters. It also includes thin, average and mildly overweight men and women experiencing a full range of eating disorders (ED), mood syndromes and substance abuse. Within these groups there are numerous intricate interconnections, interrelationships and co-occurrences. For instance, current research suggests that approximately 50% of those with an ED are also substance abusers, including 57% of men with binge eating disorder experiencing long-term drug and alcohol abuse. Cross addictions abound as people transition from drugs to cupcakes, from alcohol to sugar, and from bariatric surgery to alcohol. This complicated web of interrelationships is one reason that determining the precise prevalence of food addiction is such a challenge.

In essence, the larger the treatment population, the wider the spectrum of therapeutic modalities required, and thus, the greater the need to individualize and customize treatment for addictive eating behaviors. To address this challenge, I have created the Integrative Nutrition and Holistic Lifestyle Program at Malibu Vista in California. This women’s residential treatment program treats women, many of whom have co-occurring mood and food conditions, specifically addictive eating. This pilot program has garnered national attention including a recent NBC Today Show segment.

The program’s blueprint is based upon my three pronged, customized approach to: 1. mental/spiritual wellness (MIND); 2. whole food nutrition (MOUTH); and, 3. physical activity (MUSCLE). Therapists use a wide range of cognitive psychotherapeutic methods to treat mental health conditions including trauma. Body movement modalities include yoga, tai chi, and meditative walks to foster an improved mind-body association. Nutritionally, the chefs have eliminated any refined or processed foods, including table sugar and artificial sweeteners. Our culinary nutritionist, who is both a certified chef and registered dietitian, assesses each woman. This includes completion of the Yale Food Addiction Scale, a metabolic evaluation, and documentation of any history of substance abuse and disordered eating. An individualized plan is created and refined during the typical 4-5 weeks in-residence. Through hands-on cooking lessons and nutrition education sessions, individuals can reframe and redefine their relationship with food. Group fellowship is critical to ongoing support and success. Continued coaching continues upon discharge. For example, Sandie, featured in the Today Show segment, is now off her anti-anxiety medications, no longer binges, has halved her diabetes medication, and has thus far removed over 50 pounds of excess weight.

In honoring each woman’s unique story and the complexities of treating addictive eating behavior, the Malibu Vista team draws upon elements found from a multitude of resources, including but not limited to 12-step programs. Individualized strategies are designed to use a wide range of interventions to optimize body-brain-mind healing. The end goal is to help each person manage the triple challenge posed by the food-mood-addiction triad, and in doing so, create a blueprint for long term recovery, and success in navigating addictive eating’s many shades of grey.