Clinical validation of the trait and state versions of the Food Craving Questionnaire

A short version of the Food Cravings Questionnaire-Trait: the FCQ-T-reduced

One of the most often used instruments for the assessment of food cravings is the Food Cravings Questionnaire (FCQ), which consists of a trait (FCQ-T; 39 items) and state (FCQ-S; 15 items) version. Scores on the FCQ-T have been found to be positively associated with eating pathology, body mass index (BMI), low dieting success and increases in state food craving during cognitive tasks involving appealing food stimuli. The current studies evaluated reliability and validity of a reduced version of the FCQ-T consisting of 15 items only (FCQ-T-r). Study 1 was a questionnaire study conducted online among students (N = 323). In study 2, female students (N = 70) performed a working memory task involving food and neutral pictures. Study 1 indicated a one-factorial structure and high internal consistency (α = 0.94) of the FCQ-T-r. Scores of the FCQ-T-r were positively correlated with BMI and negatively correlated with dieting success. In study 2, participants reported higher state food craving after the task compared to before. This increase was positively correlated with the FCQ-T-r. Hours since the last meal positively predicted food craving before the task when controlling for FCQ-T-r scores and the interaction of both variables. Contrarily, FCQ-T-r scores positively predicted food craving after the task when controlling for food deprivation and the interaction term. Thus, trait food craving was specifically associated with state food craving triggered by palatable food-cues, but not with state food craving related to plain hunger. Results indicate high reliability of the FCQ-T-r. Replicating studies that used the long version, small-to-medium correlations with BMI and dieting success could be found. Finally, scores on the FCQ-T-r predicted cue-elicited food craving, providing further support of its validity. The FCQ-T-r constitutes a succinct, valid and reliable self-report measure to efficiently assess experiences of food craving as a trait.

Impulsive reactions to food-cues predict subsequent food craving

Low inhibitory control has been associated with overeating and addictive behaviors. Inhibitory control can modulate cue-elicited craving in social or alcohol-dependent drinkers, and trait impulsivity may also play a role in food-cue reactivity. The current study investigated food-cue affected response inhibition and its relationship to food craving using a stop-signal task with pictures of food and neutral stimuli. Participants responded slower to food pictures as compared to neutral pictures. Reaction times in response to food pictures positively predicted scores on the Food Cravings Questionnaire - State (FCQ-S) after the task and particularly scores on its hunger subscale. Lower inhibitory performance in response to food pictures predicted higher FCQ-S scores and particularly those related to a desire for food and lack of control over consumption. Task performance was unrelated to current dieting or other measures of habitual eating behaviors. Results support models on interactive effects of top-down inhibitory control processes and bottom-up hedonic signals in the self-regulation of eating behavior, such that low inhibitory control specifically in response to appetitive stimuli is associated with increased craving, which may ultimately result in overeating.

Food cravings among bariatric surgery candidates

PURPOSE

Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples.

METHODS

In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T.

RESULTS

Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses.

CONCLUSIONS

Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.

Cravings and food consumption in Binge Eating Disorder

The purpose of this study was to extend existing work that examines the role of cravings in Binge Eating Disorder (BED). The current study uses a case-control design to establish a relationship between cravings and food exposure, and between cravings and food consumption in individuals diagnosed with BED. Twenty-nine females with BED, 40 obese controls, and 50 normal-weight controls were first presented with a neutral cue and completed a food-craving measure. They were then presented with their favourite snack food and completed the craving measure again, after which they were allowed to consume the food. The BED group had significantly higher scores for pre- and post-craving measures, and consumed more food compared to the controls. There was, however, no significant interaction between group and craving scores. Results also showed a positive correlation between food consumption and cravings scores both before and after food exposure for individuals with BED. The findings suggest that the level of cravings prior to food exposure may be sufficient to predict overeating in BED and that treatment may want to target this as a defining feature that differentiates individuals with BED from those who do not binge eat.

Effects of laparoscopic sleeve gastrectomy on attentional processing of food-related information: evidence from eye-tracking

BACKGROUND

Weight loss after laparoscopic sleeve gastrectomy (LSG) might be associated partially with changes in reward system functioning and altered appetitive responses to food cues. Food cue processing refers to motivational, affective, and cognitive responses to stimuli that are associated with food. We investigated if food cue processing is altered 6 months after weight loss that is induced by LSG. We expected patients after LSG to show reduced appetitive responses to food cues.

METHODS

In an experimental longitudinal exploratory study, 17 severely obese patients (body mass index [BMI]: 48.3 ± 6.5 kg/m²) were investigated presurgery and 6 months postsurgery. We used eye-tracking to assess attentional biases during free viewing of food versus nonfood cues, assessed pleasantness ratings of food cues, and self-reported food craving.

RESULTS

After LSG, the mean BMI of patients was 36.4 ± 6.0 kg/m², and the percentage of excess weight loss (%EWL) was 46.6% ± 14.0%. Six months after LSG, patients showed an attentional bias toward nonfood cues compared with presurgery, reported lower food craving, and rated presented food stimuli as less pleasant.

CONCLUSION

Evidence of altered food cue processing was found in patients after LSG, which may be interpreted as reduced food reward associated with increased cognitive control. Surgery-induced physiologic, cognitive-motivational, and behavioral changes may lead to a desensitization of the reward system and enhanced cognitive control.

Gender differences in food craving among overweight and obese patients attending low energy diet therapy: a matched case-control study

This case-control study examined gender differences in food craving among a sample of overweight and obese patients attending low energy diet therapy. To disentangle the specific role of gender from the role of confounders, we paired groups for BMI, age and severity of binge eating as assed by the Binge Eating Scale (BES). The participants were 73 pairs of patients who were attending low energy diet therapy. All the participants were administered the State and Trait Food Cravings Questionnaire, trait version (FCQ-T) and the BES. Female patients had higher mean scores on six out of nine dimensions of the FCQ-T. When controlling for the effect of other variables, obese and overweight female patients were 1.1 times more likely to report higher anticipation of relief of negative states and feelings from eating than their male pairs. Obese and overweight female patients experience more cravings for food than their male pairs despite comparable severity of binge eating and obesity suggesting the need for tailored interventions.

Relationship of cravings with weight loss and hunger. Results from a 6 month worksite weight loss intervention

We examined the association of food cravings with weight loss and eating behaviors in a lifestyle intervention for weight loss in worksites. This research was part of a randomized controlled trial of a 6-month weight loss intervention versus a wait-listed control in 4 Massachusetts worksites. The intervention emphasized reducing energy intake by adherence to portion-controlled menu suggestions, and assessments were obtained in 95 participants at baseline and 6 months including non-fasting body weight, food cravings (Craving Inventory and Food Craving Questionnaire for state and trait) and the eating behavior constructs restraint, disinhibition and hunger (Eating Inventory). There were statistically significant reductions in all craving variables in the intervention group compared to the controls. Within the intervention group, changes in craving-trait were significantly associated with weight loss after controlling for baseline weight, age, gender and worksite. However, in a multivariate model with craving-trait and eating behaviors (restraint, disinhibition and hunger), hunger was the only significant predictor of weight change. In contrast to some previous reports of increased food cravings with weight loss in lifestyle interventions, this study observed a broad reduction in cravings associated with weight loss. In addition, greater reductions in craving-trait were associated with greater weight change, but craving-trait was not a significant independent correlate of weight change when hunger was included in statistical models. Studies are needed to examine the effectiveness of hunger suppressing versus craving-suppressing strategies in lifestyle interventions for obesity.

Skipping breakfast: morningness-eveningness preference is differentially related to state and trait food cravings

Eveningness preference is associated with unhealthy eating behaviors. We measured state and trait food cravings in chronotypes in the morning and in the evening. Less Evening (E)- than Morning (M)-types reported to have had breakfast. Accordingly, hours that had elapsed since the last meal were higher in E- than M-types in the morning, but did not differ between groups in the evening. E-types reported higher anticipation of positive reinforcement that may result from eating than M-types in the morning, but both had the same hunger levels. On a trait level, M-types reported more feelings of guilt for giving into cravings compared to E-types. Results suggest that E-types skip breakfast more often than M-types, but this eating pattern does not inevitably lead to more food cravings in the evening or more pronounced habitual cravings. Furthermore, E-types did not experience more hunger in the morning although they had not been eating for a longer time period. Results support findings about a different lifestyle in E-types compared to M-types.

State and trait food craving in people with bulimic eating disorders

In two studies, we examined trait and state food craving levels in people with a bulimic disorder (BD) (bulimia nervosa and related disorders) and healthy controls (HC) using multidimensional self-report assessments. In study 1, trait food craving was assessed in 70 people with a BD and 69 HC using the Food Craving Questionnaire-Trait. Participants also completed the Eating Disorder Examination-Questionnaire (EDE-Q). In study 2, 45 people with a BD and 29 HC completed the Food Craving Questionnaire-State and the EDE-Q following exposure to visual and real high-caloric food cues. The results showed that both trait and state food cravings were significantly higher in people with a BD, compared to HC. Trait food craving was associated with eating disorder symptomatology in both the HC and BD groups. State food craving was associated with eating disorder psychopathology, but only in the BD group. This research underscores the importance of food craving in the study and conceptualization of BD.

The Food Craving Questionnaire-Trait in a bariatric surgery seeking population and ability to predict post-surgery weight loss at six months

Food cravings have been understudied in bariatric surgery patients and the Food Craving Questionnaire-Trait has not been validated in this population. Reliability and validity of the FCQ-T were examined and a regression analysis was run to determine whether or not preoperative scores on individual subscales of the instrument could predict weight loss at 6 months. The FCQ-T demonstrated excellent internal consistency in bariatric surgery-seeking patients, and individual subscales measuring emotion and mood were correlated with other measures of depression and anxiety. Endorsement of binge eating or emotional eating behaviors during a clinical interview was correlated with similar subscales on the FCQ-T. Higher scores on the subscale 'cues that may trigger food cravings' were associated with greater weight loss at 6 months post-surgery and higher scores on the subscale 'guilt from cravings and/or giving into them' was associated with less weight loss. Management of external cues may predict successful outcomes while emotional impact of cravings may indicate the need for further intervention to help manage specific food craving traits.

Food cravings in food addiction: the distinct role of positive reinforcement

Craving for a particular substance is an essential characteristic of addictive behavior. Increasing evidence suggests that food cravings and excessive food consumption could similarly be due to addictive processes. Recently, the Yale Food Addiction Scale (YFAS) was introduced for identifying individuals with addictive eating patterns. We conducted an online study (n=616, 75.8% female) in which participants filled out the YFAS and the Food Cravings Questionnaire-Trait (FCQ-T). Participants diagnosed as being addicted to food using the YFAS had higher scores on all food craving subscales except for anticipation of positive reinforcement that may result from eating. In a subsequent regression analysis, all food craving subscales positively predicted food addiction symptoms while positive reinforcement negatively predicted food addiction symptoms. Similar to other addictive behaviors, results indicate that individuals with addictive eating patterns experience more food cravings, but concurrently do not expect a positive reinforcement through eating.

Nucleus accumbens response to food cues predicts subsequent snack consumption in women and increased body mass index in those with reduced self-control

Individuals have difficulty controlling their food consumption, which is due in part to the ubiquity of tempting food cues in the environment. Individual differences in the propensity to attribute incentive (motivational) salience to and act on these cues may explain why some individuals eat more than others. Using fMRI in healthy women, we found that food cue related activity in the nucleus accumbens, a key brain region for food motivation and reward, was related to subsequent snack food consumption. However, both nucleus accumbens activation and snack food consumption were unrelated to self-reported hunger, or explicit wanting and liking for the snack. In contrast, food cue reactivity in the ventromedial prefrontal cortex was associated with subjective hunger/appetite, but not with consumption. Whilst the food cue reactivity in the nucleus accumbens that predicted snack consumption was not directly related to body mass index (BMI), it was associated with increased BMI in individuals reporting low self-control. Our findings reveal a neural substrate underpinning automatic environmental influences on consumption in humans and demonstrate how self-control interacts with this response to predict BMI. Our data provide support for theoretical models that advocate a 'dual hit' of increased incentive salience attribution to food cues and poor self-control in determining vulnerability to overeating and overweight.

The suppression of appetite and food consumption by methylphenidate: the moderating effects of gender and weight status in healthy adults

Females typically show greater behavioural responses to stimulant drugs than males, including loss of appetite; as seen, for example, in those who use methylphenidate (MP) therapeutically for treatment of attention deficit hyperactivity disorder (ADHD). This is a relevant issue because of the strong link between ADHD and obesity. In a sample (n=132) of normal-weight (BMI <25) and obese (BMI >30) men and women we assessed appetite, cravings, and snack-food intake in response to MP (0.5 mg/kg) and placebo. Results indicated a significant three-way interaction for the three dependent variables--food-related responding diminishing in all groups from placebo to MP, except in obese males who showed no decreases to the MP challenge. These data show for the first time the existence of gender differences in the appetite response to MP, and are relevant for finding a dopamine pathway to new weight-loss medications, which would be utilized differently in males than in females.

Fighting food temptations: the modulating effects of short-term cognitive reappraisal, suppression and up-regulation on mesocorticolimbic activity related to appetitive motivation

The premise of cognitive therapy is that one can overcome the irresistible temptation of highly palatable foods by actively restructuring the way one thinks about food. Testing this idea, participants in the present study were instructed to passively view foods, up-regulate food palatability thoughts, apply cognitive reappraisal (e.g., thinking about health consequences), or suppress food palatability thoughts and cravings. We examined whether these strategies affect self-reported food craving and mesocorticolimbic activity as assessed by functional magnetic resonance imaging. It was hypothesized that cognitive reappraisal would most effectively inhibit the mesocorticolimbic activity and associated food craving as compared to suppression. In addition, it was hypothesized that suppression would lead to more prefrontal cortex activity, reflecting the use of more control resources, as compared to cognitive reappraisal. Self-report results indicated that up-regulation increased food craving compared to the other two conditions, but that there was no difference in craving between the suppression and cognitive reappraisal strategy. Corroborating self-report results, the neuroimaging results showed that up-regulation increased activity in important regions of the mesocorticolimbic circuitry, including the ventral tegmental area, ventral striatum, operculum, posterior insular gyrus, medial orbitofrontal cortex and ventromedial prefrontal cortex. Contrary to our hypothesis, suppression more effectively decreased activity in the core of the mesocorticolimbic circuitry (i.e., ventral tegmental area and ventral striatum) compared to cognitive reappraisal. Overall, the results support the contention that appetitive motivation can be modulated by the application of short-term cognitive control strategies.