Abstinence-based treatment of comorbid eating disorders and ultra-processed food addiction
by Susan P. Thompson, M. Joy Jacobs, & David A. Wiss
The evidence that ultra-processed food addiction exists and is impacting a subset of our clients with disordered eating is too significant to be ignored. Skilled clinicians with backgrounds in both substance use disorder and eating disorder can take the lead in understanding the complexity of food addiction and learning how to question long-held assumptions when evaluating patients. Along this line, developing clinical experience with the wide range of trajectories that may unfold when ultra-processed food addiction is treated concurrently with an eating disorder will offer new possibilities for patients seeking (and deserving) a nuanced, supportive treatment approach.
Subscribe for weekly insights and research exploring the link between nutrition & mental health.
Abstract
While not officially recognized as a clinical diagnosis, ultra-processed food addiction is an increasingly observed phenomenon that frequently co-occurs with eating disorders. Yet, treatment remains both understudied and controversial. Many challenges exist when treating patients with comorbid food addiction and eating disorders, particularly in the context of the polarizing debate between abstinence-based and moderation-based approaches to nutrition intervention. We present three vignettes illustrating diverse trajectories of recovery when an abstinence-based approach is explored by a patient presenting with eating disorder symptoms.
Ultimately, some patients will recover with abstinence, while others may be harmed and fare better with a moderation-based approach. This dichotomy appears difficult for many patients and clinicians to navigate, particularly since integrative middle-ground approaches remain less characterized. Patients deserve individualized treatment plans from open-minded, experienced clinicians who can comprehensively assess genetic vulnerability; upbringing; and current neurobiological, psychological, and social/cultural presentation.
We argue for a nuanced, multidisciplinary approach that combines elements of both abstinence and moderation, tailored to the patient’s specific needs, and emphasizes the importance of cross-disciplinary collaboration. More research is needed to develop evidence-based, patient-centered treatment options for ultra-processed food addiction in the context of other food- and body-related pathology.
Do you have opinions about abstinence and food addiction? Would love to hear from you.
