Ultra-processed food addiction may be an under-recognised barrier to type 2 diabetes management. Screening, non-shaming conversations, personalised food boundaries, medication review and peer support may all have a role.
In Blog 1, I introduced our Liberate feasibility and acceptability study, which suggested that an online, peer-supported, psychoeducational programme for ultra-processed food addiction was feasible, acceptable and psychologically safe.
In Blog 2, I explored our secondary analysis of binge eating symptoms, which found that symptoms reduced after Liberate and that there was no signal that an addiction-informed, real-food, low-carbohydrate approach worsened binge eating symptoms over 6 months.
This third blog takes the discussion into type 2 diabetes care.
If ultra-processed food addiction can affect eating behaviour, binge eating symptoms and wellbeing, then it may also affect diabetes self-management. This matters because recent evidence suggests that food addiction may be common among people living with type 2 diabetes, yet it is rarely screened for or addressed in routine diabetes care.
Why this conversation matters
Many clinicians meet people with type 2 diabetes who understand the advice, know which foods raise their blood glucose, and genuinely want to improve their health, yet still find themselves repeatedly eating the very foods they intended to reduce.
This can easily be labelled as "non-adherence." But that term can flatten a complex experience into a moral judgement. For some people, the missing question may be: could addictive-like eating be part of this?
This blog is not about blaming people with type 2 diabetes. It is about asking better clinical questions.
The paper that prompted this response
A systematic review and meta-analysis by da Silva Junior, Macena and Bueno examined the prevalence of food addiction and its association with type 2 diabetes. Their findings suggested that food addiction may affect approximately 30% of people living with type 2 diabetes.
This matters because people with type 2 diabetes are often asked to reduce foods that raise blood glucose, particularly refined carbohydrates and ultra-processed foods. But if those foods are also the foods a person experiences as addictive, standard dietary advice may not be enough.
How this builds on the Liberate series
Blog 1 showed that a structured, peer-supported, addiction-informed intervention for UPFA was acceptable and feasible.
Blog 2 showed that binge eating symptoms improved rather than worsened following this type of intervention.
Blog 3 asks: if this model may help people reduce UPFA symptoms and binge eating symptoms, could similar thinking be useful in type 2 diabetes care?
This is where the clinical implications become important.
What UPFA can look like in diabetes care
A person may:
- know that certain foods raise their blood glucose but feel unable to stop eating them
- eat far more than intended once they start
- experience intense cravings or "food noise"
- repeatedly promise themselves they will change tomorrow
- feel shame after eating
- hide eating behaviours
- avoid appointments because they feel they have "failed"
- be labelled as "non-compliant" when the real issue may be loss of control
Clinicians should listen for language of compulsion, not just ask about knowledge.
Screening: ask the question differently
Clinicians can start with a simple, non-shaming question:
Do you ever feel addicted to certain foods?
Or:
Are there foods where, once you start, it feels very difficult to stop?
The paper recommends considering screening for UPFA during routine diabetes reviews, especially where there is uncontrolled HbA1c, strong cravings for ultra-processed foods, or repeated difficulty following dietary plans.
CRAVED may be useful as a brief clinical screening tool, while the Yale Food Addiction Scale is more commonly used in research.
Why "everything in moderation" may not work for everyone
Moderation-based advice can be appropriate for many people. But for someone with UPFA, moderation may repeatedly fail because the problem is not lack of information. It is loss of control around specific trigger foods.
The paper suggests that addiction-informed nutritional support, including structured exclusion of individual trigger foods, may be helpful for some people, particularly when combined with behavioural relapse-prevention strategies and support.
This is not about forcing everyone into abstinence. It is about recognising that some people may need abstinence from their specific trigger foods, while others may prefer harm reduction or gradual change.
The role of CGM and feedback
Continuous glucose monitoring can make the effect of food choices visible in real time. For some people, this may help connect cravings, food choices, glucose responses, mood, fatigue and motivation.
However, CGM should be framed as information, not judgement. The aim is curiosity and learning, not shame.
CGM should not become another stick to beat people with. Used well, it can become a mirror - helping people see patterns that were previously invisible.
GLP-1 medications may help, but they are not the whole answer
GLP-1 receptor agonists may reduce appetite, cravings and food noise for some people. This could be clinically useful in people with type 2 diabetes and UPFA.
However, medication does not automatically build recovery skills. If food noise returns when medication is stopped, people may need support with relapse prevention, food environment changes, psychological tools and peer support.
Prescribers also need to monitor medication changes carefully when dietary intake, weight, blood pressure or glycaemic control improve.
Support, not shame
People with UPFA and type 2 diabetes may benefit from professionally facilitated or peer-led support, including programmes such as Liberate, SUGARx Global, Sweet Sobriety, Overeaters Anonymous or other 12-step food-related fellowships.
The key message is not that one pathway fits everyone. The key message is that people need informed options.
Healthcare professionals do not need to solve everything in one appointment, but they can open the door by recognising the pattern, reducing shame and signposting to support.
What this paper does and does not prove
This was a perspective article, not a clinical trial. It offers practical recommendations based on existing evidence, clinical experience and the findings of da Silva Junior et al.'s systematic review and meta-analysis.
More research is needed to test UPFA-informed interventions in people with type 2 diabetes, including randomised trials, long-term follow-up and studies in diverse populations.
Conclusion
Type 2 diabetes care often focuses on glucose, weight, medication and dietary advice. These are important. But for some people, the missing piece may be addictive-like responses to ultra-processed foods.
If a person repeatedly eats foods they genuinely intend to avoid, experiences cravings and food noise, and feels shame or loss of control, we may need to move beyond "non-adherence" and ask whether UPFA is part of the picture.
Recognising UPFA does not remove personal responsibility. It changes the kind of support we offer. Instead of telling people to "try harder," we can help them understand their triggers, protect their recovery, monitor medication safely, and access ongoing support.
For clinicians, the next time someone with type 2 diabetes says, "I know what to do, but I just can't seem to do it," consider asking:
Do you feel addicted to certain foods?
That one question may open a more honest, compassionate and clinically useful conversation.
References
Bennett E, Myers-Morrison C, Unwin D. Integrating the management of ultra-processed food addiction into type 2 diabetes care: a clinical response to De Silva et al. (2025) and practical recommendations for practitioners. Frontiers in Psychiatry. 2026;16:1653982. doi:10.3389/fpsyt.2025.1653982.
Silva Junior AE, Macena ML, Bueno NB. The prevalence of food addiction and its association with type 2 diabetes: a systematic review with meta-analysis. British Journal of Nutrition. 2025:1-21. doi:10.1017/S000711452500008X.
Bennett E, Lycett D, Whelan M, Bellamy EL, Banks S, Patel R. A feasibility and acceptability study of Liberate: an online, peer-supported, psychoeducational intervention for ultra processed food addiction. Frontiers in Psychiatry. 2025;16:1620372. doi:10.3389/fpsyt.2025.1620372.
Bennett EB, Bellamy EL, Lycett D, Unwin J, Whelan M, Wiss DA, Patel R. Changes in binge eating symptoms following an online community-based ultra-processed food addiction intervention: Liberate. Frontiers in Public Health. 2026;14:1807450. doi:10.3389/fpubh.2026.1807450.
Horsager C, Bruun JM, Faerk E, Hagstrom S, Lauritsen MB, Ostergaard SD. Food addiction is strongly associated with type 2 diabetes. Clinical Nutrition. 2023;42:717-721. doi:10.1016/j.clnu.2023.03.014.
Gearhardt AN, Bueno NB, DiFeliceantonio AG, Roberto CA, Jimenez-Murcia S, Fernandez-Aranda F. Social, clinical, and policy implications of ultra-processed food addiction. BMJ. 2023;383:e075354. doi:10.1136/bmj-2023-075354.
Schulte EM, Avena NM, Gearhardt AN. Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS One. 2015;10:e0117959. doi:10.1371/journal.pone.0117959.
Wiss DA, Brewerton TD. Separating the signal from the noise: how psychiatric diagnoses can help discern food addiction from dietary restraint. Nutrients. 2020;12:2937. doi:10.3390/nu12102937.