10-13-15 bgs

A Tool Kit
for
Food Addiction Assessment and Treatment;
the Basics from A to Z
For Physicians, Dietitians, Therapists and other Allied Health Professionals

Sponsored by:

UMass Department of Psychiatry

55 Lake Avenue North | Worcester, MA 01655 | 508-856-8786
umassmed.edu/psychiatry/

P.O. Box 51261 | Sarasota, FL 34232 | 941-747-1972

foodaddictioninstitute.org

Copyright: October 2015 UMass Department of Psychiatry, University of Massachusetts Medical School / UMass Memorial Health Care
and the Food Addiction Institute. These materials can be freely duplicated for distribution to patients, clients and other professionals as
long as the copyright is included. Permission is required if material is used in a document for sale or publication.

This healthcare providers tool kit introduces the diagnosis and treatment of food addiction. It gives you a brief overview of
what is involved. And it provides and explains the use of a set of concise documents (Appendices A Z) that support
diagnostic and treatment work and further provider education about these activities. Some can also be used as handouts for
patients and clients. (You may find it useful to flip back and forth between the overview and the documents, themselves.)

TABLE of CONTENTS

An Overview
1. Introduction
2. The Nature of Food Addiction
3. Screening for Food Addiction
4. An Important Choice Point
5. In Depth Assessment and Diagnosis
5.1
5.2
5.3
5.4
5.5

Using the DSM5 Diagnostic Criteria for Substance Use Disorders

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Yale Food Addiction Scale

SUGAR
Three Self-Assessment Instruments
Act As If

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6. Treatment Options Twelve Step Treatment and Support

6.1
6.2
6.3
6.4

Background
Fellowship Recommendations for Newcomers
The Twelve Steps Adapted to Food Addiction
Supporting Patients Participating in 12 Step Groups

7. Treatment Options Referring to Professionals for Individual or Group Treatment

7.1 When to Refer
7.2 Choosing Food Addiction Professionals
7.3 Warning Signs

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8. Treatment Options Other

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8.1 Didactic model

8.2 Individual food plan, resolve underlying trauma and mindfulness
8.3 Free standing mindfulness programs
8.4 A religious model
8.5 A gentle eating model
8.6 A secular empowerment model
8.7 An outpatient food addiction clinic
8.8 Comprehensive physician managed food addiction recovery
8.9 Food addiction recovery coaching practices
8.10 Proposed obesity coaching legislation
8.11 Internet Support

9. Treatment Options Bariatric Surgery

10. Some Frequently Asked Questions (FAQs)

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10.1 What about Motivation?

10.2 What about the Science?
10.3 How Can You Be Abstinent From Food?
10.4 What about Choice?
10.5 What Is A Sponsor?
10.6 Can You Say A Little More about Denial?
10.7 What about Treatment with Medications?
10.8 Is There A Progressive Ladder of Treatment For Food Addiction?

Appendices
A.
B.
C.
D.
E.
F.
G.
H.

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Do You Have Concerns About Compulsive / Binge Eating or Food Addiction brochure
Food Addiction: Beyond Ordinary Eating Disorders from the Clinical Forum of the IAEDP
Normal Eaters with Obesity, Emotional Eaters with Eating Disorders, & Food Addicts with Chemical Dependency
Discussion of Normal EatersChart
"Progressive Stages of Food Addiction and Recommendations for Treatment" chart
Clues Suggesting the Need for Food Addiction Screening.
DSM 5 statement about eating-related symptoms in context
S UNCOPE food addiction screening instrument

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I. Food-Related Twelve Step Fellowships

J. Self-Help Books on Food Addiction and Other Resources
K. Obesity Epidemic: Understanding Addiction in Managing Overeating. BHN, Vol 32 no 2
L. Yale Food Addiction Scale and Instructions
M. 12 Steps as adapted to food addiction.
N. Professional Assistance
O. 7 Mindful Eating Tips
P. The Principles of Mindful Eating
Q. American Society for Addictive Medicine (ASAM) Summary Statement on Addictions.
R. Overeaters Anonymous Dignity of Choice pamphlet Available as part of the Extras bundle.
S. Sugar (The Many Names of Sugar) T Wright
T. Glenbeigh Psychiatric Hospital / ACORN basic food abstinence plan; The Process of Working Toward Abstinence
U. Food Sponsors Dos and Donts from Overeaters Anonymous
V. Arguments Against Common Denial
W. Psychological Denial Additional Notes
X. Biochemical Addictive Denial Additional notes.
Y. Medications for Obesity, Eating Disorders and Food Addiction? - Vera Tarman, MD
Z. References

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An Overview
Introduction
A large part of your work with patients and clients will involve education about food addiction. Do You Have
Concerns About Compulsive / Binge Eating or Food Addiction (Appendix A) is a three-fold brochure developed by
the University of Massachusetts Medical School and the Food Addiction Institute to provide a quick, readable
general introduction to compulsive eating and food addiction. It is designed as a public information handout for
doctors offices and for distribution to the local community. And it is handy to share with others in your practice
with little or no knowledge of food addiction. It includes a few self-assessment questions and it can be paired with
a list of free and professional services available in your geographic area. Note: The sample resource list needs to
be revised to be useful for your local readership.

The Nature of Food Addiction

The article Food Addiction: Beyond Ordinary Eating Disorders (Appendix B) from the Clinical Forum of the
International Association of Eating Disorder Professionals (IAEDP) explains that physical obesity, psychological
eating disorders and chemical dependency on specific food(s) are three very different medical problems. Though
often found coexisting with one other, each must be separately diagnosed and each requires its own, distinct
treatment regimen. These are distinctions that the medical community is just beginning to appreciate. Those who
are overweight but also have an eating disorder or a food addiction cannot be effectively treated just by diet,
exercise and a change of life style alone. Not all the obese are food addicted, and not all those food addicted are
overweight. However, food addiction is an important driver of the larger obesity epidemic, and the most difficult
cases are often severely overweight, with unresolved trauma and advanced food addiction both found to be comorbid.
The chart Normal Eaters with Obesity, Emotional Eaters with Eating Disorders, and Food Addicts with Chemical
Dependency (Appendix C) (& Appendix D for discussion) is a simple summary of the significant diagnostic and
treatment differences common among those with these medical problems. In the case of food addiction, as with
other chemical dependencies, it is essential not just that the physician makes the correct diagnosis but also that
the potentially food addicted patient understand and accept these differences. Therefore, treatment should begin
with basic education about these three conditions.
The "Progressive Stages of Food Addiction and Recommendations for Treatment" chart (Appendix E) outlines how
food addiction tends to evolve as the condition becomes increasingly severe. It also describes the implications for
different types of treatment as the disease progresses.
Many of those with advanced food addiction will welcome learning why so many previous attempts to control
their weight and eating may not have worked. For those resistant to a diagnosis of addiction or resistant to
completely eliminating one or more of their specific trigger foods or to doing all the recovery work required to put
a food addiction in remission - an important seed will have been planted.
Even some of those who suspect that they might be addicted may choose to make one or more serious efforts at
dealing with their weight problems through diet and exercise alone. Of course, this is exactly what those who are
food addicted or emotional eaters cannot do, but unless they have already tried this and failed a number of times,
it may well be worth their trying, once again. This is why, in the introductory brochure above, we suggest
providing referrals for diet and exercise support. And this is why we also suggest supporting even those who
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screen positive for food addiction on assessment in making yet another serious try at a diet and exercise plan, if
this is what they really want to do. They may succeed. But even if they do not succeed, the failure may be just
what they need to prove to themselves that careful reasoning and self-will alone are not sufficient for them.
For a number of these people, it is a matter of finding out that they are food addicts by a process of elimination. If
yet another diet and exercise plan does not work, people in this group may sooner or later finally be willing to
seriously consider the possibility that they may indeed have biochemically induced physical cravings and mental
obsessions.
For others, however, there can be a shorter and probably less frustrating path to accepting their condition. This
path involves effective screening, assessment and diagnosis.

Screening for Food Addiction

In point of fact, similar to findings for the efficacy of a single-question in alcohol abuse (Mitchell, Bird, Rizzo,
Hussain, & Meader, 2014),1 the busy practitioner can add one simple screening question to the list of questions
routinely asked of patients or clients. It is this: Do you have trouble managing your weight or do you find yourself
overeating specific food(s)? This question can be easily and usefully added to questions about smoking, alcohol
use and other drug addictions, when taking a patients history and vitals. An affirmative response indicates the
need for further food addiction screening.
At the same time, patients will often mention something in passing that suggests further investigation is
warranted. Werdell, a clinician who has worked with over 4000 late stage food addicts, has developed a list of
Clues Suggesting the Need for Food Addiction Screening. (Appendix F) One or more of these cues may also
suggest the wisdom of pursuing a short list of additional, initial food addiction screening questions.
Although no specific food has been formally designated as addictive, the DSM 5 of the American Psychiatric
Association (APA) reports that Some individuals with disorders described in this chapter report eating-related
symptoms resembling those typically endorsed by individuals with substance use disorders, such as craving and
patterns of compulsive use.(Appendix G) Wright and Ifland describe self-reports of obese adults in the Behavior
Health Newsletter Vol 32 No2 article included below as (Appendix K) that match the accepted substance use
disorder characteristics, exactly. Gherhardt, et al published a study (in 2012) in which a surprisingly high 57% of
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those with Binge Eating Disorder tested positive for food addiction. Kessler reported on NPR All Things
Considered, in 2010, an as yet unpublished epidemiological study of a large U.S. metropolitan area in which 50% of
the obese, 30% of the overweight and 20% of the normal weight were estimated to have some level of food
addiction. Every clinician can screen for these characteristics with just a few short questions.

If a few more questions seem to be called for, the S-UNCOPE (Appendix H) is a slightly longer (6 questions)
screening tool for sugar and other food addictions. It was developed by Bitten Jonsson in Sweden, RN, and based
on a similar, well established screening tool for alcoholism and other drug addictions, developed by Norman G.
Hoffmann, PhD, in the USA. It has one easily answered question for each of the major characteristics of a
Substance Use Disorder in the DSM 4, here applied to food.
Two other ways to do an initial screening: Ask a patient or client to do some work on their own.
1) On the websites of Overeaters Anonymous (OA), Food Addicts in Recovery Anonymous (FA),
GreySheeters Anonymous (GSA) and other food-related Twelve Step fellowships (Appendix I) there
are paper and pencil self-tests which, like the traditional self-assessment instrument of Alcoholics
Anonymous (AA), have been used in practice for decades. Though they have not been independently
validated, scientifically, most include the questions on the S-UNCOPE or variations thereof and have
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the advantage of bringing the possible food addict into contact with these recovery websites (and the
support systems they represent).
2) There are a number of good self-help books on food addiction that have self -assessment questions
and excellent narrative explanations of the disease. See (Appendix J) Self-Help Books and Other
Resources. For patients who like to read up on their possible ailments these books provide additional
knowledge about food addiction. They can be sold at a providers office or purchased easily on
Amazon.com or locally.
If either of these two types of screenings comes up positive, this, too, suggests the need to doing a more in depth
assessment and diagnosis.

An Important Choice Point

For many healthcare providers, especially primary care physicians, this brings you to an important choice point.
Given the limited time available to you during the typical, brief medical encounter, even if you have managed to
complete the longer 6 question initial screen and it comes up positive, you will have run out of time to pursue
things further.
The kinds of things you would want to know at this point are these:
1) More about the patients eating, addiction and cross addiction history.
2) What are the trigger foods and the sorts of typical trigger events that lead this patient to overeat and
lose control of their eating?
3) Is the individual willing to consider eliminating trigger foods from their diet and, as far as possible,
avoiding trigger events?
4) How does information about an individuals trigger foods translate into a highly individualized,
achievable and effective food plan?
5) How much structure and what kind(s) of structure does this patient need in order to be successful in
pursuing food addiction recovery in the short, medium and long term?
6) What sorts of supports are available to this person, in the way of family and friends, if and when they
try to alter their eating behaviors?
7) Has the patient ever tried or is he or she willing to try attending a 12 step food related support group
(or a comparable support system) in order to gain access to the kind of extraordinary support that is
almost always needed when addiction has distorted the normal functioning of the brain in ways that
frustrate attempts to alter eating behavior?
8) Whether or not the individual is attending a 12 step group on a regular basis, is additional
professional help needed, either with developing an individually tailored food plan or in the way of
intensive support for dealing with food addiction denial and/or detoxification (becoming abstinent
from ones trigger foods)?
9) What other treatment and support options would be appropriate for this patient or client to consider,
given their personal preferences, interests, values, learning style, geographical location (i.e. resources
available in his or her community) and available financial resources?
For most healthcare and allied health professionals, the time and expertise (much less the adequate
reimbursement arrangements) required to pursue these things are not available. In this situation, referral to a
local 12 step, food related group and/or a food addiction professional or professional food addiction program
becomes the only feasible next step. However, it is important to know enough about these support groups and
the various forms of professional assistance that are available, and what they do, in order to be able:
1) To make sound referrals.

2) To provide effective, ongoing follow-up and home base (medical home) support to your patient, as
the person pursues his or her path toward food addiction recovery, recognizing full well that for most
people this is a chronic, meaning lifelong condition.

In Depth Assessment and Diagnosis

Here are five approaches to in depth assessment and diagnosis:
1) In a recent article in the Behavioral Health Newsletter, Wright and Ifland suggest that food addiction
can be assessed for severity using the DSM 5 diagnostic criteria for substance use disorders. The
DSM 5 diagnostic criteria allow the practitioner to evaluate clients based on these diagnostic criteria
regardless of the extent of overweight. The DSM 5 suggests that severity of addiction increases as the
number of criteria endorsed increases. (Appendix K)
2) The Yale Food Addiction Scale (Appendix L), with its 25 probing questions, has been peer reviewed
and validated as consistent with the DSM 4 criteria for a chemical dependency. For those who are
expecting questions about food addiction validity when making insurance reimbursement requests, or
for those wanting to do research, this can be a good instrument to substantiate a diagnosis. It does
not, however, provide answers to most of the questions just posed, above. This means it does not
provide the kind of in depth, diagnostic information that makes it possible to begin to work seriously
with a patient to devise an appropriate treatment plan.
3) SUGAR is a new diagnosis protocol being developed in Sweden by Jonsson. It looks at sugar and food
addiction in the context of a full addiction history and provides practical information as to the stage of
each (typically co-morbid) addiction and its severity. This can lead to a more rigorous treatment plan,
but it takes specialized training by someone already familiar with addiction to learn how to use this
protocol. For information about the next trainings in Europe and possible trainings in the United
States contact: bitten.jonsson@bittensaddiction.com
4) A critical aspect of diagnosis for any addiction is patient or client acceptance of the diagnosis. The
frequency and strength of patient resistance to a diagnosis of food addiction cannot be over
emphasized. As patients begin to understand the true nature of food addiction and begin to imagine
what it would be like to give up their trigger food(s) and to mitigate the impact of trigger events,
lifelong, they typically manifest powerful, often prolonged, possibly repeated bouts of food addiction
denial. The work of in depth diagnosis can therefore be complicated by denial and at one and the
same time need to engage with a patients denial.
In Werdells Bariatric Surgery and Food Addiction: presurgery considerations there are three selfassessment instruments, one to determine if you are a normal eater and likely to be able to use
diet and exercise to lose weight (15 questions), the second to look at psychological eating disorders
anorexia, bulimia and binge eating disorder (30 questions), and the third to evaluate for food
addiction by degree of severity (42 questions). These 3 tools can be accessed at
http://foodaddictioninstitute.org/for-food-addicts/self-assessment/ While not peer reviewed as
diagnostic instruments, they have in practice been very valuable, clinically, in that they often help to
challenge a patients or clients food addiction denial. (Note: Many food addiction professionals
believe that patients who suffer with food addiction represent a subcategory of binge eating
disordered patients.)
5) In practice, one of the most convincing ways to assess whether someone has an addiction to one or
more foods is for the patient to actually try to act as if they have a food dependency (that is, act as
if they are a food addict). For example, the patient could join a food-related Twelve Step group, a
place to get free, often extraordinary support for dealing with their condition. There they could work
to abstain completely from their binge foods, use the tools and meetings of the fellowship as support
and practice Twelve Steps as a way of working through underlying (often emotional) issues.
If this works over a period of a year, there is a high probability that the person is food addicted. This
may sound extreme as a combined assessment/diagnostic and treatment activity (although it isnt
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that different from what clinicians have done for years with conditions like ADHD), but with some
patients it turns out to be the best way to break through (or in this instance, perhaps, melt) their
denial. Some of those considering trying one more diet might be persuaded to try this acting as if
experiment instead. Others may need some form of professional treatment, such as an extended
intensive workshop, in order to be able to try such an experiment. But when a patient does try this,
even if they discover that they are not food addicted, they will have identified some ways to
effectively deal with serious health problems which they didnt have available to them, previously.
Unfortunately, most of the information identified in the section headed An Important Choice Point
above as being needed for an in depth assessment or diagnosis, information sufficient to develop a viable
treatment plan, is not easily generated outside the context of a carefully designed food addiction program, be it a
12 step food related program, a food addiction professional working as a sole practitioner or a larger professional
food addiction program of some kind (which may or may not be part of a yet larger addiction treatment practice,
center or clinic). For this reason, careful referrals of some kind are usually encouraged, both for in depth
assessment and diagnosis, and for treatment.

Treatment Options - Twelve Step Treatment and Support

Background
If a patient or client screens positive for food addiction, a next step can be to encourage them to investigate local
food-related Twelve Step fellowships. Founded in 1960 the oldest, largest and most diverse food-related Twelve
Step fellowship is Overeaters Anonymous (OA). By 1990 there were over 100,000 members in thousands of
groups throughout the United States and worldwide. An OA self-study found that about 50% of the membership
was food abstinent [from their particular trigger foods] and maintaining an average fifty pound weight loss. This
fellowship offers peer support like Alcoholics Anonymous (AA) to many different types of compulsive eaters.
From the beginning there were two tendencies within OA those who saw their problem as an eating disorder
and those who defined their problem as an addiction. Many, of course, saw it as both. Those who were selfassessed food addicts and whose disease needed more structure and support formed movements within OA
focused more rigorously on the addictive model and the principle of [selective] abstinence first. These were Grey
Sheet groups, HOW format groups and 90 Day groups. They continue within OA today and are preferable
referrals for diagnosed food addicts.
In the late 1990s, several groups left OA to form separate fellowships focusing just on the food addiction model;
these included Food Addicts Anonymous (FAA), Food Addicts in Recovery Anonymous (FA), Compulsive Eaters
Anonymous HOW (CEA-HOW), GreySheeters Anonymous (GSA) and Recovering Food Addicts Anonymous (RFA).
Each continues as a separate fellowship, today. These organizations are smaller a few thousand each each
stronger in different parts of the country and the world, but all provide substantial recovery support, especially
for later stage food addicts.
So unlike the field of alcoholism, there is not just one primary fellowship, i.e., Alcoholics Anonymous (AA) but
rather several different fellowships (Appendix I), with great variety in the amount and quality of recovery locally.
It makes a difference if a clinician is familiar with the range of support programs and can make referrals to specific
local members or meetings. When there is not strong abstinence and recovery in local food-related twelve step
meetings (several members who refrain from their triggers and who are making good progress with their recovery
work) or no meetings at all, know that there are now almost daily phone meetings available as an alternative.
(Accessible through the respective websites of many of these groups.)
Fellowship Recommendations for Newcomers
The fellowships have recommendations for newcomers that are worth passing on:
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1) It is recommended that someone new to food addiction recovery go to at least six meetings before
they decide whether or not the program might be worth trying.
2) If you are new to a fellowship, read through at least one of the basic books from that program
3) Identify members of the group who are themselves food abstinent, have worked the Twelve Steps,
and have some quality that you like or want for themselves. Talking with them as possible sponsors
or as a "temporary sponsor" can be very useful.
4) Those who want the promised results need to do the recommended program: Do each of the Twelve
Steps in order, while food abstinent, under the guidance of an experienced sponsor.
The Twelve Steps Adapted to Food Addiction.
There is a chart listing the Twelve Steps as adapted to food addiction and a summary of what this means in
practice. (Appendix M)
Supporting Patients Participating in 12 Step Groups.
For health professionals referring their clients to a Twelve Step group there are a number of follow-up questions
which constitute the basis of general Twelve Step and professional support:
1) Did the client actually go to a meeting and/or research the website?
2) Did the client do a self-assessment and/or read the basic literature?
3) Did the client identify a member who is food abstinent and who has what he/she wants as a
possible sponsor?
4) In time, is the client working with a sponsor?
5) Has the client, with help, developed and committed to a food plan?
6) How well is the client sticking to the food plan? And if there are problems, what is getting in the way?
7) Has the client started actually working the program, the Twelve Steps?

Treatment Options - Referring to Professionals for Individual or Group Treatment

When to Refer
In early recovery, many food addicts need a good deal of support to be accountable in their recovery activities. As
mentioned earlier, others need help to deal with their own resistance and food addiction denial. If patients are
having blocks to doing what is recommended, one option for the general practitioner at this point is referral of the
patient/client to a food addiction professional. For suggestions regarding available professional assistance, see
(Appendix N).
Choosing Food Addiction Professionals
It must be pointed out that to this point, most health professionals received little or no training in food addiction
screening, diagnosis or treatment during their graduate and professional school training. Many have even been
taught that food addiction does not exist. So it is important to have the following criteria in mind, at a minimum,
when selecting (or suggesting) a therapist, dietitian or other professional for food addicted patients/clients?
Key questions are, has the professional under consideration been successful in helping other food addicts to:
1) Get food abstinent?
2) Work through resistance to whats involved in food addiction recovery?
3) Challenge food addiction denial?
4) Develop skills to cope with the difficult thoughts and feeling that emerge when specific food(s) are
removed completely from their diet?
Warning Signs
In addition, there are warning signs regarding inappropriate referrals:
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1) Does the professional(s) think that everyone should be able to diet based on willpower alone?
2) Does the professional assume that everyone should try to learn to eat all foods including sugar and
other potentially addictive food substances in moderation?
3) Does the professional continue to tell clients that there is no scientific basis for food addiction?
These items may seem obvious or even laughable. But, sometimes, self-described food addiction professionals are
providers seeking to expand their market and the only way you find out that they hold these attitudes (practice
assumptions) is by asking them, their patients or your patients after they have begun to see them.
An additional practical way to identify or vet effective professionals, and one of the best, is through asking food
addicts who are successfully food abstinent and in recovery for recommendations.

Treatment Options Other

There are many approaches to food addiction treatment starting to appear. Several of these do not endorse the
addiction model and/or encourage participation in a Food-related Twelve Step fellowship as a means of gaining
support. Other approaches (some developed by presenters at UMass FAI food addiction conferences) include:
1) A didactic model of teaching what to eat in order to prevent food addiction or to curtail food addiction at
an early stage.
2) A model of beginning with an individualized plan for food abstinence, then work to resolve underlying
trauma with cognitive behavioral therapy, mindfulness training, expressive therapy or some
combinations of these approaches.
3) Free standing mindfulness programs. See (Appendix O) for Seven Mindful Eating Tips and (Appendix P)
for The Principles of Mindful Eating. Caution is advised here as those with a substance use food disorder
tend to need a good deal of structure supporting their food choices.
4) A religious model, for example, focusing on the emotional and spiritual issues from the point of view of
Christianity such as The Daniel Fast, Celebrate Recovery or Overcomers Inc.
5) A gentle eating model, using meditation training and/or exercises to develop feeling skills and ways of
discerning the difference between body hunger, emotional hunger and spiritual hunger,
6) A secular empowerment model for addiction such as that of Recovery Inc.
7) An outpatient food addiction clinic is being developed by the UMass Department of Psychiatry. It may
become a model for such programs.
8) Comprehensive physician managed, food addiction recovery practices such as those of Dr. Beth Rocchio
and Dr. Pam Peeke.
9) Food addiction recovery coaching practices like those of Esther Helga Gudmundsdottir, MSc, Bitten
Jonsson, RN, and Rhona Epstein, PsyD. (which do endorse and incorporate the addiction model)
10) Proposed obesity coaching legislation: The Treat and Reduce Obesity Act of 2015, which would
broaden reimbursement for obesity coaching to include primary care supervised health educators.
11) Internet Support including SHAPE; Facebook groups such as Food Addiction Education and Breaking Free
from Food Addiction-The Kay Sheppard Community; and the Susan Thompson Bright Line Eating Program.
We have given a lot of attention to the Twelve Step strategy for food addiction recovery in this document because
1) There is a fifty-five year history of food addicts going to these groups;
2) A thirty year history of professional treatment program support of those involved in these programs who
have trouble achieving and maintain abstinence;
3) There are already tens of thousands recovering from food addiction using this model;
4) For those needing extensive and extended support to recover, it is the most generally accessible and
inexpensive (or free) approach;
5) There is no need to build an infrastructure of support if one already exists and can be improved;
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6) This is what the primary authors of this material know best.

We will add information about other promising models to the on-line version of this tool kit (to be posted shortly
following this Oct., 2015 conference at the UMass and Food Addiction Institute websites) as it becomes available
to us.
Treatment Options Bariatric Surgery
In 2013, 468,609 bariatric surgeries were performed, worldwide. Of these, 154,276 took place in the USA / Canada
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region. Bariatric surgery can be an effective part of treatment for many people with late stage food addiction.
However, it is not a silver bullet. It is essential that bariatric surgery programs be staffed and committed to
meeting the special needs of patients who are food addicted. Otherwise, a significant proportion of these patients
are unlikely to achieve long term success. It turns out that at the present time few bariatric surgery programs
have active food addiction tracks.

Some Frequently Asked Questions (FAQs)

What About Motivation?
In working with a food addict as with alcoholics and other drug addicts willingness and motivation are key.
There are well established readiness for behavior change scales which can be used for food addiction. In the case
of food addiction, particularly, resistance to admitting having a problem is a part of the disease. Addiction is a
brain disease which tells you that you dont have a disease. It can be especially difficult to admit that it is almost
always impossible in later stages of the disease to make progress toward recovery with reason and willpower
alone. Physical cravings overpower conscious intention to eat healthfully. Mental obsessions, often called
stinking thinking, repeatedly rationalize unhealthy use and eventually dangerous abuse of specific food(s) or
overeating in general. Thus, important work of the food addiction professional often begins with helping the client
become ready and willing to try taking a systematic and reasonably structured approach to food addiction
recovery. Some, but not all, professionals trained in working with alcoholics and other drug addicts are able to
translate their experience to work with those afflicted with food addiction.
What About The Science?
Some possible food addicts, and many healthcare practitioners, are convinced the disease is real by exposure to
the latest scientific research concerning food addiction. While there was little peer reviewed evidence of food
addiction twenty years ago, the Food Addiction Institute (FAI) has a bibliography of 2,734 articles from over a
hundred scientific journals, most published since the turn of the century at
http://foodaddictioninstitute.org/scientific-research/bibliographies/ . For example, a review of the scientific
literature concerning Physical Craving and Food Addiction Cheren, et al, is appropriate for the general reader.
This article can be found at http://foodaddictioninstitute.org/scientific-research/science-review-paper/ There are
a number of lines of scientific inquiry covered there genetic, animal studies, human brain scans,
endocrinological research, and treatment outcome research. All were conducted independently of one another
and all arrived at the same conclusion: some people can be addicted to sugar and other specific food substances.
(Appendix Q) provides a summary of conclusions regarding the research on all addictions, including food
addiction, in rigorous scientific language. It comes as a new formal statement on addiction as a brain disease put
together by the American Society for Addictive Medicine (ASAM) (www.asam.org).
Currently, the definitive text book on this subject is Food Addiction, A Comprehensive Handbook, edited by Kelly
D. Brownell and Mark S. Gold. A recent, readable mass market introduction to food addiction is Food Junkies by
Vera Tarman.
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How Can You Be Abstinent From Food?

When a likely food addict is ready to begin the actual work of recovery, a priority issue in treatment is almost
always abstinence and the question: What does abstinence mean in the context of food addiction? Obviously, it
is not possible to stop eating completely. This usually means the development of and commitment to an
appropriate food plan. Translation: a plan for selective abstinence from foods the individuals system cannot
tolerate or handle.
The rule of thumb is to completely eliminate all binge and trigger foods. This is an important way that recovery
from a chemical dependency differs from dieting or eating disorder therapy. Food addiction is characterized by a
biochemical change in the brain caused by the ingestion of specific food(s) which then creates a progressive
chemical dependency on these same specific food(s). As explained in the Overeaters Anonymous Dignity of
Choice pamphlet (Appendix R) food plans for compulsive eating can range from a simple three moderate meals,
nothing in between, one day at a time to sugar-free plans to food plans that eliminate completely all flour or
all gluten or all grains. As food addiction progresses, many find they need to commit [to eating] specific foods
daily in advance and/or weigh and measure at meals in order to be successfully accountable for consuming
moderate volume.
Sometimes finding the correct food plan is relatively easy. Most food addicts need to abstain from sugar, and
many middle or late stage food addicts need to eliminate flour (because it turns into sugar so quickly when
digested).
There are a significant minority of food addicts that have very special needs, however. If hypoglycemic, they may
need to have five or six meals a day, not just three. If night eaters, food addicts may often need to include a snack
or metabolic adjustment before going to bed. The general rule is to eliminate all processed sugar, but some food
addicts need to be very specific about the dosage of the food drug of choice, and some need to carefully watch
for all the possible names of sugar (Appendix S). A basic food abstinence plan developed at Glenbeigh
Psychiatric Hospital, Tampa for their residential food addiction treatment program 1980-1990, was approved by
the American Diabetes Association and the American Heart Association (Appendix T). But even this starter plan
which was clinically tested with over 8,000 patients had to be modified immediately by the dietitian in over ten
percent of cases. And, as usual, some individuals needed to take out foods which were contraindicated because of
medications prescribed for other medical conditions. In this regard, it is important to note that a patients primary
care physician or a dietitian should always be consulted regarding any food plan.
What About Choice?
Making a decision about a food plan is not all about choice. Patients may typically not want to eliminate foods
that they are most addicted to. Physical craving is like a false starving and the addict may feel they have to
have one or more toxic foods or something horrible will happen. When a food addict is having trouble getting
abstinent (and many do), they will often search out another food plan like they historically kept looking for the
right diet. However, in at least half of these cases, the real problem is that they need more structure and support
to accept their current food plan, i.e., one that can probably work if they just dont try to do it by themselves.
They also have to give up the idea that they deserve all the food(s) that they want - an easy do-it-my-way
approach to recovery.
What Is A Sponsor?
One of the things that is fairly unique to food-related Twelve Step recovery is a frequent practice of members
committing their food specifically day by day to a food sponsor, at least until they achieve stable abstinence and
recovery. (Appendix U) Of course, this is not the only way, just as the Twelve Step approach as a whole is not the
only path to recovery, but it is useful to note that many, if not a large majority, of those within OA and other food
fellowships who have been able to achieve long term food addiction abstinence and stable weight loss will say
12

that their progress began with specific commitments of the food they would eat at each meal to a sponsor on a
daily basis.
Can You Say A Little More About Denial?
As mentioned throughout, a priority issue in early food addiction recovery is challenging individual food addiction
denial. There are three different type of addictive denial.
1) Common Denial: This is food addiction denial at a conscious level. Incorrect information is believed to be
true. This is combated through education about addictive disease and by arguments against the
particular false information about food addiction the patient expresses. (Appendix V)
2) Psychological Denial: This is denial which occurs naturally when physical, emotional or spiritual pain is
impossible to tolerate at the conscious level, and the information and memories about it are pushed into
the unconscious. Particular to food addiction, this includes the pain of being shamed for being fat and the
hopelessness faced when unable to control the basic bodily function of eating. For many probably the
majority of food addicts who have unresolved prior trauma, this is challenged as it is in treating eating
disorders. However, this therapeutic work is often not fully successful until the food addict is cleanly
abstinent of toxic foods. It would be near impossible for an active alcoholic or drug addict to have
successful outcomes until they stop using their drug of choice: the same is true for those whose substance
of choice is sugar, flour, high-fat, salt or another food. (Appendix W) [Current approaches that have been
adopted by a number of dual addiction medical providers, notwithstanding.]
3) Bio-Chemical Addictive Denial: Just as in alcoholism and other drug addictions, food addiction itself
causes distortions in the mind often at the unconscious level which block an understanding and
acceptance of the disease, its seriousness and the failure of attempts to change based on self-reliance
alone.
While long total black outs are not common with food addicts, short periods of memory loss, especially
about eating itself, do often occur. Even more frequent is the phenomenon of euphoric recall when the
food addict remembers the pleasure and good feelings related to eating specific foods but forgets the
negative consequences entirely.
Most difficult, as food addiction progresses, many food addicts develop what addiction psychiatrist
Twersky4 defines as an addictive personality. He likens it to the mental distortions of schizophrenia. But it
is often much more subtle and difficult to discern. This part of the food addicts sense of his or her own
being thinks of food as way too important - sometimes the most important aspect of their life. Life would
not be worth living without a specific food. They go to food rather than a loving person or spiritual
connection for ultimate comfort. This is, at first, often only challenged by extraordinary support like a
really good therapist or unusually accessible minister or, as we have suggested, the recovery community
of a Twelve Step fellowship. This is why effective treatment for late stage food addiction invariably
demands a long-term strategy for personality transformation or spiritual development of some kind.
(Appendix X)
What About Treatment With Medications?
Medications for Obesity, Eating Disorders and Food Addiction? (Appendix Y) suggests that there is not (yet) an
effective medication for curing food addiction. There are medications which support short term dieting, but
weight loss is typically either less than 10% or is not likely to be maintained unless medication is continued. Most
such medications have unpleasant side effects. Many food addiction professionals believe these medications are
contraindicated for most food addicts because for most food addicts they are not effective in the long term. There
is also the danger that a food addict might be particularly vulnerable to becoming addicted to such medications.
13

On the other hand, there are medications that have been used successfully to treat psychological eating disorders.
And many food addicts have co-existing eating disorders and other mental health diagnoses, and the medications
they take for these can sometimes be supportive to food addiction recovery. However, Glenbeighs hospital-based
residential treatment program used to take patients off most psychoactive meds for the first week or two. They
found that systems of anxiety and depression were reduced, and sometimes eliminated, in about half the
population, by just a week of abstinence from addictive foods and with support to deal with difficult feelings.
Further research is needed in this area. At one point, health insurance stopped supporting most food addiction inpatient admissions that were not for controlling or otherwise dealing with the effects of medication. So to repeat,
there is a need for continued basic research for medication(s) that will safely and effectively correct chemical
dependency on specific food(s), hopefully with a minimum or absence of intolerable side effects.

Is There A Progressive Ladder of Treatment For Food Addiction?

As with alcoholism and drug addiction recovery, there needs to be a progressive ladder of treatment available for
food addiction. Some patients in the early stages of this condition will be able to eliminate foods to which they are
addicted on their own. As the disease advances, more will need well organized and/or professional structure and
support. In the middle stages of food addiction, participation in a Twelve Step fellowship or other peer support
process may sometimes be sufficient; others need Twelve Step facilitation from a physician, dietitian or
therapist to supplement their twelve step involvement and related activities. In the later stages of food addiction,
many food addicts need a week of 24/7 supervised detoxification, intensive out-patient treatment or residential
treatment. (Appendix N) Currently, there is no primary residential treatment for food addiction that is not self pay
and very expensive. Most such programs closed in 1995 when health insurances stopped reimbursing for hospitalbased residential care for food addiction. This situation has certainly contributed to the staying power of the food
addicted part of the obesity epidemic. We need to continue to improvise ways of adequately supporting late and
final stage food addicts even as we need to increase aggressive advocacy on behalf of more extensive and
effective treatment and reimbursement.

14

Appendices

A. Do You Have Concerns About Compulsive / Binge Eating or Food Addiction brochure

16

B. Food Addiction: Beyond Ordinary Eating Disorders from the Clinical Forum of the IAEDP

19

C. Normal Eaters with Obesity, Emotional Eaters with Eating Disorders, & Food Addicts with
Chemical Dependency

21

D. "Discussion of Normal Eater, Emotional Eater, Food Addict Chart

22

E. Progressive Stages of Food Addiction and Recommendations for Treatment" chart

23

F. Clues Suggesting the Need for Food Addiction Screening.

24

G. DSM 5 statement about eating-related symptoms in context

25

H. S UNCOPE food addiction screening instrument

26

I. Food-Related Twelve Step Fellowships

27

J. Self-Help Books on Food Addiction and Other Resources

28

K. Obesity Epidemic: Understanding Addiction in Managing Overeating. BHN, Vol 32 no 2

31

L. Yale Food Addiction Scale and Instructions

36

M. 12 Steps as adapted to food addiction.

40

N. Professional Assistance

41

O. 7 Mindful Eating Tips

46

P. The Principles of Mindful Eating

47

Q. American Society for Addictive Medicine (ASAM) Summary Statement on Addictions.

48

R. Overeaters Anonymous Dignity of Choice pamphlet Available as part of the Extras bundle.

49

S. Sugar (The Many Names of Sugar) T Wright

50

T. Glenbeigh Psychiatric Hospital / ACORN basic food abstinence plan

51

U. Food Sponsors Dos and Donts from OA

53

V. Arguments Against Common Denial

54

W. Psychological Denial Additional Notes

56

X. Biochemical Addictive Denial Additional notes.

56

Y. Medications for Obesity, Eating Disorders and Food Addiction? - Vera Tarman, MD

57

Z. References

59

Appendix A. Do You Have Concerns about Compulsive / Binge Eating or Food Addiction brochure
appears on the following two pages.

15

16

17

18

Appendix B
Food Addiction: Beyond Ordinary Eating Disorders, by Phil Werdell, M.A.

Clinical

Forum, International Association of Eating Disorder Professionals, Winter, 1994.

Phil Werdell, M.A.[was] Director of
National Continuing Care Services and
Professional Training for the
Residential Eating Disorders and Food
Addiction Program of Glenbeigh
Psychiatric Hospital of Tampa. Prior to
this, he served as lead counselor for
Glenbeigh of Tampa. His private
practice in Seattle was committed to
helping clients with food addiction. He
received his undergraduate degree
from Yale University and his graduate
degree from Beacon College. He served
as a college administrator and teacher
of counseling for 20 years in New York
City and New England.

When considering how to be most

helpful to clients who have issues
with weight, eating behaviors, or
food, it is useful to look at three
categories of eaters: normal
eaters, problem eaters, and food
addicts.
Normal eaters can diet. Their issue
with weight is primarily physical.
After checking with a doctor for
medical complications, they have to
eat less calories, fat, and sweets
while exercising more. This often
requires attitude and behavior
change that is not easy but can be
done without the help of eating
disorder professionals.
Problem eaters cannot diet. Their
problem is not just physical but also
psychological: something is eating
them. These clients need help
learning to identify and
communicate feelings, be assertive,
reframe societal notions of beauty,
make peace with family, and
resolve abuse issues in addition to
dealing with changing their eating
behaviors. Many of these people

experience success after intensive

therapeutic work for a few months
or years.
Then there are the food addicts.
While the food addict shares much
in common with problem eaters, he
or she is in a much more severe
pattern. Generally, this person has
a long history, perhaps 5 to 20
years, of attempts to change using
diets, OA, (Overeaters Anonymous),
intensive outpatient work, and
even repeat inpatient treatment.
These people find it impossible to
stop abusing food. They are
chemically dependent on food
exactly as an alcoholic or drug
addict is to their substance. Most
have tried to deal directly with
underlying psychological problems,
but it hasnt changed how they use
food, at least for long.
The recovery process for a food
addict includes all of the work of
both the normal eater and problem
eater, that is, to relearn healthy
eating, learn to deal with feelings,
and face deep emotional issues.
But they must first become
abstinent from the substance that
creates an addictive response in
both physiology and thinking.
A therapist working with a person
who is food addicted uses a
markedly different paradigm: food
is dealt with first. Everything the
therapist does is directed at gaining
and maintaining abstinence. One
of the primary tasks of therapy
then is to challenge the food
addicts denial. The client must
19

come to the point that she accepts

she cannot handle certain foods in
the same way as most people and
that her judgment about these
foods is unreliable.
Food addicts have to detoxify get
off of the addictive substance(s)
usually sugar, flour, caffeine, and
sometimes wheat, fat, salt, and
other substances. During detox,
people complain of the same
physiological changes seen in
detoxification from drugs or
alcohol: headaches, sleepiness,
insomnia, accelerated anxiety
patterns, panic to leave, etc.
From this point on, the bulk of the
work is to accept addiction to food
and the inability to control it oneself. This is not an easy task. Few
people want to admit
powerlessness. Yet when people
have diabetes or cancer, they
wouldnt think they had the power
to control these diseases. Even in
remission, they would acknowledge
the need for constant preventative
measures. Thinking of food
addiction as a disease takes away
the implication that a person
should be able to fix this on their
own. The willingness to recover
will be based on a long-term
process of committing food every
day, going to meetings, and
working a program of recovery such
as the 12-step program.
The person has to become honest
about food. Otherwise, honesty is
impossible in any other realm of
life. At first, there will be
temptation to re-try old foods or

patterns after just a couple of

successful weeks on the new
regime. This naivet can jeopardize
the early recovery process. When
people commit to try this approach
long-term, they will usually have to
grieve the loss of food and of old
ways of life.
To face powerlessness, most
people have to do very deep
emotional work, including being
able to get angry. Otherwise, they
risk relapse. Also, they may have to
face old issues of abuse and accept
powerlessness in the face of that
trauma. Many need professional
therapeutic help to do this. For
most, it also means finding a new
meaning or spirituality.
When people are out of control
with their eating, there is no room
in life to be spiritual, no time to
contact the spirit within. Their
concept of God may be very
negative coming from non-religious
or overly religious parents:
religiousness is confused with
spirituality. They may be angry at
life or God, be agnostic, or even
atheistic.
Most addicts have come to
worship the substance they are
addicted to. They need to replace
this with something else in order to
break the control the substance has
over them. They need find some
other way to explain the basic
meaning of life to themselves. It
may be a very different kind of
spirituality, but it must be their
own. Most often, they need to feel
and clear fear, anger, grief and pain
in order to open up to the process
of seeking their own individual,
very personal spirituality.

Some people come to spirituality

through parents, religious
institutions, being in nature, or
fellowship with kindred people.
The 12-step process is a path that
has helped many people who have
been battered internally by
addiction and externally by the
world to reclaim their personal
spirituality. It can be especially
helpful for those who have not
learned elsewhere to be spiritual or
to use a spiritual approach to help
them deal with food and/or other
addictions.
For many of those who have come
to their most hopeless place and
turn to a 12-step group, what they
may find is a spiritual awakening.
Again, it appears to be true for
many people that recovery requires
replacing the substance they have
become addicted to with
something else as the central focus
of their lives. For many, finding this
is experienced as a spiritual
experience. It involves an everyday
commitment to abstain, attend
meetings for support, and have a
sponsor who shares the wisdom of
a well-worn path to healthier living.
A wider recognition on the part of
the therapeutic community of food
addiction is important so that more
people can recover. Many people
who use OA groups are working
with therapists who resist using the
addictive model. They continue to
encourage clients, many of whom
are very self-aware, to get to the
bottom of their feelings so they can
eat normally. Yet most
professionals would never support
drug dependent clients to use while
in therapy much less have a goal of
using addictive drugs normally.
20

By learning about food addiction

and considering whether each
client might be food dependent, a
therapist can use clinical issues and
clinical work to support abstinence
and appropriately steer such a
client to get support in OA or an
equivalent source of the
extraordinary support he or she
needs.
It is important, however, to know
that there is much more variance in
OA groups than with AA with
alcohol where everyone agrees that
drinking must stop. In OA,
abstinence is defined in many
different ways. For someone who
is food-dependent, it is essential to
find a sponsor or group that
recognizes abstinence from sugar,
flour, caffeine, and other key binge
foods.
Finally, it is my hope that the policy
for eating disorder treatment will
come to reflect the need for
complete detoxification for those
who are food dependent so that
treatment centers will incorporate
this important element and that
the general public will come to
understand the disease process of
food addiction for what it truly is.
Copyright Philip R. Werdell, 1994
(edited 2015)

Appendix C

Normal Eater, Emotional Eater, Food Addict

NORMAL EATER

EMOTIONAL EATER

FOOD ADDICT

(with obesity)

(eating disorder)

(chemical dependency)

The problem is physical:

Weight

The solution is physical:

Medically approved diet

Moderate exercise

Support for eating, exercise

and lifestyle change

What works:

Willpower

The problem is physical and

mental-emotional:
Binge eating, restricting,
and/or purging over
feelings

Unresolved trauma

And possibly weight

(sometimes overweight
and sometimes
underweight)

The solution is mental-emotional:

Develop skills to cope
with feelings other than
with restricting, purging
and bingeing

Resolve past emotional

trauma and irrational
thinking (healing trauma)

The problem is physical, mentalemotional and spiritual:

Physical craving
(false starving)
Mental obsession
(false thinking)
Self-will run riot (false self)

And often trauma and weight

The solution is spiritual:

Abstinence from binge foods and
abusive eating behaviors

Rigorous honesty about all

thoughts and feelings

A disciplined spiritual program,

e.g. The Twelve Steps or equiv.

. . . and physical
And those to the left

. . . and mental-emotional and physical

o And all those applicable to the left

What works:
Moderation (along with
feeling your feelings)

What works:

Copyright Philip R. Werdell and Mary Foushi, 1997 (revised 2012)

21

Accept your addiction and all the

changes that that implies.

Appendix D
Discussion of Normal Eater, Emotional Eater, Food Addict Chart
NORMAL EATERS may have problems with weight (even obesity) if they do not eat the appropriate number of calories
(and exercise moderately) to maintain an ideal, healthy weight. The problem for normal eaters is primarily physical: If
they choose to eat a balanced diet, exercise moderately, and get support for lifestyle changes, they can lose unwanted
weight (or gain weight) and keep their weight in a normal range. Basically, willpower works; just put down the fork and
push away from the table.
EMOTIONAL EATERS often have similar problems with weight but find themselves powerless to follow directions to lose
(or gain) weight and restore their health even when they want to. For those with diagnosable eating disorders i.e.,
anorexia, bulimia or binge-eating disorder the underlying problem is mental-emotional: Its not what you are eating
but rather what is eating you. Problem eaters use food to numb or medicate their feelings. What works for problem
eaters are a moderate food and exercise plan, as well as developing skills to cope with feelings.
FOOD ADDICTS become chemically dependent on specific foods or on food in general. The way their body processes
food is bio-chemically different than that of normal eaters and emotional eaters. Many food addicts are predisposed to
becoming addicted to food especially to sugar, flour, wheat, fat, salt, caffeine, and/or excess volume to any food just
as alcoholics are predisposed to being chemically dependent on alcohol and drug addicts to heroin, cocaine or
prescription drugs. As the disease of addiction progresses, food addicts become powerless over physical craving and
develop distortions and obsessions of the mind that keep them in denial.
SO, WHAT WORKS FOR FOOD ADDICTS? Diets alone dont work. Simple therapy alone does not work. What works for
food addicts is surrender. Giving up, through physical abstinence, the foods to which they are chemically dependent.
Surrendering to rigorous honesty with all their thoughts and feelings about food. Surrendering to whatever structure
and support is needed. Ultimately, surrendering to the process of a spiritual experience, i.e., the type of psychic change
that has given relief and healing to thousands of chemically dependent individuals.
Most food addicts have weight problems the majority are obese, though some are a normal weight or may even be
dangerously underweight. Many also have unresolved emotional trauma similar to those who are diagnosed with eating
disorders, e.g. anorexia, bulimia, binge-eating disorder. In short, most food addicts have problems similar to those of
normal eaters and problem eaters, but for food addicts, their addiction to food must be the primary focus.
If food addicts just diet, they may lose some weight but inevitably will gain it back. If food addicts do not commit to
being rigorously honest preferably with another food addict (a sponsor) or with a healthcare professional that
understands food addiction they may make some gains in therapy, but will eventually relapse into their food addictive
patterns of behavior; this will make them even more anxious or depressed. To be successful in healing from food
addiction, one needs to first accept that they are food addicted and then, once again, deal with this first.
Most successful, long-term recovering food addicts approach their physical abstinence and deeper internal healing as a
spiritual discipline or an equivalent journey to find and keep meaning in their lives that is healthy rather than selfdestructive. While one approach to this is to study and practice the Twelve Steps, this clearly is not the only way as
there are an endless number of spiritual paths (personal journeys) that will work. However, the Twelve Steps are a
spiritual practice specifically designed for those who suffer from addiction.
Copyright Philip R. Werdell and Mary Foushi, 1997 (revised 2012)

22

Appendix E

Food Addiction: Progression and Recommended Actions

Disease Stage

Recommended Actions

Pre-Disease

Prevention

No sign of abnormal eating or reactions to specific

foods. If no dependency or pathology develops, this
stage will continue through the persons entire life.

Education about food addiction. Ongoing checks for signs

of chemical dependency. Moderation in eating, especially
commonly addictive foods, e.g., sugar, caffeine, excess fat,
alcohol, drugs.

Early Stage

Detox and Abstinence

Problems with weight management, cycles of weight

gain followed by dieting, weight loss, and weight
gain again. Occasional binge eating on sugar, excess
fat, or volume. Could be early-stage food addiction
or a normal eater making unhealthy choices.

Identify addictive foods. Eliminate binge and trigger foods.

Move through detoxification. This often seems extreme if
negative consequences are not yet severe, the beginning
of addictive denial.

Middle Stage

Twelve Step Group/Counselor

Frequent binge eating and grazing. Purging or severe

restriction may begin. Rationalizing before eating,
guilt afterward. Could be advancing food addiction
or emotional problem eater with a psychologically
based eating disorder.

Participation in a food-related Twelve Step program, e.g.,

Overeaters Anonymous, and/or work with a food
addictions counselor. Assistance with addressing blocks to
physical abstinence, especially denial. Develop feeling
skills, resolve trauma.

Late Stage

More Structure and Support

Serious consequences from overeating morbid

obesity, Type II diabetes, chronic depression and/or
spiritual disillusionment, and eating anyway. Food
no longer provides comfort, escape, oblivion, etc.
Loss of control, increasing tolerance

Participation in a highly structured Twelve Step program,

e.g., Food Addicts in Recovery Anonymous, Compulsive
Eaters AnonymousHOW. Outpatient treatment and/or
workshops such as those offered by ACORN. Abstinence as
a spiritual path.

Final Stage

Primary Inpatient or Residential Treatment

Severe consequences hospitalization for heart

attacks, suicide attempts, lost jobs or inability to
work, ruined relationships, treatment and/or
intestinal surgery followed by relapse, housebound
or confined to nursing homes.

Given the lack of any hospital-based inpatient treatment

for food addiction, alternatives include Turning Point of
Tampa, Milestones, Shades of Hope, ACORNs year-long
Living in Abstinence program. This is sometimes
insufficient.

DEATH
copyright Phil Werdell, Bariatric Surgery & Food Addiction: Preoperative Considerations, 2008

23

Appendix F
Clues Suggesting the Need for Food Addiction Screening

1. THE PATIENT/CLIENT IS OVERWEIGHT OR OBESE

2. THERE IS A PATTERN OF GAINING WEIGHT AND RESTRICTING FOOD
3. THE PATIENT ADMITS TO GUILT OR SHAME REGARDING STEALING FOOD AND LYING ABOUT OVEREATING
4. ANOREXIC BEHAVIOR IS BECAUSE IT IS THE ONLY WAY I CAN STOP BINGEING
5. THERE IS A PATTERN OF OVEREATING OR ALCOHOLISM IN THE BLOOD FAMILY
6. A PERSON IS REACTIVE OR A LITTLE TOO DEFENSIVE AT THE SUGGESTION OF BEING FOOD ADDICTED
7. HAS GONE TO OR CONSIDERED ATTENDING FOOD-RELATED 12 STEP MEETINGS
8. THINKS LIFE WOULD NOT BE WORTH LIVING WITHOUT FAVORITE BINGE FOODS
9. DISPLAYS MANY OR MOST OF THESE CHARACTERISTICS DOESNT THINK OF IT AS UNUSUAL
10. TREATING ONESELF AS IF A FOOD ADDICT WORKS WHEN NOTHING ELSE DOES

Other Signs:
Euphoric recall
Short blackout during or after eating
Continuing to eat while in pain
Eating when peaceful and happy as well as sad, angry or fearful
Regaining weight after bariatric surgery
Becoming an alcoholic or drug addicted after surgery
Gaining a lot of weight after quitting smoking or alcohol
Continuing to overeat when obesity is likely driving life-threatening disease: diabetes, depression, heart
disease

24

Appendix G
DSM 5 Statement About Eating-Related Symptoms in context

Feeding and
Eating Disorders
Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-related behavior
that results in the altered consumption or absorption of food and that significantly impairs physical health or
psychosocial functioning. Diagnostic criteria are provided for pica, rumination disorder, avoidant/restrictive food intake
disorder anorexia nervosa, bulimia nervosa, and binge-eating disorder.
The diagnostic criteria for rumination disorder avoidant/restrictive food intake disorder, anorexia nervosa, bulimia
nervosa, and binge-eating disorder result in a classification scheme that is mutually exclusive so that during a single
episode, only one of these diagnoses can be assigned The rationale for this approach is that, despite a number of
common psychological and behavioral features, the disorders differ substantially in clinical course, outcome, and
treatment needs. A diagnosis of pica, however, may be assigned in the presence of any other feeding and eating
disorder.
Some individuals with disorders described in this chapter report eating-related symptoms resembling those typically
endorsed by individuals with substance use disorders, such as craving and patterns of compulsive use. However, the
relative contributions of shared and distinct factors in the development and perpetuation of eating and substance use
disorders remain insufficiently understood.
Finally, obesity is not included in DSM-5 as a mental disorder. Obesity (excess body fat) results from the long-term
excess of energy intake relative to energy expenditure. A range of genetic, physiological, behavioral, and environmental
factors that vary across individuals contributes to the development of obesity; thus, obesity is not considered a mental
disorder. However, there are robust associations between obesity and a number of mental disorders (e.g., binge-eating
disorder, depressive and bipolar disorders, schizophrenia). The side effects of some psychotropic medications contribute
importantly to the development of obesity, and obesity may be a risk factor for the development of some mental
disorders (e.g., depressive disorders).

Feeding and Eating Disorders. (2013). In Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed., p.
329). Washington, D.C.: American Psychiatric Association.

25

Appendix H
S-UNCOPE Screening for [Food]/Sugar Addiction
BITTEN JONSSON Reg. Nurse, Leg.SSK
Member of NAATP www.naatp.org & NAADAC www.naadac.org
Food Addiction Institute http://foodaddictioninstitute.org

Screening for sugars [food]*, alcohol and drugs :

Sugars can be any carbohydrate such as pasta, bread, sweets, cookies, soda, ice cream, junk food etc.
1. U= Unplanned Use
In the past year, have you ever eaten [food] sweets*, more than you meant to? Or have you spent more
time eating and using sweets* than you intended to?
YES
NO
2. N = Neglected
Have you ever neglected some of your usual daily responsibilities because of using sweets* and/or
overeating?
YES
NO
3. C= Cut down
Have you felt that you wanted or needed to cut down on eating/sweets*, in the last year?
YES
NO
4. O= Objected
Has anyone objected to you overeating sweets*, ? Or, has your family, a friend, or anyone else ever told
you they objected to your eating habits ?
YES
NO
5. P = Preoccupied Have you ever found yourself preoccupied with wanting [food] sweets* ? Or have you
found yourself thinking a lot about sweets/food*.
YES
NO
6. E = Emotional discomfort
Have you ever used sweets/food* to relieve emotional discomfort, such as fatigue, sadness, anger, tiredness
or boredom etc ?
YES
NO
*With four or more yes to sweets/overeating/food the risk to be addicted is very high. I recommend doing a
diagnostic interview to know for sure.
Key to interpret
0-1 Yes, Indicates Social Use
2-3 Yes, Indicates Abuse/Harmful Use
4 or more Yes, Indicates Addiction
BJ 2007
Adapted from the UNCOPE instrument developed by Norman G. Hoffmann, PhD

BITTENS ADDICTION, Tamms Kanalvg 11 C, SE 820 64 Nsviken, Sweden,

Ph. +46 (0)650 54 06 00 Cell. +46 (0)70 643 73 73
bitten.jonsson@bittensaddiction.com www.bittensaddiction.com

26

Appendix I
Food Related 12 Step Fellowships

COMPULSIVE EATERS ANONYMOUS HOW

(CEA-HOW)
www.ceahow.org
562-342-9344

OVEREATERS ANONYMOUS(OA)
www.overeatersanonymous.org
505-891-2664
OVEREATERS ANONYMOUS HOW (OAHOW)
www.oahow.org
(612) 377-1600 or (888) 540-1212

FOOD ADDICTS ANONYMOUS (FAA)

www.foodaddictsanonymous.org
561-967-3871
GREYSHEETERS ANONYMOUS (GSA)
www.greysheet.org

OVEREATERS ANONYMOUS 90-DAY

MEETINGS
www.oasv.org/html/90day.htm
(408) 268-7243

FOOD ADDICTS IN RECOVERY ANONYMOUS (FA)

www.foodaddicts.org
781-321-9118

RECOVERY FROM FOOD ADDICTION, Inc.

www.Recoveryfromfoodaddiction.org
713-673-2848

OVERCOMERS OUTREACH
(Christian-based)
www.overcomersoutreach.org
800-310-3001

27

Appendix J
Self-Help Books on Food Addiction and Other Resources
Self-Help Books
Title

Author

Description

Anatomy of a Food Addiction: The Brain

Chemistry of Overeating: An Effective
Program to Overcome Compulsive Eating
Fat Is a Family Affair: How Food
Obsessions Affect Relationships
Food Addiction: The Body Knows

Anne Katherine, M.A.

A counselor offers a staged way to give up sugar and

flour.

Judi Hollis, Ph.D.

Good information for family members.

Kay Sheppard, M.A.

Food Junkies: The Truth About Food

Addiction
Food Triggers: End Your Cravings, Eat
Well and Live Better

Vera Tarman, MD and

Philip Werdell, M.A.
Rhona Epstein, Psy.D.

The classic on the subject. See also, From the First

Bite and Cookbook.
The most recent general reader about food addiction.

Sugars and Flours: How They Make us

Crazy, Sick and Fat, and What to do
About It
The Hunger Fix: The Three-Stage Detox
and Recovery Plan for Overeating and
Food Addiction

Joan Ifland, Ph.D.

Pamela Peeke, M.D. and

Mariska van Aalst

A compilation of recent science and a solution using

abstinence from specific foods, trauma reduction and
strengthening executive function.

Why Can't I Stop Eating: Recognizing,

Understanding, and Overcoming Food
Addiction

Debbie Danowski, Ph.D. and

Pedro Lazaro, M.D.

Written by the medical director of a treatment center

and a prior patient.

Why Diets Fail (Because You're Addicted

to Sugar): Science Explains How to End
Cravings, Lose Weight, and Get Healthy

Nicole M. Avena, Ph.D. and

John R. Talbott

A starter book for early stage sugar addicts. Good

layman's chapter on science.

A licensed psychologist and certified addictions

counselor, Epstein brings insights learned through
her own battle with addictive eating to deliver
tangible action steps to overcome eating issues.
A look at the potential problem of all processed food
and a guide for not eating them.

Twelve Step Recovery Books

Title

Author

Description

Alcoholics Anonymous

Alcoholics Anonymous

Anorexics and Bulimics Anonymous:

The Fellowship Details Its Program of
Recovery for Anorexia and Bulimia
Food Addicts in Recovery Anonymous

Anorexics and Bulimics

Anonymous

The first 164 pages are a textbook of the 12-Step

program.
Eating disorders approached using the addiction
model.

Greysheeters Anonymous

Greysheeters Anonymous

Overeaters Anonymous, First, Second

and Third Edition
The Twelve Steps and Twelve
Traditions of Overeaters Anonymous

Overeaters Anonymous

Food Addicts in Recovery

Overeaters Anonymous

28

An application specific to food addiction. Excellent

stories.
Soon to be published recovery book by a food
related Twelve Step fellowship based on a food plan
which eliminates all sugar and grain.
Stories of members from around the world who have
found help.
An application of AA to overeating.

New York Times best sellers on the overall food addiction problem
Title

Author

Description

Salt Sugar Fat: How the Food Giants

Hooked Us
Sugar Blues
The End of Overeating: Taking Control of
the Insatiable American Appetite

Michael Moss

A journalist shows how Big Food has changed the

American diet.
A historical and political polemic.
Dr. Kessler was the commissioner of the Food and
Drug Administration and Dean of Yale Medical
School.

William Duffy
David A. Kessler, MD

Scientists on the Science

Title

Author

Description

Definition of Addiction
Public Policy Statement

American Society of Addiction

Medicine

Formal statement on addiction. All addictions,

including food addiction, are brain diseases.

Food and Addiction: A Comprehensive

Handbook
Physical Craving and Food Addiction: A
Scientific Review

Kelly D. Brownell, Ph.D. and Mark

S. Gold, MD
Mark Cheren, Ph.D., Mary
Foushi, Esther Helga
Gumundsdttir, Colleen Hillock,
Marty Lerner, Ph.D., Michael
Prager, Mary Rice, Louisa Walsh,
Philip Werdell, M.A.

A medical textbook.
A review of the science by members of the Food
Addiction Institute's advisory board
http://foodaddictioninstitute.org/FAIDOCS/Physical-Craving-and-Food-Addiction.pdf

Books on Food Addiction from Treatment Centers

Title

Author

Description

A Guide to Eating Disorder Treatment:

Defining the Problem and Finding the
Solution
Shades of Hope: How to Treat Your
Addiction to Food
The ACORN Primary Intensive: A New
Model of Professional Support

Marty Lerner, Ph.D.

Approaching traditional eating disorders with the

addiction model at Milestones in Recovery.

Tennie McCarty and

Ashley Judd
Philip Werdell, M.A. and
Mary Foushi

The philosophy of a treatment program by the same

name.
A new residential workshop model from ACORN
Food Dependency Recovery Services.

Special Topics
Title

Author

Description

Addiction and Grace: Love and

Spirituality in the Healing of Addictions
Addictive Thinking: Understanding Self
Deception
Bariatric Surgery and Food Addiction:
Preoperative Considerations

Gerald G. May, MD

Overweight: What Kids Say: What's

Really Causing the Childhood Obesity
Epidemic

Robert A. Pretlow, M.D.

A look at food and other addictions from a spiritual

point of view.
Good for understanding and dealing with food
addiction denial.
Relief for the many who regain their weight or
become addicted to drugs or alcohol after weight
loss surgery.
A physician analyzes the addictive problem in
childhood obesity from 16,000 postings on his
website www.weigh2rock.com.

Abraham J. Twerski, MD
Philip R. Werdell, M.A.

29

Memoirs and Stories of Food Addiction Recovery

Title

Author

Description

Fat Boy, Thin Man

Michael Prager

Holy Hunger: A Woman's Journey from

Food Addiction to Spiritual Fulfillment
My Yellow Suit

Margaret Bullitt-Jonas

The progression of the disease until an intervention

by his employee assistance program.
Young daughter of Harvard professor finds herself
through the addiction model of treatment.

Raja' Batarseh

Memoir of a Middle Eastern woman who discovers

she is food addicted.

Movies
Title

Director/Author

Description

"Fed Up"

"Suicide by Sugar"

Stephanie Soechtig and Katie

Couric
Dr. T. Colin Campbell and Dr.
Caldwell Esselstyn
Nancy Appleton, Ph.D.

"Supersize Me"

Morgan Spurlock

How the American food industry may be responsible

for more sickness than previously realized.
How our present menu of animal-based and
processed foods affects degenerative diseases.
Why our sweet tooth may be killing us. Sugar is seen
as our #1 addiction.
Explores the consequences on health of a diet of
solely McDonalds food for one month.

"Forks Over Knives"

30

Appendix K
Behavior Health Newsletter, Vol 32 No 2, Fall, 2014

31

32

33

34

35

Appendix L
Yale Food Addiction Scale

36

Instrument Title:
Instrument Author:
Cite instrument as:

Yale Food Addiction Scale (YFAS)

Ashley N. Gearhardt, William R. Corbin, Kelly D.
Brownell
Ashley N. Gearhardt, William R. Corbin, Kelly D.
Brownell. (2012) . Yale Food Addiction Scale (YFAS)
. Measurement Instrument Database for the Social
Science. Retrieved from www.midss.ie

YFAS- Please note, on this website there is a modified version and a version for children:
http://fastlab.psych.lsa.umich.edu/yale-food-addiction-scale/

37

38

39

Appendix M
12 Steps as Adapted to Food Addiction

The Twelve Steps of Overeaters Anonymous

1.

We admitted we were powerless over food that our lives had become unmanageable.

2.

Came to believe that a Power greater than ourselves could restore us to sanity.

3.

Made a decision to turn our will and our lives over to the care of God as we understood Him.

4.

Made a searching and fearless moral inventory of ourselves.

5.

Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6.

Were entirely ready to have God remove all these defects of character.

7.

Humbly asked Him to remove our shortcomings.

8.

Made a list of all persons we had harmed and became willing to make amends to them all.

9.

Made direct amends to such people wherever possible, except when to do so would injure them or others.

10.

Continued to take personal inventory and when we were wrong, promptly admitted it.

11.

Sought through prayer and meditation to improve our conscious contact with God as we understood
Him, praying only for knowledge of His will for us and the power to carry that out.

12.

Having had a spiritual awakening as the result of these Steps, we tried to carry this message to compulsive
overeaters and to practice these principles in all our affairs.

Many of us exclaimed, What an order! I cant go through with it. Do not be discouraged. No one among us
has been able to maintain anything like perfect adherence to these principles. We are not saints. The point
is that we are willing to grow along spiritual lines. The principles we have set down are guides to progress.
We claim spiritual progress rather than spiritual perfection.

Alcoholics Anonymous, Big Book pages 59-60, Adapted for Overeaters

Copyright by Overeaters Anonymous, Inc.
Reprinted by permission of Overeaters Anonymous, Inc

40

Appendix N
Professional Assistance

Treatment Centers and Programs

ACORN Food Dependency Recovery Services
www.foodaddiction.com
ACORN is a professional organization offering retreats, workshops and intensives led by recovered food addicts for food
addicts. Programs are offered on a fee-for-service basis all over the United States, Canada and Iceland. The Primary
Intensive is a residential workshop which duplicates the experiential part of a week of food addiction treatment for
those not needing hospitalization or direct medical supervision. For those needing longer support, there is the Living in
Abstinence program in which participants attend two or more ACORN programs within a year. A specialized Living in
Abstinence program is integrated with the FAI/ACORN Food Addiction Professional Training Program for those who want
regular recovery support but are not at this time considering working as professionals. Like most addiction model
treatment, ACORN sees its work as support for abstinence and breaking addictive denial so participants can better use
12 Step fellowships.

Compulsive Overeaters Retreat

www.cormn.org
COR participants spend five days and four nights together at the McIver Center for Spiritual Development at The Retreat
in Wayzata, Minnesota. The Retreat is a nationally renowned 12 Step recovery center for drugs and alcohol. The McIver
Center is a separate facility located on The Retreat campus in the Big Woods of Wayzata. Regularly used to house
families of treatment participants for programs of their own, COR now calls the McIver Center home, as well.
The Compulsive Overeaters Retreat or COR is designed to provide each participant with a positive experience in food
management, including selection and portion control. These and other skills experienced at COR have proven to be
integral to reversing compulsive overeating.
Family-style mealtime at the retreat will include nutritious, health conscious selections intended to support individual
eating plans and dietary needs. The retreat menus have been selected to assist each attendee with abstaining from
white flour, sugars and processed foods. Individuals concerned about their relationship with food are provided a safe,
caring and comfortable setting in which to recognize and begin the process to change destructive, unhealthy behaviors
as they learn to adapt and assimilate positive, healthful coping mechanisms as part of a whole, joyful life.

Milestones in Recovery
www.milestonesprogram.org
41

Milestones in Recovery is a treatment program for eating disorders and food addiction in Cooper City, FL (north of
Miami). The usual length of treatment is one or more months. All health insurance is accepted. Participants attend a day
treatment at Milestones and live together in nearby apartments. The focus of the program is to support clients to
achieve physical food abstinence and maintain it while living in the community. This is done around the programmatic
themes of Spirituality, Exercise, Relaxation and Food Plan, S.E.R.F. There are lectures, recovery groups and individual
counseling sessions each day. At night and on the weekends, participants buy and cook their own food, go to 12 Step
meetings, and work on their individualized assignments. Milestone has an active aftercare program for alumnae.

Shades of Hope
www.shadesofhope.com
Shades of Hope is a residential treatment program for all addictions, specializing in eating disorders and food addiction,
in Buffalo Gap, Texas. They will work with your health insurance provider for coverage. There are several programs on
the campus: six day intensives, a 42 day residential treatment program, a transition house, two halfway houses, and a
three-quarter way house. The entire program has been sugar and white flour free for over two decades. The six week
program includes education about foods plans, regular abstinent meals in a common dining hall, daily community group,
workshops on body image issues and family sculpting, a series of lectures, a family weekend, opportunities to try
different recovery fellowships, and individualized assignments. This is the program which is the basis of the reality show
Addicted to Food on the OWN network.

Turning Point (of Tampa)

www.tpoftampa.com
Turning Point began as a well-regarded halfway house for drug and alcohol recovery. In the 1990s, a number of halfway
houses focused on supporting food addiction recovery were added. About ten years ago, Turning Point added a full
residential treatment program including a Recovery Village in which participants, cook and eat in small cottages on the
property. There continues to be houses just for eating disorder and food addiction clients. The program for food uses
the addiction model: abstinence first, rigorous honesty about thoughts and feeling, lectures, process groups, a family
week and individualized aftercare supporting 12 Step work. There are trauma resolution groups for those needing to
deal with deep emotional issues.

PROMIS (UK)
www.promis.co.uk
PROMIS (UK) offers extensive experience in treating many addiction problems relating to; alcohol, drugs, eating
disorders, stress and depression. PROMIS is made up of several private rehab clinics with treatment facilities in Kent,
London, Paris, Madrid, Geneva and Amsterdam. They provide residential primary treatment, secondary care, detox,
42

counseling, interventions and aftercare as well as a dedicated young persons and family program. The food program at
the Kent center follows the addiction model philosophy set out in Common Sense in the Treatment of Eating Disorders,
by Dr. Robert Lefever, the founder of the program.

MFM Matarfknarmistin / MFM Food Addiction Center (Iceland)

www.matarfikn.is
The MFM food addiction center is an out-patient recovery program in Reykjavik, Iceland both for those completely new
to the idea of chemical dependency on food and for self-assessed food addicts having trouble achieving and maintaining
food abstinence. There are several stages of the program. After an individual assessment, the initial program is a
weekend in which recovering food addicts cook food abstinent meals for the group; there are meetings after each meal
to discuss what they have eaten, to support detoxification, and to help participants figure out how to cook abstinently at
home. The second stage is a weekly recovery group for three months, in which questions are answered about shopping,
meal preparation, dealing with family reactions and remaining abstinent one day at a time while on the job or going
about ones daily business. This is followed by another weekly group for three months in which members are introduced
to skills for dealing with difficult feelings and working on underlying spiritual issues; many at this point join one of the
two local 12 Step fellowships, Overeaters Anonymous or Greysheeters Anonymous. The last stage is for those
participants who feel they need additional professional support while also working a 12 Step program with a sponsor.
For those learning to be individual counselors and lead groups, there is now a three year FAI Professional Training
Program in Iceland.

Medical Doctors
Vera Tarman, MD, M.Sc, FCFP, CASAM (Toronto, Canada)
www.addictionsunplugged.com
As founder and spokesperson for Addictions Unplugged, Dr. Tarman has focused her medical practice over the past 7
years on addiction treatment and recovery. A specialist in addiction behavior and treatment, she speaks on the topics of
the science behind food addiction and why we use food for comfort.

Beth Rocchio, MD (East Greenwich, RI)

www.integratedmedicalweightloss.com/
A board certified weight management physician, Dr. Beth is the founding medical director of IMWL. She helps people
with permanent weight loss after recovering from overeating herself. For over a decade she has maintained a 50 lb.
weight loss. She has a special interest in helping people recover from food addiction and stress, emotional or
compulsive eating using integrated mind-body medicine as well as twelve step facilitation.

43

Pam Peeke, MD, MPH, FACP

http://www.drpeeke.com/
Dr. Peeke is founder of The Peeke Performance Center for Healthy LivingTM where she conducts her Peeke Week
Retreats teaching her Peeke Performers how to transform themselves, mentally and physically, for optimal health and
wellbeing. She specializes in an integrated approach to the treatment of food addiction combining abstinence from
specific foods, trauma reduction and strengthening executive function.

Dietitians and Nutritionists

Lori Herold, LD/N Nutritionist at Turning Point of Tampa, Inc. and private practice.
(727) 725-6049 Clearwater, FL

H. Theresa Wright, MS, RD, LDN, Founder and President, Renaissance Nutrition Center, Inc. author of Your Personal
Food Plan Guide, nutritionist specializing in food addiction since 1980, individual counseling, groups, and workshops.
www.sanefood.com/about/theresa_wright.htm

Counselors, Therapists and Coaches

Anna Bacher, PsyD, LMHC, therapist specializing in food addiction and sports psychology. Sarasota, FL (941) 266-1900
Rhona Epstein, PsyD (Paoli, PA) Since 1994, Rhona provides individual, couples, family, and group psychotherapy at
Life Counseling Services in Paoli, Pennsylvania. While she's expanded her practice to reach people with a wide range of
issues, she specializes in treating addictions and eating disorders. Depending on the client, Rhona integrates either
twelve-step recovery principles or biblically-based spirituality in therapy. - See more at:
http://www.rhonaepstein.com/about.php#sthash.bStl3R8v.dpuf

Mary Foushi, food addiction professional and recovery coach, Cofounder and National Services Coordinator of
ACORN Food Dependency Recovery Services, Coauthor of Food Addiction Recovery: A New Model of
Professional Support The ACORN Primary Intensive. Sarasota, FL (941) 378-2122
Esther Helga Gudmundsdottir, food addiction professional, counselor, therapist and founder of MFM
midstodin (MFM food addiction center). Reykjavik, Iceland. Tel: +354-568 3868
Gerri Helms, Life Coach, MCC, CSC, Author of Trust God and Buy Broccoli, A Spiritual Approach to Weight Loss.
(407) 921-7268
Joan Ifland, PhD (Houston, Texas) CEO at Victory Meals, LLC; Chair, American College of Nutrition Council on Food
Addiction. Joan seeks to promote awareness of existing research related to processed food addiction to the public and
44

to health professionals, to help food addiction researchers situate their findings in clinical practice, and to create new
knowledge about the course of disease of processed food addiction, especially assessment and withdrawal. She works
tirelessly to bring products and services to market that encourage recovery from food addiction such as prepared meals,
education, and support. She moderates the Food Addiction Education page on Facebook.

Bitten Jonsson, RN, Leg.SSK, is an addiction therapist. She does training in relapse prevention, and specializes in work
with food addiction. Based in Nsviken, Sweden, Bitten adapted the UNCOPE for use in sugar/food addiction screening
has developed a pioneering diagnostic protocol for food addiction, SUGAR . Ph. +46 (0)650 54 06 00
bitten.jonsson@bittensaddiction.com www.bittensaddiction.com

Anne Katherine, MA, LMHC has an online program at www.masteryourappetite.com and 8 books in print,
including Your Appetite Switch: Master Your Eating and Free Your Life, Anatomy of a Food Addiction, and, for your
family, Lick It! Fix Her Appetite Switch.

Sara Levite, MA, family and individual counselor specializing in working with eating disordered and food addicted
clients. Portland, Maine slevite@maine.rr.com

Tennie McCarty, LCDC, ADCIII, CEDC, CAS, therapist and food addiction professional. Founder, CEO and Coowner of Shades of Hope, Buffalo Gap, Texas www.shadesofhope.com
Kay Sheppard, MA, LMHC, CEDS, therapist, trainer, author of Food Addiction: the Body Knows; From the First
Bite and Food Addiction: Healing Day by Day www.kaysheppard.com

Linda B Sherr, MA, LMFT, LMHC, family and eating disorder therapist with experience helping food addicts. Sarasota,
FL (941) 955-1330

Jan Smith, MA, Years of experience giving individual and group therapy with a specialization in working with
chronically relapsing food addicts. Chicago, IL (708) 957-3303

Clare Weldon, MSW, LCSW, food addiction professional with extensive experience working with food addicts in
individual counseling, recovery groups and residential settings. Delran, New Jersey (856) 779-2330

Philip Werdell, MA, food addiction professional, individual coach, organizational consultant, public speaker and
professional trainer. Author, Physical Craving and Food Addiction, and Bariatric Surgery and Food Addiction:
Preoperative Considerations. Sarasota, FL (941) 378-2122. Founder, Food Addiction Institute.

Martha Zischkau, food addiction professional specializing in workshops and individual counseling for in-depth First
Step work and spirituality. Philadelphia, PA
45

Appendix O

7 Mindful Eating Tips

Contributed by Susan Albers, PsyD

When you are mindful you are fully present, in-the-moment without judgment. When it comes to eating,
mindfulness helps amplify the volume of your bodys cues so you can hear loud and clear when you are hungry
and full. Many social and environmental factors can stand in the way of being able to accurately decode your
bodys feedback. Mindfulness helps you break free from routine eating habits by examining the thoughts,
feelings and internal pressures that affect how and why you eat (or dont eat).

1. Shift out of Autopilot Eating

What did you have for breakfast? Be honest. Many people eat the same thing day in and day out. Notice
whether you are stuck in any kind of rut or routine.

2. Take Mindful Bites

Did you ever eat an entire plate of food and not taste one single bite? Bring all of your senses to the dinner
table. Breathe in the aroma of a fresh loaf of bread. Notice the texture of yogurt on your tongue. Truly
taste your meal. Experience each bite from start to finish.

3. Attentive Eating
Sure, youre busy and have a lot on your plate. Its hard to make eating a priority rather than an option or
side task. If you get the urge for a snack while doing your homework or studying, stop and take a break so
that you can give eating 100% of your attention. Try to avoid multitasking while you eat. When you eat,
just eat.

4. Mindfully Check In
How hungry am I on a scale of one to ten? Gauging your hunger level is a little like taking your
temperature. Each time you eat, ask yourself, Am I physically hungry? Aim to eat until you are
satisfied, leaving yourself neither stuffed nor starving.

5. Thinking Mindfully
Observe how critical thoughts like I dont want to gain the Freshman Fifteen. or Im so stupid, how
could I do that! can creep into your consciousness. Just because you think these thoughts doesnt mean
you have to act on them or let them sway your emotions. Negative thoughts can trigger overeating or stop
you from adequately feeding your hunger.
Remember: A thought is just a thought, not a fact.

6. Mindful Speech
Chit chatting about dieting and fat is so commonplace that we often arent truly aware of the impact it
might have on our self-esteem. When you are with friends and family, be mindful of your gut reaction to
fat talk (e.g. Im so fat! or the Im so fat; No youre not debate). Keep in mind how the words might
affect someone struggling with food issues.

7. Mindful Eating Support

Friends provide an enormous amount of support, but often its helpful to obtain assistance or a second
opinion from a trained professional. If you would like to learn more about mindful eating, or if you have
concerns about your eating habits, call your college counseling center, student health center or consult the
NEDA website www. NationalEatingDisorders.org for information and treatment referrals.

2004 National Eating Disorders Association. Permission is granted to copy and reprint materials for
educational purposes only. National Eating Disorders Association must be cited and web address listed.

www.NationalEatingDisorders.org for information and referral helpline: 800.931.2237.

46

Appendix P

47

Appendix Q
American Society of Addiction Medicine (ASAM)
Summary Statement on Addictions

The long definition of addiction continues

and can be found at the ASAM website:
http://www.asam.org/for-the-public/definition-of-addiction

48

Appendix R
Overeaters Anonymous Dignity of Choice pamphlet

Available as part of the Extras bundle

49

Appendix S
Sugar

50

Appendix T
Glenbeigh/ACORN Basic Starter Food Plan
(Based on the addictive concept of overeaters recovery needs.)
This is a pre-diabetic food plan that is free of sugar, flour, caffeine and alcohol.

BREAKFAST

LUNCH

8 oz. low-fat milk or low-fat, sugar free plain

yogurt
2 oz. protein
1 fruit
1 oz. cereal

3 oz. protein (men get 4 oz. protein)

cup starch
1 cup cooked vegetable
1 cup salad (raw veggies)
1 fat
1 fruit

DINNER

SNACKS (Metabolic Adjustments)

3 oz. protein (men get 4 oz protein)

cup starch (men get 1 cup starch)
1 cup cooked vegetable
1 cup salad (raw veggies)
1 fat

8 oz. low-fat milk or low-fat, sugar free plain

yogurt
1 fruit
1 oz. cereal

Add 8 oz. decaffeinated, sugar-free beverage at each meal.

Optional: 1 cup clear broth (sugar free) with lunch or dinner.

WEIGHING & MEASURING

You may decide to weigh foods on a scale rather than use cup measurements. If so, it is important to
weigh all foods, i.e., dont cup some foods and weigh others on the scale. Fats may be measured
using measuring spoons or on the scale. If necessary, check with your dietitian or sponsor to confirm
amounts. Equivalents for this food plan are as follows:
Cup or Unit Measurement
8 oz (1 cup) low fat milk or yogurt
1 fruit
cup starch (women)
1 cup starch (men)
1 cup cooked vegetables
1 cup salad

=
=
=
=
=
=

Scale Measurement
8 oz
6 oz
4 oz
8 oz
5 oz
5 oz (use cut-up veggies and greens)

NOTE
ACORN Food Dependency Recovery Services does not have a specific food plan that it recommends for all participants.
The above plan is a "starter" food plan for middle and late stage food addicts and is intended for short-term use only prior
to approval from a doctor, dietitian or therapist. ACORN Primary Intensive participants who have been stably abstinent for
90 days or more on a food plan other than the one shown above are recommended to follow that particular plan. Those
who do not already have a food plan may use the ACORN food plan with the agreement that they will obtain approval
from a doctor, dietitian or therapist upon leaving the event.
The food plan originated at a hospital-based food addiction treatment center where they found that it worked for 90 percent of its
15,000 patients during detoxification and initial treatment. For the remainder, a dietitian made adjustments based upon medical
need. Almost all food addicts require food plan adjustments at some point, especially as they near goal weight.

51

The Process of
Working Toward Food Addiction Abstinence
Committing Your Food
Common guidelines for committing your food in early recovery are:
1. Write down your food specifically before eating.
2. Read what you wrote to a peer sponsor.
3. Dont change your commitment (except for an extreme health emergency)
4. Check back with your sponsor after you eat and be rigorously honest.*

*If you broke your commitment in any way do an inventory physically, mentally-emotionally
and spiritually and create a plan for the next meal/day.

ACORN Food Dependency Recovery Services

PO Box 50126 Sarasota, FL 34232 941-378-2122 www.foodaddiction.com

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Appendix U
Dos and Donts of Choosing a 12-Step Sponsor
"Get a sponsor." But why? And how?
Addicts helping addicts is part of what makes AA/NA so effective. Sponsorship involves one recovering addict walking another
through the Steps and helping them stay sober. A sponsor is someone you call when you need emotional support or feel threatened by
relapse. They will respond without judgment or criticism by teaching you the language of AA/NA, encouraging you to continue
working your recovery program, providing emotional support by staying in regular contact and sharing their experience of recovery.
Working with a sponsor is like any relationship it requires some navigating in order to be mutually beneficial. Here are a few dos
and donts to follow when making this important decision:
DO Get a Sponsor
While it is true that not everyone needs a sponsor, most recovering addicts benefit from giving sponsorship a try. A sponsor is in the
unique position to understand what youve been through and offer their friendship, advice and support when you need it most. There is
no such thing as too much support, or too much accountability, in early recovery. Sponsorship guards against many of the problems
that contribute to relapse, including isolation and dishonesty. If youre willing to learn by working the Steps, a sponsor can be an
important influence on your continuing sobriety.
DO Choose Wisely
Not all sponsors are an ideal match for a newcomer to AA/NA. Frankly, some should be avoided. Who you put your trust in during the
vulnerable early stages of recovery can be critical for your continuing sobriety. Choose someone you relate to, who has had the type of
recovery you respect and admire. Dont shy away from someone who is honest and willing to confront dishonesty or diseased
thinking.
The ideal sponsor has at least one year sober, preferably more, and has an active relationship with their own sponsor. In studies, the
average sponsor had about 10 years of sobriety and AA attendance and was strongly affiliated with the AA program. While length of
time clean is one factor, it is not the only one. Does your sponsor live the 12-Step principles in their own life? Do they already have a
number of sponsees? Are they honest and open-minded?
DONT Make a Rash Decision.
When choosing a sponsor, talk to a number of people and find out if theyre truly living by the programs principles. Choosing the
right match from the start can quickly get you on the road to recovery.
DO Establish and Respect Boundaries
A sponsor is another addict in recovery who is willing to share their experience. They are not an expert in all things. Do not rely on
your sponsor for legal, financial, employment or relationship advice outside the scope of the 12-Step program. If they try to provide
this type of advice, meddle in your personal life, make specific demands for your thinking or behavior, or try to convince you that they
have all the answers, find a new sponsor. Do not, under any circumstances, get romantically involved with your sponsor. This is a setup for relapse. Protect yourself by choosing a sponsor of the gender youre not attracted to.
DO Seek Additional Help
A sponsor is not a therapist. They do not have special training; they are not perfect. They are simply fellow addicts in recovery. If you
need guidance in other areas, which most recovering addicts do, it is a good idea to see an individual therapist.
DONT Hesitate to Change Sponsors, if Necessary
Like all relationships, the sponsor-sponsee combination must be mutually rewarding. Someone who is inspirational and caring in the
early stages of recovery may not be as effective when youre more grounded in your sobriety and need a different type of guidance. It
is also possible for sponsors to relapse, in which case finding a new sponsor, at least for the time being, is strongly advisable.
If you feel that your sponsor is not a match for you not because they are honest and forthright, but because you dont feel safe or
comfortable with them or your philosophies are dramatically different talk to a few other sponsors and see if theres a stronger
connection. While a change of sponsor is sometimes necessary, be sure youre not giving up on a worthy mentor just because loving
confrontation can be difficult to take or because addictive thinking is causing you to sabotage your recovery.
When you look back on your recovery 5, 10, 20 years down the road, your 12-Step sponsor is likely someone who will stand out as an
important part of your journey. Even when your recovery is firmly grounded and you are confident in yourself, your sponsor may
continue to be a lifelong friend. They may even be the person you emulate if and when you become a sponsor yourself.
Copyright by Overeaters Anonymous, Inc. 2015
Reprinted by permission of Overeaters Anonymous, Inc.
https://www.oa.org/newcomers/tools-of-recovery/#sponsorship

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Appendix V
Arguments Against Common Denial

DENIAL #1
There is NO such thing as food addiction.
Dr. Nicola Avena reviewed all relevant studies and found animals can be addicted to sugar.
Dr. Mark Gold reviewed all relevant brain scan research on humans and found that sugar creates identical brain
impairments as alcohol and addictive drugs.
Dr. Nora Volkow concludes that the scientific evidence for food addiction is overwhelming.
DENIAL #2
Unlike alcoholism and drug addiction, you cant stop eating.
Dr. Pedro Lazaro, Like alcoholism where you can drink water, milk, tea, coffee but not alcohol; food addicts can eat over
200 foods, but not their binge and trigger foods, e.g. [with] added sugar.
DENIAL #3
Sugar is natural and the body needs sugar
for energy.
Dr. Robert Lustig, It is a matter of dosage and timing. When you eat an apple, the sugar enters the blood stream slowly as
you digest the roughage. This delay is missing in most processed foods.
The World Health Organization found that the average American now eats about 30 teaspoons of sugar a day, mostly in
processed food, but needs about 8 12 teaspoons per day.
DENIAL #4
Some people are able to lose weight and maintain it by diet and exercise; others should be able to do this also..
Dr. David Kessler, In a study of a large U.S. city, 50% of the obese were addicted, 30% of them were overweight and 20% of
normal weight, i.e. they exhibited the characteristics of physical craving and loss of control.
Almost all research on obesity treatment has concluded that less than 10% are able to diet successfully, even with support
like Weight Watchers.
DENIAL #5
If someone has lost control over their eating, they should go to a therapist or eating disorder specialist and resolve
underlying issues.
Ashley Gearhardt, PhD, (ABD), Studies using the Yale Food Addiction Scale find that 40 60 % of those with Binge Eating
Disorder also test positive for food as a substance use disorder.
DSM 5 of American Psychiatric Association, many with (Feeding and Eating Disorders) present with the symptoms of
substance use disorderscraving and loss of control.
DENIAL #6
Abstinence does not work with food addiction because people feel too deprived and relapse.
Overeaters Anonymous World Service did a randomized self-study of the fellowships and found that about 50% of
members were abstinent from compulsive overeating and with an average weight loss of over 50 pounds. This was
confirmed by an independent study of OA in the D.C. metropolitan area by Kriz.
Dr. Kelly Brownell supervised a study by Yale graduate students of a small group of late stage food addicts in residential
detox and found that their symptoms of withdrawal were comparable to those withdrawing from addictive drugs. Would
we eliminate abstinence from narcotic drugs because those addicted felt too deprived?
DENIAL #7
Many adults and a majority of young people in one large study say they binge on almost all foods. You cant eliminate
all foods.
Dr. Lustigs research assistants found that thirty years ago 20% of processed foods had sugar in them; today over 80% of
the 600,000 processed foods contain sugar. Mostly adults and hardly any children know which foods contain added sugar
or other addictive substances.
Theresa Wright, MS, RD, suggests late stage food addicts are often helped by committing meals with specific foods and
specific quantities, and weighing and measuring.
An outcome study of ACORN Food Addiction Recovery Services alumnae found that 68% weighed and measured all meals.
DENIAL #8
Stopping overeating is entirely a matter of reason and willpower.
The American Society of Addiction Medicine holds that addiction, including food addiction, is a brain disease that effects
not just the pleasure center but also the control center and the memory center of the brain.

54

Dr. William Silkworth put it this way: the action of alcohol on chronic alcoholics is a manifestation of an allergy; that the
phenomenon of craving is limited to this class and never occurs in the average drinker. This applies equally to food
addiction.
DENIAL #9
Some people are just genetically programmed to be overweight.
A recent study in Nature found hundreds of genes affecting weight and Dr. Earnest Nobel found that some obese adults
eating out of control have the same D2 dopamine gene marker as many alcoholics and drug addicts. Food addicts, like
alcoholics and other addicts, are able to recover by using an addiction model.
DENIAL #10
No one ever robbed a bank to be able to buy sugar.
Food addictive substances are very inexpensive. Still, clinicians working with food addicts find that many, if not most, stole
food or money to buy food as children. This was like robbing the only bank they had access to. Stealing and lying about food
progresses with the disease into adulthood.
DENIAL #11
If food is an addiction, there are much fewer other social consequences than there are for alcoholics and drug addictions.
This is not true. Food addiction is an underlying driver of a large portion of the obesity epidemic. Obesity increases the
likelihood of diabetes, heart disease, stroke, and some cancers, and food addicts are likely to die five to ten years sooner
than normal eaters. The CDC shows that if current patterns continue, this generation will be the first to die earlier than
their parents generation.
DENIAL #12
If people have trouble losing weight, they should work on underlying issues that cause emotional eating, and this will
solve the problem.
If emotional eaters are also food addicted, talk therapy is not likely to work in the long term. It is like asking an alcoholic
who is still drinking or a drug addict who is abusing their substance to do effective therapy.
DENIAL #13
Overeating is gluttony, a sin.
Food addiction is a biochemical brain disease and not a moral issue. This has long been understood in the medical
profession about alcoholism and drug addiction and the general public is moving toward acceptance of this. Now that
science has established addiction to one or more foods as an addictive disease, it is equally clear that food addiction is not a
moral issue.
DENIAL #14
Sugar is a mild opiate.
Dr. Colantuoni found evidence from many different lines of scientific research that sugar can create an endogenous opiate
in humans. Even if the sugar opiate is milder, than the cocaine opiate, sugar addiction becomes severe as the sugar addict
ingests 30 to 40 teaspoons a day. Here is the amount of sugar in one Coke.

DENIAL #14
If sugar or other foods are addictive in concentrated and intensive dosages, then you should just eat these substances in
moderate doses.
Dr. Vera Tarman shows how the biochemistry of food addiction, like other addictions, changes the instinctual parts of the
brain. These primal instincts then override the less powerful conscious part of the mind.
DENIAL #15
If sugar or other foods are addictive in concentrated doses, then you should just eat sugar in moderation.
Dr. Vera Tarman shows how the biochemistry of food addiction, like other addictions, changes the instinctual parts of the
brain. These primal instincts then override the less powerful conscious parts of the mind. Even small doses of added sugar
create cravings and loss of control.

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Appendix W
Psychological Denial Additional Notes
1. Most psychological denial is created by external environmental and family trauma.
2. Unique type of trauma is caused by the food addiction itself: physical and emotional pain caused by
weighing more than the social norms; internalized toxic shame from being unable to control the
basic function of eating; spiritual trauma as life becomes more and more unmanageable.
3. Food addiction psychological denial is treated by trauma reduction.

Appendix X
Biochemical Addictive Denial Additional notes.

1. False Starving: not being able to differentiate between natural hunger and physical craving (Dr. William
Silkworth).
2. False Thinking: believing rationales for eating that are not true, e.g., euphoric recall and mental obsession (Dr.
Gerald May).
3. False Self: the disease disturbing the will and hijacking personality and sense of self (Dr. Abraham Twerski).

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Appendix Y
Medications for Obesity, Eating Disorders and Food Addiction? - Vera Tarman, MD
Names

Amphetamines

Mechanism

Vyvanse (2015)
Ritalin
Dexedrine
Ephedrine
FlenFluramine (Ponerax)
Dexfenfuramne (Redux)
Fen-Phen
Xenical (Orlistat)

Fat Blocker

Psychotropic

Craving Blockers

SSRIs (Prozac, Celexa)

SSNRIs (Effexor)
Wellbutrin
Topiramate
Meridia (off market)
Belviq (2013)

Qsymia (2013)

Combos

Contrave

Leptin

Pramlintide (Symlin)

Hormones

Significant (to less than

10%) weight loss
Insomnia, anxiety
Paranoia
Cardiac tachycardia
Heart valve defect

Blocks absorption of fat in

small intestine by
inhibiting pancreatic
enzyme (Lipase)
Treats self medicated
eating
Suppresses appetite

Less than 10% weight loss

Fecal soiling
Vitamin deficiency

Sedation
Less than 10% weight loss
Weight gain
Low libido
Atypical mood reaction
Heart valve defect
Liver Disease
Depression
Suicide
Binge eating reduced?

Birth defects
Mood lability / suicide
Insomnia, paranoia?
Decreased libido, seizures

Leptin satiates gives

feeling of fullness
Diminishes reward
potential

Mimics Amylin, a
pancreatic hormone that
delays gastric emptying to
provide satiety
Mimics intestinal
hormone that delays
gastric emptying to
provide satiety

Significant weight loss for

Leptin insufficiency
Injectable
Not effective for Leptin
resistance (most obesity is
caused by too much leptin
rather than not enough)
Injectable at mealtime
Only available for diabetics

Significant weight loss

Twice daily injections
Only available for diabetics
Pancreatitis, thyroid
cancer

Improves insulin
resistance
Curtails livers production
of glucose

Mainly for diabetics

ReVia is an opiate blocker

Rimonabant is an
endocannaboinoid blocker
Reduces cravings for
opiates, alcohol and sugar
GABAnergic
Appetite suppressant
mixed with Topiramate
Naltrexone with
Burpropion

ReVia
Remonabant (off market)
Baclofen
Campril

Exenatide (Byetta)
Saxenda

Metformin

57

Issues

Appetite suppressant
Increase bodys
metabolism

Names

OTC /
Herbal Supplements

Devices

Novel Ideas?

Mechanism

Issues

Synthyroid
Eltroxin

Mimics thyroxin, the

hormone that governs
body metabolism

Weight loss
Insomnia
Diarrhea
Tremors

Metamucil
Caffeine
Ephedrine
Abidexinem, Myoshred,
Green Tea Extract/Green
Coffee Bean Extract
Fucoxanthin (Seaweed)
White Bean Extract
Chia, Glucomannan
hCG
Hoodia
Raspberry Ketones
Garcinia Cambogia Extract (Dr.
Oz)
Dr. Bernsteins Vitamin B 6
and12 fat burner

Bloating
Waste of money
Anxiety
Injections and diet (diet
probably causes wt loss)

Gastric Bypass
Laproscopic Banding
Maestro
Gelesis 100 (with implant)
Met
Intragastric balloon
Aspire Assist Pump (Europe)

Botox
Chemicals that scar stomach
lining
Hypothermia (cold water)

Fiber to feel full

Increases metabolism
Testosterone enhancer
Fat burners
Starch blocker (Green Tea)
Appetite suppressant
Prevents Fat Storage

Maestro is an implant
that blocks vagus nerve
(feel full)
Particles that expand to
feel full remove in 6
months
To fill stomach
To such up 30% of food
(to toss into toilet)

Stun nerves to the

stomach /intestines to feel
full
Reduce food absorption
Enhance brown adipose
cells thermogenesis (fat
burning rather than
storage)

58

Weight loss 15%

Alcoholism
Surgical Mishaps
Barretts Esophagitis,
gallstones
Balloon can deflate
Abdo pain, constipation
Infection
Bulimia

Digestion impaired
Malnutrition / Vitamine
Deficiency

Appendix Z
References
1

Mitchell, A. J., Bird, V., Rizzo, M., Hussain, S., & Meader, N. (2014). Accuracy of one or two simple questions
to identify alcohol-use disorder in primary care: a meta-analysis. Br J Gen Pract, 64(624), e408-418.
doi:10.3399/bjgp14X680497

An examination of the food addiction construct in obese patients with binge eating disorder
AN Gearhardt, MA White, RM Masheb - of Eating Disorders, 2012 - Wiley Online Library
... Widespread reward-system activation in obese women in response to pictures of high-calorie
foods. ... JAMA 2009; 3: 17. Web of Science Times Cited: 23. 11 Gearhardt AN,Corbin
WR,Brownell KD. The preliminary validation of the Yale food addiction scale. ...[see abstract below]
3

Angrisani L1, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide
2013. Obes Surg. 2015 Oct;25(10):1822-32. doi: 10.1007/s11695-015-1657-z.
4

Twerski, Abraham J. MD Addictive Thinking: Understanding Self Deception (1990, 1997)

An Examination of the Food Addiction Construct in Obese Patients with Binge Eating Disorder. Ashley N. Gearhardt, MS1
Marney A. White, PhD, MS2 Robin M. Masheb, PhD2 Peter T. Morgan, MD, PhD2 Ross D. Crosby, PhD3,4 Carlos
M. Grilo, PhD1,2
ABSTRACT Objective: This study examined the psychometric properties of the Yale food addiction scale (YFAS) in obese
patients with binge eating disorder (BED) and explored its association with measures of eating disorder and associated
psychopathology. Method: Eighty-one obese treatment seeking BED patients were given the YFAS, structured interviews
to assess psychiatric disorders and eating disorder psychopathology, and other pathology measures. Results:
Confirmatory factor analysis revealed a one-factor solution with an excellent fit. Classification of food addiction was
met by 57% of BED patients. Patients classified as meeting YFAS food addiction criteria had significantly higher levels
of depression, negative affect, emotion dysregulation, eating disorder psychopathology, and lower selfesteem. YFAS
scores were also significant predictors of binge eating frequency above and beyond other measures. Discussion: The
subset of BED patients classified as having YFAS food addiction appear to represent a more disturbed variant
characterized by greater eating disorder psychopathology and associated pathology. VC 2011 by Wiley Periodicals, Inc.
Keywords: binge eating; food addiction; substance use; drug use; emotional eating; obesity (Int J Eat Disord 2012;
45:657663)

59