[SPEAKER_00]: Welcome to Food Psych, a podcast dedicated to critiquing diet and wellness culture, and answering your questions about intuitive eating and the anti diet approach.
[SPEAKER_00]: I'm your host, Christy Harrison, and I'm a registered dietitian certified intuitive eating counselor, journalist, and author of the books, anti diet, the wellness trap, and the new emotional eating, chronic dieting, binge eating, and body image workbook, which are all available wherever you get your books or at christyharrison.com slash books.
[SPEAKER_00]: That's christyharrison.com slash books.
[SPEAKER_00]: And by the way, on this show, we avoid diet culture details like weight and calorie numbers, but we don't censor swear words or other adult language, so listener discretion is advised.
[SPEAKER_00]: Hey there, welcome to another episode of Food Psych.
[SPEAKER_00]: My guest today is eating disorder's dietician Marcie Evans, who returns to discuss the current science on quote unquote food addiction, sometimes now called ultra processed food addiction.
[SPEAKER_00]: And what's changed since I first interviewed her about this topic for the pod way back in twenty sixteen.
[SPEAKER_00]: That episode has been a fan favorite for a long time, so we knew we wanted to update that content and get into the current science, and this is really a fascinating episode.
[SPEAKER_00]: We talk about how food addiction is defined and measured and what that definition leaves out.
[SPEAKER_00]: The overlap between disorder to eating and high scores on food addiction scales.
[SPEAKER_00]: How food addiction discourse perpetuates weight stigma?
[SPEAKER_00]: The nuances behind the research showing that people's brain scans are different when eating ultra-process versus minimally processed food, and whether it's really useful to think about food in terms of addiction at all.
[SPEAKER_00]: In the paid portion, we talk about practical applications.
[SPEAKER_00]: How Marcy would help someone who has addictive like tendencies or thinks of themselves as being addicted to food?
[SPEAKER_00]: What we can learn from this discussion of quote unquote food addiction to how people have a better relationship with food and lots more.
[SPEAKER_00]: This is a great conversation and I can't wait to share it with you in just a moment.
[SPEAKER_00]: First though, an announcement.
[SPEAKER_00]: It's come to my attention recently that some listeners in the UK got served ads for an online diet program built around weight loss drugs, which of course is totally antithetical to our values here at food sake and not something I would ever intentionally sign up for.
[SPEAKER_00]: I'm sorry to anyone who heard that and was confused.
[SPEAKER_00]: I do not endorse them or any other weight loss company or diet drug or diet culture product or service period.
[SPEAKER_00]: I just would never do that.
[SPEAKER_00]: The issue is that we have what are called programmatic ads, which are third-party ads handled by our podcasting platform, that we have no control over other than blocking specific categories.
[SPEAKER_00]: And in some cases, blocking specific brands after the fact if there's a slip.
[SPEAKER_00]: When I signed up for our platform's programmatic ads a few years ago to try to help cover the cost of running this podcast, I preemptively blocked anything related to health and wellness and food and beverage, as well as a bunch of other categories that didn't align with my values, thinking that would prevent any weight loss or diet products or food products or general wellness nonsense from being advertised on the podcast.
[SPEAKER_00]: The system works really well when it works, but the problem I've since learned is that sometimes advertisers or ad sales reps miscategorize their ads.
[SPEAKER_00]: And in some cases, it seems very intentional and sneaky on the part of the advertisers.
[SPEAKER_00]: Like one time when the makers of a chewing tobacco product found a dubious loophole by going through the hobbies and interests category and selecting the subcategory cigars, even though I had blocked the entire separate category of tobacco products.
[SPEAKER_00]: They snuck in through this back door to get access, not just to all of you, but I assume also to countless other audiences of podcasters who had said no to tobacco ads.
[SPEAKER_00]: Thankfully, a listener wrote in about it and we were able to catch it, because otherwise we might never have known since everybody gets served different ads.
[SPEAKER_00]: This kind of thing is an issue across the landscape of programmatic ads, but I've also done some research and found that other podcasting platforms give podcasters more control over which programmatic categories and subcategories to block.
[SPEAKER_00]: We really didn't have as much choice or as much individual control with the podcasting platform that we were with before.
[SPEAKER_00]: So over the summer, I move to a new platform that seems to do a better job of leading out ads that aren't aligned with our values and gives us more ability to block subcategories as well as the broader categories.
[SPEAKER_00]: The platform also gives me the opportunity to start doing some host red ads again, which allows the highest level of control, obviously, over what I will and won't advertise.
[SPEAKER_00]: I'm hoping this change will prevent you from ever having to hear ads for diet products, or food, or tobacco, or wellness, or beverage products on this podcast ever again.
[SPEAKER_00]: But of course, I still can't really know for sure, since I only hear the ads serve to my particular demographic and my particular location.
[SPEAKER_00]: So I'm incredibly grateful to the handful of listeners who've brought these kinds of admissalignments to my attention over the past couple of years.
[SPEAKER_00]: And I would love for you to reach out going forward if you ever hear any ads that contradict the messages and values of this podcast.
[SPEAKER_00]: You can write in at admin at christiharisand.com and let us know what the ad was for and where and when you were listening when you heard it.
[SPEAKER_00]: Finally, I just want to thank you for listening, and especially if you're one of our long time listeners.
[SPEAKER_00]: This week marks twelve years since I launched food site, which is just wild.
[SPEAKER_00]: And, you know, it's been through many different iterations in that time, but I'm so glad I get to keep doing it in some form or another, and so grateful to you for being here for it.
[SPEAKER_00]: So thank you.
[SPEAKER_00]: Now, without any further ado, here's my conversation with Marcie Evans.
[SPEAKER_00]: I first interviewed you about food addiction back in twenty sixteen or like a lifetime ago, right?
[SPEAKER_00]: For my first podcast food sake and it was one of the most popular episodes of that podcast.
[SPEAKER_00]: So I wanted to have you back on for an update on the research because a lot has changed obviously in the last nine years.
[SPEAKER_00]: And I think it's important that we stay up on current evidence, especially because that episode has continued to get shared sometimes.
[SPEAKER_00]: And I think the science is changing so quickly and has evolved to much that we really need to.
[SPEAKER_00]: dig into like what it's actually saying now.
[SPEAKER_00]: But before we do that, I want to talk about where you're coming from in relation to this area of study, you know, to introduce you to the rethinking wellness listeners, most of whom probably know you, but some of whom may not, you know, your primary orientation to the food addiction research is through the lens of eating disorders, right?
[SPEAKER_00]: You're eating disorder clinician.
[SPEAKER_00]: So I'm curious what sort of the strengths and limitations and just, you know, the unique perspective that you might have on this research coming from that place.
[SPEAKER_01]: Sure, that's a great setup.
[SPEAKER_01]: As you mentioned, my background in my area specialty is eating disorders.
[SPEAKER_01]: And so that's the frame that I read this research through.
[SPEAKER_01]: And it's also the frame that I'm thinking about and the clinical implications.
[SPEAKER_01]: of the food addiction research.
[SPEAKER_01]: And so for better or worse, I am not able to see really, I think, outside of the realm of eating disorders.
[SPEAKER_01]: And I want to name that because the food addiction field doesn't necessarily, from my reading of the research, hold in mind a whole lot the world of eating disorders.
[SPEAKER_01]: It's almost like we're
[SPEAKER_01]: occurring in silos alongside one another, which is really interesting.
[SPEAKER_01]: So I'm mindful of the fact that the research isn't developed through the lens of thinking about researching and helping folks with eating disorders necessarily, and yet that's the lens that I'm sort of extrapolating and applying the implications of the research as I understand it.
[SPEAKER_00]: Yeah, that makes a lot of sense.
[SPEAKER_00]: And there is so much crossover overlap between, you know, so called food addiction, which we'll talk about the nuances of that term and problematic aspects of it, and also that overlapping with eating disorders.
[SPEAKER_00]: And I think it is unfortunate that the two sides are so siloed, but I really appreciate your perspective in bringing in unpacking some of this research for an eating disorder audience.
[SPEAKER_00]: So to start from like the ten thousand foot view, what do you see has changed?
[SPEAKER_00]: What are kind of the major changes in the scientific literature on food addiction since our last interview way back in twenty sixteen?
[SPEAKER_01]: This is really interesting to me.
[SPEAKER_01]: You know, I was digging into the research sort of like really intensely around maybe twenty fourteen twenty fifteen twenty twenty sixteen when you and I had that first conversation.
[SPEAKER_01]: and it was a surprise to me that so many people ended up referring back to that podcast episode and referring back to some of the blog posts that I had written because I didn't necessarily consider myself to be an expert in this field, but it was an area that I was really invested in trying to understand because it was so relevant for me as an eating disorder provider.
[SPEAKER_01]: You know the number of people you know this Christi who come
[SPEAKER_01]: to get help come because they are often feeling so distressed about their relationship with food, things feel unhinged, they feel out of their control.
[SPEAKER_01]: And that's why they often come to an eating disorder provider.
[SPEAKER_01]: So I sort of found myself in a position that felt, it was a little bit surprising to me.
[SPEAKER_01]: And to the honest, it felt a little overwhelming and a little bit stressful in terms of kind of kicking up my own perfectionism, in my own desire to want to get everything I put out into the world sort of exactly precise and exactly quote unquote right, whatever that means.
[SPEAKER_01]: And I watched myself over a number of years sort of stepping back a little bit and not really staying super on top of the topic.
[SPEAKER_01]: I'm also, I mean, I kind of make the joke that I am really a one-trick pony where I do needed disorders and like that's my gig.
[SPEAKER_01]: You know, I teach and I supervise and I still work as a clinician.
[SPEAKER_01]: I see individual patients still in my practice, but it's really in the problem of eating disorders.
[SPEAKER_01]: But within eating disorders,
[SPEAKER_01]: have a ton of interests, things I'm really passionate about, body image embodiment, digestive disorders, and then food addiction sort of ended up being one of them, just sort of like an interest of mine, because I love reading scientific research.
[SPEAKER_01]: And so I noticed that as sort of some of the conversations were becoming a little bit more challenging within the eating disorders profession, as it related to food addiction,
[SPEAKER_01]: And that, you know, things were evolving in the food addiction space.
[SPEAKER_01]: I sort of took a little bit of a hate as but was noticing that people were continuing to kind of point to material that I had put out.
[SPEAKER_01]: And I started to feel some responsibility around things have evolved.
[SPEAKER_01]: I haven't really provided much of an update or provided a resource that might be a bit more of an update for clinicians to look to.
[SPEAKER_01]: And it just so happens that I am right now, I'm in the process of co-authoring a textbook.
[SPEAKER_01]: And that was the kick that I needed to really sit down and spend actually was several months trying my best to wrap my head around the research that's been published over the past few years.
[SPEAKER_01]: So that was a really kind of long-winded setup.
[SPEAKER_01]: But I just wanted to share with a little bit of transparency around my own process of the facts.
[SPEAKER_01]: But I try really hard
[SPEAKER_01]: to engage really thatfully and openly and critically and try really hard to engage with material that might even be sometimes where I might have my own defensiveness kick out around things that I feel really strongly about and things that I've observed in my clinical practice.
[SPEAKER_01]: And so I also am working very hard to kind of lean into discomfort, lean into those sort of important conversations that might feel a little tricky, that it was really, it was really interesting to spend so much time
[SPEAKER_01]: you know, delving into the research.
[SPEAKER_01]: And I think I have at least a handful of points that might be helpful for listeners and getting a sense of, well, what, what has shifted over the past almost a decade, which is like, Christy.
[SPEAKER_01]: Wild.
[SPEAKER_01]: That feels impossible, but I guess it's true.
[SPEAKER_01]: So I'll just share some of those, the changes that I've observed.
[SPEAKER_01]: So one is a shift in terminology, right?
[SPEAKER_01]: So the research that I was reading from a decade ago, fifteen years ago, talked about food addiction and sometimes you'd see the term sugar addiction.
[SPEAKER_01]: But one of the big critiques that I had at the time was this total lack of specificity.
[SPEAKER_01]: That's like, well, what are we talking about?
[SPEAKER_01]: What food?
[SPEAKER_01]: What are people supposedly addicted to?
[SPEAKER_01]: And when we're talking about sugar, we talk about table sugar.
[SPEAKER_01]: Are we talking about refined, mostly carbohydrate-based products?
[SPEAKER_01]: And so there was a real lack of specificity when we were looking at particularly research that was done on humans as opposed to Romans.
[SPEAKER_01]: And so there's been a shift over the past couple of years where there's been a specificity around what's being called ultra-processed food addiction.
[SPEAKER_01]: And that moves us to a bit more sort of specificity where we're looking at these highly processed foods, commercially made foods, we're looking at typically a combination, sort of combination of carbohydrates and fat and that are designed to
[SPEAKER_01]: be really pleasurable and highly palatable.
[SPEAKER_01]: And often folks are pointing to this classification, which I'm sure you're familiar with, and Nova classification of foods, which is interesting, although I would say, still maybe not as much specificity as folks might think.
[SPEAKER_01]: You sort of think like, oh, it's a, it's a Nova four that sort of sounds
[SPEAKER_01]: It sounds very scientific perhaps, but it's this umbrella category that has a huge number of foods and there isn't total agreement in terms of where a certain food might fit.
[SPEAKER_01]: And so some people might classify bread that's maybe made in an industrial kitchen, some might say, well, that's a group four.
[SPEAKER_01]: And other people might say, well, if you look at the ingredient list, it's really a group three.
[SPEAKER_01]: It's the kind of conversation that I actually quickly become pretty disinterested in, just sort of like, but I'm not sure exactly what we're talking about.
[SPEAKER_00]: And it's changed over the years too, right?
[SPEAKER_00]: The people who develop a novel classification system have moved things around and other researchers have kind of moved things around or made arguments for one type of food actually being in a different category.
[SPEAKER_00]: And then there's things like, you know, commercially produced bread is in is a four, but what is it like bakery home made or bakery bread is in a category three or something like that.
[SPEAKER_00]: And it's like, okay, what are the actual differences then between these foods?
[SPEAKER_01]: Yeah, right, if this is supposedly, and we'll get into this, right, like an ingredient or a process that's creating an addiction, what are we really talking about here?
[SPEAKER_01]: You know, the more I kind of dove into it, I was like, oh, this is maybe not quite as clear as I had originally thought.
[SPEAKER_01]: And, you know, the other piece that I think will probably get more into this is that there is some compelling
[SPEAKER_01]: data showing, oh, there's specific response to these ultra-processed foods that are happening in these brain imaging studies that we're not seeing in minimally processed foods, but we don't yet have a causal link.
[SPEAKER_01]: between which foods are addictive.
[SPEAKER_01]: This is pretty important that speaks to this other area that I see as sort of this evolution in the research in that a decade ago, there really wasn't consensus around what type of an addiction.
[SPEAKER_01]: Are we talking about a process of addiction?
[SPEAKER_01]: So you can think of like gambling would be considered
[SPEAKER_01]: process addiction, or are we talking about a substance addiction?
[SPEAKER_01]: Like you might think about alcohol or nicotine cocaine.
[SPEAKER_01]: And with this framing of the ultra-processed food addiction is really resting on demonstrating evidence that we are talking about a substance-based addiction, not a process-based addiction.
[SPEAKER_01]: So getting clarity around, well, what substance is it?
[SPEAKER_01]: If we're saying it's a substance,
[SPEAKER_01]: What substance is it?
[SPEAKER_01]: Is it the substance itself?
[SPEAKER_01]: Is it the processing of the substances?
[SPEAKER_01]: So there's a lot in there that I feel pretty curious about and that I haven't been able to kind of get the clarity around it that I'm hoping for.
[SPEAKER_01]: So there's a lot of disagreement and sort of lack of lack of consensus when you start getting really kind of into the nitty-gritty details.
[SPEAKER_00]: Right.
[SPEAKER_00]: And I think from like this sort of lay press, you know, general public perspective, it sort of seems like, oh, there's all this science on ultra-process foods and even some of the food addiction people will be like, you know, there's so much research.
[SPEAKER_00]: There's like thousand studies now done on this.
[SPEAKER_00]: This is not new science or whatever, but
[SPEAKER_00]: In the grand scheme of things, that is still actually very new science and there's still a lot of debate among researchers about what we're really talking about here.
[SPEAKER_00]: And like you said that clarity that you might be looking for about what exactly is it?
[SPEAKER_00]: How do we define what is so quote unquote bad about ultra-process foods?
[SPEAKER_00]: Like that is just a slippery concept and nobody has really pinned it down.
[SPEAKER_00]: Is it certain ingredients?
[SPEAKER_00]: Is it some sort of process processing?
[SPEAKER_00]: Nobody knows.
[SPEAKER_00]: And it's not a cotton dried scenario.
[SPEAKER_00]: It's certainly not a causal link the way that it's made out to be in, you know, sort of the general public.
[SPEAKER_01]: Right.
[SPEAKER_01]: There are lots of continued and evolving questions that remain and some pretty fundamental big questions which if you get into the research and we're very happy to provide you with some of the citations and that I'm kind of referencing and informed by today, the researches themselves say that really plainly, really clearly.
[SPEAKER_01]: And I think one of the things that I've appreciated in
[SPEAKER_01]: reading some of the newer research is that things that I was really kind of grappling with or critiquing a decade ago are in some of the research it's being responded to and you know I was like okay you know I appreciate that it sort of
[SPEAKER_01]: helps me kind of drop some of my own defensiveness to allow myself to be a little bit more engaged, critically engaged in the scientific process and sort of allowing myself to take me to be a little bit more open and curious about what is here, what's here and how do I understand that and what's not here, what remains to be seen.
[SPEAKER_01]: It's been an interesting interesting process for me as well.
[SPEAKER_01]: The last piece, maybe that I'll share, that's been interesting to observe over time is just how this is getting measured.
[SPEAKER_01]: We're talking about quote unquote addiction and how are we looking at it?
[SPEAKER_01]: How are we assessing what we're seeing and the research from ten, twenty years ago was a lot more rodent-based.
[SPEAKER_01]: which is, you know, but easier for us to say, we'll sure there might be some interesting modeling here, but humans are not rats, and there are some pretty big differences here.
[SPEAKER_01]: There were some early FMRI studies, and of course, and I think we'll probably get into this a bit, there was the Yale food addiction scale that came on the scene.
[SPEAKER_01]: I don't have the date in terms of when that was first published, which is really painting.
[SPEAKER_01]: a subjective experience kind of a picture.
[SPEAKER_01]: So people are able to look at these questions and get a sense of what is their experience?
[SPEAKER_01]: Whereas the neuro-emaging research is looking at the actual images of brains and what's happening when people are thinking about or exposed to two different types of food.
[SPEAKER_01]: And there's been evolution, of course, in this area.
[SPEAKER_01]: where there's been some mapping done, where the neural imaging research is mapping onto the Yale food addiction scale diagnosis.
[SPEAKER_01]: So someone might take the food addiction scale and receive a quote unquote diagnosis of a food addiction.
[SPEAKER_01]: And they're like, what is also happening in the brain imaging?
[SPEAKER_01]: And it's like, oh, there's some mirroring there that it kind of matches up what one would see.
[SPEAKER_01]: There is, I think, still quite small, but growing body of neuro-imaging research that's showing some structural similarities of ultra-processed foods that is comparable to what we would see with substance use disorder.
[SPEAKER_01]: And so what these researchers are looking at are similar common neural substrates, structural changes to the brain.
[SPEAKER_01]: shared mechanisms and changes in what's called functional connectivity and the functional connectivity meaning these different regions of the brain that are in communication with one another and how are they in communication with one another and also what they're looking for as best as I understand is they're not just looking for in the moment what are we seeing in the brain scans which was a bit of a learning curve for me because
[SPEAKER_01]: When I was kind of critiquing early on, and you see this critique quite a bit, which is, well, yeah, those reward centers of the brain do write up, just like when we're like holding a baby or listening to music, any type of activity that would be pleasurable those pleasure centers like a brain.
[SPEAKER_01]: And what's helped me to learn the difference is that
[SPEAKER_01]: We're trying to understand, but are there long-term changes to connectivity and function as a result of long-term exposure and consumption of these foods?
[SPEAKER_01]: This is very early-stage research.
[SPEAKER_01]: It's my opinion when you look at the research that's not just looking at brain regions lighting up, but looking at how do
[SPEAKER_01]: regions of the brain, connect, and communicate and are their alterations.
[SPEAKER_01]: It happened to the brain over time.
[SPEAKER_01]: This is really limited.
[SPEAKER_01]: Very, very, very, very early stage research, really only a handful of studies.
[SPEAKER_01]: So I get a little, you know, there's this part of me that gets a little antsy where I'm like, wow, yes, the field of food addiction studies is evolving and the number of studies does continue to grow.
[SPEAKER_01]: And the evidence for really being able to tie and point to very specific foods as being addictive from my vantage point, there is still a lot of scientific research to be done before I feel really convinced that it is either, I guess, a specific food item or how it is processed or a specific food ingredient.
[SPEAKER_00]: Yeah, totally.
[SPEAKER_00]: I really appreciate it all that and I want to put a pin for sure in the brain imaging stuff because I think that is super fascinating.
[SPEAKER_00]: But first I want to go back a little bit in like kind of zoom in to each point.
[SPEAKER_00]: Go through kind of the current main points of food addiction research in some detail and just unpack them as we go along.
[SPEAKER_00]: I think it's helpful maybe to start with how food addiction is defined and measured in the research.
[SPEAKER_00]: Like you said, there's been sort of all these different ways of measuring it throughout the years from, you know, rodents to like the early use of the L food addiction scale.
[SPEAKER_00]: And now it seems like the Yale food addiction scale is kind of the basis of most of this research in humans.
[SPEAKER_00]: Is that correct?
[SPEAKER_00]: Would you say?
[SPEAKER_01]: Yes, that is correct.
[SPEAKER_01]: The yellow food addiction scale, particularly, I think the two point out, which I believe is the newest version, is really considered to be the gold standard.
[SPEAKER_01]: And that is taken into account in terms of these kind of areas of diagnosis.
[SPEAKER_01]: So the way that I think about it is is that we've got
[SPEAKER_01]: a person's individual subjective experience, we have their behavioral symptoms.
[SPEAKER_01]: So what are they displaying?
[SPEAKER_01]: What sort of behavior are they displaying with food?
[SPEAKER_01]: And then we have these engagement of the brain regions that are related to reward and motivation.
[SPEAKER_01]: And yet, we know that as clinicians, that if this is going to be used diagnostically, which I personally have a lot of reservations about,
[SPEAKER_01]: use, I don't recommend that any provider use the ill-puted addiction scale as a standalone way to diagnose a food addiction.
[SPEAKER_01]: But those pieces taken together is my understanding of how researchers are thinking about making a diagnosis.
[SPEAKER_01]: However, as clinicians, of course, we don't have access to neuroimaging.
[SPEAKER_01]: We don't have patients in our office so we do the yellow food addiction scale and put them in an FMRI and then we have a confirmed diagnosis, which is why I think the researchers are feeling pretty excited when at least in the research they're sort of mapping on to one another.
[SPEAKER_01]: And those folks are feeling pretty validated, right?
[SPEAKER_01]: The brain imaging sort of affirming
[SPEAKER_01]: the Yale food addiction scale as this thing that can be, you know, reliably utilized.
[SPEAKER_01]: And I've got, I've got some pretty good, great concerns about that.
[SPEAKER_01]: And we can, we can talk about that.
[SPEAKER_01]: And that's, of course, through my lens is a needing disorder provider.
[SPEAKER_00]: Yes, so let's talk about that.
[SPEAKER_00]: What does the Yale food addiction scale measure and what does it leave out?
[SPEAKER_00]: And, you know, I'm really curious about this overlap between clinical eating disorders in the Yale food addiction scale scores or, you know, other measures of food addiction like brain imaging and things like that.
[SPEAKER_00]: Is there any way to sort of tease apart whether someone is showing signs of genuine quote unquote food addiction or an eating disorder?
[SPEAKER_01]: That is a great question.
[SPEAKER_01]: So this scale is not at all designed or intended to screen out for an eating disorder.
[SPEAKER_01]: Nor does it ask questions related to past or present dietary restriction or dietary restraint, which is, of course, one of the central reasons that you have eating disorder providers who get pretty fiery
[SPEAKER_01]: in that the early stage rodent-based research was really clear that the amplified responses to sugar that we were seeing in those rodents were occurring in the context of dietary deprivation.
[SPEAKER_01]: And so those of us in the eating disorder profession say, that's our day-to-day work, right?
[SPEAKER_01]: We see people come in and they have this history of deprivation and then feeling chaotic around eating.
[SPEAKER_01]: And when we work to decrease the deprivation and the restriction often there is a bit of a parallel and that is the restriction and the restraint and the moralization and judgment around food is that lessons that the chaotic end of things tends to lessen as well that we think about sort of the bingeing and the
[SPEAKER_01]: the chaos and then the disconnected eating often happens in response right after and use the analogy of a pendulum.
[SPEAKER_01]: And so, you know, I was wanting many people who get, you know, pretty worked up about the ill food addiction scale because I was like, we're seeing people who, yes, absolutely, quote unquote, feel addicted, but we aren't sort of screening out for restriction, sort of what might be a real primary driver.
[SPEAKER_01]: That's why there's an eating disorder and dietitian and researcher, David West, who published an article along with Timothy Brutin, who is, I believe, a psychologist or an MD.
[SPEAKER_01]: He has a background where he specializes in eating disorders, trauma, and substance use.
[SPEAKER_01]: And they published an article, I believe in, I've been, twenty, twenty.
[SPEAKER_01]: I'll look it up and put it in the show notes too.
[SPEAKER_01]: Perfect.
[SPEAKER_01]: It's essentially encouraging clinicians to utilize multiple tools to softly discern alongside with clients.
[SPEAKER_01]: Is this kind of quote unquote a false positive?
[SPEAKER_01]: Is this positive on the yellow food eviction scale or is this person who is really feeling addicted to food?
[SPEAKER_01]: Is this a consequence or a remnant of
[SPEAKER_01]: in a dietary restriction restraint dieting, or is this due to something else?
[SPEAKER_01]: Perhaps this is someone for whom they don't have a history of dietary restriction, and maybe their challenges with food started out with binging, and that restriction really isn't part of the profile, and the case that they make is that when you go through
[SPEAKER_01]: a number of processes to kind of understand the full picture of what might be happening for a person.
[SPEAKER_01]: There's a way to kind of parse out what might be a quote unquote true addiction from what we might think of as looking like an addiction, but as perhaps something else.
[SPEAKER_01]: I think that is an interesting idea.
[SPEAKER_01]: I don't know if we're looking at the behavioral presentation and we're looking at the subjective experience and we're also looking at the neuro imaging and we're sort of collectively seeing the same things on the surface what makes one an addiction and one not an addiction.
[SPEAKER_01]: And why I tend to be less drawn towards an addiction framework and more towards something is happening here.
[SPEAKER_01]: What is happening here?
[SPEAKER_01]: There is a something.
[SPEAKER_01]: And how do we understand what that something is?
[SPEAKER_01]: Do we call it addiction?
[SPEAKER_01]: Might it be something else?
[SPEAKER_01]: Is it amplified salience in response to food?
[SPEAKER_00]: Which can results from restriction, like not just the food itself, but that can be the result of restriction.
[SPEAKER_01]: It can be the result of a few different things.
[SPEAKER_01]: It can be the result of restriction, you know, mountain nutrition, perhaps it's the result of the actual food ingredients, right, which is the folks who are in really in proponents of the ultra-processed food addiction, would say it's the actual ingredients.
[SPEAKER_01]: And I know we'll be spending some time on this, but
[SPEAKER_01]: and this kind of ties us back, kind of brings us back to the neuroimaging conversation, which is we can see a what when we're looking at neuroimaging.
[SPEAKER_01]: We can see that's something is happening.
[SPEAKER_01]: But we can't necessarily see why it's happening.
[SPEAKER_01]: So there is a there there.
[SPEAKER_01]: Is it the actual ingredients?
[SPEAKER_01]: Because, again, one might say, well, we see it with the processed foods.
[SPEAKER_01]: We don't see it with the minimally processed foods.
[SPEAKER_01]: But you and I both know,
[SPEAKER_01]: There are moral attachments to these foods, and there are generational liacies, and there are histories, and there is sociocultural messaging, and there is culture, and so there's just a way, and this is what I really interested in.
[SPEAKER_01]: There's a way that we can't strip the ingredients
[SPEAKER_01]: from all that we bring with us, that my history with dried lentils is different than my history with pizza.
[SPEAKER_01]: You know, for me, pizza has been from the time I was a little Friday night, you know, it's like the work we've done, it's been birthday parties, dried lentils, I didn't eat going up.
[SPEAKER_01]: That's not something that I have a lot of history with.
[SPEAKER_01]: And so that's something I've been really thinking a lot about is
[SPEAKER_01]: not wanting to dismiss that there's something here, right?
[SPEAKER_01]: People do have these powerful relationships with people respond to cheetos differently than they respond to broccoli, like that's real and that's true.
[SPEAKER_01]: And how can we understand that in all of the complex layers?
[SPEAKER_01]: And I think that's one of the sort of critiques that's not unique to me, critiques that had been made by many people,
[SPEAKER_01]: when it comes to neural imaging research is that it is devoid of context, it's devoid of social meaning and context.
[SPEAKER_00]: Well, yeah, I'm thinking about that in terms of something you said earlier where, you know, these researchers are seeing like there's a way to tease out perhaps like disordered eating or the effects of dieting and chronically restraint eating sort of making it look like somebody has an addictive relationship with food when actually it's sort of a result of their restraint versus, you know, somebody who didn't have restraint first and they started binging first.
[SPEAKER_00]: And so, like, dieting just isn't part of the picture, I would really question that too, right?
[SPEAKER_00]: Because I think thinking about the context again that we all live in.
[SPEAKER_00]: Yes, there probably are some people.
[SPEAKER_00]: I would say probably rare people just in my experience who have no dieting anywhere in the picture and it's only binging, but I think
[SPEAKER_00]: Just from what I have seen and what it seems like in some of the literature, the restraint often is part of the picture, even if it doesn't come into play first, right?
[SPEAKER_00]: Because I've known people who were like children when they started turning to food for comfort and it was sort of like a coping mechanism for trauma or something that was going on in their life that they didn't have the language or the tools to cope with otherwise.
[SPEAKER_00]: And so they turned to food and found that it had the soothing effect and did it more and it became kind of a habit.
[SPEAKER_00]: But then, you know, that was often stigmatized, right?
[SPEAKER_00]: It was often weight gain happened and that was stigmatized and the person was told to lose weight or shamed for their eating behaviors because it was seen as something that would lead to weight gain or, you know, make them unhealthy in some way, right?
[SPEAKER_00]: There's all this baggage on perceived over eating or eating certain kinds of foods in our culture that I think it's, it's impossible to really escape.
[SPEAKER_00]: And so,
[SPEAKER_00]: even if the bingeing or the eating and what feels like an addictive way preceded the dieting, it's like dieting often becomes part of the picture or restrictive eating or even just shame about the eating becomes part of the picture for people at some point.
[SPEAKER_00]: And so how do you completely divorce that and say, well, this is an addiction versus this is disordered eating driven by dieting, like oftentimes it's a very muddy.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: I think that
[SPEAKER_01]: what we experience in our offices with individuals is just an unbelievable amount of nuance and layers and getting curious about all of those details and that can, I think a lot of times unintentionally get a raise store can be minimized when we try to put frameworks right around these concepts and try to put steps and things to it.
[SPEAKER_01]: is that this is really highly individual and there is a lot in there that gets wrapped up into what is considered to be normal and not even no worthy in our culture.
[SPEAKER_00]: Yeah, it's not even something to be controlled for in the scientific research because nobody thinks of it as anything other than normal.
[SPEAKER_01]: Right.
[SPEAKER_01]: This is the way things are.
[SPEAKER_00]: Right.
[SPEAKER_00]: So I'm curious then with that in mind, you know, how do you
[SPEAKER_00]: or do food addiction researchers really control for not just clinical eating disorders, but also subclinical disorder eating or anything kind of on that spectrum, right?
[SPEAKER_00]: The dieting spectrum, like, because there is some researchers who argue that there are areas of not overlap between the Yale food addiction scale and eating disorder scales, right?
[SPEAKER_00]: And so that that is like the little slice of the venn diagram that we're talking about is like true food addiction or something.
[SPEAKER_00]: But is it also possible that those areas of non overlap could be something else, right?
[SPEAKER_00]: Subclinical disorder, eating, chronic dieting, diet mentality, that sort of thing?
[SPEAKER_01]: Right.
[SPEAKER_01]: Yeah.
[SPEAKER_01]: It's an interesting question.
[SPEAKER_01]: My understanding, as I've engaged in the literature, is that many food addiction researchers don't contend
[SPEAKER_01]: as much as I would like with clinical eating disorders.
[SPEAKER_01]: And there are some researchers who are looking at, is this a food addiction by itself?
[SPEAKER_01]: So we're doing these assessments.
[SPEAKER_01]: We're using a yell food addiction scale, not sure exactly what's utilized in the research.
[SPEAKER_01]: I would have to look at the research specifically to see what they're utilizing to screen more assess for an eating disorder.
[SPEAKER_01]: Isn't an eating disorder?
[SPEAKER_01]: is it both?
[SPEAKER_01]: So there is research that shows, nope, this is just a food addiction, this person just meets criteria for food addiction, this person meets just criteria for an eating disorder, although I'm going to come back to them and then there are the individuals who meet criteria for both.
[SPEAKER_01]: And what has some eating disorder professionals who also are in the substance use disorder space really pay attention to this group because there is research that shows individuals who sort of score positively for both
[SPEAKER_01]: are having worse outcomes in eating the sort of treatment and they're having more severe symptoms.
[SPEAKER_01]: So this does tell us this is a subset of individuals for whom their challenges that are showing up as food symptoms are more severe.
[SPEAKER_01]: And when we look at the clinical picture, there tends to be not always that there tends to be some shared vulnerabilities in terms of histories of trauma,
[SPEAKER_01]: Exposure to early childhood, versity, and we're looking at individuals who may be happy, TSD, individuals who maybe have differences in neurological processing, maybe they have a diagnosis of ADHD.
[SPEAKER_01]: So there's something even more notable, even more striking for these individuals who meet criteria for both.
[SPEAKER_01]: where this gets a little bit sticky for me is that when we look at diagnosing with the EL food addiction scale, which I, as I mentioned, have some pretty big concerns about one we should mention, ultra-process food addiction is not something that is actually yet recognized as a formal addiction.
[SPEAKER_01]: It's its proposed, but it's not
[SPEAKER_01]: There isn't an agreed upon like in the DSM, like we agree that this isn't entity.
[SPEAKER_01]: So the diagnosis is to my mind in quotes.
[SPEAKER_01]: But when we are applying that diagnosis to people who don't have eating disorders, the prevalence rates for the general
[SPEAKER_01]: population in the United States is somewhere around fourteen to fifteen percent, which is not far off from other substance use addictions or disorders.
[SPEAKER_01]: But in the eating disorder population, we get prevalence rates that are as high as ninety seven percent.
[SPEAKER_01]: So that has me concerned that if clinicians, if they're going to be using this tool, and they don't have the training and the skill and the awareness to be assessing and screening for an eating disorder, the likelihood of this, you say you are feeling this way, this is your experience, that's real and true.
[SPEAKER_01]: And now we have a tool to diagnose it.
[SPEAKER_01]: If the primary intervention is, well, it's an ultra processed food addiction, so the way to treat it is to get rid of the ultra processed foods, that has me as an eating disorder provider feeling pretty worried.
[SPEAKER_01]: That's where I get a little like, ooh, you know, is the application, you know, outpacing sort of how we're understanding this research.
[SPEAKER_01]: And because we live in a culture,
[SPEAKER_01]: that is really eager to have reasons and proof for food restriction.
[SPEAKER_01]: It's not a hard sell for a lot of people.
[SPEAKER_00]: for anyone who's not in the eating disorders field and sort of knows why that would be a bad thing to like tell someone they have an ultra-process food addiction versus an eating disorder, right?
[SPEAKER_00]: Like the treatments are totally different and sort of the proposed treatment for the proposed diagnosis of ultra-process food addiction is ultra-process food avoidance, right?
[SPEAKER_00]: Versus with an eating disorder where there's like a restrictive component driving the feelings of addiction
[SPEAKER_00]: the treatment involves a lot of different things, but among them making peace with food and trying to not have as many food roles and not restrict and deprive oneself of those particular foods that one feels triggered by and that can look a number of different ways and sort of be approached in a nuanced way.
[SPEAKER_00]: It's not like all or nothing, but I think ultimately the goal is abundance and sort of openness to different kinds of foods and not this sense of rigidity.
[SPEAKER_00]: because I know there are some people listening who are not really from the eating disorder world, so I want to kind of make sure that we highlight that as well.
[SPEAKER_01]: Not at all.
[SPEAKER_01]: It was great.
[SPEAKER_01]: It's an important context.
[SPEAKER_01]: And I think speaks to the fact that, you know, they're listening to a person, me, who has a particular perspective.
[SPEAKER_01]: I have been writing about this topic in my newsletters.
[SPEAKER_01]: And I'm really trying to encourage people, particularly clinicians, as they are, they're my primary audience that I'm speaking to, is to be open to
[SPEAKER_01]: how I'm sharing this information and I hope that it inspires them to critically engage with the material on their own terms, right?
[SPEAKER_01]: That this is hopefully giving them a little bit of an introductory into this topic and that they're of course going to ask their own sets of questions and have their own lenses based on the individuals that they work with.
[SPEAKER_01]: and what they've seen in the work that they've done with their clients.
[SPEAKER_00]: Absolutely.
[SPEAKER_00]: I want to talk a little more about some of the issues with the Yale Food Addiction Scale and particularly internalized weight stigma, right?
[SPEAKER_00]: I'm curious about there is some research showing that that correlates with Yale Food Addiction Scores.
[SPEAKER_00]: Can you talk a little bit about that?
[SPEAKER_01]: stunning to me when I was stumbled upon this research because I actually didn't know it.
[SPEAKER_01]: There have been serious studies and again, not dozens but a handful of studies done by a few different researchers where it's a correlation just like you said.
[SPEAKER_01]: And that weight stigma and internalized weight stigma as well as the fear of experiencing weight stigma.
[SPEAKER_01]: worsens the experience or feeling of having a food addiction or addictive like eating.
[SPEAKER_01]: So there is this parallel, right, that the more someone has internalized weight stigma or is feeling fearful of being exposed to weight stigma correlates with the sense or this experience felt sense of addictive like eating.
[SPEAKER_01]: And I mean, this is just incredibly important to me as somebody who feels very strongly about that positivity, body liberation, weight inclusivity, that, again, it's a correlation, it's not causal.
[SPEAKER_01]: I don't want to make the sort of faulty jumps that I criticize, you know, the weight loss research for, but I'm like, wow, I don't want to get
[SPEAKER_01]: two to last in pointing to the food.
[SPEAKER_01]: And I feel like this is so much of my career, right?
[SPEAKER_01]: That we sort of see the food as an entry point.
[SPEAKER_01]: But we don't want to just stay at the food, right?
[SPEAKER_01]: That there is something else happening for somebody who has experienced the trauma of weight stigma.
[SPEAKER_01]: I would be very curious about parsing that out and learning more about their histories with dieting.
[SPEAKER_01]: their histories with dietary restriction, right?
[SPEAKER_01]: Individuals who live in larger bodies are going to be more at risk of being pressured by other people to quote unquote fix their bodies.
[SPEAKER_01]: That's my own, you know, my own deducing there that, wow, we have, we've got individuals who are dealing with weight stigma.
[SPEAKER_01]: They are
[SPEAKER_01]: dealing with the stigmatization and the stress of the stigmatization.
[SPEAKER_01]: And then our risk, right, of there being a pointing to, well, you can fix this if you could fix your food and how much you're eating.
[SPEAKER_01]: And then it becomes sort of a personal willpower issue or sort of a more realistic issue around what they are eating.
[SPEAKER_01]: So there's, I think, a lot there to understand on path.
[SPEAKER_00]: You have said that food addiction research and sort of general food addiction discourse contains a lot of weight stigma, right?
[SPEAKER_00]: And can perpetuate harm for higher weight people?
[SPEAKER_00]: Can you talk a little bit about how that weight stigma is sort of woven into the research and the way that people talk about food addiction?
[SPEAKER_01]: Oh my gosh, it is.
[SPEAKER_01]: pretty painful to read some of the research where there is, and I don't know if this is about getting funding, that if you're funding, you know, higher weight studies and how to get people to lose weight.
[SPEAKER_01]: Your studies are funded, I'm not sure, but it is totally wrapped up, the majority of it.
[SPEAKER_01]: is erupt up in treating weight and seeing high weight as pathological.
[SPEAKER_01]: And there is this case that many researchers are trying to make that it's the food addiction that's driving the highway and that it can treat the food addiction that we can treat the weight.
[SPEAKER_01]: which is all sorts of problematic, and has actually been critiqued by some food addiction researchers who point out that food addiction, at least diagnosed by the ill food addiction scale, actually occurs across the weight spectrum.
[SPEAKER_01]: It's not unique to individuals and larger bodies, and not weight we know is incredibly complex.
[SPEAKER_01]: There are so many factors
[SPEAKER_01]: that determine where a person's body size is and how it changes over time.
[SPEAKER_01]: So to be sort of pointing to the food addiction is really not useful, but I'm a clinician.
[SPEAKER_01]: I'm not a researcher, but I am a clinician who reads a lot of research, but I think about
[SPEAKER_01]: the impact I have witnessed particularly in clients and larger bodies who have a very long history of being put on diets being sent to food addiction-based communities that were incredibly harmful.
[SPEAKER_01]: and actually perpetuated and lengthened their eating disorder.
[SPEAKER_01]: And so there is a lack of attention to by not all but most food addiction researchers, a lack of concern for and certainly no amends attempted to be made by the harms that have been caused of course unintentionally.
[SPEAKER_01]: I don't think any of it was malicious.
[SPEAKER_01]: but that have been caused for many people over decades that this language and this framing has been for some people.
[SPEAKER_01]: I'm not going to say of course for all people for the folks that I work with.
[SPEAKER_01]: You know, they come many with these histories of harm.
[SPEAKER_01]: And one of the things that I will point out
[SPEAKER_01]: is that there are a very few number of people who are eating disorder specialists and who work within the addiction field.
[SPEAKER_01]: are really putting forth, I think, some good faith efforts at trying to repair some of these harms to not repeat and also to think much more expansively, much more flexibly and much more creatively around what are the multiple tools that we pull in to support people who haven't eaten disorder and who according to their framing also have
[SPEAKER_01]: an ultra-processed food addiction.
[SPEAKER_01]: I don't want to paint with two broad abreast stroke that I think there are pockets of nuance, but on the whole what I have read is very aligned with the medicalization of body size and the framing that of course a larger body is a sick body and a body to be fixed.
[SPEAKER_00]: Yeah, that is well said.
[SPEAKER_00]: Thank you.
[SPEAKER_00]: Let's dig in a little bit more to the brain imaging research.
[SPEAKER_00]: I'm curious kind of what you make of these brain scans and, you know, the research showing that they're different when people are eating ultra processed food versus minimally processed food.
[SPEAKER_00]: We talked about that a little bit and sort of the the missing context, but I'd love to hear more about kind of like
[SPEAKER_00]: what is missing from that discourse and the sort of, you know, the jump from, well, it's brain imaging scans so that has to show that it's causal or, you know, the brain imaging scans line up with the L food addiction scale and therefore that sort of proves the existence or the validity of this construct, you know, versus like the reality of the kind of narrowness of these brain imaging scans and what they can show versus what they can.
[SPEAKER_01]: And I'll offer this up as somebody who is a dietitian and not a neurobiologist.
[SPEAKER_01]: So we have these researchers who are human and who bring their lived experiences and their biases.
[SPEAKER_01]: The sociocultural norms and their training, all of that, they bring into the design of the research, the questions that they're even asking, and then the meaning-making of what this is telling us.
[SPEAKER_01]: So these theories are shaped by their own experience, their perspectives,
[SPEAKER_01]: assumptions or biases, just as mine are as well, right?
[SPEAKER_01]: I am just as flawed of a human.
[SPEAKER_01]: So, you know, I'm totally on that.
[SPEAKER_01]: And so, I just, shoved to believe that if I was to look at, you know, neuroimaging of my clients, and they're, you know, in one moment eating a salad or something, in the next moment they're eating fun tries.
[SPEAKER_01]: that it's telling me more than just what ingredients and what went into making that salad and what went into making those french fries.
[SPEAKER_01]: That I'm learning something about their own embodied, lived experiences that they're carrying, right?
[SPEAKER_01]: The relationship to food is just layered with
[SPEAKER_01]: all of our socio-cultural, familial, spiritual, generational food like a seed.
[SPEAKER_01]: And that is going to be a part that informs what lights up.
[SPEAKER_01]: Not to mention, our brains have been designed and made evolved over millennia brilliantly to respond
[SPEAKER_01]: stronger that there's increased salience and drive for foods that are energy dense, right?
[SPEAKER_01]: Those highly palatable, so it's just the language used in the research.
[SPEAKER_01]: No, to be highly palatable food.
[SPEAKER_01]: That is what we're driven towards.
[SPEAKER_01]: Right?
[SPEAKER_01]: And so sure, I guess it doesn't seem like a stretch then that a food that is showing something on that narrow imaging for more highly processed foods is going to be different from minimally processed foods, right?
[SPEAKER_01]: That by design, like that's the design.
[SPEAKER_01]: And I just right now, and not convinced that it's revealing an addiction.
[SPEAKER_01]: And that's for a lot of reasons.
[SPEAKER_01]: A little of it has to do with the research, but most of it does have to do with my experience working with hundreds of people over a decade and a half, which is when
[SPEAKER_01]: they get and we know a lot of people, most people don't actually have access to this kind of treatment.
[SPEAKER_01]: But when individuals get really good eating disorders care and opportunity for multi-dimensional healing, that over time these feelings of food addiction don't seem to endure.
[SPEAKER_01]: And that is not to say that that is everybody's experience.
[SPEAKER_01]: And I want to be really careful about that because the last thing I want to do is alienate or minimize the people for whom they have a different experience.
[SPEAKER_01]: And that's real and true for them.
[SPEAKER_01]: And perhaps part of why this theory feels resonant for some people.
[SPEAKER_01]: But my experience is that as people get nourished and as they have access to treatment and I'm not just talking about getting re-fed.
[SPEAKER_01]: that people don't finish eating disorder's treatment and getting exposed to these quote-unquote addictive foods, feeling more addicted.
[SPEAKER_00]: And you would think that it would be the opposite if it was genuinely something in the food that was addictive, right?
[SPEAKER_01]: That would be my understanding.
[SPEAKER_01]: And there might be a listener who can provide me some clarity on that.
[SPEAKER_01]: I would be really interested in seeing like, okay, if we were to deliver, you know, the ill-food addiction scale, let's just even say residential treatments, sort of before residential treatment or after residential treatment or, you know, a bit of a before and after.
[SPEAKER_01]: In my experience, I don't see people who are able to access treatment, finishing treatment, more dysregulated, more compulsive, feeling more unwell with food.
[SPEAKER_01]: And I don't want to dismiss the fact that there is that small number of people captured in the research who have this complex picture, often highly complex picture for whom eating disorder's treatment is sorely lacking, right?
[SPEAKER_01]: And they are not feeling like the treatment is actually attending to and feeling helpful.
[SPEAKER_01]: for their experience.
[SPEAKER_00]: I absolutely want to coastline that because I have known people for whom eating disorders were decades longer, lifelong struggle, even in and out of treatment and that something in their experience and their sort of picture just wasn't being served by traditional eating disorders treatment.
[SPEAKER_00]: But that's not everyone, right?
[SPEAKER_00]: That's a subset of people.
[SPEAKER_00]: And I agree that for the most part, you know, I see people going through treatment and becoming less quote unquote addicted or feeling less addicted to food, including myself.
[SPEAKER_00]: You know, I mean, I didn't go through formal eating sour treatment, but just an outpatient and, you know, my own sort of years of recovery and winding path that I had to healing my relationship with food many decades ago now.
[SPEAKER_00]: It was
[SPEAKER_00]: very true that I felt addicted to food and especially certain kinds of foods, you know, that we would call it to process now, right?
[SPEAKER_00]: But like carbs, you know, at the time, it was the low carb moment.
[SPEAKER_00]: And so I was really focusing on the fact that they were carbs, but, you know, anything sort of sweet or salty, carb-y, starchy, was something I felt like I couldn't have in my house and couldn't let past my lips, otherwise I'd finish the whole box or whatever.
[SPEAKER_00]: And now that is just not my reality.
[SPEAKER_00]: Like I have these foods all the time, I have them in
[SPEAKER_00]: amounts that I don't feel out of control with them.
[SPEAKER_00]: I can have them and put them down.
[SPEAKER_00]: I can go about my day and not that that's like a badge of honor to have something sitting in my pantry because I'll eat it when I want it.
[SPEAKER_00]: But I personally have this very real experience of having felt so addicted to these foods and then not.
[SPEAKER_00]: And then feeling totally a piece of them through the course of learning to be at peace with that, right?
[SPEAKER_00]: Learning to
[SPEAKER_00]: be exposed to them and not feel like the the salience of them decreased over time.
[SPEAKER_00]: I also want to not impose that experience on everyone because I know there are some people for whom that doesn't happen or hasn't happened yet and it feels like far away dream and you know feels like it may never happen.
[SPEAKER_00]: I also am curious in the research, you know, what you've seen because I think I have seen that some research people's Yale food addiction scale scores do go down as they receive eating disorder treatment.
[SPEAKER_00]: Is that correct?
[SPEAKER_00]: Or is that sort of limited research rate?
[SPEAKER_01]: It's limited, it's limited.
[SPEAKER_01]: I wish there was more of that research and really interested, and the studies don't go into the kind of detail I wish they did, but it reflects.
[SPEAKER_01]: My experience, you know, so of course it makes sense that it's sort of affirming to me.
[SPEAKER_01]: So I'm like, oh, this is actually what I've seen with, you know, I don't even know how many clients at this point that the experience at the beginning versus the experience at the end of the beginning
[SPEAKER_01]: feels very much like a drug.
[SPEAKER_01]: I mean, I have clients who said this feels akin to what I'm doing drugs.
[SPEAKER_01]: Like when I'm eating ice cream, I feel high.
[SPEAKER_01]: Like as if I'm smoking weed, they make these comparisons.
[SPEAKER_01]: And then they go through eating disorder's treatment and somehow that feeling doesn't endure.
[SPEAKER_01]: So one of the questions that I get curious about is can addictions disappear?
[SPEAKER_01]: Right?
[SPEAKER_01]: Is it an addiction?
[SPEAKER_01]: If it is, you know, there in one moment and then, you know, after two years of treatment or whatever, we're not measuring it anymore.
[SPEAKER_01]: You know, there's evidence that healing has occurred.
[SPEAKER_01]: Or is it that the addiction framework is maybe not the best match?
[SPEAKER_01]: Is it that it wouldn't be considered an addiction anymore because neurobiological rewiring and hearings happen?
[SPEAKER_01]: I don't know.
[SPEAKER_01]: I'm really interested in those questions.
[SPEAKER_01]: I mean, my gosh, I have so many questions, more questions than answers.
[SPEAKER_01]: But I, of course, was really interested in the research that shows that at least for some people after going through eating disorders treatment, this diagnosis no longer fits.
[SPEAKER_01]: Which, for me, begs the question, particularly for the eating disorders population, how much you tell
[SPEAKER_01]: Is there to use this food addiction model?
[SPEAKER_01]: Is there utility of using the model for a small subset of people for home, even with treatment or sort of traditional approaches for home that has been proven to be very unhelpful, you know, is it worth?
[SPEAKER_01]: modifying or reducing their exposure to certain foods.
[SPEAKER_01]: And what are the risks and benefits of legitimizing a food addiction for people within eating disorder?
[SPEAKER_01]: I'm really curious about the ways in which there are similarities and overlaps in terms of proposed treatments versus how treatment for a food addiction within eating disorder, like how would that depart from traditional eating disorders treatment?
[SPEAKER_01]: You know, really interested in terms of my client's experience, right?
[SPEAKER_01]: There's an addiction model, reduce shame.
[SPEAKER_01]: Does it amplify shame?
[SPEAKER_01]: Does it increase feelings of empowerment?
[SPEAKER_01]: Does it decrease feelings of empowerment?
[SPEAKER_01]: and I believe so strongly that I can't assign that for anybody, right?
[SPEAKER_01]: That is going to be the experience of the individual that I'm sitting with, that is there is a small subset of individuals with needing to sort of for whom a different kind of approach may give them opportunities for hearing
[SPEAKER_01]: that maybe they haven't otherwise been able to access.
[SPEAKER_01]: And reading there's two papers that are looking at treating a food addiction alongside an eating disorder and sort of how that would look.
[SPEAKER_01]: And they kind of bullet point a lot of the pieces or elements of the treatment.
[SPEAKER_01]: There's a lot of overlap.
[SPEAKER_01]: There's a lot of agreement.
[SPEAKER_01]: I think the big difference would be in terms of the nutritional protocol.
[SPEAKER_01]: In terms of harm reduction approach, are we looking at reducing access to certain types of foods?
[SPEAKER_01]: Would it be reducing those foods within certain settings?
[SPEAKER_01]: Is it eliminating those foods?
[SPEAKER_01]: is it an abstinence-based model?
[SPEAKER_01]: I think that there has been, it's not the exact same picture of the community-based approaches that many people have a negative reaction to that it is different in terms of what clinicians are proposing within the eating disorders space.
[SPEAKER_01]: There is also some alignment there, right, that what they're proposing, of course, is
[SPEAKER_01]: adequate calories that this isn't a dieting protocol.
[SPEAKER_01]: You know, adequate micronutrients, a balance of macronutrients from all of the kind of core food groups.
[SPEAKER_01]: This interesting piece here, the piece that is, you know, the most charged that the clinicians feel the strongest about is that are we intentionally reducing the exposure or totally eliminating the exposure piece of ultra-processed foods?
[SPEAKER_01]: And I actually think that a lot of eating disorder providers
[SPEAKER_01]: use so much nuance in the ways that they work with their clients.
[SPEAKER_01]: I don't think that most eating disorder providers who believe in moving towards helping clients feel okay around eating foods and sort of feeling.
[SPEAKER_01]: You know, flexible and body are saying to their clients, nope, you've got to pack your fridge.
[SPEAKER_01]: Nope, you have to fill your grocery cart.
[SPEAKER_01]: You have to be eating foods that might be the experience certainly of people in residential treatment settings where there isn't the kind of autonomy, right?
[SPEAKER_01]: And there is a lot of food exposure.
[SPEAKER_01]: But in terms of outpatient care, I think that most outpatient eating sort of providers
[SPEAKER_01]: are incredibly creative and responsive to their clients and try things on and experiment and listen to and learn from their clients' lived experiences.
[SPEAKER_00]: Well, I think that's a great segue into what I want to spend the rest of our time together talking about, which is like the practical applications of this and specifically how you would work with someone who has the food addiction world might call addictive tendencies or that we might call addiction like tendencies or whatever.
[SPEAKER_00]: or someone who thinks of themselves as being addicted to food.
[SPEAKER_00]: In the book you use a case study to look at how clinicians who treat disordered eating clients can approach working with people who feel out of control of certain ultra-process foods specifically.
[SPEAKER_00]: And you know you talk about the importance of nuance in this approach and how a person's relationship with food can change over time as a result of this work.
[SPEAKER_00]: And it's not just open the floodgates, you have to have everything, which as you say, like, you know, residential treatment people may feel like that.
[SPEAKER_00]: Also, in my experience, people who are just doing their recovery on their own with help of social media, I think sometimes feel like that because
[SPEAKER_00]: I think some of the messaging out there about intuitive eating and diet culture recovery and all this stuff is just have all the food all the time open access completely and no food is off limits.
[SPEAKER_00]: And you know, I think in some of my earlier work, maybe I was not nuanced enough about
[SPEAKER_00]: talking about how that process works and I think there's value to saying like all foods fit and you have unconditional permission to eat and sort of these like big statements that then require some unpacking but I think sometimes people don't go past the headline or the you know the quick meme that doesn't do a lot of the unpacking and so can end up feeling this pressure to like have everything all the time.
[SPEAKER_00]: eat all the foods that are sort of tricky for them all the time and have them in their house and all the ones which can contribute in some ways to feeling out of control with those foods if you're not approaching it a way that feels like safe right and feels you know for some people maybe it works but I think a lot of people I have seen need maybe a little bit more support in that process.
[SPEAKER_00]: So I would love to talk about this case study and sort of how you would work with a client in this nuanced way.
[SPEAKER_01]: Sure, I was so hearing what you were saying it's interesting because I have plans for whom
[SPEAKER_00]: That was the first half of my interview with Marcie Evans, and if you want to hear the whole thing with lots of practical applications to take away from this conversation, you can become a paid subscriber at rethinkingwellness.substack.com or click the link in the show notes.
[SPEAKER_00]: If you're already paid subscriber and you happen to be hearing this, look at your welcome email for instructions on how to set up your special podcast feed or just hit reply to that email and someone on my team can help you out.
[SPEAKER_00]: In the meantime, you can find Marcy at MarcyRD.
[SPEAKER_00]: That's like registered dietician, MarcyRD.com.
[SPEAKER_00]: Thanks so much for coming back on the show and for this great conversation.
[SPEAKER_00]: If you liked this episode, I'd love for you to subscribe or follow Rethinking Wellness on Apple Podcasts, Spotify, or wherever you listen.
[SPEAKER_00]: Thanks for being here and I'll talk to you soon.
[SPEAKER_00]: Take care.