Psychometric properties of the English Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

Adding thread-embedding acupuncture to auricular acupuncture enhances short-term weight reduction in overweight and obesity: A double-blinded, randomized, sham-controlled trial

Background

Auricular acupuncture (AA) has been widely used in overweight and obesity management due to its safety and effectiveness. The combination of other acupuncture therapies with thread-embedding acupuncture (TEA) has shown enhanced effects. However, there is a lack of evidence regarding AA plus TEA for overweight and obesity. This study was conducted to address this question.

Methods

A randomized placebo-controlled trial was conducted involving 66 overweight or obese participants, divided into two groups: 33 received AA plus TEA, and 33 received AA plus sham TEA over eight weeks. The primary outcome was body weight (BW) reduction. Secondary outcomes included changes in body mass index (BMI) and waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), food cravings questionnaire-trait-reduced (FCQ-Tr) and food craving visual analog scale (VAS) scores. Safety outcomes were adverse events (AEs).

Results

After eight weeks, BW decreased by a mean (SD) of -4.45 (1.29) kg and -2.05 (1.33) kg in the AA plus TEA and AA plus sham TEA groups, respectively (MD [95 % CI]: 2.40 [1.75; 3.05]). BMI, WC, WHR, and food craving VAS score decreased significantly more in the AA plus TEA group than in the AA plus sham TEA group. No significant differences were found in FCQ-Tr and HC between groups. Seven AEs were recorded that were mild and resolved without treatment.

Conclusion

The addition of TEA to AA is a safe and effective management of overweight and obesity. Further studies should incorporate dietary and lifestyle modifications and follow-up after the intervention to assess long-term effectiveness.

Trial registration

The study protocol had been registered on ClinicalTrials.gov (NCT06091761).

Crying the pain away: the nature, measurement, and function of benign masochism

This study explores benign masochism, the ostensibly non-adaptive enjoyment of inherently aversive experiences (e.g., rollercoasters). After confirming the proposed eight-factor structure of the Benign Masochism Scale (BMS), gender differences in BMS scores and their association with measures of acculturation were examined to assess if benign masochism reflects degree of immersion in the dominant culture. Data were then used to test the hypothesis that benign masochism serves an emotion regulatory function comparable to behaviors like substance use or non-suicidal self-injury. Participants (n = 585, 51.1% female) completed the BMS and measures of sensation-seeking, impulsivity, emotion regulation deficits, and acculturation. Finding suggest significant gender differences in benign masochism and links with degree of acculturation in participants from diverse backgrounds. Associations between BMS scores, impulsivity, sensation-seeking, and emotion regulation deficits were replicated here, though variables accounted for little variance in BMS scores. In spite of similarities to established clinical phenomena such as substance use and non-suicidal self-injury, the mechanisms underlying the common yet relatively understudied phenomenon of benign masochism appear to differ and require further exploration.

Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving?

BACKGROUND AND AIMS

Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments.

METHODS

The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication.

RESULTS

This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire.

CONCLUSION

This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.

Mindful eating and eating behaviours in Greece: exploring the validity and reliability of two mindful eating scales and other eating behaviours for Greek-speaking populations

BACKGROUND

Mindful eating has seen an increase in clinical and non-clinical practices of changing health outcomes. Meanwhile, the restriction of not having validated scales in other languages proposes a barrier to exploring the impact of mindful eating cross-culturally, and specific to the present project, across Greek-speaking populations, limiting the potential of exploring the association with Mediterranean dieting.

METHODS

In the present research, volunteers (n = 706) completed online the Mindful Eating Behaviour Scale and the Mindful Eating Scale. A forward-backwards translation, leading to face validity, and was assessed for internal consistency (Cronbach's Alpha) and followed up by an assessment of the factorial structure of the scales. Divergent and convergent validity was explored using motivations to eat palatable foods, grazing, craving, Dusseldorf orthorexia, Salzburg emotional eating, and the Salzburg stress eating scales.

RESULTS

Results indicated that both scales displayed good internal consistency, and the assessment of the factorial structure of the scales was equally good and semi-consistent with the English versions, with parallel analyses and item loadings proposing problems that have been shown in critical review literature. Associations of mindful eating scales to other eating behaviours were replicated to previously established findings with English-speaking populations.

CONCLUSIONS

Findings that deviated from the expected outcomes are central to the discussion on the measurement of mindful eating, and further direction highlights the way forward for researchers and clinicians.

LEVEL V

Descriptive studies.

Long-term effects of imaginal retraining in overweight and obesity: A controlled study

BACKGROUND

Imaginal retraining (IR) is a self-help technique that targets automatic approach tendencies toward appetitive stimuli. In a randomized controlled trial (RCT; N = 384), IR reduced craving for high-calorie foods after a six-week intervention period (small effect). The aim of the present study was to evaluate long-term effects of IR in this sample.

METHODS

One year after baseline, participants from the initial RCT were recontacted. A visual analogue scale measuring craving, the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), the Three-Factor Eating Questionnaire, the Beck Depression Inventory, quality of life, and subjective appraisal of the intervention were assessed online. Participants were classified as users or nonusers based on self-reported usage of IR over the previous year.

RESULTS

Linear-mixed models showed no significant interaction effects of time and group for any outcome (trend level effects were found for two subscales of the FCQ-T-r). Yet, higher usage of IR was associated with greater symptom reduction. Although overall subjective appraisal of the intervention was comparably good to the initial study, usage of IR and completion rate were unsatisfactory.

LIMITATIONS

Main limitations of the present study include the nonrandomized group allocation and the low completion rate.

CONCLUSIONS

This study did not find evidence for the long-term efficacy of IR in individuals with craving for high-calorie foods. Only upon high usage of IR, improvement was found. However, low completion rate and usage of the intervention may have resulted in a Type-II error. Future studies may consider low-intensity professional guidance to increase adherence and assess the long-term effects of IR in RCTs.

EXPRESS: Reliability and Convergence of Approach/Avoidance Bias Assessment Tasks in the Food Consumption Domain

Theories of motivation posit that people will more readily approach positive or appetitive stimuli, and there has been growing interest in the relationship between biases in approach and avoidance behaviours for food cues and food craving and consumption behaviour. Two paradigms commonly employed by research to investigate this relationship are the Approach Avoidance Task (AAT) and the Stimulus Response Compatibility Task (SRCT). However, it is yet to be determined whether the measures yielded by these tasks reflect the same processes operating in the food craving and consumption domain. The present study examined the internal reliability and convergence of AAT and SRCT paradigms in their assessment of biased approach to unhealthy compared to healthy food stimuli, and whether the measures yielded by the AAT and SRCT paradigms demonstrated associations with individual differences in food craving and eating behaviour. One hundred and twenty-one participants completed an SRCT, an AAT using an arm movement response mode, and an AAT using a key-press response mode. The measures yielded comparable and acceptable levels of internal consistency, but convergence between the different task bias scores was modest or absent, and only approach bias as measured with the AAT task using an arm movement response mode was associated with self-report measures of eating behaviour and trait food craving. Thus, tasks did not converge strongly enough to be considered equivalent measures of approach/avoidance biases, and the AAT task using an arm movement response seems uniquely suited to detecting approach biases argued to characterise maladaptive eating behaviour and craving.

Validation of the food craving Acceptance and action questionnaire (FAAQ) in a weight loss-seeking sample

OBJECTIVE

The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure psychological flexibility around food-related internal experiences (e.g., thoughts, feelings, urges) and has two subscales, acceptance and willingness. However, the FAAQ factor structure has not yet been systematically validated with a clinically relevant sample.

METHODS

Two weight-loss treatment seeking samples (total N = 462; 80.4% female) ages 18 to 70 (M = 52.6, SD = 9.8) completed the FAAQ before and after group-based treatment of overweight or obesity.

RESULTS

Confirmatory factor analysis on the FAAQ's previously observed two-factor model produced poor model fit. An alternative 7-item model removing specific items that contributed to poor fit and were conceptually relevant to remove provided good model fit. The resulting revised 7-item FAAQ (items 1,3,6 removed) had adequate internal consistency and significant predictive validity for the Total score and subscales, and showed initial construct validity for the Total score.

CONCLUSIONS

Results from this study suggest researchers and clinicians should now use the 7-item FAAQ-II, which retains the Willingness and Acceptance subscales. Future research is needed with other relevant samples to confirm the FAAQ-II's factor structure and psychometric properties.

Using psycho‐behavioral phenotyping for overweight and obesity: Confirmation of the 6 factor questionnaire

Objective

Methods

Results

Conclusions

An assessment of rapamycin for weakening binge-eating memories via reconsolidation: a pre-registered, double-blind randomised placebo-controlled experimental study

BACKGROUND

Maladaptive learning linking environmental food cues to high-palatability food reward plays a central role in overconsumption in obesity and binge eating disorders. The process of memory reconsolidation offers a mechanism to weaken such learning, potentially ameliorating over-eating behaviour. Here we investigated whether putatively interfering with synaptic plasticity using the mammalian target of rapamycin (mTOR) inhibitor, rapamycin, could weaken retrieved chocolate reward memories through blockade of reconsolidation.

METHODS

Seventy five healthy volunteers with a tendency to binge eat chocolate were randomised to retrieve chocolate reward memory under 10 mg rapamycin (RET + RAP, active condition), or placebo (RET + PBO), or they received 10 mg rapamycin without subsequent retrieval (NO RET + RAP). Indices of chocolate reward memory strength were assessed one week pre and post manipulation and at one month follow-up.

RESULTS

Contrary to hypotheses, the RET + RAP group did not show any greater reduction than control groups on indices of motivational salience of chocolate cues, motivation to consume chocolate or liking of chocolate. Mild evidence of improvement in the RET + RAP group was found, but this was limited to reduced chocolate binge episodes and improved healthy food choices.

CONCLUSIONS

We did not find convincing evidence of comprehensive naturalistic chocolate reward memory reconsolidation blockade by rapamycin. The effects on chocolate bingeing and food choices may warrant further investigation. These limited positive findings may be attributable to insufficient interference with mTOR signalling with 10 mg rapamycin, or failure to destabilise chocolate memories during retrieval.

Twenty Years of the Food Cravings Questionnaires: a Comprehensive Review

Purpose of Review

The Food Cravings Questionnaires (FCQs; Cepeda-Benito, Gleaves, Williams, & Erath, 2000) are among the most widely used instruments for measuring food cravings. In addition to the Food Cravings Questionnaire–Trait (FCQ–T) and the Food Cravings Questionnaire–State (FCQ–S), several modified versions have been developed as well. For their 20th anniversary, this article provides a comprehensive description of the FCQs and reviews studies on their psychometric properties and correlates.

Recent Findings

The FCQs and their modified versions have excellent internal reliability. Expectedly, the FCQ–T (and its derivatives) has higher retest-reliability than the FCQ–S as the FCQ–S is sensitive to situational changes such as food deprivation and food intake. However, while the FCQ–T is largely unaffected by such momentary states, it is also sensitive to change during weight-loss treatments and other interventions. Factor structure of the FCQ–T and FCQ–S has only partially been replicated. Construct validity of the FCQs is supported by experimental and longitudinal studies that measured food craving and food consumption in the laboratory and with ecological momentary assessment.

Summary

Numerous studies support reliability and validity of the FCQs and their modified versions, yet findings about their factor structures are inconsistent. Thus, using total scores or the short versions of the FCQs may be preferable.

Imaginal retraining decreases craving for high-calorie food in overweight and obese women: A randomized controlled trial

Overweight and obesity are epidemic conditions. Obesity is associated with somatic and psychological sequelae, including serious life-shortening disorders (e.g., diabetes). This study aimed to evaluate the efficacy of a newly developed imaginal variant of approach bias modification (i.e., imaginal retraining) for the reduction of craving for high-calorie food. In a randomized controlled trial, 384 women with a body mass index above 25 were allocated to a wait-list control group or to two variants of imaginal retraining (ratio: 1; 0.5; 0.5). The two intervention groups were sent a manual on imaginal retraining. One group was explicitly encouraged and instructed to use electronic reminders (RER); the standard retraining group (RS) was not encouraged to use electronic reminders. Assessments were 6 weeks apart and were carried out online. Craving for high-calorie food represented the primary outcome (based on the Visual Analog Scale, VAS). Secondary outcomes included the Food Cravings Questionnaire (FCQ-T-R). The study was registered as DRKS00017220. Women in the RER group utilized the retraining technique more often than those in the RS condition, and utilization frequency in turn was associated with improvement on craving and eating behavior scales. Both intention-to-treat and per-protocol analyses showed a favorable effect of the RER group, which achieved significance on the primary outcome, as well as on several other outcomes relative to controls at a small to medium effect size. For those participants who measured their weight before and after the assessment using a scale, weight loss in the RER group was significantly greater compared to the control group. Both retraining groups (RER: 39.4%; RS: 31.1%) reduced their subjective amount of eating relative to controls (24.2%). Approximately two-thirds of the sample (68.3%) performed the exercises at least once during the study period. The present results show that, when used regularly, imaginal retraining may reduce craving for high-calorie food in overweight and obese women. Of note, there was also evidence suggestive of weight reduction, although no diet or lifestyle change was recommended in the manual. Because a large subgroup neither read the manual nor performed the exercises, we recommend that future imaginal retraining be conveyed via short video clips.

Exploring the structural and construct validity of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

OBJECTIVE

Food cravings play an important role in the neurobiology of appetitive behavior, being positively associated with negative feelings, eating disorders, and obesity. This study aimed to assess the psychometric properties of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), a short version of the most widely used measure of this behavior.

METHODS

Undergraduate students (n=505) completed the full version of the FCQ-T and the Three-Factor Eating Questionnaire. Respondents' height and weight were also measured. Exploratory factor analyses were performed.

RESULTS

The FCQ-T-r exhibited a single-factor structure and satisfactory internal consistency (α > 0.80). A positive correlation was observed between FCQ-T-r scores and those of the original version. Furthermore, FCQ-T-r scores correlated positively with uncontrolled eating and emotional eating behaviors. No correlation was found between body mass index and FCQ-T-r scores. Considering our sample characteristics, we suggested specific FCQ-T-r cutoff points for males and females in the Brazilian population.

CONCLUSION

Our results support the structure of the Brazilian adaptation of the FCQ-T-r, which seems to be a viable instrument to investigate food cravings, particularly in time-constrained settings. Further studies are needed to verify these findings in other age ranges and clinical samples.

A review of food craving measures

OBJECTIVE

Summarize and evaluate self-report measures of food craving, provide suggestions on future directions for the field of food craving measurement, and deliver guidance on how to select a food craving measure.

METHODS

Online bibliographical databases (PsycINFO and PubMed) were searched for peer-reviewed literature on self-report measures of food craving.

RESULTS

There is a wide selection of food craving measures that researchers and clinicians can use to assess state, past, and trait food cravings. Most questionnaires were tested on homogenous samples and their psychometric properties in older, male, and socioeconomically, racially, and ethnically diverse samples is largely unknown. Few questionnaires were tested in samples with overweight/obesity or eating disorders. Relatively few questionnaires adequately evaluate contextual factors that can trigger craving. There appears to be limited data on the predictive validity of food craving measures in regards to response to eating disorder treatment. A decision tree was provided to help researchers and clinicians select a food craving measure that is best suited to a particular clinical or research purpose.

CONCLUSIONS

It is recommended that researchers adequately assess the contextual factors that may trigger craving and the multi-sensory nature of craving for food. It would be beneficial for researchers to evaluate the psychometrics of food craving measures in more diverse samples (in terms of sex, race, ethnicity, socioeconomic status, weight status, and eating disorder psychopathology). More longitudinal studies should be conducted to provide information on the predictive validity of food craving measures regarding response to eating disorder treatment. Furthermore, it is suggested that researchers assess which tactics people use to reduce the frequency and strength of food cravings and restrain their consumption of craved foods.

Targeting acceptance in the management of food craving: The mediating roles of eating styles and thought suppression

Food craving is now widely considered to be a cognitively motivated state. Acceptance-based treatments are effective in reducing the adverse impact of food cravings on consumption, via a hypothesized decrease in experiential avoidance. The mechanisms that drive the success of acceptance-based management of craving remain to be empirically tested. This study examined the role of eating styles and thought suppression as mediators in the relationship between experiential avoidance and craving. Participants (n = 298, 51.5% female) completed the Food Craving Acceptance and Awareness Questionnaire (FAAQ), the Dutch Eating Behavior Questionnaire (DEBQ), the White Bear Suppression Inventory (WBSI; a measure of thought suppression), and the reduced version of the Food Craving Questionnaire- Trait (FCQ-T-r). Scores on the FAAQ were inversely associated with scores on the FCQ-T-r, DEBQ, and WBSI; FCQ-T-r scores were positively correlated with scores on the DEBQ and WBSI (all p < 0.001). The total indirect effect of acceptance on craving through the hypothesized mediators was significantly different from zero. Controlling for eating styles and thought suppression, acceptance remained a significant predictor of craving. Results thus provide initial evidence that eating styles and thought suppression mediate the relationship between food-specific experiential avoidance and food craving. Findings lay the foundation for future study of the proximal antecedents of food cravings and lend preliminary support for targeting thought suppression and eating styles in acceptance-based approaches to the management of craving.

Food cravings in food addiction: exploring a potential cut-off value of the Food Cravings Questionnaire-Trait-reduced

PURPOSE

The Food Cravings Questionnaires are among the most often used measures for assessing the frequency and intensity of food craving experiences. However, there is a lack of studies that have examined specific cut-off scores that may indicate pathologically elevated levels of food cravings.

METHODS

Receiver-Operating-Characteristic analysis was used to determine sensitivity and specificity of scores on the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) for discriminating between individuals with (n = 43) and without (n = 389) "food addiction" as assessed with the Yale Food Addiction Scale 2.0.

RESULTS

A cut-off score of 50 on the FCQ-T-r discriminated between individuals with and without "food addiction" with high sensitivity (85%) and specificity (93%).

CONCLUSIONS

FCQ-T-r scores of 50 and higher may indicate clinically relevant levels of trait food craving.

LEVEL OF EVIDENCE

Level V, descriptive study.

Indirect effects of trait impulsivity on body mass

Trait impulsivity has been suggested as a risk factor for weight gain. However, it is implausible that a construct that does not cover energy intake or expenditure affects fat mass directly. Instead, it is likely that eating-related variables mediate the effect of impulsivity on body mass. In the current study, a serial mediation model tested two eating-related variables (trait food craving and perceived self-regulatory success in weight regulation) as mediators of the relationship between trait impulsivity and body mass. Participants (n=432, 88% female, 79% students) completed the Barratt Impulsiveness Scale - short form, the Food Cravings Questionnaire-Trait-reduced, and the Perceived Self-Regulatory Success in Dieting Scale (PSRS), in addition to providing sociodemographic and anthropometric data. Trait impulsivity did not correlate with body mass index (BMI), but was indirectly related to BMI via food cravings and PSRS scores. Specifically, higher impulsivity predicted more frequent food cravings, which in turn predicted lower perceived self-regulatory success in eating and weight regulation, which in turn predicted higher BMI. Findings suggest possible mechanisms that mediate the association between impulsivity and BMI. Importantly, they show that impulsivity can indirectly affect BMI via eating-related variables, even in the absence of a total effect. Longitudinal studies are needed that support these assumed causal directions.

Trait-based food-cravings are encoded by regional homogeneity in the parahippocampal gyrus

Food cravings can reflect an intense trait-like emotional-motivational desire to eat palatable food, often resulting in the failure of weight loss efforts. Studies have linked trait-based food-cravings to increased risk of overeating. However, little is known about resting-state neural mechanisms that underlie food cravings. We investigated this issue using resting-state functional magnetic resonance imaging (fMRI) to test the extent to which spontaneous neural activity occurs in regions implicated in emotional memory and reward motivation associated with food cravings. Spontaneous regional activity patterns correlating to food cravings were assessed among 65 young healthy women using regional homogeneity analysis to assess temporal synchronization of spontaneous activity. Analyses indicated that women with higher scores on the Food Cravings Questionnaire displayed increased local functional homogeneity in brain regions involved in emotional memory and visual attention processing (i.e., parahippocampal gyrus and fusiform gyrus) but not reward. In view of parahippocampal gyrus involvement in hedonic learning and incentive memory encoding, this study suggests that trait-based food cravings are encoded by emotional memory circuits.

Development of a six-factor questionnaire for use in weight management counseling

OBJECTIVE

To develop and validate a new 6 factor questionnaire (6-FQ) that identifies unhealthful behavioral, cognitive and affective lifestyle pattern factors among a large sample of adults who are overweight or obese.

METHODS

Based on a previously developed 53-item lifestyle patterns questionnaire completed by 10,000 subjects, a new 6-FQ was developed and validated by using two prospective subject groups (n=640) with combined mean age of 43±11.4years and BMI 33.8±9.1kg/m².

RESULTS

An exploratory factor analysis and multidimensional scaling were conducted that identified 6 distinct factors with excellent psychometric properties. Cronbach's internal consistency reliability estimates ranged from 0.76 to 0.85. The prevalence rates and odds ratios of the factors are generally and directly related with increasing BMI categories. The 6-FQ is highly correlated with multiple subscales from the co-administered IWQOL-Lite questionnaire.

CONCLUSIONS

The 6-FQ is a 27-item self-administered instrument with excellent psychometric properties that measures patients' lifestyle pattern factors.

PRACTICE IMPLICATIONS

The 6-FQ is a convenient, short, self-administered instrument that has potential to target patients' self-identified lifestyle patterns related to body weight, and should allow clinicians to efficiently and effectively counsel patients on targeted treatment recommendations.