• addiction;
  • dependence;
  • DSM IV;
  • sugar;
  • obesity;
  • litigation

Summary  The notion that sweetness is ‘addictive’ endures in the scientific literature and in the popular press. The most common targets of food cravings and addictions are energy-dense foods that are sweet, high in fat, or both. In clinical studies, the consumption of sweet and high-fat foods has been selectively reduced by opiate antagonists, suggesting a link between hedonic pleasure response and the brain systems of reward. Recent brain imaging studies have further implicated the dopamine system in mediating the pleasure response to food as well as a range of addictive behaviours. However, suggestions that sugar and fat have a permanent impact on the neurobiology of food preference are in sharp contrast with the view that the vast majority of food addictions are simply a matter of misattribution. Dietary restraint, coupled with ambiguous attitudes towards good-tasting but energy-dense foods, may lead consumers to claim that some aspects of eating behaviour are beyond their control. This distinction between addiction and attribution has implications for obesity-related lawsuits. The chief attraction of addiction theory for the plaintiff’s counsel lies in the claim of diminished personal responsibility and abrogation of free choice. However, sugar and sweets do not appear to meet the current criteria for substance dependence as formulated in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition. Examining scientific literature on sweet food ‘addictions’ and their putative links to the obesity epidemic is the topic of this review.