Questioning the validity of Food Addiction: A critical review

Jônatas Oliveira^1*Giulia Cazetta Bestetti¹Isis De Carvalho Stelmo²Larissa Antunes²Priscylla Rodrigues Vilella³

• ¹Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
• ²Institute for Research on Behavior and Food, São Paulo, Brazil
• ³Universidade Federal de Goiás, Goiânia, Goiás, Brazil

Food cravings (FC) are closely associated with behaviors such as loss of control, binge eating, and emotional eating. FC is one of the symptoms proposed for Food Addiction (FA); however, we suspect that the distress associated with eating, managing cravings, and experiencing loss of control are already well-established constructs. Grouping these under the FA label and diagnosing individuals with FA presents a potential risk in the healthcare field, particularly in light of the possibility of its inclusion in the DSM. This integrative review sought to explore these concepts and their interrelations using methodologies such as self-report questionnaires and visual analog scales. A systematic search of PubMed, Scopus, and PsycINFO databases, with no time restrictions, yielded 37 original studies for qualitative analysis. Investigations have been described where FA and FC were analyzed as primary outcomes and discussed into five thematic sections: 1. Genetic factors, 2. Neurobiology, 3. Behavioral factors, 4. Emotional factors and 5. Food cues. Findings indicate that cravings play a mediating role between disordered eating patterns and binge episodes and are linked to excessive consumption in individuals with symptoms attributed to FA. We explore two key points: (i) theoretical and psychometric issues in FA and (ii) whether FA is fundamentally a matter of semantics. The notion of FA also appears to blend cultural perceptions about food with established constructs, drawing on multiple previously understood phenomena. Exploring the spectrum that encompasses (i) cravings, (ii) disordered eating attitudes, and (iii) distress related to body image is a complex task for researchers, particularly if they fail to grasp the human narratives underlying this multifaceted phenomenon. Without a clear theoretical and epistemological framework, the boundaries of FA risk becoming overly broad, diminishing its utility as a diagnostic tool or basis for interventions. The challenges in establishing a consistent and precise definition underscore the need for further research to ensure the concept represents a distinct and scientifically valid phenomenon rather than a generalized reflection of eating-related challenges.