Food addiction among men and women in India

Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: results from the D-CLIP trial

PURPOSE

This study aimed to validate the factor structure of the 12-item Short-Form (SF-12) health-related quality of life (HRQOL) survey for Indian adults and assess the impact of lifestyle modification on the SF-12 of Indian adults with prediabetes.

METHODS

To validate the context-specific construct of the SF-12, two-factor confirmatory factor analysis (CFA) was performed using data from 1285 adults residing in Chennai, India, who screened for the Diabetes Community Lifestyle Improvement Program (D-CLIP). D-CLIP was a randomized controlled trial of 578 participants with prediabetes (283 treatment, 293 control), focusing on the effect of lifestyle modifications on the prevention of diabetes. Physical and mental component scores (PCS and MCS) were computed by using CFA standardized factor loadings. Multiple linear regression was subsequently conducted to estimate the effect of lifestyle modification on post-study changes of PCS and MCS among D-CLIP participants.

RESULTS

Cronbach's alpha and CFA fit indices demonstrated acceptable reliability and model fit of the SF-12 for Indian adults. The intervention group showed greater mean change in PCS after study participation compared to the controls (1.63 ± 0.82, p = 0.046); no significant difference was observed for MCS between two groups (1.00 ± 0.85, p = 0.242).

CONCLUSION

The study confirmed that the SF-12 is suitable for assessing the physical and mental health dimensions of HRQOL for Indian adults. Our findings suggest that the benefits of diabetes prevention lifestyle modification strategies may primarily enhance the physical well-being of adults with prediabetes. Further studies validating the SF-12 in a broader Asian Indian population are needed.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT01283308.

[Psychometric validation of the Yale Food Addiction Scale for Children (YFAS-C) in Spanish in a Mexican population]

Introduction

Introduction: Mexico is one of the countries with the highest prevalence of childhood obesity worldwide. The increase of addictive behaviors at an early age is a possible cause of its development. The Yale Food Addiction Scale for Children (YFAS-C) allows identifying children with food addictive behaviors. Objective: to validate the YFAS-C scale in Spanish in a population sample of Mexican children and adolescents. Material and methods: an exploratory and confirmatory factor analysis was performed. The study sample consisted of 448 children from seven to 14 years of age. The first stage involved translation into Spanish; a second stage involved the solution of questions with discrepancies; then, a reverse translation into the original language and a review by experts on the subject of eating disorders in pediatric population were performed; and in the last stage, a pilot test in order to culturally adapt the instrument and the evaluation of the psychometric properties was carried out. Results: using the principal component extraction method, four components were identified that explained 47.1 % of the sample variance. In the confirmatory factor analysis, it was found that the goodness-of-fit indices met the required values (CFI = 0.906: GFI = 0.932; AGFI = 0.915, SRMS = 0.007 and RMSEA = 0.043). Conclusions: a validated Spanish version of the YFAS-C scale was obtained for Mexican children and adolescents to assess food addiction.

Food addiction and weight in students with high academic performance

OBJECTIVE

The purpose of this study was to analyse the relationships between food addiction (FA), anthropometric characteristics and academic performance.

DESIGN

The average age (sd) of the participants was 17·5 (sd 2·7) years (64·1 % female). Each study participant indicated their sex, height, weight and academic performance and completed the Yale Food Addiction Scale.

SETTING

Syktyvkar, Kirov, Tyumen, Yekaterinburg, Russia; Aizawl, India.

PARTICIPANTS

The study involved 3426 people.

RESULTS

FA was found in 8·7 % of participants from Russia and 14·6 % from India. In schoolchildren but not in university students, high academic performance was associated with a higher incidence rate of FA detection (OR = 1·16, 95 % CI 1·07, 1·26) and a lower BMI (OR = 0·72, 95 % CI 0·56, 0·94).

CONCLUSIONS

These data showed an increased incidence rate of FA detection in adolescents with high academic performance.

Food addiction and psychiatric comorbidities: a review of current evidence

BACKGROUND

Food addiction (FA) is characterised by the consumption of appetible foods and by addictive psychological and behavioural symptoms such as cravings, tolerance, limited control of substance intake and withdrawal symptoms. Despite previous research on FA has been hindered by the lack of a formal definition for this condition, recent global trends have stirred the interest of the scientific community towards a proper classification and construct of FA. More specifically, recent studies have pointed towards shared defective neurobiological mechanisms as well as frequent comorbidities between FA, eating disorders, mood disorders, anxiety disorders and substance-related and addictive disorders.

OBJECTIVE

In this review, we will provide an overview of the complex symptomatology of food addiction evaluating its relationship with mood disorders, anxiety disorders, eating disorders and substance-related and addictive disorders.

METHODS

We wrote a systematic review and followed a PRISMA methods.

RESULTS

Patients with FA and substance use disorders show similar risk factors, neurobiological and hormonal correlates, personality traits and symptom profiles. The presence of FA appears to be directly proportional to the burden of symptoms of affective disorder. The comorbidity between FA and other eating disorders is associated with worse clinical conditions and symptoms.

CONCLUSION

FA should be considered a sort of transnosological construct existing in different psychopathological domains that have similarities with substance-related, affective, and eating disorders. Furthermore, FA seems to be likely an important factor related to several psychopathological dimensions, but further studies are needed to clarify this view.

LEVEL OF EVIDENCE

Level V, review article.

Body image disturbance partially explains eating-related psychosocial impairment in food addiction

BACKGROUND

This study aimed to explore the association of food addiction (FA) with eating-related psychosocial impairment and examine the extent to which this association was explained directly by FA symptoms themselves, versus through body image disturbance.

MATERIALS AND METHODS

Participants (356 university students and 544 crowdsourced adults) completed self-report measures of FA (Yale Food Addiction Scale; YFAS 2.0), psychosocial impairment (Clinical Impairment Assessment; CIA 3.0), and body image disturbance (Eating Disorders Examination Questionnaire; EDE-Q 6.0), and reported their body mass index (BMI) and gender.

RESULTS

Endorsement of distress and/or impairment on the YFAS corresponded to ratings on the CIA. Structural equation models indicated the relationship between FA and eating-related psychosocial impairment was partially mediated by body image disturbance. The indirect effect of body image disturbance explained more variance in eating-related psychosocial impairment than did YFAS scores themselves. Neither BMI nor gender significantly moderated any direct or indirect pathways from food addiction to psychosocial impairment.

CONCLUSIONS

Food addiction is associated with clinical impairment in men and women across the weight spectrum. A large portion of psychosocial impairment associated with food addiction may be explained by body image disturbance. Due to its role in explaining psychosocial impairment, body image disturbance warrants increased attention in FA research.

An exploratory study of food addiction in Indian youth

BACKGROUND AND AIMS

As the understanding of food addiction increases, there is a need to explore the occurrence of this condition in different population groups. This exploratory study aimed to assess the occurrence of food addiction in a sample of respondents from India using a Hindi version of the Yale Food Addiction Scale (YFAS).

METHODS

The Hindi language version of the scale was developed using the back-translation methodology. Subsequently, an online questionnaire-based study was conducted using convenience sampling which presented the Hindi version of YFAS.

RESULTS

From 376 respondents (median age 19 years, 42.8% males), the rate of occurrence of food addiction was 13.3%. Persistent desire or repeated unsuccessful attempts to quit was the most common symptom domain endorsed. The weight (median 67 kg versus 60 kg) and BMI (median 25.89 kg/ m²versus 23.04 kg/ m²) were higher in the food addiction group as compared to the non-food addiction group.

CONCLUSIONS

Despite the limitations of potential selection bias, this exploratory study suggests that food addiction may be present in a proportion of young aged Indians. The association of food addiction with higher weight and BMI suggests propensity to develop metabolic syndrome, and the need to evaluate interventions that could modify phenomenological expression of food addiction.

The Clinical Utility of Food Addiction: Characteristics and Psychosocial Impairments in a Treatment-Seeking Sample

Little is known about the characteristics of individuals seeking treatment for food addiction (FA), and the clinical utility of FA has yet to be established. To address these gaps, we examined (i) the demographic, eating pathology, and psychiatric conditions associated with FA and (ii) whether FA is associated with psychosocial impairments when accounting for eating-related and other psychopathology. Forty-six patients seeking treatment for FA completed self-report questionnaires and semi-structured clinical interviews. The majority of the sample were women and self-identified as White, with a mean age of 43 years. Most participants (83.3%) presented with a comorbid psychiatric condition, most commonly anxiety and mood disorders, with a mean of 2.31 comorbid conditions. FA was associated with binge eating severity and anxiety symptoms, as well as psychological, physical, and social impairment. In regression analyses controlling for binge eating severity, food cravings, depression, and anxiety, FA remained a significant predictor only of social impairment. Taken together, the results suggest that individuals seeking treatment for FA are likely to present with significant comorbid conditions, in particular anxiety disorders. The results of the present research provide evidence for the clinical utility of FA, particularly in explaining social impairment.

Studying physical and mental health status among hijra, kothi and transgender community in Kolkata, India

Individuals with diverse sexual orientation and gender identities have historically experienced the major share of stigma, discrimination, and marginalization among all the LGTBIQ+ communities in India. Transgender, intersex, or queer individuals are deprived of their basic rights, self-dignity, bodily autonomy, and healthcare leading to significant negative health status. Recent legal reforms such as the decriminalization of Section 377 of the Indian Penal Code (prohibited same-sex activity) and amendments to the Transgender Persons (Protection of Rights) Bill may improve their health. In this context, the study has the following objectives: 1) to measure the physical and the mental health status of hijra, kothi, and transgender (HKT) individuals using the Short Form 12 (SF-12) questionnaire; 2) understand the variation in their health status by social determinants; and 3) identify spatial patterns of HKTs general, physical, and mental health. Data was collected using a Bengali version of SF-12 (N = 98). We calculated physical (PCS) and mental (MCS) health composite scores and conducted relevant statistical and spatial analysis. Findings revealed that HKT individuals had poor mental health (mean MCS = 42.3) compared to their physical health (mean PCS = 49.0). ANOVA tests showed statistically significant variation of PCS and MCS among HKTs by their age and income. Participants with both poor and good health conditions were evenly distributed in the study area, with no significant spatial clustering. This study was the first attempt to assess the health-related quality of life among the HKT individuals using SF-12, not previously adapted to gender-diverse communities in India. Results clearly indicate that there is a pressing need to address both physical and mental health among gender-diverse communities by not only improving awareness of their healthcare rights but by also removing social and structural barriers to health programs, increasing targeted health interventions, grassroot level activism, and government advocacy.

Considering Food Addiction through a Cultural Lens

Purpose of Review

Research suggests that cultural factors influence eating behaviors, however little is known about the relationship between food addiction and culture. This narrative review aimed to i) review theoretically related work on the relationship between sociocultural demographic variables, food cravings, and eating disorders; ii) review the available literature assessing cultural aspects of food addiction, specifically the rates of food addiction across the globe and notable differences in relevant sociodemographic variables: race, ethnicity, gender and acculturation level; iii) discuss the potential impact of culture on our current understanding of food addiction and future research directions emphasizing the inclusion of sociocultural variables.

Recent Findings

Preliminary data suggest that food addiction symptoms occur cross-culturally, and that there may be significant differences between sociodemographic groups. Issues related to adequate lexicalization of concepts central to food addiction (e.g., craving, addiction) and global variations in eating culture and presentation of similar constructs (e.g. binge-eating) contribute to questions raised and identify avenues for further research.

Summary

Multidimensional cultural assessment is called for to characterize food addiction among diverse groups and improve our understanding of the etiology, maintenance, and sequelae of food addiction cross-culturally.

Examining Food Addiction and Acculturation Among a Hispanic Bariatric Surgery-Seeking Participant Group

OBJECTIVE

This study examined food addiction (FA) and acculturation among a Hispanic bariatric surgery-seeking sample.

SETTING

University hospital.

METHOD

Four hundred forty-four (n = 215 English-speaking; n = 229 Spanish-speaking) Hispanic adults seeking bariatric surgery completed established self-report measures examining food addiction and acculturation.

RESULTS

35.8% met criteria for FA, which was significantly associated with acculturation level to the USA. Participants who endorsed greater acculturation also endorsed a significantly higher level of FA symptoms compared with those who endorsed less acculturation. Acculturation level was significantly associated with FA and BMI.

CONCLUSIONS

FA rate in this bariatric surgery-seeking Hispanic patient group is similar to rates reported among bariatric candidates of varying ethnic backgrounds. Our results suggest a relationship between FA symptom expression and acculturation to the USA. Improving understanding of the onset and progression of severity of FA symptoms may have clinical implications for Hispanic patients seeking bariatric surgery.

Food addiction in young adult residents of Russia: Associations with emotional and anthropometric characteristics

The incidence of food addiction (FA) and associations between FA and anthropometric and psycho-emotional characteristics of young Russian adults were studied. In this study, 1,237 students (age, M = 20.6, SD = 4.6 years; 79% females) of universities located in four cities of Russia were attended. They provided demographics and filled in the Yale Food Addiction Scale (YFAS), the Dutch Eating Behavior Questionnaire, and the Zung Self-Rating Depression Scale. Data were analysed via Chi-squared tests, logistic regression analysis, and an analysis of covariance. 13.2% of participants met diagnostic criteria for FA based on the YFAS. On average, the participants reported 2.6 FA symptoms (SD = 1.5). FA was more commonly detected in females (OR = 1.86, 95% CI = 1.10, 3.15, p = .021). No relationship was found between age and the incidence of FA. Significant positive associations between FA, the severity of depression (OR = 2.31, 95% CI = 1.91, 2.80, p = .000), and an emotional eating behaviour (OR = 1.45, 95% CI = 1.20, 1.76, p = .000) were found. The waist-to-height ratio was found to be the anthropometric indicator most closely associated with FA (OR = 1.49, 95% CI = 1.27, 1.76, p = .000). HIGHLIGHTS: The prevalence of food addiction in the current sample was 13.2%. In young Russian adults, emotional eating behaviour and depression are associated with food addiction. In young Russian adults, the waist-to-height ratio is the anthropometric indicator most closely associated with food addiction.

The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults

Background

Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL).

Methods

A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs.

Results

Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA.

Conclusion

Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.

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.