The qualitative evaluation of the Yale Food addiction scale 2.0

Validity of the Addiction-like Eating Behavior Scale among Patients with Compulsive Eating

Food addiction (FA) and binge eating disorder (BED) co-occur and share compulsive eating symptoms. When using an FA measure, it is important to evaluate its performance in a population presenting compulsive eating. The study aims to validate the Addiction-like Eating Behavior Scale (AEBS) among a clinical sample characterized by compulsive eating and overweight/obesity and to evaluate its incremental validity over the Yale Food Addiction Scale 2.0 (YFAS). Patients seeking help for compulsive eating (n = 220), between January 2020 and July 2023, completed online questionnaires, including FA, compulsive eating, and BMI evaluations. The factor structure, internal consistency, and convergent, divergent, and incremental validity were tested. The sample had a mean age of 44.4 years old (SD = 12.7) and a mean BMI of 38.2 (SD = 8.0). The two-factor structure provided a good fit for the data, with factor loadings from 0.55 to 0.82 (except for item 15) and the internal consistency was high (ω = 0.84-0.89). The AEBS was positively correlated with the YFAS (r = 0.66), binge eating (r = 0.67), grazing (r = 0.47), craving (r = 0.74), and BMI (r = 0.26), and negatively correlated with dietary restraint (r = -0.37), supporting good convergent and divergent validity. For each measure of compulsive eating, linear regression showed that the AEBS "appetite drive" subscale had a unique contribution over the YFAS. This study provided evidence that the AEBS is a valid measure among a clinical sample of patients with compulsive eating and overweight/obesity. However, questions remain as to whether the AEBS is a measure of FA or compulsive eating.

Ultra-Processed Food Addiction: A Research Update

PURPOSE OF REVIEW

Detail recent advancements in the science on ultra-processed food (UPF) addiction, focusing on estimated prevalence rates and emerging health disparities; progress towards identifying biological underpinnings and behavioral mechanisms; and implications for weight management.

RECENT FINDINGS

Notable developments in the field have included: (1) estimating the global prevalence of UPF addiction at 14% of adults and 15% of youths; (2) revealing health disparities for persons of color and those with food insecurity; (3) observing altered functioning across the brain-gut-microbiome axis; (4) providing early evidence for UPF withdrawal; and (5) elucidating poorer weight management outcomes among persons with UPF addiction. The breadth of recent work on UPF addiction illustrates continued scientific and public interest in the construct and its implications for understanding and treating overeating behaviors and obesity. One pressing gap is the lack of targeted interventions for UPF addiction, which may result in more optimal clinical outcomes for this underserved population.

The qualitative evaluation of food addiction across the lifespan

Although it remains controversial, food addiction (FA) research has expanded substantially and empirical evidence for FA is growing. While quantitative studies have explored the prevalence and correlates of FA during childhood and adolescence, little is known about the perceived lived experience of FA across the lifespan, nor how experiences and perceptions of FA may change over time. For this study, 16 participants who met symptom threshold criteria for FA on the Yale Food Addiction Scale 2.0 completed in-depth, semi-structured qualitative interviews focused on their perceptions of the development of FA overtime, and perceived risk and protective factors. Thematic analysis was used to develop themes about the lived experience of FA in childhood, adolescence, and adulthood. Overall, highly palatable foods were viewed as the most problematic, while minimally processed foods were less associated with impairment and distress. Themes in childhood included a strong desire for highly processed foods and the perception that parental control over food choices could be either protective or risky for the later development of FA depending on which foods were available at home. In adolescence and young adulthood, increasing autonomy over food choices and the high availability of highly processed foods in the college environment were viewed as risk factors. Additionally, weight gain was a prominent theme. Finally, adulthood was characterized by more severe manifestations of FA, and the stress of adult responsibilities (e.g., work, parenting) contributed to this perception. This research sets the stage for future quantitative studies to explore these novel findings at the population level.

From theory to practice: challenges and rewards of implementing ketogenic metabolic therapy in mental health

This perspective article delves into the implementation of Ketogenic Metabolic Therapy (KMT) by a mental health counselor who attempts to bridge the gap between emerging research and real-world clinical application. Grounded in the author's clinical experiences, the article communicates the potential of KMT in mental health care, highlighting both its therapeutic promise and the insights gained from hands-on patient interactions. While the adoption of KMT necessitates adjustments in societal, emotional, and dietary domains, especially within diverse mental health contexts, these challenges are surmountable with appropriate guidance and support. The article encourages the capture of qualitative data alongside quantitative measures and advocates for an approach that considers the broader implications of improved mental well-being on families and communities. As the field advances, interdisciplinary collaborations between researchers and clinicians will be pivotal in refining and expanding the application of KMT, ultimately enhancing patient outcomes and elevating the standard of mental health care.

Measuring Pleasure from Food-Validation of the Food Pleasure Scale by Multiple Techniques and Mixed Methods

The development of scales and questionnaires to assess pleasure perception has gained prominence, particularly for evaluating anhedonia in mental disorders. The Food Pleasure Scale is a comprehensive tool exclusively dedicated to measuring pleasure perception from food and food-related experiences. This study aimed to evaluate the face validity and consistency reliability of the Food Pleasure Scale using a mixed methods approach. Twenty-two participants completed the Food Pleasure Scale questionnaire and participated in in-depth interviews to understand their interpretation of the scale items. The interview data underwent thematic analysis, and the quantitative survey data was compared to the qualitative interview responses. Results indicated a high level of understanding of all items in the Food Pleasure Scale, confirming its face validity and applicability. The mixed methods approach supported the consistency reliability, showing consistency between quantitative measures and participants' explicit and implicit expressions of food pleasure. Furthermore, the study revealed a novel aspect related to food pleasure: the concept of "making an effort". Overall, this study highlights the comprehensibility, validity, and potential of the Food Pleasure Scale in consumer studies. It effectively captures the subjective experience of pleasure derived from food and food-related encounters, making it a valuable tool for further research in this domain.

Exploring Psychological Constructs in People Receiving Treatment for Addictive Eating Behaviours: "I Hate Loving Food as Much as I Do"

Research into the complexities of addictive eating behaviours continues to develop, as a deeper understanding of this construct beyond self-report diagnostic tools emerges. In this study, we undertook structured interviews with 40 participants engaged in a personality-based management program for addictive eating, to gain insight into what situations lead people with addictive eating behaviours to overeat, and how they believe their lives would be different if they had control over their eating. A phenomenological analysis to explore compulsion and control in the context of food experiences for participants was used to construct two main themes of the addictive eating paradox and striving to transition from 'other' to 'normal'. The addictive eating paradox identified multiple contradictory experiences of a situation, e.g., 'loving food' but 'hating food'. Striving to transition from 'other' to 'normal' encompassed the idea that participants envisaged that by gaining control over their eating they could become 'normal'. This study emphasises the need to provide support and strategies to help people navigate paradoxical thoughts and presents new ideas to increase the effectiveness of interventions for individuals struggling with the complex self-beliefs held by those with addictive eating behaviours.

No association of the dopamine D2 receptor genetic bilocus score (rs1800497/rs1799732) on food addiction and food reinforcement in Chilean adults

Purpose: Different systems regulate food intake. In the reward system, dopamine (DA) is the main neurotransmitter, and a variety of genetic variants (rs1799732 and rs1800497) are associated with addiction. Addiction is a highly polygenic disease, where each allelic variant adds a small amount of vulnerability. Polymorphisms rs1799732 and rs1800497 are associated with eating behavior and hedonic hunger, but links to food addiction remain unclear.

Aim: To evaluate the association between the bilocus profile (rs1799732-rs1800497) of the dopaminergic pathway with food reinforcement and food addiction in Chilean adults.

Methods: A cross-sectional study recruited a convenience sample of 97 obese, 25 overweight, and 99 normal-weight adults (18–35 years). Anthropometric measurements were performed by standard procedures and eating behavior was assessed using the: Food Reinforcement Value Questionnaire (FRVQ) and Yale Food Addiction scale (YFAS). The DRD2 genotypes were determined by TaqMan assays (rs1800497 and rs1799732). A bilocus composite score was calculated.

Results: In the normal weight group, individuals who were heterozygous for the rs1977932 variant (G/del) showed higher body weight (p-value 0.01) and abdominal circumference (p-value 0.01) compared to those who were homozygous (G/G). When analyzing rs1800497, a significant difference in BMI was observed for the normal weight group (p-value 0.02) where heterozygous showed higher BMI. In the obese group, homozygous A1/A1 showed higher BMI in comparison to A1/A2 and A2/A2 (p-value 0.03). Also, a significant difference in food reinforcement was observed in the rs1800497, where homozygous for the variant (A1A1) show less reinforcement (p-value 0.01).In relation to the bilocus score in the total sample, 11% showed “very low dopaminergic signaling”, 24.4% were “under”, 49.7% showed “intermediate signaling”, 12.7% showed “high” and 1.4% showed “very high”. No significant genotypic differences were observed in food reinforcement and food addiction by bilocus score.

Conclusions: The results indicate that the genetic variants rs1799732 and rs1800497 (Taq1A) were associated with anthropometric measurements but not with food addiction or food reinforcement in Chilean university students. These results suggest that other genotypes, such as rs4680 and rs6277, which affect DA signaling capacity through a multilocus composite score, should be studied. Level V: Evidence obtained from a 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.