Food Addiction and Its Potential Links with Weight Stigma

Exploring the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents

OBJECTIVE

Relationships exist between food addiction symptoms, weight bias internalization, and psychological distress, yet previous research is primarily cross-sectional with adults from Western contexts. We examined the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents.

METHODS

Over three time points (Time 1, baseline; Time 2, 6-months; Time 3, 12-months) spanning 1 year, we examined cross-sectional and bi-directional relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents (N = 589; aged 14-18 years at baseline). Pearson correlations and cross-lagged models examined the cross-sectional and longitudinal relationships between food addiction symptoms, weight bias internalization, and psychological distress.

RESULTS

Cross-sectional correlations suggested positive relationships between food addiction symptoms, weight bias internalization, and psychological distress at each time point. Regarding bi-directional relationships, higher psychological distress was associated with both higher weight bias internalization and higher food addiction symptoms at the following time points. However, food addiction symptoms and weight bias internalization were not prospectively associated. Time 2 psychological distress did not significantly mediate the relationship between Time 1 weight bias internalization and Time 3 food addiction symptoms.

DISCUSSION

Findings suggest no direct longitudinal link between food addiction symptoms and weight bias internalization and vice versa. However, findings do suggest that psychological distress is temporally associated with higher food addiction symptoms and weight bias internalization in Chinese adolescents. Targeting psychological distress may prove useful in treatments of food addiction symptoms and weight bias internalization in Chinese adolescents.

PUBLIC SIGNIFICANCE

Positive associations exist between food addiction symptoms, weight bias internalization, and psychological distress, but findings are largely cross-sectional and bound to adult populations from Western contexts. Using a longitudinal design in Chinese adolescents, findings suggested that baseline psychological distress was associated with higher food addiction symptoms and higher weight bias internalization at follow-up time points. Treatments targeting psychological distress may be helpful in reducing food addiction symptoms and weight bias internalization in Chinese adolescents.

Sequentially mediated effects of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction among Taiwanese university students: A cross-sectional study

BACKGROUND

Weight-related stigma has negative physiological and psychological impacts on individuals' quality of life. Stigmatized individuals may experience higher psychological distress and therefore increase the potential risk to develop obesity and/or food addiction. The present study examined the associations and mediated effect between perceived weight stigma, weight-related self-stigma, and psychological distress in explaining food addiction among Taiwanese university students.

METHODS

All participants (n = 968) completed an online survey which included the Perceived Weight Stigma Questionnaire, Weight Self-Stigma Questionnaire, Depression, Anxiety, Stress Scale-21, and Yale Food Addiction Scale Version 2.

RESULTS

After controlling for demographic variables, significant associations were found in the paths from (1) perceived weight stigma to weight-related self-stigma ([Formula: see text] = 0.23), psychological distress ([Formula: see text] = 0.35), and food addiction ([Formula: see text] = 0.23); (2) weight-related self-stigma to psychological distress ([Formula: see text] = 0.52) and food addiction ([Formula: see text] = 0.59); and (3) psychological distress to food addiction ([Formula: see text] = 0.59) (all p-values < 0.001). The mediation model showed the sequential mediated effect of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction.

CONCLUSIONS

The results provide novel insights that weight-related self-stigma and psychological distress sequentially mediated the relationship between perceived weight stigma and food addiction among Taiwanese university students. The findings of the present study could be implemented into interventions that aim to reduce food addiction derived from weight-related stigma. Future studies should consider group analysis to consider confounding factors or other populations to provide more evidence regarding the mechanism of weight-related stigma.

A randomized study of effects of obesity framing on weight stigma

OBJECTIVE

Growing evidence suggests highly processed foods may trigger an addictive-like process, which is associated with obesity. Other research suggests an addictive-like process occurs in response to eating itself, rather than specific foods. Addiction-based obesity explanations raise concerns about double stigmatization of people with obesity and addiction. This study compared effects of obesity framings on external and internalized weight stigma.

METHODS

The study was preregistered via Open Science Framework. Four hundred and forty-seven adults read an informational passage that described food addiction, eating addiction, or calorie balance explanations for obesity or a control passage about memory. Participants then completed external and internalized weight stigma measures.

RESULTS

Participants in the food addiction condition reported higher internalized weight stigma compared with those in the control condition. Obesity framing did not significantly affect external weight stigma compared with the control.

CONCLUSIONS

These findings suggest that food addiction explanations for obesity may elicit greater internalized weight stigma than non-obesity-related messages. Addiction-based and traditional obesity explanations do not appear to influence external weight stigma. Illuminating the effects of obesity framing on stigma will help researchers communicate discoveries in ways that mitigate stigma.

The effect of a food addiction explanatory model of eating behaviours on weight-based stigma: An experimental investigation

Weight stigmatization and discrimination are pervasive issues that have numerous adverse consequences for those with excess weight. It has been proposed that some individuals may be addicted to hyperpalatable processed foods, resulting in weight promoting eating behaviours. The current study replicated and extended a study examining the effect of a food addiction explanation for eating behaviours on weight-based stigma and weight-controllability beliefs. Undergraduate students (N = 757) were randomly assigned to one of four conditions where they read a newspaper article accompanied by a photo of a woman 1) who was either of a higher body mass index (BMI) or a lower BMI, and 2) that attributed her eating behaviours to either food addiction or poor dietary and lifestyle choices. Stigma towards the woman and individuals with a higher BMI in general were assessed. Results indicated that the woman with a higher BMI elicited greater weight stigma. Attributing weight to food addiction increased perceptions of psychopathology towards the woman, whereas attributing weight to poor dietary and lifestyle choices elicited judgment towards the woman. Neither explanation about eating behaviours elicited stigma towards individuals with a higher BMI in general. Findings suggest that a food addiction explanation alone may not be sufficient to reduce weight stigma.

The Effect of a Food Addiction Explanation Model for Weight Control and Obesity on Weight Stigma

There is increasing scientific and public support for the notion that some foods may be addictive, and that poor weight control and obesity may, for some people, stem from having a food addiction. However, it remains unclear how a food addiction model (FAM) explanation for obesity and weight control will affect weight stigma. In two experiments (N = 530 and N = 690), we tested the effect of a food addiction explanation for obesity and weight control on weight stigma. In Experiment 1, participants who received a FAM explanation for weight control and obesity reported lower weight stigma scores (e.g., less dislike of ‘fat people’, and lower personal willpower blame) than those receiving an explanation emphasizing diet and exercise (F_(4,525) = 7.675, p = 0.006; and F_(4,525) = 5.393, p = 0.021, respectively). In Experiment 2, there was a significant group difference for the dislike of ‘fat people’ stigma measure (F_(5,684) = 5.157, p = 0.006), but not for personal willpower weight stigma (F_(5,684) = 0.217, p = 0.81). Participants receiving the diet and exercise explanation had greater dislike of ‘fat people’ than those in the FAM explanation and control group (p values < 0.05), with no difference between the FAM and control groups (p > 0.05). The FAM explanation for weight control and obesity did not increase weight stigma and resulted in lower stigma than the diet and exercise explanation that attributes obesity to personal control. The results highlight the importance of health messaging about the causes of obesity and the need for communications that do not exacerbate weight stigma.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term ‘food addiction’ is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Obesity Stigma: Is the 'Food Addiction' Label Feeding the Problem?

Obesity is often attributed to an addiction to high-calorie foods. However, the effect of "food addiction" explanations on weight-related stigma remains unclear. In two online studies, participants (n = 439, n = 523, respectively, recruited from separate samples) read a vignette about a target female who was described as 'very overweight'. Participants were randomly allocated to one of three conditions which differed in the information provided in the vignette: (1) in the "medical condition", the target had been diagnosed with food addiction by her doctor; (2) in the "self-diagnosed condition", the target believed herself to be a food addict; (3) in the control condition, there was no reference to food addiction. Participants then completed questionnaires measuring target-specific stigma (i.e., stigma towards the female described in the vignette), general stigma towards obesity (both studies), addiction-like eating behavior and causal beliefs about addiction (Study 2 only). In Study 1, participants in the medical and self-diagnosed food addiction conditions demonstrated greater target-specific stigma relative to the control condition. In Study 2, participants in the medical condition had greater target-specific stigma than the control condition but only those with low levels of addiction-like eating behavior. There was no effect of condition on general weight-based stigma in either study. These findings suggest that the food addiction label may increase stigmatizing attitudes towards a person with obesity, particularly within individuals with low levels of addiction-like eating behavior.

Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review

The concept of food addiction has generated much controversy. In comparison to research examining the construct of food addiction and its validity, relatively little research has examined the broader implications of food addiction. The purpose of the current scoping review was to examine the potential ethical, stigma, and health policy implications of food addiction. Major themes were identified in the literature, and extensive overlap was identified between several of the themes. Ethics sub-themes related primarily to individual responsibility and included: (i) personal control, will power, and choice; and (ii) blame and weight bias. Stigma sub-themes included: (i) the impact on self-stigma and stigma from others, (ii) the differential impact of substance use disorder versus behavioral addiction on stigma, and (iii) the additive stigma of addiction plus obesity and/or eating disorder. Policy implications were broadly derived from comparisons to the tobacco industry and focused on addictive foods as opposed to food addiction. This scoping review underscored the need for increased awareness of food addiction and the role of the food industry, empirical research to identify specific hyperpalatable food substances, and policy interventions that are not simply extrapolated from tobacco.

A Critical Examination of the Practical Implications Derived from the Food Addiction Concept

PURPOSE OF REVIEW

Adopting an addiction perspective on eating disorders and obesity may have practical implications for diagnostic classification, prevention, and treatment of these disorders. The present article critically examines these implications derived from the food addiction concept.

RECENT FINDINGS

Introducing food addiction as a new disorder in diagnostic classification system seems redundant as most individuals with an addiction-like eating behavior are already covered by established eating disorder diagnoses. Food addiction may be a useful metaphor in the treatment of binge eating, but would be inappropriate for the majority of obese individuals. Implying an addiction to certain foods is not necessary when applying certain approaches inspired by the addiction field for prevention and treatment of obesity. The usefulness of abstinence models in the treatment of eating disorders and obesity needs to be rigorously tested in future studies. Some practical implications derived from the food addiction concept provide promising avenues for future research (e.g., using an addiction framework in the treatment of binge eating or applying abstinence models). For others, however, the necessity of implying an addiction to some foods needs to be scrutinized.