Food cravings, binge eating, and eating disorder psychopathology: Exploring the moderating roles of gender and race

Habitual behavioural control moderates the relation between daily perceived stress and purging

OBJECTIVE

Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA).

METHOD

Women (N = 81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes.

RESULTS

Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant.

CONCLUSIONS

Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress.

Psychometric evaluation of three-factor eating questionnaire -R18 in aging Finnish men with increased risk for type 2 diabetes

BACKGROUND

Deeper comprehension of eating-related behaviour (how and why people eat) can reveal new aspects to support health and prevent type 2 diabetes (T2D). However, such research is largely missing in aging men.

AIM

The aim was to investigate suitability of the Three-Factor Eating Questionnaire-R18 (TFEQ-R18) in Finnish aging men which is widely used to examine factors: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE).

METHODS

Study population consisted of 420 men aged 50-75, who completed the TFEQ-R18 at the baseline of the T2D-GENE lifestyle intervention study. Inclusion criteria were impaired fasting glucose (IFG) and body mass index ≥25 kg/m2. Confirmatory factor analysis was used to study psychometrics (reliability, validity, and model fit) and factor structure of TFEQ-R18.

RESULTS

The items loaded to the three factors (CR, UE, EE) as in previous studies, except two items at CR factor and one at UE factor, which were therefore omitted. UE was also discovered split into two sub factors (named as 'craving' and 'loss-of-control'), UE being a higher-order (h) factor. The resultant revised version was named as Three-Factor Eating Questionnaire Revised to 15-items with higher-order factor (TFEQ-R15h).

CONCLUSION

The original 18-item version of the TFEQ was not optimal in the population consisting of Finnish aging men with elevated T2D risk. A modified 15-item version of the TFEQ could be used to describe EB in this population instead.

Effect of emotional priming on eating willingness of women with restrictive diet

Background

There is controversy regarding whether negative or positive emotions have a greater impact on the eating behavior of restrictive dieters. Moreover, it is unclear whether unconscious emotional processing can predict the eating behavior of restrictive dieters. This study investigated the effects of conscious and unconscious emotional processing on the dietary behavior of women with restrictive diet.

Methods

Female student participants (N = 600) completed the Dutch Eating Behavior Questionnaire to screen 60 each of successful, unsuccessful restrictive and unrestricted eaters. They were randomly and equally divided into two groups for supra-threshold and subliminal emotional priming and carried out a behavioral task to index eating intentions.

Results

The restrictive dieters increase their willingness to eat when they are in a positive mood, even if they are not consciously aware of their happiness. Furthermore, the unsuccessful restrictive dieters are more intense.

Conclusion

This study presents empirical evidence on the impact of positive emotions on the eating intention of restrictive dieters and the cognitive characteristics of unsuccessful restrictive dieters. Additionally, it offers guidance for unsuccessful restrictive dieters to personalize their treatment goals.

Early evaluation of a DBT-informed online intervention for people with eating disorders

OBJECTIVES

Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours.

METHOD

We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention.

RESULTS

We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours.

DISCUSSION

Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.

Gender similarities and differences in associations between weight discrimination, shape/weight concerns, and eating disorder symptoms among post-9/11 veterans

OBJECTIVE

Weight discrimination, defined as mistreatment of people based on body weight, is associated with body image concerns and eating disorder (ED) symptoms. Military veterans are particularly vulnerable to developing ED symptoms, which may be due to experiences of weight discrimination resulting from the military's strict weight and fitness requirements. However, no previous study has examined these associations among veterans. We investigated relationships between weight discrimination during and after military service and shape/weight concerns and ED symptoms in post-9/11 veterans. Based on evidence for gender differences in weight discrimination, body image, and ED symptoms, we also examined whether gender moderated these associations.

METHOD

Participants were randomly selected from the population of post-9/11 U.S. veterans who had been discharged from the military within the previous 18 months. A total of 1494 veterans completed the Everyday Discrimination Scale, Eating Disorders Examination-Questionnaire, and the Eating Disorder Diagnostic Scale-5.

RESULT

Women were more likely to report weight discrimination and had higher levels of ED symptoms and shape/weight concerns than men. Weight discrimination in and after leaving the military were positively associated with shape/weight concerns and ED symptoms in the full sample and among men and women. Gender moderated the association between weight discrimination after leaving the military and shape/weight concerns such that the association was stronger among men.

DISCUSSION

Both male and female veterans may be vulnerable to developing ED symptoms, in part due to weight discrimination experienced during and after military service. Our findings emphasize the need to address weight discrimination and its consequences in veterans.

Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods

Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.

New form of addiction: An emerging hazardous addiction problem of milk tea among youths

BACKGROUND

Milk tea has experienced tremendous growth in popularity in China, especially among youths. The primary objective of this study is to investigate whether milk tea addiction may have a detrimental impact on youths' mental health, such as anxiety, depression, and suicidal ideation. Additionally, we aim to explore its potential role in influencing various mental health outcomes.

METHODS

A large-scale, cross-sectional study was conducted from 5281 college students in Beijing, China. Participants self-reported depressive, anxiety symptoms, suicidal ideation, and milk tea addiction symptoms including milk tea consumption, dependence, guilty feelings, withdrawal, tolerance, unable to stop, craving, and intention to stop.

RESULTS

Nearly 77 % of participants consumed milk tea at least 6-11 cups in the last year. The confirmatory factor analysis (CFA) supported the one-factor structure of the milk tea addiction scale, developed according to DSM-5 substance use guidelines. Moreover, we found that a higher level of milk tea addiction was significantly associated with a higher risk of depression (b = 0.24, p < 0.001), anxiety (b = 0.21, p < 0.001), and suicidal ideation (b = 0.06, p < 0.001), respectively, after controlling confounding variables, among youths consuming milk tea. The possible mediating role of milk tea addiction between loneliness feelings and mental health outcomes was further addressed.

CONCLUSIONS AND IMPLICATIONS

Our findings highlighted that milk tea consumption might lead to addiction, and it is associated with depression, anxiety, and suicidal ideation. Current findings can assist policymakers in developing regulations such as restricting advertising, providing psycho-education, establishing food hygiene standards for such a prosperous youth-dominant consumption industry while protecting their mental health.

Metabolic and feeding adjustments during pregnancy

Eating behaviours are determined by the integration of interoceptive and environmental inputs. During pregnancy, numerous physiological adaptations take place in the maternal organism to provide an adequate environment for embryonic growth. Among them, whole-body physiological remodelling directly influences eating patterns, commonly causing notable taste perception alterations, food aversions and cravings. Recurrent food cravings for and compulsive eating of highly palatable food can contribute to the development and maintenance of gestational overweight and obesity with potential adverse health consequences for the offspring. Although much is known about how maternal eating habits influence offspring health, the mechanisms that underlie changes in taste perception and food preference during pregnancy (which guide and promote feeding) are only just starting to be elucidated. Given the limited and diffuse understanding of the neurobiology of gestational eating patterns, the aim of this Review is to compile, integrate and discuss the research conducted on this topic in both experimental models and humans. This article sheds light on the mechanisms that drive changes in female feeding behaviours during distinct physiological states. Understanding these processes is crucial to improve gestational parent health and decrease the burden of metabolic and food-related diseases in future generations.

Role of estrogen in the regulation of central and peripheral energy homeostasis: from a menopausal perspective

Estrogen plays a prominent role in regulating and coordinating energy homeostasis throughout the growth, development, reproduction, and aging of women. Estrogen receptors (ERs) are widely expressed in the brain and nearly all tissues of the body. Within the brain, central estrogen via ER regulates appetite and energy expenditure and maintains cell glucose metabolism, including glucose transport, aerobic glycolysis, and mitochondrial function. In the whole body, estrogen has shown beneficial effects on weight control, fat distribution, glucose and insulin resistance, and adipokine secretion. As demonstrated by multiple in vitro and in vivo studies, menopause-related decline of circulating estrogen may induce the disturbance of metabolic signals and a significant decrease in bioenergetics, which could trigger an increased incidence of late-onset Alzheimer's disease, type 2 diabetes mellitus, hypertension, and cardiovascular diseases in postmenopausal women. In this article, we have systematically reviewed the role of estrogen and ERs in body composition and lipid/glucose profile variation occurring with menopause, which may provide a better insight into the efficacy of hormone therapy in maintaining energy metabolic homeostasis and hold a clue for development of novel therapeutic approaches for target tissue diseases.

Emotional eating: elusive or evident? Integrating laboratory, psychometric and daily life measures

PURPOSE

Emotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity).

METHODS

102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis.

RESULTS

A one-factor model provided a good fit. The resulting EElat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating.

CONCLUSIONS

The one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health.

LEVEL OF EVIDENCE

II (Evidence obtained from well-designed controlled trials without randomization).

The mother-daughter Shared Agency in Weight Management Scale (SAWMS): development, validation, and implications for body dissatisfaction

BACKGROUND

Much research suggests that mothers play an important role in shaping daughters' body image, yet less is known about how mother-daughter relationship dynamics in weight management affect daughters' body dissatisfaction. The current paper described the development and validation of the mother-daughter Shared Agency in Weight Management Scale (SAWMS) and examined its associations with daughter's body dissatisfaction.

METHODS

In Study 1 (N = 676 college students), we explored the factor structure of the mother-daughter SAWMS and identified three processes (control, autonomy support, and collaboration) whereby mothers work with daughters in weight management. In Study 2 (N = 439 college students), we finalized the factor structure of the scale by conducting two CFAs and assessing the test-retest reliability of each subscale. In Study 3 (same sample as Study 2), we examined the psychometric properties of the subscales and their associations with daughters' body dissatisfaction.

RESULTS

Combining results from EFA and IRT, we identified three mother-daughter dynamics in weight management-maternal control, maternal autonomy support, and maternal collaboration. However, based on various empirical results indicating poor psychometric properties of the maternal collaboration subscale, we removed it from the mother-daughter SAWMS and only evaluated the psychometric properties of the remaining two subscales (i.e., control and autonomy support). They explained a significant amount of variance in daughters' body dissatisfaction over and above the effect of maternal pressure to be thin. Maternal control was a significant and positive predictor of daughters' body dissatisfaction; maternal autonomy support was a significant and negative predictor.

CONCLUSIONS

Results suggested that maternal control in weight management was associated with daughters' increased body dissatisfaction, whereas maternal autonomy support in weight management was associated with daughters' lower body dissatisfaction. These specific ways in which mother work with daughters in weight management provide nuances in understanding young women's body dissatisfaction. Our SAWMS offers new ways to examine body image among young women through the mother-daughter relationship dynamics in weight management.

Habituation or sensitization of brain response to food cues: Temporal dynamic analysis in an functional magnetic resonance imaging study

Introduction

In the modern obesogenic environment, heightened reactivity to food-associated cues plays a major role in overconsumption by evoking appetitive responses. Accordingly, functional magnetic resonance imaging (fMRI) studies have implicated regions of the salience and rewards processing in this dysfunctional food cue-reactivity, but the temporal dynamics of brain activation (sensitization or habituation over time) remain poorly understood.

Methods

Forty-nine obese or overweight adults were scanned in a single fMRI session to examine brain activation during the performance of a food cue-reactivity task. A general linear model (GLM) was used to validate the activation pattern of food cue reactivity in food > neutral contrast. The linear mixed effect models were used to examine the effect of time on the neuronal response during the paradigm of food cue reactivity. Neuro-behavioral relationships were investigated with Pearson's correlation tests and group factor analysis (GFA).

Results

A linear mixed-effect model revealed a trend for the time-by-condition interactions in the left medial amygdala [t(289) = 2.21, β = 0.1, P = 0.028], right lateral amygdala [t(289) = 2.01, β = 0.26, P = 0.045], right nucleus accumbens (NAc) [t(289) = 2.81, β = 0.13, P = 0.005] and left dorsolateral prefrontal cortex (DLPFC) [t(289) = 2.58, β = 0.14, P = 0.01], as well as in the left superior temporal cortex [42 Area: t(289) = 2.53, β = 0.15, P = 0.012; TE1.0_TE1.2 Area: t(289) = 3.13, β = 0.27, P = 0.002]. Habituation of blood-oxygenation-level-dependent (BOLD) signal during exposure to food vs. neutral stimuli was evident in these regions. We have not found any area in the brain with significant increased response to food-related cues over time (sensitization). Our results elucidate the temporal dynamics of cue-reactivity in overweight and obese individuals with food-induced craving. Both subcortical areas involved in reward processing and cortical areas involved in inhibitory processing are getting habituated over time in response to food vs. neutral cues. There were significant bivariate correlations between self-report behavioral/psychological measures with individual habituation slopes for the regions with dynamic activity, but no robust cross-unit latent factors were identified between the behavioral, demographic, and self-report psychological groups.

Discussion

This work provides novel insights into dynamic neural circuit mechanisms supporting food cue reactivity, thereby suggesting pathways in biomarker development and cue-desensitization interventions.

Validation of the Italian version of the Power of Food Scale in the adult population

PURPOSE

The Power of Food Scale (PFS) is designed to measure the personal susceptibility to highly processed and palatable foods. The purpose of this study was to validate the Italian version of PFS (PFS-It) in the adult population.

METHODS

Data were obtained from 536 Italian adults aged between 18 and 86 years. The PFS-It and the Binge Eating Scale (BES) were administered to all participants.

RESULTS

The factorial structure of the PFS-It was investigated using a CFA that returned excellent fit indices. The Cronbach's alpha coefficients for the PFS-It total score and for its subscales (Food Available, Food Present, and Food Tasted), as well as for the BES total score, revealed good to moderate reliability. Finally, PFS-It was positively and significantly correlated with BES.

CONCLUSION

To our knowledge, this is the first study to propose the norms and psychometric characteristics of the Power of Food Scale in an Italian population. The results show that PFS-it is a valid and reliable instrument for the measurement of Hedonic Hunger in an adult Italian population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The effects of prefrontal vs. parietal cortex transcranial direct current stimulation on craving, inhibition, and measures of self-esteem

While prefrontal cortex dysfunction has been implicated in high food cravings, other cortical regions, like the parietal cortex, are potentially also involved in regulating craving. This study explored the effects of stimulating the inferior parietal lobule (IPL) and dorsolateral prefrontal cortex (DLPFC) on food craving state and trait. Transcranial direct current stimulation (tDCS) was administered at 1.5 mA for 5 consecutive days. Participants received 20 min of IPL, DLPFC, or sham stimulation (SHAM) each day which consisted of two rounds of 10-min stimulation, divided by a 10-min mindfulness task break. In addition, we studied inhibition and subjective psychological aspects like body image and self-esteem state and trait. To decompose immediate and cumulative effects, we measured the following on days 1 and 5: inhibition through the Go/No-go task; and food craving, self-esteem, and body appreciation through a battery of questionnaires. We found that false alarm errors decreased in the participants receiving active stimulation in the DLPFC (DLPFC-group). In contrast, false alarm errors increased in participants receiving active stimulation in the IPL (IPL-group). At the same time, no change was found in the participants receiving SHAM (SHAM-group). There was a trending reduction in craving trait in all groups. Momentary craving was decreased in the DLPFC-group and increased in IPL-group, yet a statistical difference was not reached. According to time and baseline, self-esteem and body perception improved in the IPL-group. Furthermore, self-esteem trait significantly improved over time in the DLPFC-group and IPL-group. These preliminary results indicate that tDCS modulates inhibition in frontoparietal areas with opposite effects, enhancing it in DLPFC and impairing it in IPL. Moreover, craving is moderately linked to inhibition, self-esteem, and body appreciation which seem not to be affected by neuromodulation but may rely instead on broader regions as more complex constructs. Finally, the fractionated protocol can effectively influence inhibition with milder effects on other constructs.

Exploring the association of body mass index, mindful and emotional eating, and orthorexia

BACKGROUND

Orthorexia nervosa (ON) is defined as a fixation on healthy eating behaviours. Research exploring ON and body mass index (BMI) has been inconsistent, with some findings indicating a positive relationship between ON and BMI, while other studies have suggested no relationship. To date, potential associations with emotional and mindful eating have been explored only in a vegan population. The present research adopted an exploratory approach and examined the relationship between orthorexia and BMI, and possible associations with emotional and mindful eating. The potential predictive value of mindful and emotional eating with respect to ON was also explored, while the role of four different types of emotional eating (happiness, sadness, anger, anxiety), utilising an emotional eating scale incorporating positive and negative emotions, was further explored.

PARTICIPANTS AND PROCEDURE

Two hundred and twenty-three participants completed the online survey that was distributed via social media to a British sample.

RESULTS

The findings suggested a negative correlation between ON and BMI. Participants who presented higher levels of orthorexia were more likely to display higher levels of focused eating, a central aspect of mindful eating, as well as lower levels of emotional eating in response to happiness - two elements that further predicted ON in multiple regression models.

CONCLUSIONS

The results suggest a need to conduct further research to explore the possible role of happiness as a potential protective tool against ON, and further suggest the likely negative role of some components of mindful eating in ON. Future directions are discussed in light of the present findings.

Combined oral contraceptive use and risk for binge eating in women: Potential gene × hormone interactions

Extant animal and human data suggest endogenous ovarian hormones increase risk for binge eating in females, possibly via gene × hormone interactions and hormonally induced increases in genetic influences. Approximately 85 % of women will take combined oral contraceptives (COCs) that mimic the riskiest hormonal milieu for binge eating (i.e., post-ovulation when both estrogen and progesterone are present). The purpose of this narrative review is to synthesize findings of binge eating risk in COC users. Few studies have been conducted, but results suggest that COCs may increase risk for binge eating and related phenotypes (e.g., craving for sweets), particularly in genetically vulnerable women. Larger, more systematic human and animal studies of COCs and binge eating are needed. The goal of this work should be to advance personalized medicine by identifying the extent of COC risk as well as the role of gene × hormone interactions in susceptibility.

Effects of the HEARTY exercise randomized controlled trial on eating behaviors in adolescents with obesity

Background

There are well-recognized benefits of behavioral interventions that include exercise for children and adolescents with obesity. However, such behavioral weight management programs may precipitate unintended consequences. It is unclear if different exercise modalities impact eating behaviors differently in youth with obesity.

Objectives

The purpose of this study was to examine the effects of aerobic, resistance, and combined aerobic and resistance exercise training on eating attitudes and behaviors (uncontrolled eating, restrained eating, emotional eating, external eating and food craving) among adolescents with overweight and obesity.

Methods

N = 304 (70% female) adolescents with overweight and obesity participated in the 6-month Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) randomized controlled trial. All participants were inactive post-pubertal adolescents (15.6 ± 1.4 years) with a mean BMI = 34.6 ± 4.5 kg/m². The Food Craving Inventory (food cravings), Dutch Eating Behavior Questionnaire (restrained eating, emotional eating, external eating), and the Three-Factor Eating Questionnaire (uncontrolled eating) were used to assess eating attitudes and behaviors.

Results

All exercise groups showed within-group decreases in external eating and food cravings. Participants randomized to the Combined training group and were more adherent showed the greatest improvements in eating behaviors and cravings.

Conclusions

A 6-month exercise intervention produced improvements in disordered eating behaviors and food cravings, but effects may be gender and modality-specific. Findings highlight the need to tailor exercise intervention to participant characteristics for the promotion of healthier eating and weight management outcomes in youth with obesity.

Clinical Trial Registration # and Date: ClinicalTrials.Gov NCT00195858, September 12, 2005.

Development of the Hedonic Overeating–Questionnaire (HEDO–Q)

Addictive-like eating is prevalent, but a clear conceptualization and operationalization outside of an addiction framework is lacking. By adopting a biopsychological framework of food reward, this study sought to develop and evaluate a brief self-report questionnaire for the trait assessment of hedonic overeating and dyscontrol. Items in the Hedonic Overeating–Questionnaire (HEDO–Q) were constructed following a rational approach and psychometrically evaluated in a large random sample from the German population (N = 2531). A confirmatory factor analysis supported the unidimensional nature of the six-item HEDO–Q with the three postulated components of wanting, liking, and dyscontrol. Psychometric properties were favorable with good corrected item-total correlations, acceptable item difficulty and homogeneity, and high internal consistency. Population norms were provided. The HEDO–Q revealed strict measurement invariance for sex and partial invariance for age and weight status. Discriminant validity was demonstrated in distinguishing participants with versus without eating disturbances or obesity. Associations with the established measures of eating disorder and general psychopathology supported the convergent and divergent validity of the HEDO–Q. This first evaluation indicates good psychometric properties of the HEDO–Q in the general population. Future validation work is warranted on the HEDO–Q’s stability, sensitivity to change, and predictive and construct validity.

Linking drug and food addiction via compulsive appetite

BACKGROUND AND PURPOSE

"Food addiction" is the subject of intense public and research interest. However, this nosology based on neurobehavioral similarities among obese individuals and patients with eating disorders and drug addiction remains controversial. We thus sought to determine which aspects of disordered eating are causally linked to preclinical models of drug addiction. We hypothesized that extensive drug histories, known to cause addiction-like brain changes and drug motivation in rats, would also cause addiction-like food motivation.

EXPERIMENTAL APPROACH

Rats underwent extensive cocaine, alcohol, caffeine or obesogenic diet histories, and were subsequently tested for punishment-resistant food self-administration or "compulsive appetite", as a measure of addiction-like food motivation.

KEY RESULTS

Extensive cocaine and alcohol (but not caffeine) histories caused compulsive appetite that persisted long after the last drug exposure. Extensive obesogenic diet histories also caused compulsive appetite, although neither cocaine nor alcohol histories caused excess calorie intake and bodyweight during abstinence. Hence, compulsive appetite and obesity appear to be dissociable, with the former sharing common mechanisms with preclinical drug addiction models.

CONCLUSION AND IMPLICATIONS

Compulsive appetite, as seen in subsets of obese individuals and patients with binge-eating disorder and bulimia nervosa (eating disorders that do not necessarily result in obesity), appears to epitomize "food addiction". Because different drug and obesogenic diet histories caused compulsive appetite, overlapping dysregulations in the reward circuits, which control drug and food motivation independently of energy homeostasis, may offer common therapeutic targets for treating addictive behaviors across drug addiction, eating disorders and obesity.

The transdiagnostic role of food craving: An application of substance use models

Food craving is a transdiagnostic process underlying clinically significant disordered eating behaviors and eating disorder diagnoses. However, the lack of literature examining the role of food craving as it relates to the full spectrum of disordered eating behaviors, including restrictive eating and compensatory behaviors, may be due to the traditional definition of food craving as the desire to consume particular foods. Applying motivational models of substance use craving to food craving may help to explain inconsistencies within existing literature. Three motivational models of craving from the substance use literature may be particularly applicable to (1) provide a clear definition of food craving as a motivational process, (2) understand the role of that motivational process as it underlies the full spectrum of disordered eating behavioral patterns, (3) provide insight for the most appropriate ways in which to accurately assess food craving, and (4) establish ways in which food craving may represent a useful motivational process to target in eating disorder treatments. This narrative review describes three models of substance use craving and provides suggestions for utilizing motivational models to understand the transdiagnostic role of food craving as it relates to the full spectrum of disordered eating behaviors in both research and clinical work.

Food approach and avoidance appetitive traits in university students: A latent profile analysis

Eating behaviors are influenced by many factors including appetitive traits. Few studies have utilized latent profile analysis (LPA) to examine food approach and food avoidance appetitive traits. This study utilized LPA to define cluster profile groups based on appetitive traits in undergraduate and graduate/professional students at a large University in the southwest United States. Students completed a cross-sectional online survey in fall 2020 assessing demographic information, appetitive traits via the Adult Eating Behavior Questionnaire (AEBQ), and anxiety via the Generalized Anxiety Disorder Scale (GAD-7; higher scores indicate more severe anxiety symptoms). Appetitive traits were combined into eight scales (four food approach and four food avoidance traits). Latent profile analyses were conducted to identify homogenous subgroups of participants based on AEBQ scale scores. The final sample included 1243 students (mean age = 26.5 years, 73% female, 59% White, 57% undergraduates). LPA revealed four cluster profile groups: Cluster 1 (moderate eaters: lower than mean scores for food approach and avoidance traits), Cluster 2 (food seekers and avoiders: higher than mean scores for food approach and avoidance traits), Cluster 3 (food seekers: higher than mean scores for food approach traits), and Cluster 4 (food avoiders: higher than mean scores for food avoidance traits). Distribution of age, gender, race/ethnicity, and student status differed significantly between clusters. GAD-7 score was highest in Cluster 2 (food seekers and avoiders) and lowest in Cluster 1 (moderate eaters). Among the four LPA-defined cluster profile groups, students who endorsed both food approach and avoidance traits reported more severe anxiety symptoms compared to moderate eaters, food seekers, and food avoiders. It is useful to consider clusters of appetitive traits instead of individual appetitive traits when examining associations with physical and mental health.

The Role of Acceptance in Eating Behaviors-Spanish Validation of Food Craving Acceptance and Action Questionnaire (FAAQ-S)

Background: The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure food craving acceptance, but has not yet been adapted to Spanish. The aim of this study was to validate the FAAQ to the Spanish population and to analyze its psychometric properties.

Method: Two studies were conducted. In the first study, the sample consisted of 224 undergraduate students who participated in the comprehension of the Spanish version and the Confirmatory Factor Analysis (CFA). The second sample consisted of 378 participants from a community sample who completed the refined version of the FAAQ and similar and dissimilar measures.

Results: Study (1) The CFA was conducted, showing an inadequate fit of the model (CFI = 0.74, RMSEA = 0.18). Therefore, FAAQ was refined and it was administered to the community sample. Study (2) After an exploratory factor analysis, two factors were obtained as in the original FAAQ, Acceptance (30.92% variance explained) and Willingness (36.05%). The internal consistency was adequate for both subscales (ω = 0.88 and ω = 0.87, respectively). Correlation between the factors was r = 0.07, which provides evidence that Acceptance and Willingness are different constructs. Correlations of Acceptance with similar variables (r between −0.30 and −0.52) were stronger than the dissimilar measures (r between −0.26 and 0.24). This did not occur for the Willingness subscale, since correlations were low in all cases (r between −0.22 and 0.25).

Conclusions: Spanish version of the FAAQ showed evidence of its reliability and validity, and may be a measure to provide a better understanding of how acceptance of thoughts and emotions concerning food and willingness impact eating management behaviors.

Food cravings and loss-of-control eating in youth: Associations with gonadal hormone concentrations

OBJECTIVE

Among youth with overweight, food cravings (FC) are associated with loss-of-control (LOC)-eating, but the impact of sex-associated biological characteristics on this relationship is unknown. We examined whether sex and gonadal hormone concentrations moderated the relationships between FC and LOC-eating severity among healthy boys and girls across the weight strata in natural and laboratory environments.

METHOD

Using ecological momentary assessment (EMA), FC, and LOC-eating severity were reported 3-5 times a day for 2 weeks. In the laboratory, participants reported FC, consumed lunch from a buffet test meal designed to simulate LOC-eating, and rated LOC-eating severity during the meal.

RESULTS

Eighty-seven youth (13.0 ± 2.7 years, 58.6% female, 32.2% with overweight/obesity) participated. EMA measured general and momentary FC were positively associated with LOC-eating severity (ps < .01), with no differences by sex (ps = .21-.93). Estradiol and progesterone significantly moderated the relationships between FC and LOC-eating such that general FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) estradiol (p = .01), and momentary FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) progesterone (p = .01). Boys' testosterone did not significantly moderate the associations between FC and LOC-eating severity (ps = .36-.97). At the test meal, pre-meal FC were positively related to LOC-eating severity (p < .01), without sex or hormonal moderation (ps = .20-.64).

DISCUSSION

FC were related to LOC-eating severity in boys and girls. In the natural environment, gonadal hormones moderated this relationship in girls, but not boys. The mechanisms through which gonadal hormones might affect the relationship between FC and LOC-eating warrant investigation.

The food craving inventory in an Iranian population: post-hoc validation and individual differences

PURPOSE

The present study was performed to develop the Persian version of food craving inventory (FCI) (FCI-P) and to assess food craving in Iranian adult population. In addition, individual differences, including sex and body mass index (BMI) in food craving were assessed.

METHODS

Eight hundred and twenty subjects who participated in the same study Hill (Proc Nutr Soc 66: 277-285, 2007) were studied (540 women and 280 men). The FCI-P, International Physical Activity Questionnaire (IPAQ), Three-Factor Eating Questionnaire (TFEQ), and a questionnaire pertaining to demographic characteristics were completed for all participants.

RESULTS

Good content, construct, and convergent validity was observed for the FCI-P. A good reliability was found for both aggregate scores of the FCI-P and scores of its five factors. Exploratory factor analysis showed a five-factor model including "sweets," "high-fat foods," "fast food fats," "carbohydrates/starches" and "high-fat meats". These five factors accounted for 47.31% of the total variance. The scores of "uncontrolled eating" and "emotional eating" of the TFEQ were significantly correlated with the scores of the FCI-P factors and its total score. A significant correlation was found between BMI and the FCI-P score (r = 0.199). Significant differences were observed in the mean age and physical activity score among normal weight, overweight, and obese participants. Normal weight and overweight groups were more active than obese group. Obese participants had higher FCI-P score (P < 0.001) than the normal and overweight groups. FCI-P score was significantly higher in women than men.

CONCLUSIONS

FCI-P can be used as a valid and reliable measure to assess food craving in Iranian populations. Obese individuals experienced food craving more than normal weight subjects. Similarly, women may experience food craving more than men.

LEVEL OF EVIDENCE

Level V, cross sectional study.

The effects of puberty and ovarian hormone removal on developmental trajectories of palatable food and chow intake in female rats

OBJECTIVE

Palatable food (PF) intake is significantly greater in females than males and increases during adolescence. Previous data suggest that puberty and ovarian hormones may contribute to these sex and developmental differences, but few studies have examined this possibility. The aim of the current study was to address these gaps by examining trajectories of PF and chow intake during pre-puberty, puberty, and adulthood in intact female rats (Study 1) as well as in those receiving pre-pubertal ovariectomies (P-OVX) (Study 2).

METHOD

We examined our study aims using archival data from 66 intact Sprague-Dawley female rats (Study 1) and 77 P-OVX and 79 intact Sprague-Dawley female rats (Study 2). PF and chow intake were measured using a free-choice, intermittent exposure paradigm in which rats were exposed to both food types starting in pre-puberty and continuing into adulthood.

RESULTS

Mixed linear models revealed a specific effect of puberty on PF intake in both studies. PF intake increased substantially during puberty in all rats, but increases were particularly pronounced in P-OVX rats in Study 2. By contrast, chow intake increased significantly during pre-puberty (rather than puberty) in both studies, and these increases were relatively unaffected by P-OVX.

DISCUSSION

Findings confirm a specific effect of puberty and ovarian hormone removal on PF intake in female rats. Differential trajectories of PF versus chow intake highlight potential reward-based processes in pubertal and ovarian hormone effects on PF intake in females.

Dysfunctional Patterns of Food Intake by Anxiety during Isolation by COVID-19 in Chile, Colombia and Mexico

The aim of this research was to compare food intake dysfunctional patterns score with the subjective perception of anxiety and sociodemographic characteristics of the participants in isolation by COVID-19 from Chile, Colombia, and Mexico. A cross-sectional research was carried out, with a virtual questionnaire of subjective perception of anxiety and the questionnaire of three 18-item feeding factors. 958 people of both sexes participated (F = 83%, M = 17%), mainly in the 18 to 35 age range. Dysfunctional eating patterns presented high scores in people who perceived anxiety, as well as in participants from Chile. Additionally, it was found that women present greater cognitive restriction and emotional intake, and college students showed greater disinhibition. In conclusion, the scores of the three dysfunctional eating patterns were higher in people with subjective perception of anxiety during social isolation due to COVID-19, and there were also differences according to country, sex, and educational level.

Gender-specific approach in psychiatric diseases: Because sex matters

In both animals and human beings, males and females differ in their genetic background and hormonally driven behaviour and show sex-related differences in brain activity and response to internal and external stimuli. Gender-specific medicine has been a neglected dimension of medicine for long time, and only in the last three decades it is receiving the due scientific and clinical attention. Research has recently begun to identify factors that could provide a neurobiological basis for gender-based differences in health and disease and to point to gonadal hormones as important determinants of male-female differences. Animal studies have been of great help in understanding factors contributing to sex-dependent differences and sex hormones action. Here we review and discuss evidence provided by clinical and animal studies in the last two decades showing gender (in humans) and sex (in animals) differences in selected psychiatric disorders, namely eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), schizophrenia, mood disorders (anxiety, depression, obsessive-compulsive disorder) and neurodevelopmental disorders (autism spectrum disorders, attention-deficit/hyperactivity disorder).

The Effects of Individual and Dual ACE Domains on Binge Drinking: Comparisons by Gender

BACKGROUND

Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE categories are fundamentally different, yet little distinction is given to specific ACE domains. The current study investigates which individual and dual ACE domain combinations are associated with binge drinking.

METHODS

Data were obtained from the Behavioral Risk Factor Surveillance System (2011-2017; N = 80,391). A series of ANCOVAs were conducted to determine the association between single and dual combination ACE domains and binge drinking.

RESULTS

Results show gendered effects of ACEs on binge drinking such that at 0, 1, and 2 ACEs, males reported statistically higher rates. For males with exactly two ACEs, combinations of either sexual abuse or family incarceration presented the highest levels of binge drinking- with the highest mean binge drinking score being the exact combination of the two. This contrasts with males with 1 ACE, where experiencing family incarceration or sexual abuse, as a single domain, did not represent significant risk above the average of having a single ACE.

CONCLUSIONS

Results suggest that males may be resilient to either of these domains as singular events, yet when found in combination, may present a synergistic effect that increases the likelihood of binge drinking. Due to lower overall binge drinking rates, no significant patterns were found among females.

The effects of imaginary eating on visual food cue reactivity: An event-related potential study

Previous research has demonstrated that imagining consumption of a specific type of food helps individuals to consume less of that food. The present event-related potential study aimed at investigating the underlying neural correlates of this appetite-reducing strategy. A total of 86 women (mean age = 23.65 years) were randomly assigned to one of three imagination conditions. In each condition, they listened to a guided imagery script that either described the eating of 30 colorful button-shaped chocolates (M&Ms), the sorting of 30 M&Ms by color, or the sorting of 30 marbles by color. Subsequently to the imagery task, the participants were presented with images of M&Ms and marbles while their electroencephalogram and craving ratings were recorded. The results showed that imaginary eating did not reduce the appetitive value of M&M pictures. The M&M sorting group reported enhanced craving and showed increased late positivity toward M&M pictures (300-600 ms after picture onset) compared to the two other groups. The present findings indicate that the imagined handling of food increases food cue reactivity and that imaginary eating is not a reliable method to reduce appetite.

Considering Food Addiction through a Cultural Lens

Purpose of Review

Research suggests that cultural factors influence eating behaviors, however little is known about the relationship between food addiction and culture. This narrative review aimed to i) review theoretically related work on the relationship between sociocultural demographic variables, food cravings, and eating disorders; ii) review the available literature assessing cultural aspects of food addiction, specifically the rates of food addiction across the globe and notable differences in relevant sociodemographic variables: race, ethnicity, gender and acculturation level; iii) discuss the potential impact of culture on our current understanding of food addiction and future research directions emphasizing the inclusion of sociocultural variables.

Recent Findings

Preliminary data suggest that food addiction symptoms occur cross-culturally, and that there may be significant differences between sociodemographic groups. Issues related to adequate lexicalization of concepts central to food addiction (e.g., craving, addiction) and global variations in eating culture and presentation of similar constructs (e.g. binge-eating) contribute to questions raised and identify avenues for further research.

Summary

Multidimensional cultural assessment is called for to characterize food addiction among diverse groups and improve our understanding of the etiology, maintenance, and sequelae of food addiction cross-culturally.

Support for a two-dimensional model of food craving using self-report questionnaire and cue-reactivity methodologies

OBJECTIVE

Evidence supports the transdiagnostic importance of food cravings across the spectrum of disordered eating behaviors. The ambivalence model of craving (AMC), originally applied to substance use craving, highlights the need to consider not just the motivational state of "approach," but also that of "avoidance." The aims of this project were to (a) extend the existing literature by providing additional psychometric support for the food approach and avoidance questionnaire (FAAQ), (b) extend research supporting the validity of applying the AMC to disordered eating by incorporating a cue-reactivity paradigm, and (c) examine the unique contributions of the FAAQ and in-the-moment cue-elicited craving to the prediction of disordered eating.

METHOD

Participants (N = 223; 52.0% female, age M = 20.51 years) were recruited from a large southeastern university. Participants completed a food cue-reactivity paradigm and measures of food craving and disordered eating in a lab setting.

RESULTS

The factor structure and construct validity of the FAAQ was supported and both general states of food craving (i.e., FAAQ) and cue-elicited food craving were incrementally associated with the spectrum of disordered eating behaviors. As anticipated, both FAAQ and in-the-moment cue-elicited approach were primarily associated with overeating behaviors, whereas FAAQ and cue-elicited avoidance were primarily associated with restrictive eating behaviors.

DISCUSSION

Findings highlight the importance of including an avoidance dimension of food craving and have important implications for disordered eating prevention and intervention work.

Food cravings: Associations with dietary intake and metabolic health

Food cravings are a desire for specific foods which, if uncontrolled may lead to excess energy intake and weight gain. However, information on the relation between food cravings, dietary intake, and indices of metabolic health is limited. This study used baseline data from females (n = 229; aged 40.9 ± 0.7 years; BMI 34.7 ± 6.4 kg/m²) who were dependents of active duty and retired military personnel, and enrolled in the Healthy Families Healthy Forces weight loss and maintenance study. Measures obtained included food cravings using the Food Craving Questionnaire-Trait (which provides a habitual and stable measure of food cravings), dietary composition and eating patterns from three 24-h dietary recalls and the Stanford 7-day Physical Activity Recall, body composition from anthropometric measures, cardiometabolic risk factors from blood measures, and demographic information from questionnaires. Linear, quantile, or logistic regression models were used to examine the association of total food craving scores on dietary intake, and indices of metabolic health. In individuals reporting plausible energy intake (n = 146; 2210 ± kcals/day) higher food craving scores were associated with a lower diet quality (P < 0.05), higher eating frequency (P = 0.02), longer daily eating interval (P < 0.05), and a lower likelihood of following a time restricted eating pattern (P = 0.02). Food cravings were also positively associated with BMI (P = 0.03) and waist circumference (P = 0.01), but not with measures of cardiometabolic risk (LDL, HDL, total cholesterol:HDL, triglycerides, glucose, glycated hemoglobin, insulin and C-reactive protein concentrations, blood pressure, metabolic syndrome). Our findings of significant associations of food cravings with lower diet quality, poor eating patterns, and unfavorable body composition strongly support efforts of targeting cravings in behavioral programs for weight management.

Eating Disorder Among Malaysian University Students and Its Associated Factors

Eating disorder is highly prevalent among university students worldwide. However, in Malaysia, studies on eating disorder is scanty and were mostly conducted among medical students. A stratified cluster sampling was used to recruit participants in a university based in Kuala Lumpur. This cross-sectional study was conducted among 1017/1132 students (response rate: 89.8%). The questionnaires administered was a combination of the Eating Attitude Test-26 and items related to perceived body weight, body mass index, trying to weight loss, tobacco use, posttraumatic stress disorder, and depression. Descriptive analyses were performed to provide background information of at-risk students by gender. Multiple logistic regressions were used to identify associated factors of eating disorder. The results showed that 13.9% of the university students were at risk of eating disorder. Students who were trying to lose weight and had posttraumatic stress disorder predicted eating disorder. Hence, eating disorder among university students merits attention and requires implementations of public health policies.

Fight, Flight, - Or Grab a Bite! Trait Emotional and Restrained Eating Style Predicts Food Cue Responding Under Negative Emotions

In today's society, obesity rates are rising as food intake is no longer only a response to physiological hunger signals that ensure survival. Eating can represent a reward, a response to boredom, or stress reduction and emotion regulation. While most people decrease food intake in response to stress or negative emotions, some do the opposite. Yet, it is unclear who shows emotional overeating under which circumstances. Emotion regulation theories describe emotional overeating as a learned strategy to down-regulate negative emotions. Cognitive theories, by contrast, attribute emotional overeating to perceived diet breaches in individuals who chronically attempt to diet. After consuming "forbidden foods", they eat more than individuals who do not restrict their food intake. This laboratory study investigated emotional overeating by exposing individuals to a personalized emotion induction while showing images of palatable foods. Outcome variables indexed cue reactivity to food images through picture ratings (valence, desire to eat), facial expressions (electromyography of the corrugator supercilii muscle), and brain reactivity by detecting event-related potentials (ERPs) by means of electroencephalography (EEG). The influence of emotion condition (negative, neutral) and individual differences (self-reported trait emotional and restrained eating) on outcome variables was assessed. Valence ratings and appetitive reactions of the corrugator muscle to food pictures showed a relative increase in the negative condition for individuals with higher emotional eating scores, with the opposite pattern in lower scores. Desire to eat ratings showed a similar pattern in individuals who showed a strong response to the emotion induction manipulation, indicative of a dose-response relationship. Although no differences between conditions were found for ratings or corrugator activity with restrained eating as a predictor, an ERP at P300 showed increased activation when viewing food compared to objects in the negative condition. Findings support emotion regulation theories: Emotional eaters showed an appetitive reaction in rating patterns and corrugator activity. EEG findings (increased P300) suggest a motivated attention toward food in restrained eaters, which supports cognitive theories. However, this did not translate to other variables, which might demonstrate successful restraint. Future studies may follow up on these findings by investigating eating disorders with emotion regulation difficulties.

The Transdiagnostic Nature of Cravings: Smoking Cessation and Food Craving in Pregnancy

OBJECTIVES

Smoking cessation prior to pregnancy is strongly encouraged due to the adverse effects of tobacco use on the developing fetus, but appears to also increase risk of excess gestational weight gain (GWG). Smoking cessation has previously been shown to cause weight gain in non-pregnant individuals, in part due to an increase in food craving frequency. Food craving frequency in pregnancy is a known predictor of excess GWG, but has not yet been examined in relation to pre-pregnancy smoking status. This study sought to test the hypothesis that pre-pregnancy smoking cessation elevates excess GWG risk via an increase in food craving frequency.

METHODS

Pregnant women (n = 82) completed measures of pre-pregnancy tobacco use and current general and specific food cravings. Gestational weight gain was calculated based on participant self-report of pre-pregnancy weight and data on weight prior to delivery culled from medical records.

RESULTS

Pre-pregnancy tobacco use was associated with significantly greater food craving frequency in pregnancy (p = .05), specifically for high-fat and fast-foods (both p < .05), compared to women who did not smoke. Emotional and physiological aspects of cravings accounted for 35% of the variance in excess GWG (p < .03).

CONCLUSIONS

Pre-pregnancy smoking appears predictive of food raving frequency in pregnancy and could thus contribute to excess GWG risk. Findings highlight the importance of incorporating strategies for managing cravings into behavioral interventions promoting healthy GWG for women endorsing pre-pregnancy tobacco use.

Is food addiction a predictor of treatment outcome among patients with eating disorder?

OBJECTIVES

The study aimed to examine whether food addiction (FA) was associated with greater severity in both binge eating disorders (BED) and bulimia nervosa and, therefore, to determine if FA was predictive of treatment outcome.

METHOD

Seventy-one adult patients with bulimia nervosa and BED (42 and 29, respectively) participated in the study. FA was assessed by means of the Yale Food Addiction Scale.

RESULTS

The results confirmed a high prevalence of FA in patients with binge disorders (around 87%) and also its association with a greater severity of the disorder (i.e., related to an increased eating psychopathology and greater frequency of binge eating episodes). Although FA did not appear as a predictor of treatment outcome in general terms, when the diagnostic subtypes were considered separately, FA was associated with poor prognosis in the BED group. In this vein, FA appeared as a mediator in the relationship between ED severity and treatment outcome.

DISCUSSIONS

Our findings suggest that FA may act as an indicator of ED severity, and it would be a predictor of treatment outcome in BED but not in BN.

Psychometric properties of Power of Food Scale in Iranian adult population: gender-related differences in hedonic hunger

PURPOSE

The present study was performed to develop the Persian version of Power of Food Scale (PFS) questionnaire (PFS-P) and to assess the hedonic hunger in Iranian adult population. In addition, associations between individual differences, including sex and body mass index (BMI) and the appetitive motives measured by the PFS-P were assessed.

METHODS

Eight hundred and twenty participants were studied. The PFS-P, the International Physical Activity Questionnaire, the Three-Factor Eating Questionnaire, and a questionnaire pertaining to demographic characteristics were completed for all participants.

RESULTS

The Cronbach's alpha values for the factors "food available", "food present" and "food taste" were 0.87, 0.85, and 0.78, respectively. The intraclass correlation coefficient ranged from 0.80 to 0.97 for the factors of PFS-P. Good content, face, criterion, and construct validity were observed for the PFS-P. In addition, a good reliability was found for both aggregate score of the PFS-P and the scores of its three factors. Relatively strong associations were found between BMI and the PFS-P score (r = 0.43). The hedonic hunger was significantly higher in women than men (p < 0.001).

CONCLUSIONS

The findings of the present study provide further evidence in support of the suitability of PFS as a valid instrument to measure hedonic hunger. PFS-P can be used as a valid and reliable measure to assess hedonic hunger in Iranian populations. In addition, a moderately strong correlation was observed between BMI and hedonic hunger scores. This study revealed that women may experience hedonic hunger more than men.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Association of food cravings with weight gain, overweight, and obesity in patients after liver transplantation

OBJECTIVE

After liver transplantation (LTx), patients often gain weight and many become overweight or obese; however, the association between LTx and food craving (FC) is unknown. The aim of this study was to describe FC among patients after LTx and verify its association with weight gain and obesity.

METHODS

This was a cross-sectional study that assessed 301 patients who underwent LTx (55.1 ± 12.7 y of age; time since LTx 6.6 ± 4.4 y; 64.1% men). Pregnant or nursing women were excluded. Patients were interviewed once either in the outpatient clinic or by completing the online questionnaire, from August 2016 to February 2017.

RESULTS

The median weight variation after Ltx was 8 kg (ranging from -16 to +41 kg). At evaluation, 62.5% (n = 188) of the patients presented excessive weight and 22.3% (n = 67) presented with obesity. The average score on the Food Craving Questionnaire-State (FCQ-S) was 33.4 ± 9 and for the Food Craving Questionnaire-Trait (FCQ-T) the median score was 68 (39-163). The FCQ-T dimensions of lack of control, preoccupation, emotion, environmental triggers/stimuli, and guilt correlated positively with weight gain (P < 0.05). The desire dimension on the FCQ-S was significantly associated with overweight in post-LTx patients (P < 0.05) and the FCQ-T dimensions [negative reinforcement (P = 0.013), lack of control (P = 0.016), emotion (P = 0.009), environmental triggers/stimuli (P = 0.029), and guilt (P = 0.007)] were associated with obesity.

CONCLUSION

Lack of control, preoccupation, emotion, trigger, and guilt were positively correlated with weight gain. Desire was significantly associated with overweight. Negative reinforcement, lack of control, emotion, environmental triggers/stimuli, and guilt were associated with obesity.

Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?

PURPOSE

Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED).

METHODS

Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure.

RESULTS

In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving.

CONCLUSIONS

This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

Anxiety symptoms and emotional eating are independently associated with sweet craving in young adults

Sweet craving (SC), defined as a strong desire for sweet foods, seems to be closely related to negative emotions, such as anxiety and unhealthy eating behaviors. The objective was to investigate factors that are associated with SC and to assess the relationships among SC, anxiety symptoms, and eating behavior in university students. This was a cross-sectional study involving 300 students of both sexes (20.5 ± 4.4 years) who were freshmen in a Brazilian public university. Eating behavior was evaluated using the Three Factor Eating Questionnaire, anxiety symptoms were assessed using the Beck Anxiety Inventory, SC was identified by a yes/no question ("Have you had a very strong desire to eat sweet food over the last three months?"), and characterized by the Questionnaire for Assessment of Sweet Substance Dependence. Individuals with SC scored significantly higher for uncontrolled eating (UE), emotional eating (EE), and anxiety symptoms. Logistic regression analysis revealed that anxiety symptoms are independently associated with SC. In conclusion, negative emotions, like anxiety, and eating guided by these emotions can contribute to the SC phenomenon.

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.

A reconceptualization of the definition of binge eating for African American women: A concept analysis

AIM

The aim of this analysis is to develop a better understanding of the concept of binge-eating behavior among African American women (AAW).

BACKGROUND

Obesity is a major public health concern that is disproportionately prevalent among AAW. Among the factors that contribute to obesity development, binge eating may be of significant concern to AAW.

DESIGN

A critical analysis and synthesis of the empirical literature using Walker and Avant's model for concept analysis. The databases MEDLINE, Cumulative Index to Nursing Health Literature (CINAHL) Complete, PsycINFO, and PsycARTICLES were used. Keywords included binge eating AND African American women or Black women race or ethnicity or minority.

RESULTS

Binge eating is a behavior that exists on a continuum that involves the overconsumption of food, with or without loss of control (LOC), whereas binge eating with LOC is related to increased impairment and severity. While the main attribute of binge eating involves the consumption of a large amount of food, the LOC component of binge eating definition may not be culturally relevant criteria to include as a requirement, as it may exclude AAW in diagnostics and subsequent treatment as well as overlook the health implications of binge eating regardless of LOC endorsement.

CONCLUSION

Including LOC in defining binge-eating behavior among AAW is significant, but should not be necessitated. This concept analysis illustrates the complexities related to binge-eating behavior among AAW, enumerating the characteristics of binge eating that may be unique to certain populations. The definition for binge eating among AAW developed from this concept analysis needs to be further explored in future studies.

Food cravings and body weight: a conditioning response

PURPOSE OF REVIEW

To provide current information on interventions that alter food cravings. Specifically, dietary, physical activity, pharmacologic, and bariatric surgery interventions are examined. Lastly, the effects of social determinants and current controversies on food cravings are outlined.

RECENT FINDINGS

Dietary, pharmacologic, and bariatric surgery weight loss interventions decrease food cravings. Physical activity interventions also decrease cravings. There is potential to see differential responses in food cravings in different demographic and socioeconomic groups, but more research is needed.

SUMMARY

Food cravings influence body weight. Food craving reductions are because of reductions in the frequency of consuming craved foods, independent of energy content, but further research is warranted. Most findings continue to support the conditioning model of food cravings.