Where Does Food Fit on the Hierarchy of Addiction?

In an addiction hierarchy, where would food fit? Foods, such as fats, sugars and carbohydrates, are only very recently being recognized as addictive substances. Crack cocaine, heroin, and alcohol are all deadly addictions and widely recognized as such. The idea of food as addictive is a novel concept. Food has no place on a hierarchy of addiction.

Fortunately, the medical community and addiction specialists are beginning to understand that food does belong in an addiction hierarchy. The common hegemony of obesity being the fault of the individual and a result of a simple lack of willpower is proving false. There is an increased understanding of what goes on in the reward centers of the brain when presented with pleasurable stimuli. This neural response is similar for crack cocaine or alcohol as it is for sugars and fats. There may be a difference in intensity, and speed of access to the brain, but the addictive process is the same.

The prevailing societal belief is that obesity is the result of individual weakness. This response has been severely damaging to the food addict. It has shamed the food addict into perpetuating the addictive cycle of dieting and binging, which leads to further pathological eating behaviour. It has left the food addict alone without adequate resources: Because obesity has not been understood as an addiction there has been no organized professional attempt to treat it as an addiction. The addict is told to ‘learn’ to control ‘their drug’, and if the addict cannot, he or she is seen as weak or stubborn. We no longer expect this kind of willpower of the alcoholic or the drug addict.

The responsibility for the dissemination of this ideology lies at least in part with the food industry. Food is a multi-billion dollar business. Fast food, replete with ever-increasing fats and sugar, is just like heroin to the food addict. It is instant gratification. Dr. Kessler, in his book, The End of Overeating (2009) makes just this point, but stops short of naming our cravings for these ‘hits’ of fats and sugars as addictive. The diet industry further supports this hegemony. Most dieticians focus on limiting the content of food and its caloric value, rather than on focusing on the addictive nature of that substance. Telling a person they eat too much implies blame and shame of the individual; telling a person that they are eating a highly addictive substance which surpasses self control implies a societal, as well as an individual, solution. Avoid (rather than limit) the addictive substance.

By recognizing food as an addiction, we can start treating it. One in four Canadian children is obese. This has severe ramification for their health in the short term and in the long term. Many of these children will have diseases such as Type 2 diabetes, liver and breathing problems by the time they are thirty! Is it a stretch to suggest that holding a children’s birthday party at McDonald’s could be considered abuse? Indeed, an editorial in a leading medical journal (JAMA, see below #1) in the United States, where childhood obesity is one in three, has suggested that children who are obese should be removed from the parental home and placed in foster care.

Eric Clapton, when asked what drug he was first addicted to, said “Sugar!” It is not a stretch to suggest that sugar provides a gateway to the more ‘deadly’ drugs following… nicotine, THC, alcohol and cocaine. Ask an addict who is abstinent from their drug if they have resorted to their initial ‘drug of choice’ – sugar. It is a common phenomena that the recovering alcohol and addict has a pronounced (often rediscovered) sweet tooth.

It is so important, for the addict and indeed for society as a whole, to make sure certain foods are included when we speak of addictive substances. It is last and lowest on the list of addictive substances to be recognized. Should it not be just as high on the hierarchy of addiction as cocaine? Should it not be seen as just as deadly? Heart attacks, strokes, diabetes that are due to obesity kill more people than do drugs or alcohol.

Perhaps then, instead of blaming the parents for over feeding their children, or obese individuals for being stubbornly resistant to common sense, we can focus our attention on treating the addiction instead. It would seem to these authors that would be the most compassionate way to go.

1. State Intervention in Life-Threatening Childhood ObesityJAMA. 2011;306(2):206-207