An animated image of processed foods, including a cheeseburger, a donut, and colorful processed food packaging.Although physical therapists in Maryland legally cannot provide advice about nutrition and healthy eating – the Maryland PT Board has ruled that this is not in the scope of physical therapy – we would like to share a few interesting studies about eating highly-processed food (HPF). As physical therapists, we are concerned about the health of our patients, and with the holidays coming up, we feel that the new findings are worthy of sharing.

As you may know, the Surgeon General issued a report in 1988 describing tobacco products as addictive based on three primary scientific criteria. According to the Surgeon General, tobacco can 

  1. cause highly controlled or compulsive use
  2. cause psychoactive, including mood-altering effects via their effect on the brain 
  3. reinforce behavior. 

More recently, it has become clear that tobacco products trigger strong urges or cravings, which is another indicator that tobacco can lead to addiction. 

Researchers Gearhardt and DiFeliceantonio published an alarming study that highly-processed food meets the same four criteria and should be considered addictive, similar to tobacco! 1 Even though food addiction was first described in 1956, 2 it is still not recognized in the Diagnostic and Statistical Manual of Mental Disorders. Many people eat primarily HPF as it is cheaper than healthier foods, readily available, and heavily marketed to adults and children. Did you know that about 14% of adults and 12% of children suffer from food addiction? 1 Highly processed foods are technologically engineered to rapidly deliver carbohydrates and added fat, which triggers addictive behaviors. 

Many highly processed foods can lead to food addiction, such as carbonated soft drinks, sweet or savory snacks, chocolate, candies, ice cream, cakes, cookies, bread, and pizza (among many others). 3 To check whether your favorite food or snack is highly processed, check the list of ingredients. Ultra-processed foods contain a combination of ingredients you would probably not use in your kitchen, such as high-fructose corn syrup, hydrogenated or inter-esterified oils, hydrolyzed proteins, or classes of additives designed to make your food look more appealing and delicious, such as artificial flavors, flavor enhancers, colors, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents. 3 There is no question that HPFs can trigger compulsive use, which can contribute to serious health issues, such as diabetes, obesity, and cardiovascular disease. While it may sound unbelievable, HPFs and their components increase dopamine in a part of the brain called the striatum at a similar magnitude as nicotine! Even after undergoing gastric bypass surgery, 20-50% of people who had this surgery start gaining weight again, which can be attributed to consuming HPFs! 4 Minimally processed foods (MPFs), such as fruit, vegetables and legumes, do not cause these problems as few individuals become addicted to veggies, but most people prefer candy, cake, ice cream, and pizza. Even after eating a full meal, there is always room for chips or dessert.

Gearhardt and DiFeliceantonio advocate for stricter guidelines to curb the devastating impact of HPFs. Obviously, that is not going to happen in the very near future. In the meantime, you may want to check the labels and lists of ingredients of the food you are going to eat during the holidays. Maybe a good New Year’s resolution is to drastically reduce your intake of HPFs, even if that means no more daily frozen meals, cookies, sodas, etc. 

  1. Gearhardt AN, DiFeliceantonio AG. Highly processed foods can be considered addictive substances based on established scientific criteria. Addiction. 2022.
  2. Randolph TG. The descriptive features of food addiction; addictive eating and drinking. Q. J. Stud. Alcohol. 1956;17:198-224.
  3. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936-941.
  4. Li Z, Pan Y, Zhang Y, Qin J, Lei X. Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review. Obes. Surg. 2022;32:2023-2034.