The Weekly Vlog

Significant Impairment or Distress

Jan 17, 2024

This week, I want to weave together three topics for you.

First: I’m co-writing a book chapter on ultra-processed food addiction for an academic book on weight loss. I’m writing right now about the 11 DSM-5 criteria for substance use disorder. Research indicates that ultra-processed food addiction meets each of these criteria. A large meta-analysis of hundreds of studies showed that about 20 percent of people in the general population qualify for a diagnosis of food addiction.

But the average person has 2.38 of these 11 symptoms, and to get a diagnosis, you only need to have 2 of them. A mild diagnosis is 2–3 symptoms, moderate 4–5, and a severe case has 6 or more symptoms.

When you hear what the symptoms are, it’s pretty easy to imagine that a lot of people have them. One symptom, for example, is eating more food than you intended to. Another is repeated failed attempts to cut back or a persistent desire to cut back. The whole dieting industry is built on this.

The point is this: it would seem that the average person, with 2.38 of these symptoms, would have a food addiction. But they don’t, because having these symptoms isn’t enough. There has to be a pattern of use that leads to significant clinical impairment or distress.

The people with two or more symptoms often don’t meet that benchmark. They may have tried to cut back or perhaps they notice themselves overindulging, but they’re not stressed out about it. They just move on with their lives. Many people have what we could call an addictive relationship with food—but they don’t have a food addiction. Food addiction needs that clinically significant impairment or distress.

The second thing I want to share has to do with a person I’ve been talking to lately who is struggling. She has a fair bit of weight to lose, but she’s young enough that it’s not impacting her health. She’d like to look better, from her perspective, and she’s distressed. And, when she eats addictively, she loses the ability to function in her life. So she is experiencing clinically significant impairment or distress.

Part of her doesn’t believe in food addiction. She thinks it’s a choice, and she should just be able to control it. She thinks she could quit if she just had more moral fiber. She’s been trying for years. Last time we talked, I reminded her that the science shows it IS an addiction, and the belief that she’s choosing to eat these foods is erroneous.

There was a professor at NYU, Rodolfo Llinas, who did an experiment: he would try to point his toe forward while electrodes placed in the motor cortex of his brain were telling his foot to flex back. He ran the experiment over and over. He was horrified, not because he could not override those electrodes and point his toe, but because his brain kept telling him that he was changing his mind and meant to flex his foot back. The same is true with my friend. Her brain is telling her she’s choosing, but she’s not.

Another example: Let’s say I told you there was a bag with five billion dollars waiting for you up forty flights of stairs but the rule is that to get it, you have to hold your breath the whole time you climb the stairs. You couldn’t do it. You would eventually breathe, and it would seem like your choice—but it really wasn’t. You were capitulating to the demands of your brain which then manipulated you into thinking that you were choosing to breathe.

Lastly: I was speaking to a group last week, and I said to them how grateful I was that I both like and want my Bright recovery. This way of life is something that I deeply appreciate for its structure, for the support system, for everything about it that allows me to be the person I most want to be.

In addiction literature, there’s a lot about wanting and liking. Initially, when we’re not in an addictive state, we want flour, sugar, and other foods only a little. But then, we eat them and like them a lot. As the brain wires itself for addiction, the wanting gets bigger and bigger and the liking gets smaller and smaller. Studies have shown that people with obesity intensely want ultra-processed food, sugar, and flour. But when they’re eating it, the parts of the brain that are associated with liking are muted. They don’t even like it that much anymore.

Lots of people want to lose weight and want to try Bright Line Eating. But when they realize it’s more involved than they thought, a full lifestyle and not a simple diet, they don’t like it and don’t want to do it. Some people grow to like it, Some grow to love it. What a gift that is!

So people like my friend may think they have a weight problem and a willpower problem. She isn’t on board with the Bright Line way. She doesn’t believe in it. She thinks intuitive eating makes more sense. And I get that. I’ve tried intuitive eating, not weighing and measuring my food, and eating flour and sugar, and what happened? Within a month I was out of control.

Most addicts experience periods where they feel like they’re regaining control. But it don’t last. That’s what powerlessness is—an inability to achieve the desired result, peace with food and weight, on one’s own. If your relationship with food and weight bothers you a lot, that’s clinically significant distress.

What a gift it is to work a potent-enough program for whatever degree of addiction you have! To break free. To live joyously, contently, and free. Not everyone gets that gift—because addiction is just a beast.

Click here to listen to this episode on Bright Line Living™ - The Official Bright Line Eating Podcast.

Susan Peirce Thompson, Ph.D. is a New York Times bestselling author and an expert in the psychology and neuroscience of eating.  Susan is the Founder and CEO of Bright Line Eating®, a scientifically grounded program that teaches you a simple process for getting your brain on board so you can finally find freedom from food.

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