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A Functional Medicine Nutritionist on Patient Care and Processed Food Addiction

Q&A with Brigid Titgemeier, MS, RDN, LD


Forty years ago the prevalence of underweight individuals was twice as high as obese individuals. That equation has flipped according to a recent global analysis. The Lancet recently reported that obesity rates worldwide increased from 105 million in 1975 to 641 million in 2014. Nutritionist Brigid Titgemeier, MS, RDN, LD, talks about an increased prevalence of food addiction and how she works with patients to achieve better food management.


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In general, what do you think of the obesity problem we have worldwide?

BT: Rising obesity rates have led to an increased burden on our healthcare system, an increased risk of co-morbidities and larger societal issues. In healthcare we frequently make general recommendations to lose weight and eat smaller portions in moderation. But these tips don’t seem to be making a dent on the trajectory of obesity.

These oversimplified recommendations don’t always get to the root of the problem, which for some individuals may be processed food addiction. In Functional Medicine, our goal is to accurately assess the root cause in order to help individuals improve their nutritional intake and relationship with food.

What is food addiction?

BT: General food addiction is a psychological dependence and a condition that manifests cognitively and physically. Studies have looked at the association between eating certain foods and a neurotransmitter called dopamine, which is what motivates us to eat food and engage in rewarding behaviors. Researchers identified over 10 years ago that individuals who are obese had fewer dopamine receptors than normal weight individuals, which is similar to individuals who are addicted to cocaine and alcohol. A decrease in dopamine receptors can lead to overeating.

In an animal study, rats that were fed junk food became obese after a few months and had lower dopamine levels compared to the control group. Processed foods can lead to a decrease in dopamine and opioid receptors, meaning a built up tolerance and need for more to stimulate a reward. Eating the junk food appeared to alter brain chemistry and promote obesity. Processed foods that have been found to have a highly addictive nature include sweeteners, flour, salt, caffeine, some dairy foods and unhealthy fats.


In 2009, the Yale Food Addiction Scale was developed as a diagnostic tool to identify who and when it is appropriate to make a diagnosis for food addiction. According to researchers, the medical community as a whole has made strides towards identifying and validating processed food addiction.

How is functional medicine trying to counter this?

BT: Functional medicine is trying to counter addiction by educating patients on the benefits of eating whole foods and the importance of thinking about food as medicine and information for your cells. In Functional Medicine, we take a “food first” approach to people’s health, and every patient is required to see a dietitian to discuss their diet and how to optimize their nutrient intake. Our emphasis is on gathering the patient’s story and taking an individualized approach to health.

How do you incorporate this understanding into your practice?

BT: I discuss the idea of processed food addiction with patients who are struggling to remove sugar and processed food from their diets. They often blame themselves for lacking willpower. My goal is to help people understand the power of food addiction and help them to see how society sets us up to eat more processed foods. We focus on their progress, not the guilt. I also refer to Holistic Psychotherapy at the Wellness Institute if the patient needs additional support.

So what is your approach to care?

BT: I get an in depth history of their food patterns, previous diets, and relationship with food as a part of the initial nutrition assessment. Some people have a more difficult time making dietary changes and need more support, which can also be provided by our Health Coaches in Functional Medicine. My goal is to allow patients to develop an understanding of these complex layers that impact their relationship with food. While I believe that this can be beneficial for individuals, preventing food addictions on a larger scale will require policy changes that take place on a national level.

What is nutritionist’s role at Cleveland Clinic’s Center for Functional Medicine?

BT: The Center for Functional Medicine takes a whole foods approach to people’s health because the leading causes of death in the United States are diet and lifestyle-related diseases. Every patient is required to see a doctor and a dietitian to discuss their diet and how it relates to their disease state.

We assess anthropometrics, biomarkers that indicate possible nutrient insufficiencies, and nutrition-related risk factors. We use these components to work with patients to create individualized nutrition plans that are designed to get to the root cause of disease and create optimal health. Instead of counting calories, we emphasize paying attention to nutrient density and using every time that they eat as an opportunity to consume more nutrients for their body. We also discuss the importance of:

  • Mindful eating
  • Decreasing meals eaten out of the home
  • Buying local
  • Balancing the dinner plate


I take different approaches with patients. It depends upon the person’s readiness to change, diet history, access to nutritious foods, knowledge of food and medical nutrition therapy needs.


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