Purpose of Review
Weight stigma and discrimination are significant issues facing people who are overweight. There is growing acceptance that obesity is caused by a neurobiologically driven addiction to some foods. This review examines the evidence that obesity is due to a food addiction and the impact that this may have on attitudes towards excess weight.
There is limited evidence that food addiction explanations may reduce external stigma and self-blame. However, these positives may come at the expense of adverse impacts on overweight person’s self-efficacy and eating. The “addict” label may also further exacerbate weight stigma.
Current research on the impact of food addiction explanations on stigma is scarce and inconsistent. There is almost no research examining the clinical impact of food addiction on self-efficacy, eating, or treatment seeking. More research clarifying these issues is essential given the growing acceptance of “food addiction” explanations in society.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.
Statistics ABo. Overweight and obesity national health survey: first results, 2014–2015. 2015. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/4364.0.55.001~2014-15~Main Features~Overweight and obesity~22.
Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014, US Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health Statistics; 2015.
Rosenheck R. Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk. Obes Rev. 2008;9(6):535–47.
Ello-Martin JA, Ledikwe JH, Rolls BJ. The influence of food portion size and energy density on energy intake: implications for weight management. Am J Clin Nutr. 2005;82(1):236S–41S.
Gearhardt AN, Davis C, Kuschner R, Brownell KD. The addiction potential of hyperpalatable foods. Current Drug Abuse Reviews. 2011;4(3):140–5.
Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. International Journal of Obesity (2005). 2008;32(6):992–1000.
•• Puhl R, Latner J, O'Brien K, Luedicke J, Daníelsdóttir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes. 2015;39(7):1166–73. This paper assessed levels of, and predictors for, anti-fat attitudes across Canada, the U.S., Iceland and Australia.
Pischon T, Nimptsch K. Obesity and risk of cancer: an introductory overview. In: Pischon T, Nimptsch K, editors. Obesity and cancer. Recent results in cancer research, vol 208. Cham: Springer; 2016.
Collaborators TGO. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27. https://doi.org/10.1056/NEJMoa1614362.
Puhl R, Suh Y. Health consequences of weight stigma: implications for obesity prevention and treatment. Curr Obes Rep. 2015;4(2):182–90.
Vartanian LR, Porter AM. Weight stigma and eating behavior: a review of the literature. Appetite. 2016;102:3–14.
Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS One. 2013;8(7):e70048.
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.
Hatzenbuehler ML, Keyes KM, Hasin DS. Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity. 2009;17(11):2033–9.
Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring, Md). 2009;17(5):941–64.
Tompson T, Benz J, Agiesta J, Brewer K, Bye L, Reimer R, et al. Obesity in the United States: public perceptions. The Food Industry. 2012;53(26):21.
Gearhardt AN, Corbin WR, Brownell KD. Food addiction an examination of the diagnostic criteria for dependence. J Addict Med. 2009;3(1):1–7.
•• Meadows A, Nolan LJ, Higgs S. Self-perceived food addiction: Prevalence, predictors, and prognosis. Appetite. 2017;114:282–98. This study assessed the prevalence of self-perceived food addiction and it’s relationship with validated measures of food addiction symptomology, weight stigma, body image and eating behaviours.
•• Hardman RPJ, Dallas R, Scott J, Ruddock HK, Robinson E. “Food addiction is real”. The effects of exposure to this message on self-diagnosed food addiction and eating behaviour. Appetite. 2015;91:179–84. Authors address concerns that exposure to food addiction messages may increase self-diagnosis of food addiction thereby promoting the intake of unhealthy foods. Those exposed to food addiction messages showed increased self-diagnosis and more variability in food intake than controls.
Ruddock HK, Dickson JM, Field M, Hardman CA. Eating to live or living to eat? Exploring the causal attributions of self-perceived food addiction. Appetite. 2015;95:262–8.
Davis C, Curtis C, Levitan RD, Carter JC, Kaplan AS, Kennedy JL. Evidence that 'food addiction' is a valid phenotype of obesity. Appetite. 2011;57(3):711–7.
Gearhardt AN, Bragg MA, Pearl RL, Schvey NA, Roberto CA, Brownell KD. Obesity and public policy. Annu Rev Clin Psychol. 2012;8(1):405–30.
Smith DG, Robbins TW. The neurobiological underpinnings of obesity and binge eating: a rationale for adopting the food addiction model. Biol Psychiatry. 2013;73(9):804–10.
Ifland J, Preuss H, Marcus M, Rourke K, Taylor W, Burau K, et al. Refined food addiction: a classic substance use disorder. Med Hypotheses. 2009;72(5):518–26.
Ruddock HK, Hardman CA. Food addiction beliefs amongst the lay public: what are the consequences for eating behaviour? Current Addiction Reports. 2017;4(2):110–5.
•• Lee NM, Lucke J, Hall WD, Meurk C, Boyle FM, Carter A. Public views on food addiction and obesity: implications for policy and treatment. PLoS One. 2013;8(9):e74836. https://doi.org/10.1371/journal.pone.0074836. Provided the first large survey demonstrating significant public support for food addiction explanations of obesity and its likely impact on public policy and clinical treatment.
Volkow ND, O'Brien CP. Issues for DSM-V: should obesity be included as a brain disorder? Am J Psychiatr. 2007;164(5):708–10.
Volkow ND, Wang G-J, Tomasi D, Baler RD. The addictive dimensionality of obesity. Biol Psychiatry. 2013;73(9):811–8.
Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience & Biobehavioural Reviews. 2008;32(1):20–39.
Avena NM, Bocarsly ME, Hoebel BG, Gold MS. Overlaps in the nosology of substance abuse and overeating: the translational implications of "food addiction". Current Drug Abuse Reviews. 2011;4(3):133–9.
Volkow N, Wang GJ, Fowler JS, Tomasi D, Baler R. Neuroimgaing of addiction. In: Seeman P, Madras BK, editors. Imaging of the human brain in health and disease. San Diego: Elsevier; 2014. p. 1–26.
Stice E, Figlewicz DP, Gosnell BA, Levine AS, Pratt WE. The contribution of brain reward circuits to the obesity epidemic. Neurosci Biobehav Rev. 2013;37(9, Part A):2047–58.
Stice E, Yokum S. Neural vulnerability factors that increase risk for future weight gain. Psychol Bull. 2016;142(5):447–71.
Smith DG, Jones PS, Williams GB, Bullmore ET, Robbins TW, Ersche KD. Overlapping decline in orbitofrontal gray matter volume related to cocaine use and body mass index. Addict Biol. 2015;20(1):194–6. https://doi.org/10.1111/adb.12081.
Johnson PM, Kenny PJ. Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nat Neurosci. 2010;13(5):635–41.
Koob GF, Le Moal M. Neurobiology of addiction. New York: Academic Press; 2006.
Geiger B, Haburcak M, Avena N, Moyer M, Hoebel B, Pothos E. Deficits of mesolimbic dopamine neurotransmission in rat dietary obesity. Neuroscience. 2009;159(4):1193–9.
Gearhardt CWR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009;52(2):430–6.
Long CG, Blundell JE, Finlayson GA. Systematic review of the application and correlates of YFAS-diagnosed ‘food addiction' in humans: are eating-related ‘addictions' a cause for concern or empty concepts? Obesity Facts. 2015;8(6):386–401.
•• Carter A, Hendrikse J, Lee N, Yucel M, Verdejo-Garcia A, Andrews Z et al. The neurobiology of ‘food addiction’ and its implications for obesity treatment and policy. Annual Reviews of Nutrition. 2016;36:105–28. This paper critically analyses the neuroscientific evidence for food addiction, and its clinical, social and policy implications.
Ziauddeen H, Farooqi IS, Fletcher PC. Obesity and the brain: how convincing is the addiction model? Nat Rev Neurosci. 2012;13(4):279–86.
Friedman R. What cookies and meth have in common. The New York Times [Internet]. 2017 [cited 13 January 2018]; SR1. Available from: https://www.nytimes.com/2017/06/30/opinion/sunday/what-cookies-and-meth-have-in-common.html
Tait M. A food addiction has defined my entire life. And it is slowly killing me. The Guardian [Internet]. 2017 [cited 13 January 2018];. Available from: https://www.theguardian.com/commentisfree/2017/jun/01/a-food-addiction-has-defined-my-entire-life-and-it-is-slowly-killing-me
O'Brien KS, Latner JD, Ebneter D, Hunter JA. Obesity discrimination: the role of physical appearance, personal ideology, and anti-fat prejudice. Int J Obes. 2013;37(3):455–60.
Roehling MV, Roehling PV, Pichler S. The relationship between body weight and perceived weight-related employment discrimination: the role of sex and race. J Vocat Behav. 2007;71(2):300–18.
O'Brien KS, Latner JD, Halberstadt J, Hunter JA, Anderson J, Caputi P. Do antifat attitudes predict antifat behaviors? Obesity. 2008;16(S2:S87–92.
Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One. 2012;7(11):e48448.
O'Brien KS, Hunter JA, Banks M. Implicit anti-fat bias in physical educators: physical attributes, ideology and socialization. Int J Obes. 2007;31(2):308–14.
Greenleaf C, Petrie TA, Martin SB. Relationship of weight-based teasing and adolescents' psychological well-being and physical health. J Sch Health. 2014;84(1):49–55.
Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Health. 2014;54(6):724–9.
Madowitz J, Knatz S, Maginot T, Crow S, Boutelle K. Teasing, depression and unhealthy weight control behaviour in obese children. Pediatric Obesity. 2012;7(6):446–52.
Major B, Eliezer D, Rieck H. The psychological weight of weight stigma. Soc Psychol Personal Sci. 2012;3(6):651–8.
Hunger JM, Major B. Weight stigma mediates the association between BMI and self-reported health. Health Psychol. 2015;34(2):172–5.
Jackson SE, Beeken RJ, Wardle J. Obesity, perceived weight discrimination, and psychological well-being in older adults in England. Obesity. 2015;23(5):1105–11.
Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: cortisol reactivity to manipulated weight stigma. Obesity. 2015;23(2):368–74.
Tomiyama AJ, Epel ES, McClatchey TM, Poelke G, Kemeny ME, McCoy SK, et al. Associations of weight stigma with cortisol and oxidative stress independent of adiposity. Health Psychol. 2014;33(8):862–7.
Schvey NA, Puhl RM, Brownell KD. The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosom Med. 2014;76(2):156–62.
Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91(4):449–58.
Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. J Exp Soc Psychol. 2014;51:74–80.
•• Puhl RM, Quinn DM, Weisz BM, Suh YJ. The role of stigma in weight loss maintenance among US adults. Annals of Behavioral Medicine. 2017;51:754. This study assessed the potential role of internalised weight bias as a barrier to weight loss maintenace.
Pearl RL, White MA, Grilo CM. Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity. 2014;22(5):E142–E8.
Hilbert A, Braehler E, Haeuser W, Zenger M. Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity. 2014;22(1):79–85.
Pearl RL, Puhl RM. The distinct effects of internalizing weight bias: an experimental study. Body Image. 2016;17(Supplement C):38–42.
Pearl RL, Wadden TA, Hopkins CM, Shaw JA, Hayes MR, Bakizada ZM, et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity. 2017;25(2):317–22.
Latner JD, Barile JP, Durso LE, O'Brien KS. Weight and health-related quality of life: the moderating role of weight discrimination and internalized weight bias. Eat Behav. 2014;15(4):586–90.
O'Brien KS, Latner JD, Puhl RM, Vartanian LR, Giles C, Griva K, et al. The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite. 2016;102:70–6.
Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: implications for binge eating and emotional well-being. Obesity. 2007;15(1):19–23.
Tomiyama AJ. Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite. 2014;82:8–15.
Daníelsdóttir S, O'Brien KS, Ciao A. Anti-fat prejudice reduction: a review of published studies. Obesity Facts. 2010;3(1):47–58.
Alberga A, Pickering B, Alix Hayden K, Ball G, Edwards A, Jelinski S, et al. Weight bias reduction in health professionals: a systematic review. Clinical Obesity. 2016;6(3):175–88.
Persky S, Eccleston CP. Impact of genetic causal information on medical students’ clinical encounters with an obese virtual patient: health promotion and social stigma. Ann Behav Med. 2010;41(3):363–72.
O'Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA. Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity. 2010;18(11):2138–44.
Hilbert A, Rief W, Braehler E. Stigmatizing attitudes toward obesity in a representative population-based sample. Obesity. 2008;16(7):1529–34.
•• Latner JD, Puhl RM, Murakami JM, O'Brien KS. Food addiction as a causal model of obesity. Effects on stigma, blame, and perceived psychopathology. Appetite. 2014;77:79–84. Authors demonstrate that exposure to food addiction messages may reduce weight-stigma and blame towards overweight individuals.
Weiner B. An attributional theory of achievement motivation and emotion. Psychol Rev. 1985;92(4):548–73.
Crandall CS, D’Anello S, Sakalli N, Lazarus E, Nejtardt GW, Feather N. An attribution-value model of prejudice: anti-fat attitudes in six nations. Personal Soc Psychol Bull. 2001;27(1):30–7.
Barry CL, McGinty EE, Pescosolido BA, Goldman HH. Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatric Services (Washington, DC). 2014;65(10):1269–72.
• DePierre JA, Puhl RM, Luedicke J. A new stigmatized identity? Comparisons of a “food addict” label with other stigmatized health conditions. Basic and Applied Social Psychology. 2013;35(1):10–21. This paper assesses public attitudes towards “food addiction” in comparison with obesity and other addictions. Food addiction was viewed more favourably than alcohol and tobacco addictions but had an additive effect on weight stigma when combined with obesity.
Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan J, Link B. "A disease like any other?": a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatr. 2010;167(11):1321–30.
Gearhardt AN, White MA, Masheb RM, Morgan PT, Crosby RD, Grilo CM. An examination of the food addiction construct in obese patients with binge eating disorder. Int J Eat Disord. 2012;45(5):657–63.
Burmeister JM, Hinman N, Koball A, Hoffmann DA, Carels RA. Food addiction in adults seeking weight loss treatment. Implications for psychosocial health and weight loss. Appetite. 2013;60:103–10.
• DePierre JA, Puhl RM, Luedicke J. Public perceptions of food addiction: a comparison with alcohol and tobacco. Journal of Substance Use. 2014;19(1–2):1–6. This paper compared beliefs about the etiology and maintenance of food, alcohol and tobacco addictions. Food and smoking addictions were viewed as more behaviour-based (and less disease-based), than alcohol addiction.
Lee NM, Hall WD, Lucke J, Forlini C, Carter A. Food addiction and its impact on weight-based stigma and the treatment of obese individuals in the US and Australia. Nutrients. 2014;6(11):5312–26.
• Şanlier N, Türközü D, Toka O. Body image, food addiction, depression, and body mass index in university students. Ecol Food Nutr. 2016;55(6):491–507. This study assessed the relationships between food addiction symptomology, body image, depression and body mass index (BMI).
Cullen AJ, Barnett A, Komesaroff P, Brown W, O'Brien KS, Hall W, et al. A qualitative study of overweight and obese Australians’ views of food addiction. Appetite. 2017;115:62–70.
• Ruddock HK, Field M, Hardman CA. Exploring food reward and calorie intake in self-perceived food addicts. Appetite. 2017;115:36–44. The authors compared the eating behaviours and associated traits (dietary disinhibition, desire-to-eat, liking of foods etc.) of self-perceived food-addicts with self-perceived non-food-addicts.
•• Ruddock HK, Christiansen P, Jones A, Robinson E, Field M, Hardman CA. Believing in food addiction: helpful or counterproductive for eating behavior? Obesity. 2016;24(6):1238–43. This study explores how believing oneself to be a “food addict” impacts upon eating behaviours, finding that receiving a food addiction diagnosis may promote short term diet restriction.
Rief W, Conradt M, Dierk J-M, Rauh E, Schlumberger P, Hinney A, et al. Is information on genetic determinants of obesity helpful or harmful for obese people?—a randomized clinical trial. J Gen Intern Med. 2007;22(11):1553–9.
•• Hoyt CL, Burnette JL, Auster-Gussman L. Obesity is A disease: examining the self-regulatory impact of this public-health message. Psychol Sci. 2014;25(4):997–1002. https://doi.org/10.1177/0956797613516981. This paper assessed the impact of describing obesity as a “disease”. Whilst such messages decreased body disatisfaction, they also appeared to undermine health-focused weight loss strategies (e.g. diet and exercise).
•• Pearl R, Lebowitz M. Beyond personal responsibility: effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychol Health. 2014;29(10):1176–91. This study examined the impact of causal attributions for obesity (biology, food environment, and personal responsibility) on weight stigma, support for obesity reducing policies and beliefs aout weight loss.
Burnette JL. Implicit theories of body weight: entity beliefs can weigh you down. Personal Soc Psychol Bull. 2010;36(3):410–22.
Schulte EM, Joyner MA, Schiestl ET, Gearhardt AN. Future directions in “food addiction”: next steps and treatment implications. Current Addiction Reports. 2017;4(2):165–71.
Dr. Puhl reports research funding from Weight Watchers, Inc., outside the submitted work.
Dr. Carter reports grants from the National Health and Medical Research Council during the conduct of the study.
Dr. Hardman reports grants from American Beverage Association, personal fees from International Sweeteners Association, outside the submitted work.
Conflict of Interest
ᅟThe authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Food Addiction
About this article
Cite this article
Reid, J., O’Brien, K.S., Puhl, R. et al. Food Addiction and Its Potential Links with Weight Stigma. Curr Addict Rep 5, 192–201 (2018). https://doi.org/10.1007/s40429-018-0205-z
- Food addiction
- Weight bias