Psychometric properties of the Chinese version of the modified Yale Food Addiction Scale version 2.0 (C-mYFAS 2.0): Prevalence of food addiction and relationship with resilience and social support

Does how individuals handle social situations exacerbate the relationship between physique anxiety and food addiction? The role of emotional expressive suppression and social avoidance and distress

Background

Research on food addiction has increased significantly in recent years. It has been demonstrated that food addiction can lead to impairments in physiological, psychological, and social functioning in individuals. However, there is a lack of studies investigating the influence of how individuals handle social situations on food addiction and the specific mechanisms involved.

Method

A cross-sectional survey was conducted with 1,151 university students, with a mean age of 21.44 (SD = 4.77) years. The sample comprised 74.46% female and 25.54% male students. Participants completed the Chinese version of the modified Yale Food Addiction Scale 2.0, the Social Physique Anxiety Scale, the Expressive Suppression Scale, and the Social Avoidance and Distress Scale. Statistical analyses were performed using SPSS 26.0 and the Process (Version 3.4) plug-in.

Result

The results of the study supported our hypothesis that the association between social physique anxiety and food addiction symptoms could be partially explained by expressive suppression and social avoidance and distress. This association remained significant even after adjusting for covariates such as gender, number of cigarettes smoked per day, bedtime, education, and BMI. Specifically, more severe social physique anxiety was found to be associated with frequent use of expressive suppression and social avoidance and distress, which in turn was associated with more severe food addiction symptoms.

Conclusion

This study explored the role of expression suppression and social avoidance and distress in the relationship between social physique anxiety and food addiction symptoms. The findings provide a theoretical basis for developing interventions for food addiction in college students. These interventions could include helping students develop a healthy perception of body image, encouraging emotional expression, and promoting active social participation to reduce food addiction symptoms.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

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.

Psychogenic Nonepileptic Seizures Associated with an Eating Disorder and PTSD Are Responsive to Cognitive Processing Therapy

Objective

Eating disorders (EDs) are often associated with prior histories of trauma, subsequent PTSD and related psychiatric comorbidities. There is a paucity of information about their relationship to somatic symptom disorders, specifically psychogenic nonepileptic seizures (PNES), a type of functional neurological symptom disorder or conversion disorder.

Methods

We report a case of a 39-year-old bisexual female with bulimia nervosa (BN), PTSD, recurrent major depressive disorder (MDD), cannabis use disorder, and PNES who responded to integrated trauma-focused treatment during residential ED treatment using cognitive processing therapy (CPT). Symptoms of ED, PTSD, major depression, and state-trait anxiety were measured using validated assessment instruments.

Results

During the course of CPT treatment, the patient's total scores on the PTSD Symptom Checklist for DSM-5 (PCL-5) went from 59 to 26, which is below the diagnostic threshold for PTSD. In addition, she demonstrated improvements in the Eating Disorder Examination Questionnaire (EDE-Q) Global Severity score, the Eating Disorder Inventory (EDI-2) total score, the Patient Health Questionnaire (PHQ-9) total score, the Spielberger State and Trait Anxiety Inventory scores, and the Eating Disorder Quality of Life (EDQOL) total score. Furthermore, her PNES also abated, and she remained seizure free for ∼1 year following discharge with the exception of one short seizure, per report of the patient.

Conclusion

The use of CPT as part of an integrated trauma-informed treatment approach during residential ED treatment was successful in a woman with PNES, BN, PTSD, MDD, and cannabis use disorder.

The Influence of Social Support on the Mental Health of Elderly Individuals in Healthy Communities with the Framework of Mental Toughness

INTRODUCTION

This work aims to explore the impacts of social support measures such as analyzing greening urban spaces and improving greenspace quality on the mental health of the elderly based on the mental resilience framework to build a healthy community.

METHODS

Through literature research and a questionnaire survey, this study designs a questionnaire including basic information, a life satisfaction scale, a positive and negative emotion scale, social support rating scale, a life orientation test-revised version, and psychological resilience scale. In order to classify the scales, machine learning (ML) approaches are applied in this work.

RESULTS

The results demonstrate great variations in the scores of the elderly with various health problems in the domain of psychological resilience (p<0.001). Social support and subjective well-being are strongly related (p<0.001). Additionally, positive correlations are observed among perceived, objective, and support use (p<0.001).

CONCLUSION

Finally, it is found that psychological resilience and social support play a significant role in mediating mental health problems in elderly individuals. Therefore, social support measures such as analyzing greening urban spaces and improving greenspace quality can be adopted to improve the mental health of the elderly to build healthy communities. On this basis, this work is of certain reference value and practical significance for the construction of healthy communities and the positive influence on the mental health of elderly individuals.

Food addiction and its relationship with other eating behaviours among Spanish university students

BACKGROUND

Food addiction (FA) is characterised by symptoms such as loss of control over food consumption, inability to reduce consumption despite the desire to do so, and continued consumption despite negative consequences. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a widely used instrument to assess FA.

OBJECTIVES

To validate the Spanish mYFAS 2.0; to analyse the relationships between FA with other eating behaviours, sociodemographic variables, and Body Mass Index (BMI); and to test the eating-related variables that account for the variance in FA.

METHODS

The sample consisted of 400 university students (M_age = 24.16, SD_age = 6.12; 51% female), who completed the mYFAS 2.0 and measures of eating-related constructs.

RESULTS

A confirmatory factor analysis (CFA) supported the one-factor structure of the mYFAS 2.0. The scale showed good internal consistency (α = .78), and good convergent validity with the mYFAS. FA was related to eating styles, binge eating, and bulimia. No differences in FA were observed between males and females, and there was no association between FA and BMI. In addition, younger participants scored higher on FA than older participants. The eating-related variables explain 54.7% of the variance in FA.

CONCLUSIONS

The mYFAS 2.0 is a valid and reliable scale to assess FA in the Spanish population. The positive and significant relationship of variables related to eating (eating styles, binge eating and bulimia) with FA was demonstrated. These variables were indicated by those at high risk of FA.

The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity

Introduction

The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students.

Methods

An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity.

Results

All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's α = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01).

Discussion

Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction.

Addiction-like Eating in Chinese Adults: An Assessment Tool and Its Associations with Modern Eating-Related Habits

OBJECTIVES

The rapid increase in Chinese obesity rates has aroused research interest in addiction-like eating (AE); however, the unavailability of assessment tools is a major barrier to further investigation. To address the research gap, this study aimed to evaluate the psychometric properties of the Addiction-like Eating Behavior Scale (AEBS) and explore associations between AE and three modern eating-related habits (i.e., ordering delivery food, eating late-night meals and watching mukbang) among Chinese adults.

METHODS

The STROBE checklist was followed for reporting this cross-sectional study. We conducted a telephone survey with a two-stage cluster random sampling method and acquired a probability sample of 1010 community-dwelling Chinese adults (55.2% female; age: 18-88 years, M = 38.52, SD = 14.53).

RESULTS

Results confirmed the conceptualized two-factor structure of AEBS with satisfactory model fit, reliability and validity. Chinese adults reported higher levels of AE in the context of low dietary control rather than appetitive drive. These two AE factors showed significant and positive associations with modern eating-related habits.

CONCLUSIONS

The current study was the first to assess AE among Chinese adults and provided a reliable and valid assessment tool. Our correlational findings can also be utilized for designing interventions for weight management and healthy eating.

Exploring the self-reported physical fitness and self-rated health, mental health disorders, and body satisfaction among Chinese adolescents: A cross-sectional study

Background

Physical activity (PA) and Physical fitness (PF) have received tremendous attention in the field of physical and mental health. However, limited attention has been given to the associations of self-reported physical fitness with some health-related outcomes. Given the COVID-19 pandemic is still active in many Chinese regions, assessing health-related physical fitness (HRPF) in adolescents using field-based assessment (such as a shuttle run for cardiorespiratory fitness) is unrealistic, therefore, this study was conducted via a self-reported questionnaire.

Purpose

The present cross-sectional study was aimed at delving into the relationship between self-reported physical fitness with self-rated health, depression, anxiety, and body satisfaction in adolescents. Three thousand eight hundred and seven study participants from 12 public schools in South-eastern China were recruited and 2,407 of them provided valid data on variables that this study needed for analysis.

Materials and methods

Study participants were asked to self-report their sociodemographic factors (e.g., sex, grade, age), independence, and outcomes. Generalized linear models were used to explore the associations of self-reported physical fitness (comprising general physical fitness, cardiorespiratory fitness, muscular strength, speed and agility, and flexibility) with depression, anxiety, and body satisfaction. A total of 2,407 children and adolescents with a mean age of 13.82 (±2.1) years were included in the final study analysis.

Results

Higher self-reported levels of general physical fitness and cardiorespiratory fitness were associated with better self-rated health, and body satisfaction but with lower risks of depression and anxiety.

Conclusion

The current study offered evidence on the roles of self-reported physical fitness and health-related outcomes. To facilitate health in children and adolescents, advocating fitness education, and promotion could be a feasible approach.

Mediating effect of self-control in the relationship between psychological distress and food addiction among college students

Psychological distress is a possible trigger contributing to food addiction, which is characterized by a loss of behavioral control and compulsive food intake. However, little is known about its underlying mechanisms. Self-control, an important self-regulation skill, may mediate the effect of psychological distress on food addiction. A cross-sectional survey was used to explore the direct relationship between psychological distress and food addiction, and the mediating role of self-control in this relationship. Food addiction, psychological distress, and self-control were evaluated using the Chinese versions of the Yale Food Addiction Scale 2.0, Depression-Anxiety-Stress Scale, and Self-control Scale, respectively. Correlation analyses showed that food addiction was positively correlated with psychological distress, but negatively related to self-control. Structural equation modeling revealed the mediating role of self-control in the relationship between food addiction and psychological distress. As a significant predictor of food addiction, psychological distress may induce food addiction directly or indirectly through the effect of self-control. These findings provide a deeper understanding of the relationship between psychological distress and food addiction, and the underlying mechanism. As such, psychological distress and self-control should be included in prevention and intervention strategies to address food addiction among college students.

Validation of the Arabic version of the modified Yale Food Addiction Scale in the general population in Lebanon

BACKGROUND

Although the definition of food addiction is not agreed upon, it is characterized by eating more than expected without being hungry, not being able to visit certain places associated with overeating or unsuccessfully trying to cut down on the consumption of certain foods. The modified YFAS (mYFAS 2.0) version, instrument available to evaluate food addiction, was shown to have good psychometric properties. Our objective was to assess the psychometric properties of the Arabic version of the mYFAS (mYFAS-Ar-Leb) in the Lebanese population.

METHODS

This cross-sectional study enrolled 1268 persons residing in Lebanon (September-November 2020). The mean age of the participants was 26.18 years (SD = 11.17; min: 18; max: 85), with 65.1% females. The percentage of participants with food addiction was 226 (17.8%) in the total sample. A confirmatory factor analysis was run on the one-factor structure among the total sample.

RESULTS

The fit indices of the confirmatory factor analysis of the scale were excellent. The Cronbach's alpha value was good for the total scale. The mYFAS-Ar-Leb score was positively and strongly associated with stress, anxiety and depression.

CONCLUSION

Our study findings highlighted that the use of the mYFAS-Ar-Leb in Lebanese population might help estimate food addiction prevalence and stress on the need for effective treatment and preventive measures to craving for addictive foods.

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.

Prospective Association Between Problematic Mobile Phone Use and Eating Disorder Symptoms and the Mediating Effect of Resilience in Chinese College Students: A 1-Year Longitudinal Study

A previous cross-sectional study found that problematic mobile phone use (PMPU) was associated with students' eating disorder symptoms. However, since the cross-sectional study cannot infer the causality and the direction of effect, the longitudinal relationship between the two and the mechanism behind this relationship are unclear. Therefore, the present study explores the prospective association between PMPU and eating disorder symptoms and related mediation mechanisms using a 1-year longitudinal study of 1,181 college students (from December 2019 [T1] to December 2020 [T2]). Survey tools used include the Mobile Phone Addiction Tendency Scale, the 10-item Connor-Davidson resilience scale, and the 12 item Short Form of the Eating Disorder Examination Questionnaire. The longitudinal relationship between PMPU and eating disorder symptoms and the mediating effect of resilience was analyzed using a cross-lagged model. The results showed that PMPU (β = 0.086, P < 0.01) and resilience (β = -0.145, P < 0.01) at T1 predicted eating disorder symptoms at T2, but not vice versa. PMPU was bidirectionally associated with resilience, and the prediction effect of PMPU at T1 to resilience at T2 (β = -0.151, P < 0.001) was higher than the prediction effect of resilience at T1 to PMPU at T2 (β = -0.134, P < 0.001). The standardized indirect effect of PMPU at T1 on eating disorder symptoms at T2 via resilience was significant (β = 0.022, 95% CI = 0.010~0.040, P < 0.001). Therefore, PMPU and resilience were predictive for eating disorder symptoms in college students, and resilience may play a mediating role in the prospective association between PMPU and eating disorder symptoms. This study provides new ideas and higher-level evidence for the development of prevention and intervention measures for college students' eating disorder symptoms.

Translation of the Chinese version of the modified Yale Food Addiction Scale 2.0 and its validation among college students

BACKGROUND

Obesity prevalence has substantially increased in China over the past decade. In China, over 1 in 7 individuals meet the criteria for overall obesity, and 1 in 3 meet the criteria for abdominal obesity, obesity has become a significant problem. Studies have shown that food addiction and obesity are inextricably linked. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a brief measurement for assessing food addiction. This study aimed to explore the structure of the Chinese version of the mYFAS 2.0 and assess the occurrence of food addiction in a sample of college students in Northeast China.

METHODS

A cross-sectional design was conducted in a sample of 1099 undergraduate students in Northeast China. Participants completed the sociodemographic questionnaire, the Chinese version of the mYFAS 2.0, the Barratt Impulsiveness Scale (BIS-8), and the Self-Esteem Scale (SES) to test the hypothesis. Exploratory factor analysis and confirmatory factor analysis were performed to examine the underlying factor structure of the mYFAS 2.0. Two weeks later, 62 students who participated in the first test were recruited to evaluate the test-retest reliability.

RESULTS

The Chinese version of the mYFAS 2.0 demonstrated adequate internal consistency, good test-retest reliability and satisfactory construct validity. The results of the confirmatory factor analysis found that the Chinese version of the mYFAS 2.0 demonstrated a good fit to the two-factor solution identified by the exploratory factor analysis and showed superior fit indices compared to the one-factor model. The prevalence of food addiction in our sample was found to be in line with rates observed in other Asian and Western samples. The mYFAS 2.0 symptom count scores were correlated with BMI, the idea of dieting to lose weight, the desire to overeat, low self-esteem, and impulsivity.

CONCLUSION

The results indicate that the Chinese version of the mYFAS 2.0 has good reliability and validity, and that it can be considered a tool to evaluate the addictive eating behaviours of undergraduate students.