Lustig Robert H
Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States.
Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States.
Front Psychiatry. 2025 Aug 28;16:1621742. doi: 10.3389/fpsyt.2025.1621742. eCollection 2025.
Despite decades of nutrition, obesity, and diabetes research, and worsening prevalences and severities of virtually every chronic metabolic disease, the scientific community remains divided over the existence and veracity of the concept of food addiction. There are numerous rationalizations - 1) you need food to survive, (of which "Food is Medicine" is the latest mantra); 2) people with obesity should not be stigmatized as "mentally ill"; 3) people with obesity should instead adhere to "personal responsibility"; 4) the data are incomplete and not strong enough; 5) it's correlation but not causation; 6) everyone is exposed, but not everyone is addicted; 7) there is no "withdrawal" phenotype; and 8) it's not "food addiction" but "eating addiction". All are in play, yet more health care dollars are diverted to the treatment of food-related disease every year. While various ingestible chemicals (e.g. nicotine, cocaine, heroin, alcohol) are clearly addictive, it appears to be a stretch by some scientists to argue that individual substances found in food (e.g. sugar, caffeine), or the food itself (e.g. ultraprocessed food), rise to meet the same criteria. Symposia on food addiction proliferate and journal debates continue. The definition of addiction consists of numerous criteria, including public health demographics, biochemistry, imaging, animal trials, clinical trials, and economics. None of these have proven to be "slam dunks" to align a general consensus. But paramount for scientific acceptance is the delineation of mechanism. This article will review the history of the controversy, the data on which foods are most likely to be addictive, the two mechanisms involved in the pathogenesis of food addiction and relate it to the most likely culprits, and the role of the food industry in promulgating false narratives, in order to provide a rational way forward from this debate.
尽管在营养、肥胖和糖尿病研究领域已历经数十年，且几乎每种慢性代谢疾病的患病率和严重程度都在不断恶化，但科学界对于食物成瘾这一概念的存在及真实性仍存在分歧。存在诸多合理化解释——1）人需要食物来生存（其中“食物即药物”是最新的口号）；2）肥胖者不应被污名化为“精神疾病患者”；3）肥胖者应坚持“个人责任”；4）数据不完整且不够有力；5）这是相关性而非因果关系；6）每个人都接触食物，但并非每个人都会成瘾；7）不存在“戒断”表型；8）这不是“食物成瘾”而是“饮食成瘾”。所有这些因素都在起作用，但每年仍有更多的医疗保健资金被用于治疗与食物相关的疾病。虽然各种可摄入的化学物质（如尼古丁、可卡因、海洛因、酒精）显然具有成瘾性，但一些科学家认为，食物中发现的个别物质（如糖、咖啡因）或食物本身（如超加工食品）要符合同样的标准似乎有些牵强。关于食物成瘾的研讨会激增，期刊上的争论仍在继续。成瘾的定义包含众多标准，包括公共卫生人口统计学、生物化学、影像学、动物试验、临床试验和经济学等。但这些都未能成为达成普遍共识的“决定性证据”。而对于科学认可而言，最重要的是对机制的描述。本文将回顾这场争议的历史、最有可能导致成瘾的食物的数据、食物成瘾发病机制中涉及的两种机制并将其与最有可能的罪魁祸首联系起来，以及食品行业在传播虚假说法中所起的作用，以便为这场争论提供一条合理的前进道路。
