This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete bibliographic information, a link to the original publication on http://cardio.jmir.org, as well as this copyright and license information must be included.
Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking.
This study aimed to evaluate the availability and content of support options, accessible online, for food addiction.
A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation.
Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support.
This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction.
Food addiction is a growing area with increasing evidence suggesting that some vulnerable individuals, with issues related to overeating, report a response to food that is likened to other addictions, such as alcohol and gambling—for example continued consumption despite negative consequences or craving [
The majority of existing research in the area is focused on cross-sectional surveys of young adults, mainly female. Food addiction, as defined by self-report survey tools, is approximately 20% [
The concept of food addiction is not new and has quite a historical perspective [
Numerous alternative self-help groups exist to assist those seeking support for food addiction and overeating. These groups could be beneficial as they offer to service a condition that has strong public acceptance [
Due to the current lack of evidence-based support options for food addiction, and the apparent high demand for access to self-help groups [
A Web search was conducted using 4 search engines to identify current support availability for food addiction. In total, 3 of the most commonly used search engines [
The following terms were used for the Web searches across all 4 search engines: food addiction treatment, food addiction group, food addiction recovery, and food addiction help. These terms were selected and based on keywords from published papers in the area of food addiction [
Due to the large number of results to be retrieved from the search (128-22,400,000 from each search engine per search; Refer to
To be included in this review, the website needed to meet the following 3 criteria: (1) to specifically treat those with food addiction, (2) included meetings or interventions involving participant and group leader or counselor, and (3) the website was in English. Exclusion criteria were as follows: websites that included the support or treatment of multiple forms of addiction (ie, drugs or alcohol in addition to food) and websites including multiple treatments where it was not clear how specific support for food addiction was delivered, thus creating difficulties for analysis of available support options. Once the websites had undergone review (RM), the included websites were analyzed for content by 2 independent reviewers (RM and JS).
A standardized extraction form (
For the purposes of data extraction, the standard definitions were used. These are outlined in
Definitions used in data extraction.
Data | Definition |
Member numbers | The number of members (ie, Individuals attending meetings) as stated on the website |
Establishment year | The year the group or program was first established (not the year the website was established) |
Country of origin | Country where the program was established |
Fees | Cost associated with involvement in the program |
12 steps and traditions | Defined as the general practice followed for self-help groups meetings as originally set out for Alcoholics Anonymous. The 12 steps are underpinned by the 12 traditions of how meetings are to be facilitated, and the belief in most cases that addiction possesses medical and spiritual elements [ |
Food plans | Considered if the website stated that a predesigned daily food plan was to be followed during participation in the program |
Abstinence from food | Included if there was an expectation that group participants would exclude specific foods or food groups such as sugar and wheat from their diets |
Sponsorship | Defined as a support relationship provided by another group member of the program |
Spirituality | Defined as participants being required to align with religion or a spiritual notion to be involved in the program |
Involvement of health professionals | Considered if the program was established or delivered by an individual with a university health qualification |
Face-to-face meetings | Defined as a meeting where program participants meet at a predetermined venue |
Phone meetings | Defined as a meeting that is held as a dial-in phone meeting at a predetermined time. Considered both group phone meetings and individual phone meetings |
Online meetings | Defined as a meeting that is held online either by a program such as Skype or an online messaging forum at a specified time |
Podcasts | Defined as audio recordings on the website available to individuals |
Newsletter | Defined as a compilation of written articles on the website available to individuals or written articles emailed on a regular basis to those who sign up on the website to receive newsletters |
Retreats | Considered if a website advertised a program delivered over 2 or more days at a predetermined destination |
Evaluation | Defined as the assessment of the program to determine outcomes for participants |
Social media closed groups | Considered if the website stated that group participants would be given access to an online forum that was only accessible by other group members |
Of the 800 records retrieved across the 4 search platforms (
All 13 websites (
Flow diagram of websites included in analysis.
Frequency of location, format, and delivery mode on websites (N=13).
Website features | n | |
Country of origin | United States, n=13 | |
Fees | 5 | |
12 steps/traditions | 11 | |
Food plans | 8 | |
Abstinence from foods | 8 | |
Sponsorship | 6 | |
Spirituality based | 11 | |
Health professional involvement | 3 | |
Face-to-face meetings | 7 | |
Phone meetings | 12 | |
Online meetings | 4 | |
Podcasts | 2 | |
Newsletter | 5 | |
Social media closed groups | 5 | |
Retreats | 5 | |
Program evaluation | 0 |
Website extraction data (websites 1-6).
Website features | Website 1 [ |
Website 2 [ |
Website 3 [ |
Website 4 [ |
Website 5 [ |
Website 6 [ |
Member numbers | 54,000 | N/Aa | N/A | N/A | N/A | N/A |
Establishment year | 1960 | N/A | 1998 | N/A | 1979 | N/A |
Country of origin | United States | United States | United States | United States | United States | United States |
Fees | ✗b | ✗ | ✗ | ✗ | ✗ | ✗ |
12 steps/traditions | ✓c | ✓ | ✓ | ✓ | ✓ | ✓ |
Food plans | ✗ | ✓ | ✓ | ✓ | ✓ | ✗ |
Abstinence from foods | ✗ | ✗ | ✓ | ✓ | ✓ | ✓ |
Sponsorship | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ |
Spirituality based | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Involvement of health professionals | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
Face-to-face meetings | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ |
Phone meetings | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Online meetings | ✓ | ✓ | ✗ | ✗ | ✓ | ✗ |
Podcasts | ✓ | ✗ | ✗ | ✗ | ✓ | ✗ |
Newsletter | ✓ | ✗ | ✓ | ✗ | ✗ | ✗ |
Social media closed groups | ✓ | ✗ | ✓ | ✗ | ✗ | ✗ |
Retreats | ✗ | ✗ | ✓ | ✗ | ✗ | ✗ |
Evaluation | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
aN/A=Information not available on website.
b✗ indicates information was not provided on website.
c✓ indicates information was provided on website.
The most common fundamental feature of the websites was the inclusion of the 12-step guideline as a core program element, and spirituality as a main theme of how the program was to be interpreted and delivered. The 12 steps and 12 traditions (
Website extraction data (websites 7-13).
Website features | Website 7 [ |
Website 8 [ |
Website 9 [ |
Website 10 [ |
Website 11 [ |
Website 12 [ |
Website 13 [ |
Member numbers | N/Aa | N/A | N/A | N/A | N/A | N/A | N/A |
Establishment year | N/A | 2000 | N/A | N/A | N/A | N/A | N/A |
Country of origin | United States | United States | United States | United States | United States | United States | United States |
Fees | ✓b | ✗c | ✗ | ✓ | ✓ | ✓ | ✓ |
12 steps/traditions | ✓ | ✓ | ✓ | ✓ | ✗ | ✓ | ✗ |
Food plans | ✓ | ✓ | ✗ | ✓ | ✗ | ✗ | ✓ |
Abstinence from foods | ✓ | ✓ | ✗ | ✓ | ✓ | ✗ | ✗ |
Sponsorship | ✗ | ✓ | ✗ | ✗ | ✗ | ✗ | ✗ |
Spirituality based | ✓ | ✓ | ✓ | ✓ | ✗ | ✓ | ✗ |
Involvement of health professionals | ✓ | ✗ | ✗ | ✓ | ✗ | ✗ | ✓ |
Face-to-face meetings | ✓ | ✗ | ✗ | ✗ | ✗ | ✗ | ✓ |
Phone meetings | ✓ | ✓ | ✓ | ✓ | ✓ | ✗ | ✓ |
Online meetings | ✗ | ✗ | ✗ | ✓ | ✗ | ✗ | ✗ |
Podcasts | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
Newsletter | ✓ | ✗ | ✗ | ✓ | ✗ | ✓ | ✗ |
Social media closed groups | ✗ | ✓ | ✓ | ✗ | ✓ | ✗ | ✗ |
Retreats | ✓ | ✗ | ✗ | ✓ | ✗ | ✓ | ✓ |
Evaluation | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
aN/A=Information not available on website.
b✓ indicates information was provided on website.
c✗ indicates information was not provided on website.
The most frequently used mode of delivery among the programs was phone meetings between participant and group leaders or counselors, with 12 out of the 13 programs opting for this type of delivery. The frequency of phone meetings differed greatly between the 12 groups with phone meeting occurring daily (n=5), 6 times per week (n=1), 4 times per week (n=3), once per week (n=1), or phone meetings were held only with the individual at a time convenient to the individual (n=2). For group phone meetings, participants are provided with a phone number, and a specific time to call the number, to join the meeting. The times of the phone meetings varied with 9 websites not specifying the length of their phone meetings. Moreover, 1 website stated their phone meetings were 60 min in length, 1 website specified a length of 30 min, and another website stated that their phone meetings vary anywhere from 60, 75, and 90 min to an unspecified length of time. The content and structure of phone meetings was reported by 5 websites, with content and structure not reported, and therefore unclear for 7 websites. A total of 7 websites stated face-to-face delivery of meetings, the most common places for meetings were at religious facilities, such as churches or community centers. The least frequent was group online meetings, with 4 programs choosing this type of delivery.
Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. A total of 2 websites provide access to program-related podcasts.
This review set out to evaluate the content of websites for support options available to those seeking help specifically with addictive eating behaviors. Overall, self-help groups for food addiction appear to be the main source of support available for those seeking help with their addictive eating behaviors, with few evaluations found in published research. It was identified that there is minimal evidence surrounding the effectiveness of self-help groups for addiction, and although there was a reported focus on food and emotional recovery, the specialized input of credentialed health professionals is rarely used.
It is interesting to note that research in food addiction has a long history, with the support services from website 1 commencing in 1960. However, it is only since 2008 that the amount of published scientific literature has rapidly increased [
The 12-step format used by OA, although never evaluated for its effectiveness for the specific treatment of food addiction, has led to the formation of multiple 12-step support programs offered to those seeking help with addictive eating behaviors. The support provided by OA has been reviewed in the past; however, these reviews investigated the outcomes for eating disorders and weight loss [
A total of 9 out of the 13 support programs reviewed follow the 12-step program based on the original foundations for food addiction support as established by OA. It could be surmised that other programs have been designed to address a more modernized view of food addiction—for example, supporting the belief that sugar produces neurochemical effects in the brain and is an addictive substance to be abstained from. However, to date, there is no strong scientific evidence in humans to suggest that foods, or nutrients, such as sugar are in fact addictive in a neurochemical context [
The United States was the sole country of origin for all websites. If the rates of other addiction are considered in the United States, alcohol dependence occurs at a rate of 5.6%, with global rates at 4.9%. The United States has the highest prevalence of cocaine addiction, yet Australasia has the highest rate of opioid and amphetamine addiction [
The majority of websites (n=10) did not involve the participation of qualified health professionals in their programs. Qualified counselors, psychotherapists, and social workers were utilized in 3 programs; however, interestingly, dietitians were not involved in the development or delivery of any of the program features on the website. This is noteworthy considering the substantial emphasis on food consumption and restriction within the programs offered, and most websites offering food plans. In addition, 2 of the websites encouraged participants to seek input from general practitioners and dietitians to assist them in their recovery, but this does not appear to be considered as essential by the self-help groups in most cases.
The format of the meetings offered within the website programs is an important element. It has been suggested that by participating in group support, social relationships are formed and there is an increase in peer abstinence, which in turn promotes abstinence within the individual [
Face-to-face, phone, and online group meeting formats were the majority among websites, indicating their support in the belief of greater outcomes of abstinence within social settings. In contrast, online social support such as podcasts and newsletters were not commonly used among website support programs, as it appears the main focus of the support programs is to engage people in group situations and encourage the forming of relationships, as opposed to listening to podcasts or reading newsletters unaided.
This review was limited mainly due to the restriction placed on pages to be reviewed from searches. This occurred to ensure the review was completed in a timely manner and was based on evidence of the number of pages commonly reviewed by individuals [
This is the first review to analyze online support for food addiction. Results show 13 Web-based programs exist that are often complemented with phone support, programs vary in cost, and rarely utilize trained health professionals. The abundance of food addiction support programs available on the web displays the perceived need by the general public to have access to these types of services. By reviewing current food addiction support availability, it can provide a guide toward the development of evidence-based support for food addiction.
Summary of search results by search engine.
Food addiction website criteria extraction.
Included websites.
The AA 12 steps.
The AA 12 traditions.
cardiovascular disease
Diagnostic and Statistical Manual of Mental Disorders
Overeaters Anonymous
Yale Food Addiction Scale
RAM is supported by an Australian Government Research Training Program Scholarship. TLB is supported by a UON Brawn Research Fellowship.
None declared.