Ultra-processed foods may be as addictive as smoking

The study authors looked at an analysis of two systematic reviews that included 281 studies from 36 countries. From this data, the researchers reported that by the standards of the Yale Food Addiction Scale ultra-processed food addiction is estimated to occur in 14% of adults and 12% of children.

For comparison, the study authors pointed out levels of addiction in other legal substances in adults are 14% for alcohol and 18% for tobacco. The level of 12 percent for children is “unprecedented,” the researchers noted.

The Yale Food Addiction Scale assesses 11 symptomatic criteria for substance use disorder, including diminished control over intake, cravings, withdrawal, and continued use despite negative outcomes.

The study authors also said ultra-processed foods are associated with “biopsychological mechanisms of addiction and clinically significant problems.”

Among people with defined clinical diagnoses, the Yale Food Addiction Scale identified prevalence of food addiction reaches 32% in people with obesity who have bariatric surgery and more than 50% in those with binge eating disorder.

Food addiction based on the Yale scale 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.

While pointing out that not all food has addictive potential, the study authors identified types of food that can be addictive according to the Yale scale.

These included foods with high levels of refined carbohydrates or added fats, such as sweets and salty snacks.

Those are identified as food “most strongly implicated” as behavioral indicators of addiction, such as excessive intake, loss of control over consumption, intense cravings, and continued use despite negative consequences.

Refined carbohydrates or fats evoked “similar levels of extracellular dopamine in the brain striatum to those seen with addictive substances such as nicotine and alcohol,” the researchers reported.

The study authors said ultra-processed foods — industrially produced foods containing ingredients typically not available in home kitchens — are the main source of refined carbohydrates and added fats in the modern food supply.

The combination of these refined carbohydrates and fats seems to have a supra-additive effect on brain reward systems, the study authors noted.

The speed at which ultra-processed foods deliver carbohydrates and fats to the gut may also reflect their addictive potential. Drugs and routes of administration that affect the brain more quickly have a higher addictive potential, the research team said.

Which is why a cigarette, which rapidly delivers nicotine to the brain, is more addictive than a slow-release nicotine patch.

According to the study, additives may also contribute to the addictiveness of ultra processed foods, many of which have flavor additives increasing sweet and savory tastes. Additives meant to improve flavor include those found in cigarettes, sugar, cocoa, menthol, and alkaline salt.

The authors acknowledged there are still unanswered questions. They also say specific ingredients found in cigarettes, such as tobacco, haven’t been found in possibly addictive food and refined carbohydrates and fats don’t act on reward systems directly, though “they seem to activate neural reward systems to a similar magnitude as nicotine and ethanol.”

Dr. Sue Inonog, an internal and primary care physician for Harbor Health in Austin, Texas, told Medical News Today the study is an “illuminating call to action given the alarming and growing rates of obesity around the world.”

Inong said it’s especially pertinent given disparities in obesity rates for certain ethnic and/or disadvantaged groups that don’t have as much access to healthy food.

“[Ultra-processed foods] are the main source of refined carbohydrates and fats in the modern food supply,” Inonog said. “The authors further describe research noting the impact of refined carbohydrates and fats on the brain pathways that are involved in addiction. It is paramount to understand how and which elements of [ultra-processed foods] impact our neural-circuitry akin to how certain substances/situations impact the brain pathways that lead to substance use disorders.”

Inonog said she’s treated people “who frequently consumed [ultra-processed foods], as they were often the most affordable, accessible, and calorically dense option.”

“While I worried about the impact of [ultra-processed foods] on developing obesity and/or obesity complications, I now also worry if they additionally have unintentionally placed themselves at increased risk for a food addiction,” she said. “If we understand what elements harm our health, including the role of [ultra-processed foods], then we can work through comprehensive channels to address the culprit(s) in our society.”

Carlos Fragoso, a registered dietitian with a private practice in New York City, told Medical News Today it’s no coincidence there are few naturally occurring or minimally processed foods that contain both carbohydrates and fats, but ultra-processed foods associated with addiction are high in both.

“From an evolutionary perspective, it makes sense that our bodies would crave the foods that have tremendous amounts of added refined carbohydrates and fats – it means more fat storage for survival with less effort,” Fragoso said. “Survival is, after all, our bodies’ top priority.”

Fragoso said the companies producing these foods know what they’re doing.

“For these food companies, the more addictive the food, the greater the profit,” Fragoso said. “Food companies who manufacture these [ultra-processed foods] are gaslighting consumers by trying to deny that these foods are anything other than addictive.”

“The comparison of [ultra-processed foods] to nicotine or alcohol is not far from reality,” he said. “Though nicotine and alcohol are addictive chemicals, the high refined carbohydrate and fat content of [ultra-processed foods] act as addictive chemicals to our bodies.”

Kelsey Costa, a registered dietitian and nutrition consultant for the National Coalition on Healthcare, told Medical News Today that comprehensive policy reforms are necessary to make healthier alternatives more affordable.

“The social, economic, and structural factors contributing to the pervasive consumption of [ultra-processed foods] and their addictive potential remain significant challenges to public health,” Costa said. “The growing prevalence of [ultra-processed food] addiction also raises the need for it to be recognized officially as a diagnosis, stimulating further research into its clinical management and potentially leading to reclassifying [ultra-processed foods] as addictive substances, prompting stricter regulatory measures.”