Social, clinical, and policy implications of ultra-processed food addiction

The scientific understanding of addiction is evolving. Although addiction to certain foods is not included in diagnostic frameworks such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), research on this topic has grown rapidly in the past 20 years. Much of this research uses the Yale Food Addiction Scale (YFAS), which was developed to measure food addiction by assessing DSM-5 criteria for substance use disorder in the context of food intake (box 1). A recent analysis of two systematic reviews including 281 studies from 36 different countries found the overall pooled prevalence of food addiction using YFAS was 14% in adults and 12% in children. This reported prevalence is similar to the levels of addiction seen for other legal substances in adults (eg, 14% for alcohol and 18% for tobacco), but the level of implied addiction in children is unprecedented. In populations with defined clinical diagnoses, YFAS identified prevalence of food addiction reaches 32% in people with obesity having bariatric surgery,12 and over 50% in those with binge eating disorder. Food addiction based on the YFAS is also associated with core mechanisms of addiction, such as reward related neural dysfunction, impulsivity, and emotion dysregulation, as well as poorer physical and mental health and lower quality of life. Thus, there is converging and consistent support for the validity and clinical relevance of food addiction; what remains a more open question is the types of foods that are addictive. Despite the uncertainty, classifying foods as addictive could stimulate research and shift attitudes to regulation.