In early April, prominent National Institutes of Health nutrition scientist Kevin Hall took early retirement at the age of 54, citing administrative censorship as the main reason.
Why? One of his recent publications did not support claims that ultra-processed food is addictive, which went against Health and Human Services Secretary Robert F. Kennedy Jr.’s narratives about the dangers of ultra-processed food. Hall shared that he had been “banned from speaking freely with reporters” about this study.
Whether or not food is truly addictive is still an area of controversy.
Whereas there are a growing number of professionals, including myself, that believe that certain foods have addictive properties, and that “ultra-processed food addiction” needs to be recognized and treated within mainstream medicine, others, such as eating disorders treatment professionals who believe that labeling food addictive could make eating disorders worse, are disbelieving of and/or afraid to embrace the food addiction construct.
The ambiguity causes much suffering for people who have an addictive relationship with foods, who get nothing but mixed messages when they seek help.
However, the last thing we need is the government to step in and muddy the waters. What we need is more unbiased research — such as what Hall’s group has been doing — because it is by seeking the truth that we will figure out how to help people break free from cravings and obsessions.
Hall is now unlikely to return to the NIH, and his early retirement is a loss to the field.
Although some of Hall’s previous work bolstered food addiction narratives — one tightly controlled study showed that ultra-processed food triggers its own overconsumption — his latest finding was less supportive.
Specifically, the study failed to show that consumption of an ultra-processed food beverage acted on the brain like other addictive drugs and did not trigger a measurable amount of dopamine release from brain regions involved in reward, habit formation, and addiction.
Hall’s group also did not find a positive correlation between dopamine release in striatum and body weight. Stimulants, alcohol and opioids, by contrast, do cause large surges of dopamine in this brain region.
At the end of his paper, Hall and his colleagues concluded, appropriately, that “the narrative that ultra-processed foods high in fat and sugar can be as addictive as drugs of abuse based on their potential to elicit an outsized dopamine response in brain reward regions was not supported by our data.”
They also concluded that the unexpected results “suggest that previous findings of post ingestive striatal dopamine responses in studies with substantially smaller numbers of subjects may have been due to type 1 statistical error.”
This, too, is an appropriate conclusion since his study was the largest of its kind at 50 participants; previous results showing shake-induced dopamine surges might have been spurious, or by chance.
But did these findings shut the door on the possibility that ultra-processed foods are addictive? Not at all.
Hall’s main findings were no doubt disappointing to Kennedy and his team because, at face value, they imply that these foods actually don’t act on the brain like drugs. But censorship was absolutely unnecessary (not to mention unethical).
Hall’s group also reported in this paper that higher dopamine surges to shake consumption predicted more cookie-eating after the brain scans, and higher ratings of shake pleasantness and wanting.
The people who did have large dopamine surges had more wanting, liking and consumption of ultra-processed food. This is in line with the possibility that dopamine-related addictive processes were at play for some, if not all, individuals in the study.
Also, in the discussion section of the paper, Hall and his team stated that the shake-induced dopamine responses “may be closer in magnitude to that of nicotine — a drug widely acknowledged to promote addiction.” They then go on to cite several similar studies showing small or negligible dopamine responses to nicotine exposure in smokers.
Does anyone question that nicotine is addictive just because nicotine didn’t show the same degree of dopamine surge that illicit drugs and alcohol did? No. Then why should these findings affect our belief about food addiction, either?
I still strongly believe that high-sugar ultra-processed foods are addictive for some people. This is because addiction is not defined by the neurobiological underpinnings, but rather, by a set of behavioral criteria, according to the Diagnostic and Statistical Manual of Mental Disorders.
So, to resolve the controversies about whether food addiction is a true construct, and whether abstinence-based treatment paradigms will help or hurt, factual, well-designed, fair, non-industry funded, non-politically influenced, uncensored science is what we need to move the field forward.
And without the meddling, please.
Claire Wilcox, MD, is an addiction psychiatrist, writer and academic. She is the author of the textbook “Food Addiction, Obesity and Disorders of Overeating” and the forthcoming self-help book “Rewire Your Food Addicted Brain.”