MR. MARC FISHERFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your community with the world. I'm Marc Fisher sitting in for Kojo. And today, why is it that some people are content with a thin slice of cake, but others aren't satisfied 'til they've eaten the entire thing? Whether your weakness is macaroni and cheese, peanuts, pizza or pecan pie, the odds are good that there's some food you just can't stop eating.

MR. MARC FISHERAn uncontrollable urge for a burger and fries may not sound as dangerous as a craving for cocaine, but both may well be physical addictions. A Yale psychologist has just released a study adding to a growing body of evidence that it's possible to be addicted, not only to drugs and alcohol, but to snack foods and sodas, too. Ashley Gearhardt is a doctoral student in clinical psychology at Yale's Rudd Center for Food Policy and Obesity. She developed the Yale Food Addiction Scale which seeks to distinguish food addicts from mere over-eaters.

MR. MARC FISHERAnd Ashley Gearhardt joins us from radio station WUOM in Ann Arbor, Michigan. Welcome.

MS. ASHLEY GEARHARDTThank you.

FISHERSo I -- just before this show began, I sat down with your Yale Food Addiction Scale and ran through all the questions and came up with 11 points. I don't know if that ranks me as an over-eater or an addict, but it -- basically, I came away thinking, I'm probably not addicted, I just like some things like chips and pretzels a bit too much. What really is the distinguishing factor between someone who just eats too much and someone who is actually addicted to food?

GEARHARDTThat's a really good question. And what we do in the Yale Food Addiction Scale is we take those gold standard diagnostic criteria for how you'd be given a diagnosis of, let's say, alcohol addiction or nicotine dependence, and we ask those same questions. So to give you a sense of some of the questions we're looking to see whether or not you qualify for, we ask things like, when you cut down, do you feel withdrawal? Do you feel psychological or physical symptoms? Do you need more and more of the same substance, the same sort of food to get the effects that you once did?

GEARHARDTDo you continue using food in the same manner even though you're having significant problems with either your mental health or your physical health? And then, to meet our cut-off for food addiction, you need to have three or more symptoms in a 12-month period of time, as well as clinically significant impairment or distress. And those are the same diagnostic cut-offs that you need to meet -- to get a diagnosis of something like cocaine addiction.

FISHERSo these -- there are, I guess, 26 questions on this survey and there are things like, I find that when I start eating certain foods, I end up eating much more than I planned. Or, I eat to the point where I feel physically ill. But there seems to be a sort of qualitative difference between some of these things. Such as, I find myself continuing to consume certain foods even though I'm no longer hungry. Well, I had to check yes to that one. But then, when I got to things like, There have been times when I avoided social situations because I was not able to consume certain foods, that seems a different order entirely. Wouldn't you say?

GEARHARDTYou're correct. And we see that same difference in order when it comes to other types of addictions so not all symptoms are equally severe. That's what we're finding with alcoholism and tobacco dependence. And some of those ones that you mentioned of kind of, you know, just over consumes sometimes, seem to be one of those symptoms that people endorse a lot, whether or not they meet the full diagnostic criteria. Whereas that that one you're kind of talking about that sounded severe where you really start kind of giving up other important things in your life, it starts to become central. Really seems to be more indicative of those more kind of severe cases of addictive, like, behavior.

FISHERYou...

GEARHARDTThat being said -- oh, I'm sorry.

FISHERGo ahead. Go ahead.

GEARHARDTNo, that being said, you meet any of the three symptoms and significant impairment or distress and you meet the addiction cut-off for any of the disorders.

FISHERYou can join our conversation by calling 1-800-433-8850 or e-mail us at kojo K-O-J-O@wamu.org. And, Ashley Gearhardt, when you determine that someone is a food addict, what does that tell us that we didn't already know about someone who we just considered an over-eater? In other words, what is there about accepting this notion of food addiction that would change how we deal with this obesity issue we have across the country?

GEARHARDTWe think of this on a similar way as, how you would distinguish someone who maybe sometimes drinks too much relative to somebody who's addicted to alcohol. That alcoholic is probably going to have a much harder time cutting down, even though they really, really want to. And it's starting to really play a severe problem in their life. The other part that we really bring up is the idea that this substance, food itself, may be capable of essentially hijacking the brain in a similar manner as alcohol.

GEARHARDTSo if this is true, if certain people can become addicted to these highly processed, highly palatable foods -- it also brings into question, you know, how do we consider these foods especially when they're marketed heavily to children and they're heavily, heavily marketed in general and they're subsidized so they're very, very cheap?

FISHERAnd what this research is, obviously, forcing people to look at obesity, over-eating in a different way, but, you know, there is -- I think, addiction carries with it certain connotations that we don't associate with food. We don't see obese people who are so desperate that they resort to crime as we might associate with drug and alcohol addictions. Is there -- is this a different kind of addiction or a different intensity of addiction from those?

GEARHARDTWell, I would suggest that tobacco really paved a different path for us. Because all of those same arguments that we typically hear of, you know, people aren't parenting because of food and people aren't breaking the law are also very, very true of tobacco. And for a long time we really considered tobacco to not be as severe or addictive because of that. But when you look at the metric of public health, what is the number one leading cause of preventable death in the United States? It's tobacco.

GEARHARDTAnd even though people know they may die, that they're getting lung cancer, they're unable to stop. And we're seeing those same patterns of behavior in an equally wide spread scale when it comes to these highly processed foods. So for us, we think, depending on the metric that you use, it could be as severe, if not more severe.

FISHERAnd isn't there danger that when we declare someone to be a food addict, that we're in a sense relieving them of their personal responsibility for eating in a moderate or temperate sort of way? Is there, you know, are we -- is this one more step in creating a nation of victims who are somehow relaxing at the knowledge that there's nothing they can do about their condition?

GEARHARDTYou know, that's a good question. It's one that comes up a lot. But I'm going to use the history of other addictive substances. And so if you look at the story we use now, when people struggle with eating and we just say, you know, you just really need to have more willpower and just you -- be a little more strong willed around food. Well, that's the same story we used for decades when it came to alcohol, that those people were just morally weak willed.

GEARHARDTThey just needed to have more responsibility. And that didn't work and it left people really blaming themselves for not being able to manage something that we then found out was addictive. That had an impact on the body and the brain in a way where it kind of takes away that willpower. It's engineered to do so. So if we see this similar thing occurring with food, I see now that we have a society that people are working so hard to lose weight. People are desperately trying to be a normal weight. And they're really beating themselves up for not being able to do so.

GEARHARDTIf we say, wait a minute, this might be something more severe than just, you're too weak, you're too weak willed, you may have to seek some actual treatment for this, I'm hoping it'll have a positive effect as we've seen previously with other addictive substances. And...

FISHERIn...

GEARHARDT...Okay.

GEARHARDT...but is there, I mean, is there something particularly American about food addiction? Because, obviously, in different societies, there are different degrees of difficulty with obesity and there are certainly places around the world where that's not a big issue. Is it possible that one culture would have a propensity toward food addiction and another one wouldn't?

GEARHARDTI think you're right. And I think there's two things that really kind of increase societies' likelihood for struggling with addictive like behavior when it comes to food. And the first is our toxic food environment. So, you know, we don't see people losing control over their eating of asparagus or broccoli. You know, it really seems to be these kind of highly processed, highly palatable foods that are out there.

GEARHARDTAnd as we see the American western diet being exported around the globe, those issues with obesity are spreading in the same kind of rate and the same ratio. So we just did a study, looking at the number of McDonald's in different countries around Europe and we found an extremely strong correlation between the number of McDonald's and the obesity rates in different countries. So, you know, of course, that isn't causation, but we use it as sort of a proxy for the changing food environment, the entrance of these potentially addictive foods.

GEARHARDTSo, I think, that's one piece of the puzzle, right. You kind of have to have the addictive substance to create an addictive disorder. The other thing that I think really puts Americans at risk is this one-two punch of a toxic food environment with really severely intense thin body ideals. And so what we've seen in the addiction literature previously is that periods of binging, coupled with periods of restriction are especially likely to trigger changes in the brain that trigger addictive behaviors.

GEARHARDTAnd if you think of our society now, it's one of binging on certain highly processed foods by crash diets combined then with binging again, combined with crash diets. And so those two societal problems may combine to really create a really kind of a perfect storm for the development of addictive eating behaviors.

FISHERAshley Gearhardt is our guest. She's a clinical psychology doctoral student at Yale Universities Rudd Center for Food Policy and Obesity and she's the developer of the Yale Food Addiction Scale. And speaking of addiction, Jeremy in Bethesda talks about being an alcoholic in recovery. Jeremy, it's your turn.

JEREMYYes, good afternoon. I was calling because I developed alcohol addiction in my 30s and when into recovery in my mid 40s. After I got out, I also began eating healthy food and a couple of years after that, returned to bad habits because of time. And I'm not concerned that I am a food addict. And I was wondering if the course of treatment should be the same? I find that I'm a private eater and that I'm uncomfortable discussing what I eat and that my weight has changed significantly. And I really see the same course of conduct that I did with alcoholism. I was wondering, from your guests, if treatment is likely to be the same?

GEARHARDTWell...

FISHERAshley...

GEARHARDT...that is -- oh, I'm sorry.

FISHERGo ahead, yeah.

GEARHARDTThat's a very, very common story that I've heard. A lot of people that I've spoken with, who have identified as a food addict, previously struggled with other addictive substances. And then, when they recovered from those, food was sort of a replacement in some ways. There are some suggestions that genetically there's a risk factor for family history of alcoholism or other addictions setting you up for increased risk for obesity or pathological eating behavior. And we're starting to see similar genetics, the DRD2 Taqi A1 Allele being implicated in both the development of substance dependence, as well as obesity

GEARHARDTSo, I think, our caller's experience is really kind of born out somewhat in the literature and other people's experience. And regards to treatment, there's a couple of options to think about. The first is there are 12 steps out there, 12 step approaches to dealing with addictive like eating behavior, like over-eaters anonymous and food addicts anonymous. There's also cognitive behavioral treatment approaches that focus on binge eating and out of control eating. So either of those pathways are things to potentially look into to help to treat the out of control eating in a similar manner.

FISHERAre all foods potentially addictive? I ask because our producer, Taylor Burnie, asked readers on Facebook what foods they found themselves over consuming and interestingly it was not so much sweets as savory items. Chips and nuts and things like that. Is that typical or are there particular foods that seem to the most overeaten?

GEARHARDTYes, so we're seeing a bit of gender breakdown, which has been interesting. So similar with women, we're seeing more of those sweets come out. Ice cream and chocolate really playing a prominent role in what they say they feel addicted to, in contrast with our males. Our male participants, we're seeing more of those savory foods you're mentioning, things like French fries and pizza.

GEARHARDTBut in general, in regards to what foods are most likely to be addictive, we're really seeing that some of the processed foods have taken on attributes that we typically think of when we think of addictive drugs or attributes that increase the addictive potential of a drug. So if you think of, an example, of the coca leaf, when it's stewed in tea or chewed in a traditional manner, like, it typically has been in Latin America, it creates a slight stimulant effect and has minimal addictive properties. But we're humans, we're really good at taking something that's rewarding and making it more so.

GEARHARDTSo we've processed it down to cocaine and crack and now it's highly addictive because it's much more potent and it's absorbed much more quickly into our bloodstream. The same thing has happened with our food. Your sugar and fat typically don't co-occur, they don't occur in the same foodstuff. But now we're increasing the levels of fat and sugar, we're combining them, we're adding them with salt, caffeine, flavor enhancers and all sorts of other ingredients. And then we're stripping away protein and fibers, things that would slow their absorption into the bloodstream.

GEARHARDTSo we're getting that quick spike of these macronutrients into our system. So for us, those foods that are starting to resemble that pathway are most likely to be those that are addictive.

FISHERSpeaking of sugar and processed foods, Steven in DuPont Circle has a question about the use of high-fructose corn syrup. Steven, you're on the air.

STEVENHi, yes, I mean, I was wondering if you did a correlation between, like, when they started mass using high-fructose corn syrup to replace sugar in everyday staples and everything from like bread to soda, everything that we eat has high-fructose corn syrup in it as opposed to before when they didn't use it, it was just straight sugar.

GEARHARDTI haven't done that work specifically myself, but there is a growing body of literature linking high-fructose corn syrup and the obesity epidemic, where it's making it a little difficult to kind of understand specifically the contribution is that in that same sort of timeframe that high-fructose corn syrup has gone up, other types of added sugars and added fats have also gone up.

GEARHARDTBut there's same amazing animal model research out there suggesting that fructose really has some very scary effects on the way our body metabolizes it. That can increase our body's resistance to insulin and then kind of prevent satiety signals from really working in the manner they were designed to do so. So while I'm not an expert on that there is some evidence to suggest that's playing a role.

FISHERWe have an e-mail from Lisa, asking, "How can we be addicted to food when it's something we have to eat? In other words, we don't have to use drugs or alcohol or cigarettes but if we don't eat, we die. Isn't that an elemental difference between food and those other substances?"

GEARHARDTYes, it totally is. And when we first started doing this work and I came to my advisor, I'm an alcohol researcher, originally and I said, you know, I want to study this. There's this great evidence out there that food's addictive. He said the same thing, how can you? Of course, you're dependent on food. You have to be. You have to survive.

GEARHARDTBut what we're seeing in the current food environment isn't that people are over consuming or really becoming addicted to those foods that made the human diet for centuries, minimally processed foods, lean meats, fruits, vegetables, nuts. If anything, what's happening is that people are over consuming those foods, that if they cut out of their diet and they never ate them ever again, they're health would be much better off. And so when we think of this, we definitely think there's a distinction between foods are likely to be addictive. You know, Michael Pollan's work has suggested that maybe these kind of altered processed foods aren't really even foods anymore. They're food-like products and we think those are the likely culprits.

GEARHARDTThat being said, I think the question really resonates when I speak with people who identify as a food addict that their decision, if they've been addicted to something else previously, food was harder to deal with because they still have to eat multiple times a day and in our current food environment it's so hard to know what exactly you're eating, what's in the food in front of you and it's hard to find healthy, inexpensive choices.

FISHERYou know, it's something like 70 percent of the U.S. population is either overweight or obese and yet you note that not everyone who's addicted to food is overweight. Why is it important to treat those who may be able to maintain, you know, supposedly normal look and what would treatment for such people look like?

GEARHARDTI think of it as similar to lung cancer. So lung cancer's a medical condition and there's lots of different paths to get to lung cancer but some of them aren't smoking. You know, we think of smoking as, if someone has lung cancer they were probably smoking, but that's not necessarily true. So to treat everyone who's showing signs of lung cancer as a cigarette addict may not be that effective.

GEARHARDTSo when we think of obesity, we think, you know, there's lots of different ways that someone could've become obese, physical inactivity, metabolic concerns, that wouldn't necessarily be the result of an addictive relationship with food. You know, that being said, even if you overuse an addictive substance, it doesn't mean you're addicted to it.

GEARHARDTSo thinking of alcohol, 40 percent of college students binge drink, but only about 5 percent meet the criteria for alcohol dependence. So even if you're consuming enough food that you're starting to show some signs of obesity, it's not necessarily meaning you're addicted to it.

GEARHARDTAnd then that being said, you can do things to compensate for a potentially, extremely distressful, extremely impacting on your life, addictive relationship with food in a manner so it doesn't show up in your body mass index. So you may spend hours and hours of your day obsessing about food, fretting about food, binging and then restricting to try and manage your weight and it may be really impairing you, but you may look normal weight to other people.

GEARHARDTSo that's why for us it's really important to get down at these gold-standard indicators for what is an addiction and look at it across the board and not just rely on body weight.

FISHERIf you think you may be addicted to food, you can take a look at the Yale Food Addiction Scale and run the test yourself. There's a link at our website, kojoshow.org. And Ashley Gearhardt, is there a food that you can't resist? Have you ever considered that you might be a food addict?

GEARHARDTWell, I've taken my own test and I'm not a food addict, but I got to say the food that I think is just fantastic is Nutella. I studied abroad for a while and because I found Nutella so absolutely delicious, my food rule is that I can have Nutella in continental Europe.

GEARHARDTBut that being said, when I look at a food like Nutella that is obviously so sugary and fatty and delicious and when I see it being marketed to moms as a nutritious choice for sending their children off to school when it has an obscene amount of added sugar, it just shows me how sad our current food environment is and how difficult it is to be a parent to make healthy choices for your child in this environment.

FISHERWe've been talking with Ashley Gearhardt, a doctorial student in clinical psychology at Yale University's Rudd Center for Food Policy and Obesity. She's developed the Yale Food Addiction Scale, which seeks to distinguish food addicts from mere overeaters. And thanks very much for joining us.

GEARHARDTNo problem. Thank you.

FISHERWe'll continue the show with a conversation about planet Earth's changing climate and a look at the future of our planet with Tim Flannery, a scientist and environmentalist. That's coming up after this short break. You're listening to "The Kojo Nnamdi Show." I'm Marc Fisher, sitting for Kojo.