Food addiction in overweight and obese adolescents seeking weight-loss treatment

The Association between Grazing and Food Addiction: The Italian Version of the Repetitive Eating Questionnaire (Rep(Eat)-Q) and Its Relationships with Food Addiction Criteria

BACKGROUND

Among the dysfunctional eating behaviors associated with excessive food intake, a construct that is gaining increasing attention is grazing-the constant, continuous, compulsive, and repetitive consumption of small/moderate amounts of food. Furthermore, in some cases, grazing seems to indicate a dependence on food and/or eating. Currently, the Repetitive Eating Questionnaire (Rep(Eat)-Q) appears to be the only questionnaire that comprehensively measures grazing, including its repetitive and compulsive eating component. Therefore, in a sample of individuals with severe obesity, the objective of this study was twofold: (A) to evaluate the psychometric properties of the Italian version of the Rep(Eat)-Q, and (B) to analyze the association between grazing and food addiction (FA).

METHOD

A cross-sectional research design was used. A total of 402 inpatients with severe obesity (BMI > 35) were recruited. Participants underwent a series of questionnaires to investigate structural validity and convergent validity and association with FA criteria.

RESULTS

The factorial structure of the Rep(Eat)-Q is robust and showed fit indexes: CFI = 0.973; RMSEA = 0.074; 90%CI [0.056-0.091]; and SRMR = 0.029. Also, it exhibited good internal consistency and convergent validity. Furthermore, logistic regression analysis highlights a specific association between certain FA criteria and grazing.

CONCLUSIONS

The Rep(Eat)-Q can be considered to be a concise, robust, reliable, and statistically sound tool to assess repetitive eating, specifically grazing. Its strong psychometric properties offer significant advantages for both research and clinical applications. Furthermore, in a sample of individuals with severe obesity, the results suggest that individuals with problematic grazing exhibit a typical behavioral profile of subjects with FA, indicating that FA can manifest through problematic grazing as well.

Associations between antipsychotics-induced weight gain and brain networks of impulsivity

Given the unpredictable rapid onset and ubiquitous consequences of weight gain induced by antipsychotics, there is a pressing need to get insights into the underlying processes at the brain system level that will allow stratification of "at risk" patients. The pathophysiological hypothesis at hand is focused on brain networks governing impulsivity that are modulated by neuro-inflammatory processes. To this aim, we investigated brain anatomy and functional connectivity in patients with early psychosis (median age: 23 years, IQR = 21-27) using anthropometric data and magnetic resonance imaging acquired one month to one year after initiation of AP medication. Our analyses included 19 patients with high and rapid weight gain (i.e., ≥5% from baseline weight after one month) and 23 patients with low weight gain (i.e., <5% from baseline weight after one month). We replicated our analyses in young (26 years, IQR = 22-33, N = 102) and middle-aged (56 years, IQR = 51-62, N = 875) healthy individuals from the general population. In early psychosis patients, higher weight gain was associated with poor impulse control score (β = 1.35; P = 0.03). Here, the observed brain differences comprised nodes of impulsivity networks - reduced frontal lobe grey matter volume (Pcorrected = 0.007) and higher striatal volume (Pcorrected = 0.048) paralleled by disruption of fronto-striatal functional connectivity (R = -0.32; P = 0.04). Weight gain was associated with the inflammatory biomarker plasminogen activator inhibitor-1 (β = 4.9, P = 0.002). There was no significant association between increased BMI or weight gain and brain anatomy characteristics in both cohorts of young and middle-aged healthy individuals. Our findings support the notion of weight gain in treated psychotic patients associated with poor impulse control, impulsivity-related brain networks and chronic inflammation.

Assessing Discriminant Validity through Structural Equation Modeling: The Case of Eating Compulsivity

Food addiction (FA) and disordered eating behaviors related to obesity are gaining attention in clinical and research fields. The modified Yale Food Addiction Scale 2.0 (mYFAS2.0) is the gold standard questionnaire to measure FA, while another tool is the Measure of Eating Compulsivity 10 (MEC10). Discriminant validity is present when two measures of similar but distinct constructs show a correlation that is low enough for the factors to be regarded as distinct. However, the discriminant validity of these measures has never been tested. Through a cross-sectional study design, 717 inpatients (females: 56.20%, age: 53.681 ± 12.74) with severe obesity completed the MEC10, Binge Eating Scale (BES), and mYFAS2.0. A structural equation model (SEM) was fitted, freely estimating latent correlations with 95% confidence intervals (95% CI). The results confirmed the scales' excellent psychometric properties. Importantly, latent factor correlations between MEC10 and mYFAS2.0 (est = 0.783, 95% CI [0.76, 0.80]) supported their discriminant validity. In contrast, the latent correlation of MEC10 and BES (est = 0.86, 95% CI [0.84, 0.87]) exceeded the recommended thresholds, indicating the absence of discriminant validity and suggesting a potential overlap, consistent with previous evidence. In conclusion, MEC10 demonstrates excellent psychometric properties but is more a measure of BED and not FA.

Exploratory study of the prevalence of food addiction and its relationship with executive functioning, depression, and reinforcement sensitivity in a sample of Mexican adults

Introduction

The study of food addiction (FA) has become relevant due to its high prevalence, the negative impact on quality of life, and its association with neuropsychological and psychiatric symptoms. Several studies have provided scientific support for these associations, however, the results are contradictory. Additionally, studies have unsuccessfully elucidated the true nature of the failures in executive functioning in people with FA symptomatology, particularly when it comes to executive deficits. Therefore, the purpose of this research was to establish whether the presence of executive dysfunction, depressive symptoms and binge eating problems, as well as high reward sensitivity entails a greater severity in FA traits and high body mass index (BMI) in a sample of Mexican adults.

Methods

The sample consisted of Mexican men and women between 21-59 years (n = 36); who completed self-report questionnaires and performance tests to measure the study variables. Additionally, BMI was estimated with self-reported height and weight.

Results

Our results showed that a high number of FA symptoms were associated with higher executive dysfunction scores, greater reward sensitivity, and more severe depressive and binge eating problems. Furthermore, factors that are more strongly associated with higher scores of FA include severe executive deficits, greater activation of the punishment avoidance system, and persistence in the search for reward when the depressive symptoms increased. The factors that best explained changes in the estimated BMI of women were a decreased crystallized intellectual capacity and the inability to control food intake as the number of FA symptoms increased.

Discussion

In summary, the cognitive functioning profile characterized by general failure of the executive functioning, as well as a greater activation of the Punishment Avoidance System and persistence in the search for reward, were associated with greater severity of FA symptoms, especially when the depressive symptomatology was severe. In parallel, the psychopathology in participants associated with FA confirms the contribution of anxious and depressive symptomatology and borderline personality traits which could facilitate the expression of clinically relevant FA symptoms in women. Finally, we found that decreased crystallized intellectual capacity and inability to control food intake were linked to higher BMI when the number of FA symptoms increased.

Correlates of Food Addiction and Eating Behaviours in Patients with Morbid Obesity

INTRODUCTION

Food addiction (FA) is a promising construct regarding the multifactorial aetiology of obesity and the search for therapeutic approaches. However, there is an ongoing debate regarding the overlap/differentiation with eating disorders and the classification as a substance- or behaviour-related addiction. Energy-dense foods, especially those combining carbohydrates and fat, are associated with addictive eating and suspected of playing a role in the genesis of FA. This study aims to further understand the clinical significance of FA and to identify possible therapeutic targets. A special focus is set on potentially addictive foods (combination of carbohydrates and fat).

METHODS

Based on the Yale Food Addiction Scale 2.0, a cohort of 112 German adults with morbid obesity was divided into two sub-samples (patients with and without FA), which were examined for differences in the variables listed below.

RESULTS

The prevalence of FA was 25%. Patients meeting criteria for FA showed higher degrees of hunger, emotional, binge, and night eating than patients without FA. In addition, hunger and disinhibition were found to be significant predictors of FA. FA was not associated with sex, age, body mass index (BMI), cognitive restraint, rigid and flexible control, prevalence of substance use, age of onset of obesity, stress level, level of social support, reduction of BMI during a weight loss programme, or programme withdrawal rate. There was no significant difference in the consumption of foods rich in both carbohydrates and fat, nor of fat or carbohydrates alone.

CONCLUSION

FA can be considered as a sub-phenotype of obesity, occurring in approximately 25% of obesity cases. Dysfunctional emotional coping mechanisms associated with low distress tolerance showed to be significantly related to FA and should be targeted therapeutically. Behavioural interventions should include a bio-psycho-social model. Binge eating episodes were found to be characteristic for FA and the already stated overlap between FA and binge eating behaviour can be confirmed. The results do not support a decisive difference due to a substance-related component of FA. Despite this, the existence of FA as a distinct entity cannot be excluded, as not all patients with FA exhibit binges.

Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report

PURPOSE

Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample.

METHODS

Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology.

RESULTS

Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (β = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for.

CONCLUSION

This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Withdrawal: A key consideration in evaluating whether highly processed foods are addictive

Researchers are currently debating whether theories of addiction explain compulsive overeating of highly processed (HP) foods (i.e., industrially created foods high in refined carbohydrates and/or fat), which contributes to obesity and diet-related disease. A subset of individuals consumes HP foods with behavioral phenotypes that mirror substance use disorders. Withdrawal, the emergence of aversive physical and psychological symptoms upon reduction or cessation of substance use, is a core component of addiction that was central to historical debates about other substances' addictive potential (e.g., nicotine and cocaine). However, no one has systematically considered evidence for whether HP foods cause withdrawal, which represents a key knowledge gap regarding the utility of addiction models for understanding compulsive overeating. Thus, we reviewed evidence for whether animals and humans exhibit withdrawal when reducing or eliminating HP food intake. Controlled experimental evidence indicates animals experience HP food withdrawal marked by neural reward changes and behaviors consistent with withdrawal from other addictive substances. In humans, preliminary evidence supports subjective withdrawal-like experiences. However, most current human research is limited to retrospective recall. Further experimental research is needed to evaluate this construct. We outline future research directions to investigate HP food withdrawal in humans and consider potential clinical implications.

A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation

BACKGROUND

Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions.

OBJECTIVE

This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features.

METHODS

Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed.

RESULTS

Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention.

CONCLUSIONS

We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention.

The Association Between Food Addiction and Weight Status in School-Age Children and Adolescents

Background

The association between food addiction (FA) and weight status in children and adolescents remains poorly understood. This study aimed to elucidate the association between FA and weight status using the validated Chinese version of the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0).

Methods

Participants were enrolled from clinic visitors for regular physical check in a children's hospital. The dYFAS-C 2.0 was translated into Chinese and validated using reliability and validity tests. The participants' body mass index Z score (BMIZ) and waist-to-height ratio (WHtR) were used to characterize weight status. The FA severity was assessed using the translated dYFAS-C 2.0.

Results

Among the 903 children and adolescents enrolled, 426 (47.2%) completed the survey [277 (65%) females and 149 (35%) males]. The Cronbach α of translated dYFAS-C 2.0 was 0.934, and confirmatory factor analysis indicated an acceptable model fit. FA correlated positively with BMIZ and WHtR in the whole sample after adjusting for the effect of gender (p < 0.001). Further analyses showed that the correlation remained significant in participants with BMIZ > 1 (p = 0.006) but not in those with BMIZ ≤ 1 (p = 0.220). However, the correlations between FA and WHtR were statistically significant in both participants with or without abdominal obesity (p < 0.05). The FA could explain 12.1 and 15.8% of variance in BMIZ and WHtR, respectively. The corresponding cutoff points of FA for excessive weight risk were 0.7 (BMIZ) and 0.4 (WHtR).

Conclusion

The dYFAS-C 2.0 has good reliability and validity in the Chinese population. FA is associated with weight status characterized by BMIZ and WHtR, especially in participants with BMIZ > 1 and in those with abdominal obesity.

Clinical Trial Registration

[www.chictr.org.cn], identifier [ChiCTR2100052239].

Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective

Purpose of Review

To examine the prevalence rates of ultra-processed food addiction across different weight classes and offer guidelines for diagnosis and treatment. Clinicians are provided with practical considerations in the assessment of ultra-processed food addiction beyond the use of validated instruments.

Recent Findings

The weighted mean prevalence of ultra-processed food addiction is approximately 20% worldwide and varies widely based on the sample. At first glance, there appears a linear relationship between ultra-processed food addiction and BMI class. Further investigation indicates a J-shaped curve with heightened prevalence among the underweight. These findings highlight the need to assess for additional factors that may increase objective or subjective food addiction symptoms including eating disorders, dietary restraint, and other mental health diagnoses.

Summary

While clinical considerations across different weight classes vary, overemphasis on weight status may detract from the clinical utility of the ultra-processed food addiction construct. Considering weight status in conjunction with other psychiatric symptoms helps to better understand the various biopsychosocial mechanisms that influence eating behavior and can inform individualized treatment strategies.

Can a Behavioral Weight-Loss Intervention Change Adolescents' Food Addiction Severity?

Objective: This study examines changes in the Yale Food Addiction Scale symptom count over a 24-week, weight-loss mobile Health (mHealth) intervention incorporating elements of addiction medicine. Methods: Adolescents (n = 117) with obesity (15.5 ± 1.3 years; 66% Hispanic) were randomized to the following: (1) mHealth intervention (AppAlone), (2) mHealth intervention+coaching (AppCoach), or (3) in-person intervention (Control). A multivariate mixed Poisson regression model was used to evaluate changes in symptom counts across intervention arms after adjusting for sex, age, depressive symptomatology, stress, and executive function. Results: After the intervention, 57% of adolescents showed a decrease in symptom count (median change: -0.3 [0 to -1.5]), with a significant change by intervention arm in the intention-to-treat analysis (p = 0.045). There was a positive linear relationship between change in symptom count and change in depressive symptomatology (p < 0.01) and stress (p < 0.01), with no association with change in weight (p = 0.3). Discussion: Both mHealth and in-person obesity interventions seemed to confer benefits in food addiction symptomatology associated with change in mood and stress. Clinical Trial Registration number: NCT035008353.

Characteristics of individuals seeking addictive eating treatment

PURPOSE

There is increasing interest in food addiction and its potential treatment. However, little is known about the characteristics of people seeking addictive eating treatment, which is important to develop appropriate treatment and referral pathways. The aim was to describe the characteristics of individuals seeking addictive eating treatment and examine differences between eligible participants who did and did not engage in treatment.

METHODS

Participants interested in an addictive eating treatment were recruited to an online screening survey. The 55-item survey included demographic questions, body satisfaction; weight-loss attempts; the modified Yale Food Addiction Survey (mYFAS); the Binge Eating Scale and mental health outcomes (DASS-21).

RESULTS

Individuals seeking addictive eating treatment (n = 309) were predominantly female (61%), from the obese BMI category (67%) and had accessed a range of services for weight loss (97%). Using multiple logistic regression, participants with higher mYFAS scores were more likely to engage in treatment (AOR 1.68; 95% CI 1.12-2.52), while participants with higher DASS total scores were less likely to engage in treatment (AOR 0.97; 95% CI 0.95-0.99).

CONCLUSION

This study indicates considerable interest from consumers in seeking addictive eating treatment. Individuals who did not engage in treatment displayed higher mental health comorbidity, suggesting that higher mental health symptomatology may be a barrier to treatment. Future qualitative research is needed to provide an in-depth understanding of the reasons for seeking and engaging in addictive eating treatment, as well as to identify the optimal treatments and referral pathways.

LEVEL OF EVIDENCE

Level IV.

A cross-sectional study on the correlates of food addiction symptoms in adolescents seeking treatment for obesity: eating attitudes and gender differences

BACKGROUND AND OBJECTIVES

Multidisciplinary approach including psychiatric support, have come to the fore in the treatment of obesity. Food addiction and disordered eating behaviors are among major psychiatric problems that have important effects on both clinical manifestation and response to treatment. This study aimed to investigate correlates of food addiction among adolescents who are seeking treatment for obesity.

METHOD

This study included 126 adolescents between 11 and 18 years of age, 48 patients in the "study group" who are seeking treatment for obesity (BMI for age greater than 95th percentile) and 78 adolescents (BMI for age under 85th percentile) in the "control group" who were reached via online survey. All participants were requested to complete self-report based measurement tools of Yale Food Addiction Scale (YFAS) and Eating Attitude Test-40 (EAT-40).

RESULTS

47.9% adolescents (n = 23) in the study group met food addiction diagnosis according to diagnostic evaluation of YFAS; which was significantly higher than 5.1% (n = 4) adolescents in the control group (p < 0.001). EAT-40 total scores and the scores in subscales of "anxiety of gaining weight," "dieting," and "thin body preoccupation" were significantly higher in the study group. Gender differences were observed when food addiction symptoms were correlated with eating attitudes among the study group.

CONCLUSIONS

Comparing to the controls, food addiction and disordered eating behaviors were more common in adolescents seeking treatment for obesity. Gender differences in the correlates of food addiction symptoms imply that different approaches might be needed for psychological interventions.

The Effect of an Obesity Prevention Program on Children's Eating Behaviors, Food Addiction, Physical Activity, and Obesity Status

PURPOSE

This study was carried out to determine the effect of an obesity prevention program on children's eating behaviors, food addiction, physical activity, and obesity prevalence.

DESIGN AND METHODS

A pretest-posttest quasi-experimental design was used in the study. The study was conducted with a total of 128 students, including 55 in the intervention and 73 in the control groups. The obesity prevention program was implemented in the intervention group, and a routine curriculum training program was followed in the control group. The study data were collected before the intervention and in the third, sixth, and fifteenth months after the completion of the intervention. The data were evaluated using the chi-square test, McNeamer test, Cochrane Q test, multivariate analysis of variance in repeated measures, the Bonferroni adjusted paired t-test, power analysis, effect size, and regression analysis.

RESULTS

At the end of the study, it was determined that the body mass index values and food addiction rates of the students in the intervention group were lower than those of the students in the control group (p < .05). There was a significant difference between the mean scores of the students in the intervention and control groups obtained from the eating behavior questionnaire and the physical activity questionnaire in terms of time, group, and group * time interaction (p < .05). Also, the intervention program was found to have a large effect size (0.39) and a strong effect (0.85) on body mass index.

CONCLUSION

The obesity prevention intervention program was found to be effective in increasing children's positive eating behaviors and mean physical activity score and decreasing food addiction rates and body mass index values.

PRACTICE IMPLICATIONS

We recommend that the intervention program implemented in this study should be used widely in the curriculum of the Ministry of Education. This program shows that the school nurse is effective in preventing obesity in children. For this reason, there should be a school nurse in schools for implementing health-promoting education programs.

The impact of food addiction behaviours on the treatment of overweight students

The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, β = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.

Food Addiction and Its Relationship to Weight- and Addiction-Related Psychological Parameters in Individuals With Overweight and Obesity

Background and Aims: It is assumed that a relevant subgroup of individuals experiences an addiction-like eating behaviour (Food Addiction), characterized by an impaired control over eating behaviour, emotional eating and food craving. Individuals experiencing Food Addiction partially share common symptomatology with Binge-Eating-Disorder and Bulimia Nervosa. The aim of this study was to investigate the prevalence of Food Addiction, general psychopathology, and associations with weight- and addiction-related constructs in individuals with overweight and obesity, who did not suffer from Binge-Eating-Disorder or Bulimia Nervosa.

Methods:N=213 (67.1% female; M_BMI=33.35kg/m², SD_BMI=3.79kg/m²) participants who were included in a weight loss program (I-GENDO project) reported BMI and completed questionnaires before the start of the treatment. Food Addiction severity, depressive symptoms, alcohol use disorder, internet use disorder, psychological distress, impulsivity personality trait, impulsive and emotional eating behaviour, food related inhibitory control, weight bias internalization, and self-efficacy were assessed.

Results: The prevalence of Food Addiction was 15% with higher, although not statistically significant, prevalence in female (18.2%) compared to male (8.6%) participants. Food Addiction was associated with higher BMI at baseline assessment, low self-esteem, impulsive and emotional eating behaviour, weight bias internalization, and deficits in food-related inhibitory control. In addition, correlations were found between Food Addiction and severity of depressive symptoms, internet use disorder, and psychological distress.

Conclusion: A relevant subgroup of participants experiences Food Addiction even when controlling for Binge-Eating-Disorder and Bulimia Nervosa. Future studies are warranted that investigate whether Food Addiction affects treatment success.

A narrative review of reward sensitivity, rash impulsivity, and food addiction in adolescents

Adolescence represents a neurodevelopmental period characterised by heightened reward drive and weaker inhibitory control that may increase vulnerability to compulsive overconsumption of highly-palatable foods and food addiction. This narrative review aimed to summarise research investigating the presence of food addiction in adolescents and establish the role that impulsivity traits (i.e., reward sensitivity and rash impulsivity), previously linked to substance and behavioural addictions, play in contributing to food addiction in this cohort. It was found that the prevalence of food addiction was typically higher in studies that recruited adolescents who were overweight/obese or from clinical populations. Overall, impulsivity was found to be more consistently associated with food addiction, while the relationships between measures of reward sensitivity and food addiction were mixed. Findings of this review suggest trait impulsivity may contribute to food addiction in adolescents, however, further longitudinal and prospective research is recommended to confirm these findings and to investigate the potential interactive effects of reward sensitivity and rash impulsivity.

Food addiction and mental health in adolescents: a systematic review

The intersection between eating behaviours and mental health has garnered substantial attention in recent years. For this Review, we systematically reviewed the available research to find out the prevalence of food addiction as measured by the Yale Food Addiction Scale, and to investigate its association with mental health-related outcomes in adolescents. Eight databases were searched using keywords from Jan 1, 2009, to Aug 5, 2020, to identify studies reporting a Yale Food Addiction Scale diagnosis or symptom score, or both. In total, 27 studies were included. The prevalence of a food addiction diagnosis ranged from 2·6% to 49·9% in non-clinical and clinical populations, and prevalence was higher in women and adolescents with a higher weight status. Food addiction was associated with disordered eating, depressive and anxiety symptoms, and a poorer quality of life and self-esteem. These associations have important implications for the assessment and management of eating behaviours and mental health in adolescents. Transdiagnostic prevention and management intervention strategies could be explored.

The food craving inventory in an Iranian population: post-hoc validation and individual differences

PURPOSE

The present study was performed to develop the Persian version of food craving inventory (FCI) (FCI-P) and to assess food craving in Iranian adult population. In addition, individual differences, including sex and body mass index (BMI) in food craving were assessed.

METHODS

Eight hundred and twenty subjects who participated in the same study Hill (Proc Nutr Soc 66: 277-285, 2007) were studied (540 women and 280 men). The FCI-P, International Physical Activity Questionnaire (IPAQ), Three-Factor Eating Questionnaire (TFEQ), and a questionnaire pertaining to demographic characteristics were completed for all participants.

RESULTS

Good content, construct, and convergent validity was observed for the FCI-P. A good reliability was found for both aggregate scores of the FCI-P and scores of its five factors. Exploratory factor analysis showed a five-factor model including "sweets," "high-fat foods," "fast food fats," "carbohydrates/starches" and "high-fat meats". These five factors accounted for 47.31% of the total variance. The scores of "uncontrolled eating" and "emotional eating" of the TFEQ were significantly correlated with the scores of the FCI-P factors and its total score. A significant correlation was found between BMI and the FCI-P score (r = 0.199). Significant differences were observed in the mean age and physical activity score among normal weight, overweight, and obese participants. Normal weight and overweight groups were more active than obese group. Obese participants had higher FCI-P score (P < 0.001) than the normal and overweight groups. FCI-P score was significantly higher in women than men.

CONCLUSIONS

FCI-P can be used as a valid and reliable measure to assess food craving in Iranian populations. Obese individuals experienced food craving more than normal weight subjects. Similarly, women may experience food craving more than men.

LEVEL OF EVIDENCE

Level V, cross sectional study.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Food addiction, executive function and mood in adolescents with obesity seeking treatment

BACKGROUND

The relationships between food addiction, executive functions and mood in adolescence are not well-understood. This study examines differences in executive functioning, depression symptoms and perceived stress among adolescents with obesity with- and without food addiction.

METHODS

A total of 110 adolescents with obesity (74 females; age = 15.59 ± 1.3 y; 67% Hispanic; 74% public insurance) completed the Behavior Rating Inventory of Executive Function-2 (BRIEF-2), the Yale Food Addiction Scale for children (YFAS-c), the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression scale (CES-DC). Chi-squared and Fisher's exact tests were used to evaluate differences in BRIEF-2, CES-DC and PSS scores between participants with and without food addiction. A logistic regression model assessed the associations between executive dysfunction, depression and stress on food addiction individually. Multiple logistic regression was utilized to further examine the association between executive dysfunction and food addiction when accounting for depression and stress.

RESULTS

More than a third of participants (34.5%) met the criteria for food addiction. Females were 2.89 times more likely than males to have food addiction (95th%CI = 1.12-7.46, p = 0.03). Participants with FA had significantly higher BRIEF-2 T-scores (all p < 0.05) and higher PSS and CES-DC scores (all p < 0.05). Multiple logistic regression analysis showed depression was strongly correlated with FA when controlling for executive dysfunction and stress (p = 0.010).

CONCLUSIONS

Among obesity treatment-seeking adolescents, youths with food addiction displayed greater impairments in executive functioning and higher levels of stress and depressive symptoms than adolescents without food addiction. Prospective studies are needed to determine how this behavioral phenotype helps predict intervention outcomes.

Predictors of weight loss in participants with obesity following bariatric surgery - A prospective longitudinal fMRI study

Prevalence rates of overweight and obesity are increasing worldwide and are amongst the leading causes of death. Participants with obesity also suffer from poorer mental health with a concomitant reduced quality of life. Bariatric surgery outperforms other existing weight optimization approaches. However, hitherto, it was not possible to identify factors predicting weight loss following surgery. Therefore, we aimed at investigating neural and behavioral predictors of weight loss, as well as the neurological underpinnings of food cue-induced craving before and after bariatric surgery. The total sample consisted of 26 participants with obesity (17 females and 9 males, mean age 41 ± 12 years, mean BMI 46 ± 6 kg/m2, 21 received Roux-en-Y gastric bypass and 5 sleeve gastrectomy). Participants with obesity were prospectively assessed using functional magnetic resonance imaging two weeks before, as well as eight and 24 weeks after surgery. Imaging data were available for 11 individuals; 10 received Roux-en-Y gastric bypass and one sleeve gastrectomy. Subjective cue-induced food craving correlated positively with brain activation in the amygdala, the parahippocampal gyrus, and hippocampus, and negatively with brain activation in frontal brain regions. In the total sample (N = 26), perceived feeling of hunger and YFAS sum score explained 50.6% of the variance (R² = 0.506, F_(1,23) = 10.759, p < 0.001) and in the imaging sample, cue-induced food craving at baseline before surgery explained 49.6% of the variance (R² = 0.496, F_(1,23) = 7.862, p = 0.023) of % total weight loss (%TWL). In other words, with respect to %TWL, bariatric surgery was most efficient in candidates characterized by high cue-induced food craving, high-perceived feeling of hunger and a low YFAS sum score.

Naturalistic and Uncontrolled Pilot Study on the Efficacy of Vortioxetine in Binge Eating Disorder With Comorbid Depression

Background: Binge eating disorder (BED) is clinically relevant by virtue of the global impairment, poor quality of life, and increased overall medical morbidity. The high comorbidity with psychiatric disorders, particularly depression, has received attention as a possible mediator of the poor outcome. Further, BED and depression share cognitive dysfunctions. This naturalistic and uncontrolled pilot study aimed at evaluating the efficacy of vortioxetine (VTX) on depressive symptoms in patients with BED, secondly the efficacy in improving a broad array of executive functions, and third to explore the effect on eating behavior and body weight. Methods: This pilot study involved 30 patients with BED and comorbid MDD, treated with VTX for 24 weeks. Assessments were run at baseline (t 0), 4 (t 1), 8 (t 2), 12 (t 3), and 24 (t 4) weeks. Changes in depressive symptoms (HDRS and BDI), executive functions, eating behaviors (binge frequency and severity, night eating, food addiction), and body weight were estimated after treatment with VTX through GLM. Results: Significant improvements emerged after treatment with VTX in: depression (HDRS p < 0.001; BDI p = 0.002) regardless the dose of VTX and first diagnosis (BED/MDD), working memory (RAVLT acquisition p = 0.01, delay recall p < 0.001, RCFT percentage of recall p = 0.01, and Attentional Matrices p = 0.05), binge days frequency (p < 0.001), binge eating severity (BES p < 0.001), night eating (p = 0.001), food addiction (YFAS 2.0 p = 0.039), and body weight (p = 0.039). The improvement in depressive symptoms was associated with the concurrent improvement in night eating as assessed by the I-NEQ. Conclusions: VTX can be a valid therapeutic choice for patients with BED with comorbid depression in controlling the depressive symptoms, working memory, and eating behavior. Indeed, by acting on affective symptoms, neurocognitive functioning, and eating behaviors, it confirms the results already obtained with VTX in other disorders, expanding them to BED.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Persian Version of the Yale Food Addiction Scale 2.0: Psychometric Analysis and Setting Cutoff Point for the Food Cravings Questionnaire-Trait-Reduced

OBJECTIVE

The aims of this study were to evaluate the psychometric properties of Persian translation of the Yale Food Addiction Scale 2.0 (YFAS 2.0) as a widely accepted questionnaire for the first time and to establish a cut off score for Food Craving Questionnaire-Trait-reduced (FCQ-T-r).

METHODS

In this cross-sectional study, 330 visitors of family physician clinics in Shiraz, a city located in south of Iran, were selected. The English version of YFAS 2.0 was translated into Persian and used in this study as well as the Persian version of FCQ-T-r.

RESULTS

Confirmatory factor analysis of YFAS-2 confirmed one dimensional structure and factor loading in all eleven symptoms was above 0.4. Internal consistency for eleven symptoms was 0.813. Prevalence of food addiction in participants was 6.7% (22 participants). BMI and FCQ-T-r questionnaire score both were positively correlated with the number of food addiction symptoms but age was negatively correlated with the number of the symptoms. The ROC curve analysis showed the best suggested cut-off point for FCQ-T-r questionnaire to detect food addiction was 32.5.

CONCLUSION

The present study confirmed validity and reliability of Persian version of YFAS-2. It is suggested that food addiction occurs in different level of food craving behavior in different food cultures or genetics.

Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population

PURPOSE

To examine the structural validity, measurement invariance, reliability, and some other psychometrical properties of the Italian version of the Yale Food Addiction Scale 2 (I-YFAS 2.0) in patients with severe obesity and the general population.

METHODS

704 participants-400 inpatients with severe obesity and 304 participants enrolled from the general population-completed the I-YFAS 2.0 and questionnaires measuring eating disorder symptoms. A first confirmatory factor analysis (CFA) tested a hierarchical structure in which each item of the I-YFAS 2.0 loaded onto one of the twelve latent symptoms/criteria which loaded onto a general dimension of Food Addiction (FA). The second CFA tested a first-order structure in which symptoms/criteria of FA simply loaded onto a latent dimension. Measurement invariance (MI) between the group of inpatients with severe obesity and the sample from the general population was also tested. Finally, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed.

RESULTS

CFAs confirmed the structure for the I-YFAS 2.0 for both the hierarchical structure and the first-order structure. Configural MI and strong MI were reached for hierarchical and the first-order structure, respectively. Internal consistencies were shown to be acceptable. Prevalence of FA was 24% in the group of inpatients with severe obesity and 3.6% in the sample from the general population.

CONCLUSIONS

The I-YFAS 2.0 represents a valid and reliable questionnaire for the assessment of FA in both Italian adult inpatients with severe obesity and the general population, and is a psychometrically sound tool for clinical as well as research purposes.

LEVEL OF EVIDENCE

Level V, descriptive study.

Associations of the ANKK1 and DRD2 gene polymorphisms with overweight, obesity and hedonic hunger among women from the Northwest of Iran

BACKGROUND

Pleasure from palatable foods can stimulate hedonic eating and, therefore, might be a major culprit for obesity. Dopamine receptor polymorphisms, especially variants in the genes regulating the D2 receptor, including ANKK1 and DRD2, are the prime candidates for assessing the individual differences in hedonic eating. This study was carried out to investigate the possible associations of the T (rs1800497) and Del (rs1799732) alleles with body mass index (BMI) and hedonic hunger among Iranian Azeri women.

METHODS

A total of 372 healthy overweight/obese subjects (BMI ≥ 25 kg/m²) and 159 normal weight individuals (BMI 18.5-24.9 kg/m²) were genotyped for the polymorphisms of ANNK1 and DRD2 genes using PCR-RFLP. BMI and hedonic hunger were also evaluated.

RESULTS

Three hundred and sixty-three (68.36%), 152 (28.63%), and 16 (3.01%) of the participants had CC, CT, and TT genotypes for ANNK1 gene, respectively. Of 515 samples genotyped for DRD2 gene, 315 (60.51%), 173 (33.59%), and 27 (5.24%) had Ins/Ins, Ins/Del, and Del/Del genotypes, respectively. The genotype and genotype frequencies were significantly different between the groups (p = 0.04). Significant differences were observed between the T+ genotype (TT + TC) and the T- genotype (CC) regarding the BMI and hedonic hunger scores (p < 0.05). In addition, Del+ group (Del/Del + Ins/Del) had higher BMI and hedonic hunger scores compared to Del- group (Ins/Ins) (p < 0.05).

CONCLUSIONS

Our findings showed that the frequencies of T and Del alleles were greater in the overweight/obese individuals. Also, the polymorphism of ANKK1 (rs1800497) and polymorphism of the DRD2 gene (rs1799732) showed significant associations with BMI and hedonic hunger.

LEVEL OF EVIDENCE

Level III, case-control study.

Food Addiction and Cognitive Functioning: What Happens in Adolescents?

This study aimed to examine cognitive factors associated to food addiction (FA) symptoms in a non-clinical sample of adolescents. A group of 25 adolescents (12–18 years; Mean age = 15.2 years) with a high level of FA symptoms (two and more) were compared to a control group without FA symptoms (n = 25), matched on sex and age, on four Cambridge Neuropsychological Test Automated Battery (CANTAB) neuropsychological tasks (MT: Multitasking Test; OTS: One Touch Stockings of Cambridge; SST: Stop Signal Task; RVP: Rapid Visual Information Processing). They were also compared on self-reported questionnaires assessing binge eating, depressive and anxiety symptoms, impulsivity levels, as well as executive functioning difficulties. Group comparisons did not show significant differences on neuropsychological tasks’ performances. However, effect sizes’ estimates showed small to medium effect sizes on three scores: adolescents with a high level of FA symptoms showed a higher probability of an error following an incorrect answer (OTS), a higher probability of false alarm, and a poorer target sensitivity (RVP). When referring to self-reported measurements, they reported significantly more executive functioning difficulties, more binge eating, depressive symptoms and higher impulsivity levels. Overall, results suggested that cognitive difficulties related to FA symptoms seem to manifest themselves more clearly when assessing daily activities with a self-reported questionnaire, which in turn are strongly related to overeating behaviors and psychological symptoms. Future longitudinal research is needed to examine the evolution of those variables, their relationships, and contribution in obesity onset. More precisely, the present findings highlighted the importance of affective difficulties related to this condition, as well as the need to take them into account in its assessment.

Resilience and physical activity in people under home isolation due to COVID-19: A preliminary evaluation

BACKGROUND

The recent shelter-in-place order issued by the Spanish government (due to the outbreak of the COVID-19) forced the Spanish population to self-isolate at home. The psychological and social effects of this new situation are unknown. Therefore, this study aimed to examine the impact of such scenario on citizens' resilience, as well as the connections between resilience, physical activity (PA), gender, weight and body mass index (BMI) before and after confinement, and COVID-19-related information.

METHODS

A total of 1795 people answered an online questionnaire conducted on March 21st^, , 2020, seven days after the mandatory shelter-in-place health order was issued.

RESULTS

Results showed that individuals who regularly engaged in Vigorous PA during the first week of confinement reported higher resilience in terms of higher locus of control, higher self-efficacy, and higher optimism. Moreover, inter-personal resilience differences were observed based on gender, age groups, BMI, weight, and people living with dependent persons or under health risk conditions.

CONCLUSION

To the best of our knowledge, these findings are the first quantitative evidence pointing towards a link between engagement in Vigorous PA and resilience within the COVID-19 restrictions in Spain. These findings may have important implications for general population during the course of this pandemic, or future ones.

Associations of food addiction with metabolic control, medical complications and depression among patients with type 2 diabetes

AIMS

Food addiction (FA) is conceptualized as a behavioral pattern that is similar in some ways to addictions to alcohol and other substances. This disorder has not been well studied among patients with type 2 diabetes (T2DM). We aimed to analyze if there is any relationship between FA and clinical or psychological variables among patients with T2DM.

METHODS

Three hundred patients with T2DM were analyzed cross-sectionally. Participants were evaluated for the presence of FA by completing the Yale Food Addiction Scale 2.0 questionnaire.

RESULTS

29.3% of patients screened positive for FA. Patients with FA had a greater BMI (33.41 ± 7.5 vs. 31.6 ± 5.9 kg/m²; p = 0.04). HbA1c was higher among individuals with FA (7.9 ± 4.4 vs. 7.6 ± 1.4%, p = 0.008). The proportion of subjects with diabetic retinopathy, neuropathy and nephropathy was greater among patients with criteria for FA compared with patients without this condition (25% vs. 13.2%, 29.5% vs. 21.8% and 32% vs. 22.3%; p = 0.03, p = 0.05 and p = 0.05, respectively). The percentage of patients with FA with significant depressive symptoms was also greater (36.4% vs. 18.5%; p = 0.002).

CONCLUSIONS

The presence of FA among T2DM patients implied a worse glycaemic control. Microvascular complications and depressive symptoms were higher among these patients.

Food Addiction in a Group of Italian Adolescents Diagnosed for Eating Disorder

Research in patients with Eating Disorders (EDs) showed high rates of Food Addiction (FA) even in restrictive subtypes. The majority of studies were conducted on adult population. The present work aimed to describe and compared FA in adolescents diagnosed for different EDs and to evaluate its association with patients' psychopathology. Patients aged 12-18 y were included in the analysis. FA was assessed using the Yale Food Addiction Scale 2.0. The rate of FA was of 49.4% in the whole sample (n = 87, F = 90.8%) and of 53.7% in patients diagnosed with restrictive anorexia nervosa. No difference in FA frequency was detected between EDs. A worse psychopathological picture was found in patients diagnosed with FA. Higher age, higher score to the Eating Attitudes Test-26 and to the Eating Disorder Inventory-3's Interoceptive Deficits scale have been detected as the major predictors of FA in our sample. FA may be considered a transnosographic construct, not linked to the subtype of ED but to patients' personal characteristics and, in particular, to age and interoceptive deficits. A worse psychopathology might be considered a risk factor for the presence of FA in EDs.

Food Addiction in Sleeve Gastrectomy Patients with Loss-of-Control Eating

OBJECTIVE

Food addiction and binge eating share overlapping and non-overlapping features; the presence of both may represent a more severe obesity subgroup among treatment-seeking samples. Loss-of-control (LOC) eating, a key marker of binge eating, is one of the few consistent predictors of suboptimal weight outcomes post-bariatric surgery. This study examined whether co-occurring LOC eating and food addiction represent a more severe variant post-bariatric surgery.

METHODS

One hundred thirty-one adults sought treatment for weight/eating concerns approximately 6 months post-sleeve gastrectomy surgery. The Eating Disorder Examination-Bariatric Surgery Version assessed LOC eating, picking/nibbling, and eating disorder psychopathology. Participants completed the Yale Food Addiction Scale (YFAS), the Beck Depression Inventory-Second Edition (BDI-II), and the Short-Form Health Survey-36 (SF-36).

RESULTS

17.6% met food addiction criteria on the YFAS. Compared to those without food addiction, the LOC group with food addiction reported significantly greater eating disorder and depression scores, more frequent nibbling/picking and LOC eating, and lower SF-36 functioning.

CONCLUSION

Nearly 18% of post-operative patients with LOC eating met food addiction criteria on the YFAS. Co-occurrence of LOC and food addiction following sleeve gastrectomy signals a more severe subgroup with elevated eating disorder psychopathology, problematic eating behaviors, greater depressive symptoms, and diminished functioning. Future research should examine whether this combination impacts long-term bariatric surgery outcomes.

Investigating the relationship between reward sensitivity, impulsivity, and food addiction: A systematic review

OBJECTIVE

The aim of the current research was to identify the extent to which reward sensitivity and impulsivity were related to food addiction.

METHOD

Forty-five studies, published from 2009 to June 2019, investigating reward sensitivity and/or impulsivity with food addiction as measured by the Yale Food Addiction Scale were reviewed.

RESULTS

Reward sensitivity, as measured by the Sensitivity to Reward (SR) scale, was positively associated with food addiction in two studies, but failed to yield consistent results in other studies when measured with the Behavioral Inhibition/Behavioral Activation Scales. Self-report impulsivity, as measured by the Barratt Impulsiveness Scale (BIS-11), was consistently associated with food addiction, with attentional impulsivity and motor impulsivity the most consistent subscales. Similarly, food addiction was also consistently associated with Negative Urgency, Positive Urgency, and Lack of Perseverance as measured by the UPPS-P Impulsive Behavior Scale. Food addiction was inconsistently associated with disinhibition, as measured by behavioral tasks, indicating food addiction appears more aligned with self-report measures of impulsivity.

CONCLUSIONS

Research in this field is dominated by university student, overweight and obese samples. Additional research is required to further tease out these relationships.

Development of the Highly Processed Food Withdrawal Scale for Children

INTRODUCTION

Highly processed foods (with added fats and/or refined carbohydrates) may trigger an addictive-like process, including withdrawal when these foods are reduced. Withdrawal is marked by affective, cognitive, and physical symptoms that may hinder dietary change. A recently developed scale of highly processed food withdrawal in adults (ProWS) provides evidence for this construct. Children commonly consume highly processed foods, but no measures currently exist to examine highly processed food withdrawal in children. The purpose of this study was to develop a measure (ProWS-C) to assess for signs of highly processed food withdrawal in children.

METHODS

Parents who had recently attempted to reduce their child's highly processed food consumption were recruited through an online crowdsourcing platform. 304 parents (56.9% mothers) reported on their 3-11-year-old children (63.8% male). The ProWS-C was designed to reflect parents' observations of child behavior. Internal consistency and validity were evaluated using the Dimensional Yale Food Addiction Scale Version 2.0 for Children (dYFAS-C 2.0.), Children's Food Neophobia Scale-Modified (CFNS), and body mass index (BMI) silhouettes.

RESULTS

Exploratory factor analysis revealed a one-factor structure with 21 items (α = 0.94). The ProWS-C demonstrated convergent validity with more child food addiction symptoms (r = 0.55, p < 0.001) and higher child BMI (r = 0.24, p < 0.001) and discriminant validity with child food neophobia (r = -0.10, p = 0.08). The ProWS-C was associated with less success in reducing child highly processed food intake independent of child addictive-like eating and BMI (p = 0.001).

DISCUSSION

The ProWS-C provides preliminary evidence for highly processed food withdrawal in children and appears to be a psychometrically sound tool for assessing parent-reported withdrawal symptoms in children. Illuminating specific challenges families face when reducing highly processed foods may improve parents' ability to help their children make sustainable dietary changes.

Food addiction and its relationship with disordered eating behaviours and obesity

PURPOSE

Food addiction, eating disorders and obesity are all mutually reinforcing factors, or factors that can trigger each other. The aim of this study was to determine the relationship between food addiction, disordered eating behaviours and obesity.

METHODS

The study was conducted with 370 university students. Food addiction was assessed using the Yale Food Addiction Scale (YFAS) and disordered eating behaviours were assessed with the Eating Attitude Test (EAT)-26. A digital scale was used to measure weight, while for the measurement of height, waist and hip circumferences a non-stretching tape measure was used according to standard techniques.

RESULTS

Among the participants, 35.7% scored high on the EAT-26, while 21.1% scored high on the YFAS. Females constituted a higher ratio of those who had high scores on the YFAS and EAT-26 (p < 0.05). Overall, the ratio of YFAS high scorers was higher in the case of EAT-26 high scorers (32.6%) than that of low scorers (14.7%) (p < 0.001). A positive weak relationship existed between YFAS and EAT-26 scores (r = 0.165, p = 0.001) and the same between YFAS scores, weight, and body mass index (r = 0.263, p < 0.001; r = 0.319, p < 0.001, respectively).

CONCLUSION

In summary, a positive relation was found between food addiction, disordered eating behaviours and body mass index. Females were shown to have a higher risk of food addiction and eating disorders than that of males. Further studies can be carried out to analyze these correlations using a wider range of controlling factors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The prevalence of food addiction and its associations with plasma oxytocin level and anthropometric and dietary measurements in Iranian women with obesity

Obesity is a prevalent public health problem, and food addiction (FA) is one of the most controversial factors in its management. Therefore, this study was designed to validate an FA questionnaire for Iranian women with obesity and to determine the prevalence of FA and its associations with plasma oxytocin (OT) levels as well as anthropometric and dietary measurements. In this descriptive-analytical study, 450 adult women with obesity were included. The prevalence of FA was determined with a valid Yale food addiction scale (YFAS). Macronutrient intakes were measured by a valid semi-quantitative food frequency questionnaire (FFQ). In addition, plasma OT was measured after eight hours of fasting. In this study, the prevalence of FA was 26.2% in women with obesity. In comparison with class I obesity, the odds ratios (95% CI) of FA for class II and class III obesity were 2.5 (CI: 1.29-5.09) and 3.3 (CI: 1.69-6.4) respectively. Dietary intakes of energy, protein, carbohydrate, fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol were significantly higher in food-addicted (FAD) women compared to non-food-addicted (NFA) ones (p < 0.001). Moreover, plasma OT level was lower in FAD women with obesity than in NFA subjects (p = 0.02). In conclusion, the results of this study indicate that FA is prevalent in Iranian women with obesity. In addition, FA is related to obesity severity, dietary intakes of energy, carbohydrate, protein, fat, cholesterol, and plasma OT level.

Impulsivity Derived From the Dark Side: Neurocircuits That Contribute to Negative Urgency

Negative urgency is a unique dimension of impulsivity that involves acting rashly when in extreme distress and impairments in inhibitory control. It has been hypothesized to derive from stress that is related to negative emotional states that are experienced during the withdrawal/negative affect stage of the addiction cycle. Classically, a transition to compulsive drug use prevents or relieves negative emotional states that result from abstinence or stressful environmental circumstances. Recent work suggests that this shift to the "dark side" is also implicated in impulsive use that derives from negative urgency. Stress and anxious, depressed, and irritable mood have high comorbidity with addiction. They may trigger bouts of drug seeking in humans via both negative reinforcement and negative urgency. The neurocircuitry that has been identified in the "dark side" of addiction involves key neuropeptides in the central extended amygdala, including corticotropin-releasing factor. The present review article summarizes empirical and conceptual advances in the field to understand the role of the "dark side" in driving the risky and detrimental substance use that is associated with negative urgency in addiction.

Food Addiction in Adolescents: Exploration of psychological symptoms and executive functioning difficulties in a non-clinical sample

Recent studies on food addiction (FA) provided a better understanding of this condition in various populations. Indeed, authors have shown that FA was nearly as prevalent in adolescents as in adults, and similar correlates were observed in both populations (disordered eating behaviors, depressive and anxiety symptoms, impulsivity). The aim of the present study was to characterize FA in adolescents, according to psychological symptoms and executive functioning difficulties. A sample of 969 adolescents, aged between 12 and 18 years old, was recruited in the Quebec City area. They completed a series of questionnaires, including the Yale Food Addiction Scale 2.0 to measure FA symptoms, the Behaviour Rating Inventory of Executive Function to measure executive functioning difficulties, as well as other self-reported questionnaires assessing psychological symptoms (depressive and anxiety symptoms, impulsivity). Group comparisons showed that adolescents with a high level of FA symptoms reported significantly more psychological symptoms (binge eating, depression, anxiety, impulsivity), and more executive functioning difficulties. Finally, the relationship between FA symptoms and executive functioning difficulties was moderated by age and sex. More precisely, the previously mentioned relationship was stronger in young teen girls. The present work provides a preliminary framework in the developmental study of FA.

Validation of the Japanese Version of the Yale Food Addiction Scale 2.0 (J-YFAS 2.0)

The Yale Food Addiction Scale 2.0 (YFAS 2.0) is used for assessing food addiction (FA). Our study aimed at validating its Japanese version (J-YFAS 2.0). The subjects included 731 undergraduate students. Confirmatory factor analysis indicated the root-mean-square error of approximation, comparative fit index, Tucker⁻Lewis index, and standardized root-mean-square residual were 0.065, 0.904, 0.880, and 0.048, respectively, for a one-factor structure model. Kuder⁻Richardson α was 0.78. Prevalence of the J-YFAS 2.0-diagnosed mild, moderate, and severe FA was 1.1%, 1.2%, and 1.0%, respectively. High uncontrolled eating and emotional eating scores of the 18-item Three-Factor Eating Questionnaire (TFEQ R-18) (p < 0.001), a high Kessler Psychological Distress Scale score (p < 0.001), frequent desire to overeat (p = 0.007), and frequent snacking (p = 0.003) were associated with the J-YFAS 2.0-diagnosed FA presence. The scores demonstrated significant correlations with the J-YFAS 2.0-diagnosed FA symptom count (p < 0.01). The highest attained body mass index was associated with the J-YFAS 2.0-diagnosed FA symptom count (p = 0.026). The TFEQ R-18 cognitive restraint score was associated with the J-YFAS 2.0-diagnosed FA presence (p < 0.05) and symptom count (p < 0.001), but not with the J-YFAS 2.0-diagnosed FA severity. Like the YFAS 2.0 in other languages, the J-YFAS 2.0 has a one-factor structure and adequate convergent validity and reliability.

An addiction model-based mobile health weight loss intervention in adolescents with obesity

BACKGROUND

Clinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents.

METHODS

Adolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined.

RESULTS

Eighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs. $1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001), which was comparable to the age-matched EMPOWER program completers (p = 0.31 and p = 0.06).

CONCLUSIONS

An addiction medicine-based mHealth intervention targeted for adolescents was feasible to implement, resulted in high retention and adherence rates, and reduced zBMI and %BMIp95 in a more cost-effective manner than an in-clinic intervention.

Chronic stress increases susceptibility to food addiction by increasing the levels of DR2 and MOR in the nucleus accumbens

Background: Stress-related obesity might be related to the suppression of the hypothalamic-pituitary- adrenocortical axis and dysregulation of the metabolic system. Chronic stress also induces the dysregulation of the reward system and increases the risk of food addiction, according to recent clinical findings. However, few studies have tested the effect of chronic stress on food addiction in animal models. Purpose: The objective of this study was to identify whether chronic stress promotes food addiction or not and explore the possible mechanisms. Method: We applied adaily 2 hrsflashing LED irradiation stress to mice fed chow or palatable food to mimic the effect of chronic stress on feeding. After 1 month of chronic stress exposure, we tested their binge eating behaviors, cravings for palatable food, responses for palatable food, and compulsive eating behaviors to evaluate the effect of chronic stress on food addiction-like behaviors. We detected changes in the levels of various genes and proteins in the nucleus accumbens (NAc), ventral tegmental area (VTA) and lateral hypothalamus using qPCR and immunofluorescence staining, respectively. Results: Behaviors results indicated chronic stress obviously increased food addiction score (FAS) in the palatable food feeding mice. Moreover, the FAS had astrong relationship with the extent of the increase in body weight. Chronic stress increased the expression of corticotropin-releasing factor receptor 1(CRFR1) was increased in the NAc shell and core but decreased in the VTA of the mice fed with palatable food. Chronic stress also increased expression of both dopamine receptor 2 (DR2) and mu-opioid receptor (MOR) in the NAc. Conclusion: Chronic stress aggravates the FAS and contributed to the development of stress-related obesity. Chronic stress drives the dysregulation of the CRF signaling pathway in the reward system and increases the expression of DR2 and MOR in the nucleus accumbens.

Overweight adolescents' brain response to sweetened beverages mirrors addiction pathways

Many adolescents struggle with overweight/obesity, which exponentially increases in the transition to adulthood. Overweight/obesity places youth at risk for serious health conditions, including type 2 diabetes. In adults, neural substrates implicated in addiction (e.g., orbitofrontal cortex (OFC), striatum, amygdala, and ventral tegmental area) have been found to be relevant to risk for overweight/obesity. In this study, we examined three hypotheses to disentangle the potential overlap between addiction and overweight/obesity processing by examining (1) brain response to high vs. low calorie beverages, (2) the strength of correspondence between biometrics, including body mass index (BMI) and insulin resistance, and brain response and (3) the relationship between a measure of food addiction and brain response using an established fMRI gustatory cue exposure task with a sample of overweight/obese youth (M age = 16.46; M BMI = 33.1). Greater BOLD response was observed across the OFC, inferior frontal gyrus (IFG), nucleus accumbens, right amygdala, and additional frontoparietal and temporal regions in neural processing of high vs. low calorie beverages. Further, BMI scores positively correlated with BOLD activation in the high calorie > low calorie contrast in the right postcentral gyrus and central operculum. Insulin resistance positively correlated with BOLD activation across the bilateral middle/superior temporal gyrus, left OFC, and superior parietal lobe. No relationships were observed between measures of food addiction and brain response. These findings support the activation of parallel addiction-related neural pathways in adolescents' high calorie processing, while also suggesting the importance of refining conceptual and neurocognitive models to fit this developmental period.

Does food addiction contribute to excess weight among clinic patients seeking weight reduction? Examination of the Modified Yale Food Addiction Survey

BACKGROUND

Despite controversy surrounding the construct of food addiction, its relationship with obesity and the validity of the Yale Food Addiction Scale (YFAS), have become emerging fields of study. No prior research has examined the prevalence and correlates of food addiction, and validation of the Modified Yale Food Addiction Scale (mYFAS), in a non-research based weight management clinic setting.

OBJECTIVE

The current study sought to examine the validity of a brief version of the Yale Food Addiction Scale in weight loss seeking patients, and to determine whether food addiction contributes to excess weight in this patient population.

PARTICIPANTS

The sample consisted of 126 Veterans with overweight/obesity who attended an orientation session for a weight management program. Participants (mean age = 61.8 years, mean BMI = 38.0, male = 89.7%, Caucasian = 76.0%) completed questionnaires related to food addiction, weight and eating, and mental health and behavior.

RESULTS

Ten percent of the sample met diagnostic threshold for food addiction. Correlational analysis revealed that food addiction was significantly and highly correlated with BMI, emotional eating, night eating and screens for depression and insomnia (p's < 0.001); significantly correlated with eating pathology, and screening for PTSD (p's < 0.05); and inversely correlated with screening for alcohol use disorders (p < 0.01). The prevalence of food addiction was significantly higher in participants with Binge Eating Disorder (75%) compared to participants without (5.4%; p < 0.001). Food addiction uniquely accounted for 15% of the variance of BMI, almost three times more than general eating disorder pathology.

DISCUSSION

This study provides further evidence for the validity of the mYFAS, and clinical significance of the food addiction construct among weight loss seeking patients in non-research based weight management settings. Findings confirm that food addiction contributes to excess weight among clinic patients seeking weight reduction above and beyond the effects of disordered eating. It is recommended that clinicians and researchers consider an addiction framework for addressing comorbid overweight and food addiction among afflicted individuals seeking weight loss.