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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:
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
4
4
5
6
7
7
7
7
7
7
Background
Fellowship Recommendations for Newcomers
The Twelve Steps Adapted to Food Addiction
Supporting Patients Participating in 12 Step Groups
8
8
9
9
9
9
9
9
10
10
10
10
10
10
10
10
10
10
10
11
11
Appendices
A.
B.
C.
D.
E.
F.
G.
H.
11
11
12
12
12
13
13
14
15
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
16
19
21
22
23
24
25
26
27
28
31
36
40
41
46
47
48
49
50
51
53
54
56
56
57
59
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.
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.
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
5
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.
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.
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.
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?
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.
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.
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
22
23
24
25
26
27
28
31
36
40
N. Professional Assistance
41
46
47
48
R. Overeaters Anonymous Dignity of Choice pamphlet Available as part of the Extras bundle.
49
50
51
53
54
56
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
Appendix C
EMOTIONAL EATER
FOOD ADDICT
(with obesity)
(eating disorder)
(chemical dependency)
Weight
Moderate exercise
What works:
Willpower
Unresolved trauma
. . . and physical
And those to the left
What works:
Moderation (along with
feeling your feelings)
What works:
21
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
Recommended Actions
Pre-Disease
Prevention
Early Stage
Middle Stage
Late Stage
Final Stage
DEATH
copyright Phil Werdell, Bariatric Surgery & Food Addiction: Preoperative Considerations, 2008
23
Appendix F
Clues Suggesting the Need for Food Addiction Screening
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
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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
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Appendix I
Food Related 12 Step Fellowships
OVEREATERS ANONYMOUS(OA)
www.overeatersanonymous.org
505-891-2664
OVEREATERS ANONYMOUS HOW (OAHOW)
www.oahow.org
(612) 377-1600 or (888) 540-1212
OVERCOMERS OUTREACH
(Christian-based)
www.overcomersoutreach.org
800-310-3001
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Appendix J
Self-Help Books on Food Addiction and Other Resources
Self-Help Books
Title
Author
Description
Author
Description
Alcoholics Anonymous
Alcoholics Anonymous
Greysheeters Anonymous
Greysheeters Anonymous
Overeaters Anonymous
Overeaters Anonymous
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New York Times best sellers on the overall food addiction problem
Title
Author
Description
Michael Moss
William Duffy
David A. Kessler, MD
Author
Description
Definition of Addiction
Public Policy Statement
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
Author
Description
Special Topics
Title
Author
Description
Gerald G. May, MD
Abraham J. Twerski, MD
Philip R. Werdell, M.A.
29
Author
Description
Michael Prager
Margaret Bullitt-Jonas
Raja' Batarseh
Movies
Title
Director/Author
Description
"Fed Up"
"Suicide by Sugar"
"Supersize Me"
Morgan Spurlock
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:
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
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.
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.
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.
40
Appendix N
Professional Assistance
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.
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.
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.
43
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
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
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).
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.
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.
46
Appendix P
47
Appendix Q
American Society of Addiction Medicine (ASAM)
Summary Statement on Addictions
48
Appendix R
Overeaters Anonymous Dignity of Choice pamphlet
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
DINNER
=
=
=
=
=
=
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.
52
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
53
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.
55
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).
56
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
Qsymia (2013)
Combos
Contrave
Leptin
Pramlintide (Symlin)
Hormones
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
Mimics Amylin, a
pancreatic hormone that
delays gastric emptying to
provide satiety
Mimics intestinal
hormone that delays
gastric emptying to
provide satiety
Improves insulin
resistance
Curtails livers production
of glucose
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
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)
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)
58
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
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