Eating behavior is subject to a number of disorders, some of which are classified fairly precisely, such as bulimia and anorexia, while others are still poorly understood and described.
In practice, cases of obesity or distress related to an inability to control one’s appetite are managed on the basis of the factor of “body weight,” generally through approaches such as diets and nutritional re-education, as well as pharmacological treatments.
In reality, many overweight individuals who confront and struggle against thoughts about food every day, and who fail in their attempts to ignore or control their appetite, derive no benefit from dietary measures, simply because they are unable to manage them. This is not a matter of willpower, but of the fact that appetite, and therefore food-seeking behavior, cannot be controlled even when there is strong motivation to lose weight.
On the contrary, dieting often exacerbates thoughts and impulses concerning food in these people, and is experienced as a failed but also hateful attempt to deprive them of food. Rather than seeing their appetite reduced—which is the focus of their concern—they see the object to be consumed reduced. The brain identifies this object as essential and indispensable, and therefore reacts with increased voraciousness and frustration at the obvious inability to do what would normally be possible under ordinary circumstances: eat less and lose weight.
More importantly, these people know that the problem will not end with weight loss, and that the problem of appetite will return even after they have lost weight, resulting either in renewed weight gain or, at the very least, in chronic distress over the need to prevent that increase.
Pharmacological treatments for appetite control are effective in bulimia, but at present there is no reliable and safe medication that can keep appetite under control and be used continuously. Food addiction is therefore a “new” disorder, recently defined, which nevertheless fits the general model of an addiction—one of those addictions that are not directly chemical in nature.
Clinical Picture of Food Addiction
Being dependent on food may also include episodes of actual binge eating, involving the consumption of large quantities of food, as in classic bulimia, but this is not necessarily the case. An altered relationship with food, experienced in an excessively urgent and intense way, may manifest itself in the following forms:
Eating faster than normal, with the result that the food itself is enjoyed less.
Eating even when feeling full. Some people may use beverages, alcohol, or coffee to promote relaxation or gastric emptying so that they can introduce more food, or may ultimately induce vomiting.
Eating without any longer being able to distinguish between hunger and satiety—that is, eating without being hungry.
Taking pleasure in imagining oneself consuming food, and thinking, while engaged in other activities, about when one will “finally” be able to eat.
Realizing that one’s spending on food, as well as the amount of time devoted to eating, is increasing in an embarrassing way.
Eating alone, with a tendency to eat less when other people are present.
Essentially, food addiction is defined when:
The person desires food continuously and intensely, but in fact the gratification experienced during the meal is unsatisfactory and may even become unpleasant because of abdominal pain, shame, worsening mood and reduced energy levels after meals, perhaps accompanied by drowsiness. These symptoms may also be subtle in people who are not obese but merely overweight, and they may not be evident at the beginning but become more apparent over time.
The person finds themselves thinking, on the one hand, about consuming food as though it were the most gratifying thing in their day, while on the other hand cultivating the intention of eliminating food from their day—or rather, eliminating thoughts about food. At certain moments, a mental short circuit may develop in which the person concludes that the only way to escape this “obsession” with food is to eat enough and eat freely.
There are conspicuous forms characterized by the quantity of food consumed, which may lead the person to buy food secretly, keep it hidden, carry it with them constantly, and consume it in secret. There are also subtler forms, dominated by this daily struggle between appetite and the intention to control behavior, with body weight being compensated for by the ability to skip meals, exercise, or use other means.
Treating Food Addiction
Treatment often begins with a fundamental mistake: treating these cases as though they resulted from an abnormal appetite in terms of the way it is generated. The attempt is therefore made to restore a normal eating context and to modulate emotional, cognitive, and other factors in order to bring appetite back into line with hunger and prevent it from becoming associated with other meanings, such as gratification or self-medication of depressive states.
In reality, the tragedy of people dependent on food is that they often have an excessive appetite, sometimes from childhood, and reasoning about food and eating does not have much impact on their subsequent behavior.
Various antidepressants that reduce appetite in depressed or anxious individuals, or that treat classic bulimia, are in fact not useful for these forms. Their benefit often consists in reducing feelings of guilt and the tendency to ruminate about the problem, but they do not produce the expected results in terms of controlling eating behavior or achieving weight loss.
Diets can be successful, but the success is often temporary and is not followed by a satisfactory and stable equilibrium based on a more controlled eating pattern, which is nevertheless experienced as deprivation or renunciation.
Other pharmacological approaches aimed at controlling appetite and voracious eating, or corrective surgery for obesity, may therefore represent viable alternatives for individuals affected by these disorders.