A qualitative study of overweight and obese Australians' views of food addiction

Are healthiness and pleasure dimensions perceived similarly by people with food addiction in Brazil? A case study using holistic sensory methodologies

The relationship between the consumption of hyper-palatable ultra-processed foods and the process of addiction gains notoriety due to its relationship with obesity. Food addiction is a complex phenomenon intrinsically related to the individual's behavioral, emotional, and subjective aspects. Therefore, using classical approaches to sensory science may be insufficient to understand better the individual's sensory experience with hyper-palatable foods. In this context, sensory and consumer science techniques with holistic approaches have been aimed at accessing more subjective consumer perceptions. This study used the Yale Food Addiction Scale (YFAS 2.0) to investigate the prevalence of food addiction and the Structured Projective Mapping (S-MP) and Sorting techniques to verify how individuals with and without food addiction perceive and understand different types of food. The prevalence of food addiction was 21.77% (n = 59 out of 271) and was associated with a higher BMI but not with sociodemographic aspects. Projective Mapping (RV = 0.937) and Sorting (RV = 0.934) indicated that perception in relation to attributes such as health and pleasure was similar for all investigated foods in individuals with or without food addiction. The presence of addictive eating behavior does not seem to be related to the way individuals perceive foods from different categories, for example, minimally or highly processed and hyper-palatable foods.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

No control and overwhelming cravings: Australian adults' perspectives on the experience of food addiction

Research in the area of food addiction is continuing to increase with recent reviews suggesting that food addiction is a distinctive condition that has many symptoms similar to substance use disorders. The current study explored the perspectives and experiences of Australian adults seeking treatment for addictive eating. Quantitative data for this study was collected via self-report questionnaires completed online, including demographics, the Yale Food Addiction Scale 2.0, and the Depression, Anxiety, and Stress Scale-21. Qualitative data was collected via semi-structured interviews using open-ended questions about the individual experience of food addiction and perspectives regarding intervention and recovery. Interview data was available for 34 participants, with the majority (n = 33) being females who were overweight, (mean ± SD age = 42.9 ± 13.2 years, BMI=36.5 ± 6.8 kg/m²). Stress (19.9 ± 11.4 out of 21) and depression (16.8 ± 10.2 out of 21) were the most prominent negative emotional states. Thematic analysis identified two themes of compulsion and control. Compulsion distinguished the participants' experiences related to addictive eating behaviours, in particular the notion of craving. Control encompassed their perception of both the processes and outcomes of overcoming their addictive eating. The two themes identified were not mutually exclusive, and relationships between them and their influence on each other were observable. This study provides a unique contribution to understanding adults' experience of food addiction by highlighting the strong desire to be in control of eating behaviours, and the inability of participants to overcome their compulsions to eat specific food despite minimal anticipation of positive effect.

Living with obesity - existential experiences

Aims and objectives: The aim was to gain in-depth understanding about individuals’ existential experiences of living with obesity.

Background: People living with obesity face great vulnerability and existential challenges. The different treatments offered do not seem to meet the individual needs of persons with obesity. A deeper understanding of existential experiences from an individual perspective is needed to individualize treatment.

Design: An exploratory phenomenological–hermeneutical design was used to gain a greater understanding of the existential experiences involved in living with obesity.

Methods: The participants represented a convenient sample. 18 qualitative interviews were conducted and subjected to phenomenological–hermeneutical analysis.

Results: Four themes emerged: shaped by childhood; captured by food; depressed by the culture; and judged by oneself.

Conclusions: The burden of being obese can be experienced as being objectified and alienated as a human being. We need to turn towards a life-world perspective, seeing each human being as a living body to overcome objectification and alienation, and then move them towards becoming subjects in their own lives, through giving space for self-love. Health care workers need to assist persons living with obesity to reduce objectification and alienation. It is important to develop intervention that has an individual, holistic approach.

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.

"There is no way to avoid the first bite": A qualitative investigation of addictive-like eating in treatment-seeking Brazilian women and men

There has been polarizing debate on addictive-like eating in recent years. To move toward valid definition and measurement of this construct, qualitative research describing individuals' experiences is needed. The present study explored how Brazilian men and women define and experience addictive-like eating. Interviews were conducted with 7 men and 8 women (M_age = 46.6 years, M_BMI = 35.43 kg/m²) seeking treatment for addictive-like eating. Thematic analysis of interviews identified three saturated, overarching themes describing participants' conceptualizations of the (1) characteristics, (2) causal factors, and (3) consequences of addictive-like eating. Lack of control was a key characteristic of addictive-like eating described by all participants. A causal factor which most participants described was emotional eating. Consequences included emotional, interpersonal, occupational, and health-related impairments which appeared primarily related to weight gain, rather than to the pattern of addictive-like eating itself. These results are largely consistent with those of previous qualitative studies. Importantly, the symptoms described by our participants and in previous qualitative studies may be inadequately captured by existing self-report questionnaires designed to assess addictive-like eating. To address this potential limitation, we provide recommendations for assessing the full range of possible addictive-like eating symptoms.

The Cognitive Drivers of Compulsive Eating Behavior

Compulsivity is a central feature of obsessive-compulsive and addictive disorders, which share considerable overlap with excessive eating in terms of repetitive behavior despite negative consequences. Excessive eating behavior is characteristic of several eating-related conditions, including eating disorders [bulimia nervosa (BN), binge eating disorder (BED)], obesity, and food addiction (FA). Compulsivity is proposed to be driven by four distinct cognitive components, namely, contingency-related cognitive flexibility, task/attentional set-shifting, attentional bias/disengagement and habit learning. However, it is unclear whether repetitive behavior in eating-related conditions is underpinned by deficits in these cognitive components. The current mini-review synthesizes the available evidence for performance on compulsivity-related cognitive tasks for each cognitive domain among populations with excessive eating behavior. In three of the four cognitive domains, i.e., set-shifting, attentional bias and habit learning, findings were mixed. Evidence more strongly pointed towards impaired contingency-related cognitive flexibility only in obesity and attentional bias/disengagement deficits only in obesity and BED. Overall, the findings of the reviewed studies support the idea that compulsivity-related cognitive deficits are common across a spectrum of eating-related conditions, although evidence was inconsistent or lacking for some disorders. We discuss the theoretical and practical importance of these results, and their implications for our understanding of compulsivity in eating-related conditions.

Moving beyond the "eating addiction" versus "food addiction" debate: Comment on Schulte et al. (2017)

In a recent commentary, Schulte et al. (2017) argued that addictive-like eating should be conceptualized as a substance use disorder rather than a behavioural addiction, and noted that many parallels that Hebebrand et al. (2014) drew between addictive-like eating and behavioural addictions apply likewise to substance use disorders. However, we argue that many of the arguments advanced by Schulte et al. (2017) in support of a substance-based food addiction model, including the important role played by ingested substances, are nonspecific. That is, these arguments apply equally well to behavioural addictions and other mental disorders, notably eating disorders, which raises the question of whether the phenomenon of addictive-like eating is encompassed by existing eating disorder diagnoses. Similarities between addictive-like eating and substance use, no matter how compelling, do not ensure the validity or clinical utility of a substance-based food addiction model and should not drive the conceptualization of addictive-like eating. The present commentary discusses problems with Schulte et al.'s (2017) arguments for substance-based food addiction, and draws attention to alternative conceptualizations of addictive-like eating which risk being overlooked when this conversation is framed as a dichotomous debate between the food and eating addiction models.

Prevalence of food addiction among Iranian children and adolescents: Associations with sociodemographic and anthropometric indices

Background: Food addiction has been defined as consuming palatable foods leading to addictive-like behaviors. Little studies have assayed food addiction in children and adolescents. Thus, we aimed at identifying the prevalence of food addiction and the relationship between food addiction, sociodemographic and anthropometric indicators among children and adolescents in southwestern Iran. Methods: This cross-sectional study was conducted on 222 elementary school students aged 7 to 13 years in Ahvaz, Iran, using a random sampling method. Sociodemographic and anthropometric indicators were obtained. The 25-item child version of the Yale Food Addiction Scale (YFAS-C) was applied to provide food addiction diagnosis and symptoms. A nonparametric analysis was used for data analysis. Results: The prevalence of food addiction was 17.3%. Also, the most common symptoms associated with food addiction were (1) inability to cut down, (2) withdrawal, and (3) tolerance. The students with food addiction diagnosis were older than the undiagnosed (p=0.04). The males and students older than 8 years showed a higher food addiction score than females and students under 8 years (p<0.05). In females, significant positive correlations were found between anthropometric indicators, including body mass index and body mass index z-score, with food addiction score (p<0.01). Conclusion: Food addiction diagnosis was more prevalent in males and students over 8 years. Females with higher YFAS-C scores had elevated body mass index z-scores, suggesting that food addiction may be a remarkable problem in childhood and early adolescence and may also be related to a risk of overweight/obesity in Iranian students.