Many of us try to eat more fruits and vegetables and less ultra-processed food. But why is sticking to your goals so hard?

High-fat, sugar-rich and salty foods are simply so enjoyable to eat. And it’s not just you – we’ve evolved that way. These foods activate the brain’s reward system because in the past they were rare.

Now, they’re all around us. In wealthy modern societies we are bombarded by advertising which intentionally reminds us about the sight, smell and taste of calorie-dense foods. And in response to these powerful cues, our brains respond just as they’re designed to, triggering an intense urge to eat them.

Here’s how food cravings work and what you can do if you find yourself hunting for sweet or salty foods.

What causes cravings?

A food craving is an intense desire or urge to eat something, often focused on a particular food.

We are programmed to learn how good a food tastes and smells and where we can find it again, especially if it’s high in fat, sugar or salt.

Something that reminds us of enjoying a certain food, such as an eye-catching ad or delicious smell, can cause us to crave it.

The cue triggers a physical response, increasing saliva production and gastric activity. These responses are relatively automatic and difficult to control.

What else influences our choices?

While the effect of cues on our physical response is relatively automatic, what we do next is influenced by complex factors.
Whether or not you eat the food might depend on things like cost, whether it’s easily available, and if eating it would align with your health goals.

But it’s usually hard to keep healthy eating in mind. This is because we tend to prioritise a more immediate reward, like the pleasure of eating, over one that’s delayed or abstract – including health goals that will make us feel good in the long term.

Stress can also make us eat more. When hungry, we choose larger portions, underestimate calories and find eating more rewarding.

Looking for something salty or sweet

So what if a cue prompts us to look for a certain food, but it’s not available?

Previous research suggested you would then look for anything that makes you feel good. So if you saw someone eating a doughnut but there were none around, you might eat chips or even drink alcohol.

But our new research has confirmed something you probably knew: it’s more specific than that.

If an ad for chips makes you look for food, it’s likely a slice of cake won’t cut it – you’ll be looking for something salty. Cues in our environment don’t just make us crave food generally, they prompt us to look for certain food “categories”, such as salty, sweet or creamy.

Food cues and mindless eating

Your eating history and genetics can also make it harder to suppress food cravings. But don’t beat yourself up – relying on willpower alone is hard for almost everyone.

Food cues are so powerful they can prompt us to seek out a certain food, even if we’re not overcome by a particularly strong urge to eat it. The effect is more intense if the food is easily available.

This helps explain why we can eat an entire large bag of chips that’s in front of us, even though our pleasure decreases as we eat. Sometimes we use finishing the packet as the signal to stop eating rather than hunger or desire.

Is there anything I can do to resist cravings?

We largely don’t have control over cues in our environment and the cravings they trigger. But there are some ways you can try and control the situations you make food choices in.

• Acknowledge your craving and think about a healthier way to satisfy it. For example, if you’re craving chips, could you have lightly-salted nuts instead? If you want something sweet, you could try fruit.
• Avoid shopping when you’re hungry, and make a list beforehand. Making the most of supermarket “click and collect” or delivery options can also help avoid ads and impulse buys in the aisle.
• At home, have fruit and vegetables easily available – and easy to see. Also have other nutrient dense, fibre-rich and unprocessed foods on hand such as nuts or plain yoghurt. If you can, remove high-fat, sugar-rich and salty foods from your environment.
• Make sure your goals for eating are SMART. This means they are specific, measurable, achievable, relevant and time-bound.
• Be kind to yourself. Don’t beat yourself up if you eat something that doesn’t meet your health goals. Just keep on trying.

Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University and Justin Mahlberg, Research Fellow, Pyschology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects around 2.5% of adults and 7% of children. It causes difficulties with attention, impulsivity and hyperactivity.

If unrecognised and untreated, ADHD can significantly impact educational and work achievements, and social and emotional wellbeing. It can also increase the risks of serious accidents and injuries, offending, mental illness and substance abuse.

When accurately identified and appropriately treated, these negative outcomes can be significantly reduced.

But as a recent article in the Medical Journal of Australia highlights, some people struggle to access and afford diagnoses and treatment the disorder.

Meanwhile, some popular social media channels that provide online “tests” for ADHD are sponsored by private clinics that, once you have screened positive, direct you to their sites for an online assessment. This has raised concern about potential over-diagnosis.

So, what is ADHD diagnosis actually based on? A key component is functional impairment. Let’s take a look at what that means.

Why a brief assessment isn’t enough

In Australia, there are reports of business models where clinics are charging several thousand dollars for a quick, brief online assessment and diagnosis.

These brief assessments don’t comply with evidence-based guidelines and are problematic because they:

• focus solely on ADHD and don’t attempt to assess other aspects of a person’s difficulties
• rely heavily on information from the person being assessed and don’t seek the opinions of significant others
• rely heavily on information about symptoms, gathered through questionnaires, and don’t assess their impact on day-to-day functioning.

This is important because a core requirement for a diagnosis of ADHD is evidence that the:

symptoms must interfere significantly with social, academic, or occupational functioning.

No matter how many symptoms you have, if they’re not having an impact on your day-to-day life, a diagnosis of ADHD shouldn’t be made.

So what is a comprehensive assessment?

To make an accurate diagnosis of ADHD, a comprehensive assessment is needed. This includes a clinical interview to evaluate the current and past presence (or absence) of each of the 18 core ADHD symptoms and associated impairment.

While there are scales such as the Weiss Functional Impairment Rating Scale and the World Health Organisation Disability Assessment Schedule that can aid assessment, these are best used as conversation starters rather than stand-alone tools.

A comprehensive assessment also includes a broader assessment for current mental and physical health problems, developmental history, personal and family mental health, substance use, addiction and, where appropriate, interactions with the justice system.

This interview shouldn’t be conducted as a simple tick-box exercise, with yes and no answers. A detailed interview is needed to explore and identify symptoms, and evaluate their impact on functioning.

It’s also strongly recommended the clinician hears from one or more people who can speak to the person’s childhood and current functioning.

What counts as ‘functional impairment’ is very individual

The diagnostic manuals don’t give detailed accounts of what counts as significant enough impairment to be diagnosed with ADHD.

This has led some commentators to complain that lack of a standardised definition could lead to over-diagnosis.

But the impacts of ADHD are so broad it would be very difficult to formulate a clear, comprehensive and encompassing list of valid impairments.

Such a list would also fail to capture the very personalised nature of these impairments. What is impairing for me may not be for you and vice versa.

So a rigid definition would likely result in missed as well as mis-diagnoses.

How do clinicians determine if someone is impaired?

Clinicians are very used to assessing the impact of symptoms on functioning. They do so for many other mental and physical health conditions, including depression and anxiety.

Research has identified several common themes in ADHD:

• impaired romantic, peer and professional relationships
• parenting problems
• impaired educational and occupational achievements
• increased accidents and unintentional injuries
• driving offences
• broader offending
• substance use and abuse
• risky sexual behaviours.

ADHD symptoms are often associated with:

• emotional dysregulation
• exhausting levels of mental and physical restlessness
• low self-esteem
• fatigue
• high stress levels.

One caveat is that some people are receiving a lot of support and scaffolding or have found ways to compensate for their difficulties. Whether or not this should count as impairment depends on the circumstances and requires considerable thought.

However, ADHD shouldn’t be ruled out on the basis of high levels of achievement in certain aspects of life like school or work. A person may be under-achieving relative to their potential, or having to put in extreme levels of effort to keep afloat.

An adult with ADHD, for example, may be excelling at work but by the end of the workday is too exhausted to do anything but sleep. They may also be experiencing impairments in other aspects of their lives that aren’t obvious unless specifically asked about.

Others will present multiple impacts that, when explored, aren’t true functional impairments.

So it’s crucial clinicians drill down into the details until they’re confident that it is or isn’t a genuine impairment related to the core ADHD symptoms.

Clinician training is essential

The skill of accurately assessing impairments in ADHD is not difficult to train or learn. This is done by observing experienced clinicians and practising with structured protocols.

Newly trained clinicians quickly become confident in assessing impairment and there is generally close agreement between different professionals about whether an ADHD diagnosis should be made.

However, few health professionals currently get high-quality training in ADHD either during their core or more advanced training. This must change if we’re going to improve the accuracy of assessment and reduce missed and mis-diagnoses.

David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.