Abstinence versus harm reduction debate

On this episode of the Food Junkies Podcast, we welcome back Dr. Erica LaFata to dive into her groundbreaking work developing the Food Addiction Severity Interview (FASI) — a clinician-administered diagnostic tool modeled after the SCID alcohol use disorder module and adapted for ultra-processed foods. Building on self-report tools like the Yale Food Addiction Scale (YFAS) and mYFAS, Erica explains why the field urgently needs a structured clinical interview to validate ultra-processed food addiction as a distinct psychiatric presentation and move toward formal recognition in the DSM.

Together, we explore the nuance at the intersection of eating disorders and ultra-processed food addiction: where they overlap, where they diverge, and how mislabeling can harm people on both sides. Erica unpacks key addiction mechanisms like withdrawal and tolerance, the risks of false positives and false negatives in screening, and what clinicians should be listening for when trying to tell restrictive eating, binge eating, and addictive patterns apart – especially in youth, men, and other under-researched groups.

The conversation also gets practical and hopeful: we talk about the competencies therapists, dietitians, coaches, and other practitioners need before working with ultra-processed food addiction; the tension between abstinence and harm reduction; the "volume addiction" question; and how orthorexia and the "health halo" of protein bars and high-protein UPFs can quietly hijack recovery. Erica closes by sharing how FASI data could inform future public policy and regulation of ultra-processed foods without fueling weight stigma – and gives an exciting update on the DSM submission process for ultra-processed food addiction as a condition for further study.

In this episode, we discuss:

• Why self-report tools (YFAS, mYFAS) were a crucial first step—and why a clinician-administered interview like FASI is the necessary next one

• How FASI was modeled after the SCID alcohol use disorder module and adapted for ultra-processed foods

• The core addiction mechanisms (loss of control, withdrawal, tolerance, consequences) and how they show up with ultra-processed foods

• Key differences between traditional eating disorder frameworks ("all foods fit," no good/bad foods) and an addiction lens focused on specific ultra-processed foods

• What many food addiction coaches and practitioners may be missing without formal substance use or eating disorder training

• False positives vs false negatives in food addiction screens—and why missed cases (false negatives) are especially concerning

• How FASI uses follow-up questions to differentiate restriction, binge eating, and true addictive patterns

• What we know (and still don't know) about ultra-processed food addiction across sex, age, BMI, and developmental stages

• Early exposure in childhood and adolescence as a potential public health crisis for lifelong addictive responses to ultra-processed foods

• The high overlap between binge-type eating disorders (BED, bulimia nervosa) and food addiction—and what to prioritize in treatment

• "Volume addiction": whether what we call "addicted to volume" may actually be binge eating disorder in disguise

• Orthorexia, "clean eating," and the health halo of protein bars, high-protein snacks, and dressed-up "safe" foods

• The tension between abstinence-based and harm reduction approaches for ultra-processed foods, and why different strategies may work for different people

• How clinician bias (diet culture, anti-addiction frameworks, or rigid abstinence views) can affect assessment—and how FASI creates room for nuance

• How FASI and future data could support DSM recognition, inform policy, SNAP and marketing regulations, and reduce shame by naming ultra-processed food addiction as real and treatable

• A hopeful update on the DSM application for ultra-processed food addiction as a condition for further study