With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term ‘food addiction’ is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Modulation of dorsolateral prefrontal cortex (DLPFC) activity using non-invasive brain stimulation has been shown to reduce food craving as well as food consumption. Using a preregistered design, we examined whether bilateral transcranial direct current stimulation (tDCS) of the DLPFC could reduce food craving and consumption in healthy participants when administered alongside the cognitive target of inhibitory control training. Participants (N = 172) received either active or sham tDCS (2 mA; anode F4, cathode F3) while completing a food-related Go/No-Go task. State food craving, ad-lib food consumption and response inhibition were evaluated. Compared with sham stimulation, we found no evidence for an effect of active tDCS on any of these outcome measures in a predominantly female sample. Our findings raise doubts about the effectiveness of single-session tDCS on food craving and consumption. Consideration of individual differences, improvements in tDCS protocols and multi-session testing are discussed.

This study investigated whether the application of high definition transcranial direct current stimulation (HD-tDCS) to the dorsolateral prefrontal cortex reduces cue-induced food craving when combined with food-specific inhibitory control training. Using a within-subjects design, participants (N = 55) received both active and sham HD-tDCS across two sessions while completing a Go/No-Go task in which foods were either associated with response inhibition or response execution. Food craving was measured pre and post stimulation using a standardised questionnaire as well as desire to eat ratings for foods associated with both response inhibition and response execution in the training task. Results revealed no effect of HD-tDCS on reducing state food craving or desire to eat. Due to the COVID-19 pandemic, we were unable to achieve our maximum preplanned sample size or our minimum desired Bayesian evidence strength across all a priori hypotheses; however 6 of the 7 hypotheses converged with moderate or stronger evidence in favour of the null hypothesis over the alternative hypothesis. We discuss the importance of individual differences and provide recommendations for future studies with an emphasis on the importance of cognitive interventions.

It has been theorized that cortical feed-forward and recurrent neural activity support unconscious and conscious cognitive processes, respectively. Here we causally tested this proposition by applying event-related transcranial magnetic stimulation (TMS) at early and late times relative to visual stimuli, together with a pulse designed to suppress conscious detection. Consistent with pre-registered hypotheses, early TMS affected residual, reportedly ‘unseen’ capacity. However, conscious perception also appeared critically dependent upon feed-forward processing to a greater extent than the later recurrent phase. Additional exploratory analyses suggested that these early effects dissociated from top-down criterion measures, which were most affected by later TMS. These findings are inconsistent with a simple dichotomy where feed-forward and recurrent processes correspond to unconscious and conscious mechanisms. Instead, different components of awareness may correspond to different phases of cortical dynamics in which initial processing is broadly perceptual whereas later recurrent processing might relate to decision to report.

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