Now is the time to recognize and respond to addiction to ultra-processed foods

The idea that certain ultra-processed foods — such as candy, cookies, and chips — can be addictive is receiving increasing attention in the USA and elsewhere. During the past two years, Congressional hearings have addressed the role of addictive ultra-processed foods in escalating rates of childhood chronic diseases. In December 2024, a lawsuit was filed in Philadelphia, accusing 11 ultra-processed-food companies of designing addictive food products and aggressively marketing them toward children.

Reflecting the growing consensus that addiction science could inform food policy, the US Food and Drug Administration (FDA) and National Institutes of Health (NIH) have announced a new initiative modeled on the successful Tobacco Regulatory Science Program, which will unite both agencies’ expertise to “transform nutrition and food-related research”. That certain foods can trigger addictive behavior consistent with substance-use disorders (SUDs) is accepted by many addiction scientists and supported by evidence of neurobiological overlap with the brain circuits and molecular targets implicated in ‘classical’ drug addictions¹. Yet addiction to ultra-processed food is not formally recognized by medical classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM)² and the International Classification of Diseases (ICD). This is an oversight with major consequences for public health.

The DSM defines SUDs as a problematic pattern of intake marked by characteristics such as intense cravings, repeated attempts to cut back, and continued use despite harm. Compulsive consumption of ultra-processed food and an inability to self-regulate despite negative consequences unquestionably meets the DSM SUD criteria. In 2007, we argued that the DSM-5 should include obesity as a brain disorder with similar symptom presentation to the one described in the DSM-IV for substance abuse and drug dependence.³ At the time, the DSM-5 committee did not feel there was sufficient evidence to substantiate obesity as an addiction.

However, there are now nearly 300 studies across 36 countries documenting that processed junk foods cause patterns of intake typical of drug addiction.⁴ A recent metaanalysis estimated the global prevalence of addiction to ultra-processed food at 14% — equivalent to that of alcohol-use disorders.⁴ Patients meeting criteria for addiction to ultra-processed foods share many commonalities with patients diagnosed with SUDs, including adverse childhood experiences, impaired reward sensitivity, and comorbid depression, anxiety, and post-traumatic stress disorder.⁵

Imaging studies consistently show differences in brain connectivity and activation among people whose consumption of ultra-processed food follows similar patterns to an addiction phenotype. Studies show increased responsiveness in reward circuits to expectation of food reward and diminished activation to the actual consumption of the reward, alongside dysfunction of self-regulation networks, in parallel to what is observed in other SUDs5. Moreover, recent findings that agonists of the glucagon-like peptide-1 receptor (effective medications to control appetitive cravings and reduce weight) also substantially reduce drug consumption and improve clinical outcomes in individuals with SUDs illustrate the neurobiological overlap between compulsive food and drug intake.¹

The evidence for addiction to ultraprocessed food is much greater than that of other conditions recognized in the DSM.⁵ Yet some scientists and clinicians insist that more evidence is needed before ultraprocessed-food addiction can be recognized, even as a “condition in need of further study”, which precedes a full diagnosis. Nitrous oxide use disorder, for example, is a DSM diagnosis despite there being no consensus about its addictive properties, scant research, and little evidence of widespread harm.⁶ Similarly, caffeine use disorder was included in the DSM appendix as a “condition in need of further study” on the basis of nine cross-sectional studies from small clinical samples. We argue that addiction to ultra-processed food should be held to the same scientific standards as other diagnoses.

One argument against such a diagnosis is that, unlike tobacco or alcohol, food cannot be addictive because it is required for survival. But not all foods are addictive. Minimally processed foods — such as fruits, vegetables, and whole grains — have little association with addictive patterns of intake. People do not become addicted to carrots or quinoa. In the context of the brain reward system, ultra-processed foods high in sugars and fats share more commonalities with addictive substances⁵ than they do with naturally occurring foods.

Take nicotine as an example; to increase its addictiveness, companies found that processing
nicotine with flavor enhancers and additives, and delivering it rapidly in high doses, created a highly profitable, addictive product (cigarettes). This closely parallels how addictive ultra-processed foods are created. Sugars and fats are isolated from their naturally occurring forms, highly concentrated, delivered alongside additives that enhance flavor, mouthfeel, and absorption, and sold in attractive packages to strengthen conditioning. Just as a cigarette has little in common with a tobacco leaf, an Oreo shares few characteristics with the corn and soybeans from which it was made.

The ability to process reinforcing substances, such as sugar and fat, and optimize their delivery through ultra-processed foods has led to a modern food supply containing hundreds of thousands of uniquely formulated products. Consequently, it can be challenging to identify specifically which foods are most implicated in addiction. However, DSM criteria for diagnosing SUDs do not require clinicians or patients to precisely identify addictive products. Rather, for any addictive substance, a simplified definition is used (for example, problematic patterns of alcohol use). Likewise, the clinical interview tool for diagnosing addiction to ultra-processed food asks patients to report on ultra-processed foods not found in nature, typically high in calories, fat, and refined carbohydrates like sugar. When asked to identify the foods that they crave, patients have no trouble identifying ultra-processed products such as pizza and ice cream. Rarely do they report minimally processed foods as problematic.

If addictive food products were to be regulated like addictive substances, a more detailed taxonomy would be needed. This problem is not unique to food, but common across regulated products, from tobacco to alcohol to medical devices. The term ‘tobacco products’, for example, includes thousands of tobacco, nicotine, and vaping products with varied health effects and addictive potentials. In 2017, the FDA published a rule clarifying when products derived from tobacco are regulated as tobacco products (cigarettes, for instance), drugs (such as nicotine gum), or devices. The FDA also created the Searchable Tobacco Products database, which sorts nearly 17,000 tobacco products into categories (such as smokeless) and subcategories (for instance, loose chewing tobacco). If difficulty in precisely identifying addictive products were grounds for exclusion from the DSM, most SUDs would not qualify. Delaying the recognition of addiction to ultra-processed food in pursuit of the perfect taxonomy is unnecessary and inconsistent with the treatment of other SUDs.

Although questions remain, recognizing addiction to ultra-processed food as a disorder — or, at minimum, as a condition in need of further study — paves the way toward improved prevention, clinical care, and policies. The public-health community was a leader in establishing the scientific basis for, and recognition of, tobacco addiction and in supporting aggressive tobacco control efforts, such as taxes, marketing bans, and clean-indoor-air laws. These actions have protected children from predatory industry practices, improved prevention and treatment effectiveness, and saved countless lives.

We are now facing a public-health crisis of even greater magnitude, arising from an environment flooded with inexpensive, easily accessible, and heavily marketed ultraprocessed foods that are designed to be irresistible. Given the strength of the scientific evidence and the urgency of the public-health costs, we urge the scientific community and policy makers to recognize the addictive potential of ultra-processed food and its consequences.

Originally published in Nature Medicine.