Deutsche Übersetzung und Validierung der Yale Food Addiction Scale

Differences in Discounting Behavior and Brain Responses for Food and Money Reward

Most neuroeconomic research seeks to understand how value influences decision-making. The influence of reward type is less well understood. We used functional magnetic resonance imaging (fMRI) to investigate delay discounting of primary (i.e., food) and secondary rewards (i.e., money) in 28 healthy, normal-weighted participants (mean age = 26.77; 18 females). To decipher differences in discounting behavior between reward types, we compared how well-different option-based statistical models (exponential, hyperbolic discounting) and attribute-wise heuristic choice models (intertemporal choice heuristic, dual reasoning and implicit framework theory, trade-off model) captured the reward-specific discounting behavior. Contrary to our hypothesis of different strategies for different rewards, we observed comparable discounting behavior for money and food (i.e., exponential discounting). Higher k values for food discounting suggest that individuals decide more impulsive if confronted with food. The fMRI revealed that money discounting was associated with enhanced activity in the right dorsolateral prefrontal cortex, involved in executive control; the right dorsal striatum, associated with reward processing; and the left hippocampus, involved in memory encoding/retrieval. Food discounting, instead, was associated with higher activity in the left temporoparietal junction suggesting social reinforcement of food decisions. Although our findings do not confirm our hypothesis of different discounting strategies for different reward types, they are in line with the notion that reward types have a significant influence on impulsivity with primary rewards leading to more impulsive choices.

Risk patterns in food addiction: a Mexican population approach

BACKGROUND

Food addiction (FA) is a construct that has gained interest in recent years but its relevance in Mexican population is still unexplored.

AIMS

The present study has the aims of explore FA in a community of Mexican population, as well as identifying the risk patterns associated with it, in relation to the different etiological factors that have been described such as impulsivity, emotional regulation and eating styles. Furthermore, to identify a predictive model of FA severity.

METHODS

The sample consisted of 160 female and male university students of Pachuca city in México, who volunteered to participate in the study. Assessment included multidimensional measures for FA, eating disorder severity, eating disorder styles, emotional regulation and impulsivity.

RESULTS

A screening of FA-probable was registered for 13.8% of the sample, while 8.1% met criteria for FA-present. The FA-present group differed from FA-absent in the impulsivity levels and in emotional eating style. Patients with FA-present differed from FA-probable in the impulsivity levels. Differences between FA-probable versus FA-absent were found in the restrained eating style. Path analysis evidenced that FA severity was directly associated with older age, worse eating style profile and higher impulsivity levels, and indirectly related with the ED symptom levels.

CONCLUSIONS

Our findings suggest that it is possible to establish a specific predictive model of the development of FA and its severity in Mexican population to implement adequate prevention and treatment strategies.

EVIDENCE LEVEL

Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Anxiety and Food Addiction in Men and Women: Results From the Longitudinal LIFE-Adult-Study

BACKGROUND

Anxiety is a widespread phenomenon, and it is connected to disordered eating and obesity. We want to analyze the connection between anxiety and food addiction (FA) over two points in time to better understand the directionality of the association. Since there are gender differences with regard to anxiety and eating, we are also interested in differences between men and women.

METHODS

We used data from the population-based LIFE-Adult-Study (N = 1,474) at time 1 (baseline) and time 2 (first follow-up) to analyze the connections between anxiety (GAD-7) and FA (YFAS) using a multiple group latent cross-lagged panel model with female and male participants as groups. We controlled for age, marital status, socioeconomic status and social support.

RESULTS

Anxiety (women: β = 0.50, p ≤ 0.001; men: β = 0.59, p ≤ 0.001) as well as FA (women: β = 0.37, p ≤ 0.001; men: β = 0.58, p ≤ 0.001) exhibited stability over time for both genders. We found a significant association between anxiety at time 1 and FA at time 2 for women (β = 0.25, p ≤ 0.001) but not for men (β = 0.04, p = 0.10), and significant associations between FA at time 1 and anxiety at time 2 for women (β = 0.23, p ≤ 0.001) as well as men (β = 0.21, p ≤ 0.001).

CONCLUSION

Food addiction longitudinally affects anxiety, independent of gender and other sociodemographic variables. In addition, anxiety affects subsequent FA as well, but only in women. Interventions that address FA could reduce anxiety in men and women, while interventions that mitigate anxiety could help prevent FA in women.

Subjective Social Status Is Associated with Dysregulated Eating Behaviors and Greater Body Mass Index in an Urban Predominantly Black and Low-Income Sample

Background: Higher subjective social status (SSS) or a person’s perception of their social standing is related to better health outcomes, but few studies examined SSS in relation to obesity. Emotional eating and food addiction have been linked to obesity. Some studies indicated that manipulating SSS may lead to altered food intake, but the relationship between SSS and dysregulated eating, such as emotional eating and food addiction (FA), has not been examined. The goal of this study was to examine the associations between SSS in the community and the larger society, dysregulated eating (emotional eating and FA), and body mass index (BMI) in a majority racial minority sample. Methods: The participants (N = 89; 93% Black, 86% women, and 56% with obesity; 72% income lower than USD 2000), recruited from a publicly funded hospital in Atlanta, GA, completed the MacArthur Scale, Dutch Eating Behaviors Questionnaire, Yale Food Addiction Scale, Beck Depression Inventory, PTSD Symptom Checklist, and demographics questionnaire. Results: Twenty-two percent of the sample met the criteria for FA; those with FA had significantly higher BMI than those without (p = 0.018). In the hierarchical linear regression, the SSS community (but not in society) predicted higher severity of emotional eating (β = 0.26, p = 0.029) and FA (β = 0.30, p = 0.029), and higher BMI (β = 0.28, p = 0.046), independent from depression and PTSD symptoms. Conclusions: The findings indicate that, among Black individuals with predominantly low income in the U.S., perceived role in their community is associated with eating patterns and body mass. Given the small sample size, the results should be interpreted with caution.

Food preferences and YFAS/YFAS-C scores in schoolchildren and university students

PURPOSE

Food addiction (FA) is one of the causes of widespread obesity in modern society. It was shown that there is an age-associated increase in incidence rate of FA in adolescents/young adults. The purpose of this study was to analyze food preferences in schoolchildren and university students with FA.

METHODS

High school and university students (N = 1607; age: 17.8 ± 2.7 years; girls: 77.0%) located in four settlements of Russia anonymously took part in the study. Study participants provided personal data (age, sex, height, and weight) and completed the Yale Food Addiction Scale, the Zung Self-Rating Depression Scale and the Munich ChronoType Questionnaire. In addition, they indicated food products with which they had problems.

RESULTS

The frequency of detection of FA among university students was twice as high as among schoolchildren. University students with FA were 20.2% more likely than schoolchildren to report the symptom 'use continues despite knowledge of adverse consequences,' and 13.7% more likely to report the symptom 'tolerance.' Schoolchildren and university students with FA most often noted that foods high in sugar and fat were problematic. University students with FA also reported that foods with a high carbohydrate content were problematic.

CONCLUSION

In university students with FA, in comparison with schoolchildren with FA, there is an increase in list of problematic food products, mainly due to products with a high carbohydrate content.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Investigating Sex Differences in Rates and Correlates of Food Addiction Status in Women and Men with PTSD

BACKGROUND

Food addiction (FA) is a dysregulated eating pattern characterized by difficulties in controlling the intake of certain foods. There is an overlap in physical and mental health correlates of FA and post-traumatic stress disorder (PTSD). The purpose of this study was to examine sex differences in the rates of positive FA status in individuals with threshold/subthreshold PTSD, and to examine sex differences in the physical and mental health correlates of FA.

METHODS

Post-9/11 veterans/service members seeking PTSD treatment were recruited. Participants were diagnosed with PTSD via the administration of a clinical interview. FA status was determined using Modified Yale Food Addiction Scale-2, binary sex and body mass index were assessed with demographics questions.

RESULTS

Nearly half (43%) of the sample were women. There were no sex differences in the rates of FA, with an overall FA prevalence of 18%. There were no sex differences in FA symptom count in the whole sample (M = 1.63) or those with FA status (M = 6.21). Individuals with FA reported higher frequency of disordered eating, higher severity of PTSD, and depression symptoms.

CONCLUSIONS

FA should be assessed in tandem with PTSD symptoms, as its prevalence in that sample is higher than in the general population, and it appears to affect both sexes at similar rates.

Body image disturbance partially explains eating-related psychosocial impairment in food addiction

BACKGROUND

This study aimed to explore the association of food addiction (FA) with eating-related psychosocial impairment and examine the extent to which this association was explained directly by FA symptoms themselves, versus through body image disturbance.

MATERIALS AND METHODS

Participants (356 university students and 544 crowdsourced adults) completed self-report measures of FA (Yale Food Addiction Scale; YFAS 2.0), psychosocial impairment (Clinical Impairment Assessment; CIA 3.0), and body image disturbance (Eating Disorders Examination Questionnaire; EDE-Q 6.0), and reported their body mass index (BMI) and gender.

RESULTS

Endorsement of distress and/or impairment on the YFAS corresponded to ratings on the CIA. Structural equation models indicated the relationship between FA and eating-related psychosocial impairment was partially mediated by body image disturbance. The indirect effect of body image disturbance explained more variance in eating-related psychosocial impairment than did YFAS scores themselves. Neither BMI nor gender significantly moderated any direct or indirect pathways from food addiction to psychosocial impairment.

CONCLUSIONS

Food addiction is associated with clinical impairment in men and women across the weight spectrum. A large portion of psychosocial impairment associated with food addiction may be explained by body image disturbance. Due to its role in explaining psychosocial impairment, body image disturbance warrants increased attention in FA research.

Reliance on model-based and model-free control in obesity

Consuming more energy than is expended may reflect a failure of control over eating behaviour in obesity. Behavioural control arises from a balance between two dissociable strategies of reinforcement learning: model-free and model-based. We hypothesized that weight status relates to an imbalance in reliance on model-based and model-free control, and that it may do so in a linear or quadratic manner. To test this, 90 healthy participants in a wide BMI range [normal-weight (n = 31), overweight (n = 29), obese (n = 30)] performed a sequential decision-making task. The primary analysis indicated that obese participants relied less on model-based control than overweight and normal-weight participants, with no difference between overweight and normal-weight participants. In line, secondary continuous analyses revealed a negative linear, but not quadratic, relationship between BMI and model-based control. Computational modelling of choice behaviour suggested that a mixture of both strategies was shifted towards less model-based control in obese participants. Our findings suggest that obesity may indeed be related to an imbalance in behavioural control as expressed in a phenotype of less model-based control potentially resulting from enhanced reliance on model-free computations.

Internalized weight stigma and the progression of food addiction over time

Food addiction is associated with elevated levels of eating pathology, body image concerns, and internalized weight stigma. The role of internalized weight stigma in the progression of addictive-like eating has not been explored. This longitudinal study explored the relative contributions of weight-related self-devaluation and fear of being stigmatized by others in predicting changes in addictive-like eating behavior over time. 305 young adults (M_age = 18.7 years, SD = 1.1, range 18-28, M_BMI = 21.9 kg/m², SD =3.7 kg/m², range 13.7-38.9 kg/m²) completed online measures of "food addiction," weight-related self-devaluation, and fear of stigma from others at two time points (follow-up M = 280 days, SD = 30, range 155-474). At baseline, 7.9 % exhibited clinically relevant addictive-like eating behavior, 40.3 % self-classified as being "addicted to food", and 51.8 % neither. Using cross-lagged modelling, fear of being stigmatized, but not self-devaluation, was a predictor of worsening "food addiction" status over time. Fear of weight stigma, rather than weight-related self-devaluation per se, may be an important predictor of problematic eating behavior. As weight stigma is prevalent in Western populations, these findings have potential implications for the development of problem eating behaviors in non-clinical samples.

Food addiction in young adult residents of Russia: Associations with emotional and anthropometric characteristics

The incidence of food addiction (FA) and associations between FA and anthropometric and psycho-emotional characteristics of young Russian adults were studied. In this study, 1,237 students (age, M = 20.6, SD = 4.6 years; 79% females) of universities located in four cities of Russia were attended. They provided demographics and filled in the Yale Food Addiction Scale (YFAS), the Dutch Eating Behavior Questionnaire, and the Zung Self-Rating Depression Scale. Data were analysed via Chi-squared tests, logistic regression analysis, and an analysis of covariance. 13.2% of participants met diagnostic criteria for FA based on the YFAS. On average, the participants reported 2.6 FA symptoms (SD = 1.5). FA was more commonly detected in females (OR = 1.86, 95% CI = 1.10, 3.15, p = .021). No relationship was found between age and the incidence of FA. Significant positive associations between FA, the severity of depression (OR = 2.31, 95% CI = 1.91, 2.80, p = .000), and an emotional eating behaviour (OR = 1.45, 95% CI = 1.20, 1.76, p = .000) were found. The waist-to-height ratio was found to be the anthropometric indicator most closely associated with FA (OR = 1.49, 95% CI = 1.27, 1.76, p = .000). HIGHLIGHTS: The prevalence of food addiction in the current sample was 13.2%. In young Russian adults, emotional eating behaviour and depression are associated with food addiction. In young Russian adults, the waist-to-height ratio is the anthropometric indicator most closely associated with food addiction.

IMPULS: Impulsivity-Focused Group Intervention to Reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Randomised Controlled Trial

BACKGROUND

Impulsivity is a risk factor for binge eating disorder, and binge eating (BE) equates to impulsive eating behaviour. Hence, we developed IMPULS, a cognitive behavioural group intervention focusing on impulsive eating.

METHODS

We randomised 41 patients to the IMPULS group and 39 to the control group. The IMPULS group participated in the IMPULS treatment, while both groups completed weekly self-observations. We compared both groups concerning BE episodes in the past 4 weeks at the end of treatment (primary outcome). As secondary outcomes, we investigated eating pathology, depression, general impulsivity and body mass index (BMI) at the end of treatment and in a 3-month follow-up.

RESULTS

The primary outcome failed, because BE episodes in the past 4 weeks were reduced in both groups at the end of treatment. At follow-up, the IMPULS group showed further improvement, contrary to the control group. The BE days/episodes in the 2 months before were overall reduced in both groups. Eating pathology was reduced in the IMPULS group at the end of treatment and partly in both groups at the follow-up. Depression was only reduced in the IMPULS group. General impulsivity and BMI did not change.

CONCLUSIONS

The IMPULS study has a negative primary outcome. However, secondary outcomes indicate that the IMPULS treatment might be promising, as BE, eating pathology and depression were reduced in the IMPULS group. The initially reduced BE in the control group might represent a short-term effect from the self-observations. General impulsivity and BMI might need a longer time or more intensive treatment to change.

Comparison of women with high vs. low food addiction tendency: a pilot study with voxel-based morphometry

BACKGROUND

The concept of 'food addiction' (FA) posits that highly processed food with added fat and/or refined carbohydrates is capable of triggering addictive-like eating behavior. FA may be one possible phenotype in obesity.

METHODS

The present voxel-based morphometry (VBM) study compared data from three groups of women. One group scored high on the Yale Food Addiction Scale (YFAS) and was overweight (n = 21), whereas the two other groups had low YFAS scores and were either overweight (n = 21) or normal-weight (n = 21).

RESULTS

Overweight women with high YFAS scores had less grey matter volume (GMV) in the inferior frontal gyrus (IFG) than overweight women with low FA tendency, who in turn had less GMV in the IFG than the normal-weight group. The IFG is involved in response inhibition, which is relevant for the control of appetite and food intake. In the group with high FA tendency, the frequency of binge episodes was substantially correlated with the YFAS scores, and 11 women of this group were diagnosed with binge-eating disorder (BED). The association between IFG volume and YFAS scores was not statistically significant anymore when controlling for the effect of binge frequency as revealed by partial correlation analysis.

CONCLUSION

This VBM study revealed an association between reported FA tendency and a neural correlate of disinhibited eating. Future studies with bigger sample sizes are needed in order to demonstrate that FA is sufficiently different from existing conditions (e.g., BED) to warrant classification as a distinct disease phenotype.

A mind-brain-body dataset of MRI, EEG, cognition, emotion, and peripheral physiology in young and old adults

We present a publicly available dataset of 227 healthy participants comprising a young (N=153, 25.1±3.1 years, range 20-35 years, 45 female) and an elderly group (N=74, 67.6±4.7 years, range 59-77 years, 37 female) acquired cross-sectionally in Leipzig, Germany, between 2013 and 2015 to study mind-body-emotion interactions. During a two-day assessment, participants completed MRI at 3 Tesla (resting-state fMRI, quantitative T1 (MP2RAGE), T2-weighted, FLAIR, SWI/QSM, DWI) and a 62-channel EEG experiment at rest. During task-free resting-state fMRI, cardiovascular measures (blood pressure, heart rate, pulse, respiration) were continuously acquired. Anthropometrics, blood samples, and urine drug tests were obtained. Psychiatric symptoms were identified with Standardized Clinical Interview for DSM IV (SCID-I), Hamilton Depression Scale, and Borderline Symptoms List. Psychological assessment comprised 6 cognitive tests as well as 21 questionnaires related to emotional behavior, personality traits and tendencies, eating behavior, and addictive behavior. We provide information on study design, methods, and details of the data. This dataset is part of the larger MPI Leipzig Mind-Brain-Body database.

Psychometric properties of the modified Yale Food Addiction Scale Version 2.0 in an Italian non-clinical sample

PURPOSE

To assess the dimensionality and psychometric properties of the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) in an Italian non-clinical sample.

METHODS

262 adults (184 women) were administered the Italian versions of the mYFAS 2.0, and questionnaires measuring binge eating severity, anxiety and depression symptoms, and emotional dysregulation.

RESULTS

15 individuals (5.7%) met the criteria for a diagnosis of food addiction according to the mYFAS 2.0. Bayesian confirmatory factor analysis supported a single-factor solution for the mYFAS 2.0. The mYFAS 2.0 had good internal consistency (Ordinal α = 0.91), and convergent validity with binge eating severity (r = 0.67, p < 0.001), both anxiety (r = 0.31, p < 0.001) and depressive (r = 0.35, p < 0.001) symptoms, and difficulties in emotion regulation (r = 0.35, p < 0.001). Finally, both discriminant validity with dietary restraint (Gamma = 0.11; p = 0.52) and incremental validity in predicting binge eating severity over emotion dysregulation and psychopathology (b = 0.52; t = 11.11; p < 0.001) were confirmed.

CONCLUSIONS

The Italian mYFAS 2.0 has satisfactory psychometric properties and can be used as a brief instrument for the assessment of addictive eating behaviors when time constraints prevent the use of the original version.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Does food addiction contribute to excess weight among clinic patients seeking weight reduction? Examination of the Modified Yale Food Addiction Survey

BACKGROUND

Despite controversy surrounding the construct of food addiction, its relationship with obesity and the validity of the Yale Food Addiction Scale (YFAS), have become emerging fields of study. No prior research has examined the prevalence and correlates of food addiction, and validation of the Modified Yale Food Addiction Scale (mYFAS), in a non-research based weight management clinic setting.

OBJECTIVE

The current study sought to examine the validity of a brief version of the Yale Food Addiction Scale in weight loss seeking patients, and to determine whether food addiction contributes to excess weight in this patient population.

PARTICIPANTS

The sample consisted of 126 Veterans with overweight/obesity who attended an orientation session for a weight management program. Participants (mean age = 61.8 years, mean BMI = 38.0, male = 89.7%, Caucasian = 76.0%) completed questionnaires related to food addiction, weight and eating, and mental health and behavior.

RESULTS

Ten percent of the sample met diagnostic threshold for food addiction. Correlational analysis revealed that food addiction was significantly and highly correlated with BMI, emotional eating, night eating and screens for depression and insomnia (p's < 0.001); significantly correlated with eating pathology, and screening for PTSD (p's < 0.05); and inversely correlated with screening for alcohol use disorders (p < 0.01). The prevalence of food addiction was significantly higher in participants with Binge Eating Disorder (75%) compared to participants without (5.4%; p < 0.001). Food addiction uniquely accounted for 15% of the variance of BMI, almost three times more than general eating disorder pathology.

DISCUSSION

This study provides further evidence for the validity of the mYFAS, and clinical significance of the food addiction construct among weight loss seeking patients in non-research based weight management settings. Findings confirm that food addiction contributes to excess weight among clinic patients seeking weight reduction above and beyond the effects of disordered eating. It is recommended that clinicians and researchers consider an addiction framework for addressing comorbid overweight and food addiction among afflicted individuals seeking weight loss.

Validation of the Italian Yale Food Addiction Scale in postgraduate university students

PURPOSE

This study was aimed to examine the structural and construct validity of the Italian version of the Yale Food Addiction Scale in a multisite sample of postgraduate students.

METHODS

Two hundred and fifty-six subjects (78.1% females) aged from 18 to 53 years (mean = 23.93, SD = 4.96) and attending different postgraduate university programs at multiple Italian universities completed the Italian YFAS, the Italian Binge Eating Scale (BES), the Italian Eating Attitudes Test-26 and the Italian Dutch Eating Behavior Questionnaire (DEBQ) online through Qualtrics.

RESULTS

Confirmatory Factor Analysis showed that the single-factor model of the Italian YFAS including all original items had adequate fit indexes (χ²252 = 454.183; p < 0.001; normed χ² = 1.802; RMSEA = 0.056; 90% CI 0.048-0.076; CFI = 0.761; WRMR = 1.592). However, item analysis revealed that item#25 had zero variance (all subjects were assigned the same score after item dichotomization) and item#24 had a low factor loading, and were thus removed. Furthermore, item#10 and item#11 showed to be almost perfectly correlated (r = 0.998) and were thus parceled. The resulting 19-item single-factor model revealed a better fit to the data (χ²152 = 235.69; p < 0.001; normed χ² = 1.556; RMSEA = 0.046; 90% CI 0.034-0.058; CFI = 0.858; WRMR = 1.236) and its internal consistency was acceptable (KR-20 = 0.72). Also, a single-factor model including the seven diagnostic symptoms was tested and showed adequate fit values (χ²20 = 41.911; p < 0.003; normed χ² = 2.09; RMSEA = 0.065; 90% CI 0.037-0.093; CFI = 0.946; WRMR = 1.132). Statistically significant and small-to-high correlations were found with all convergent measures, in particular with the BES.

CONCLUSION

The Italian 19-item YFAS resulted to be a valid and reliable tool for the assessment of food addiction in postgraduate students.

LEVEL OF EVIDENCE

Level V, descriptive study.

Evaluation of disordered eating tendencies in young adults

PURPOSE

It was aimed to determine the prevalence of high disordered eating tendencies and its relationship with food addiction, emotional eating and self esteem in participants at 18 and 33 years age group.

METHODS

This study was planned as a cross-sectional study and conducted with 1359 young adult volunteers (M = 386, F = 973) with an average age of 22.4 ± 2.84 years. Eating Attitudes Test-26 (EAT-26), Yale Food Addiction Scale (YFAS), Emotional Appetite Questionnaire (EMAQ) and Rosenberg Self-Esteem Scale (RSES) were used. EAT-26 score above 20 was considered as eating disorders risk cutoff.

RESULTS

Participants with disordered eating tendencies have higher rates (22.4%) of food addiction compared to participants without high disordered eating tendencies (7.2%). There is no difference for EMAQ and YFAS scores; however, there is a significant difference for RSES and EAT-26 scores according to gender. A positive association of EAT-26 with YFAS and EMAQ-negative scores and a negative association of EAT-26 with RSES and EMAQ-positive were found.

DISCUSSION

There is association among EAT-26, YFAS, and Rosenberg Self-Esteem Scale, and Emotional Appetite Questionnaire scores. This study provides information for future studies about high disordered eating tendencies, food addiction and mood that are thought to be important in young adults.

LEVEL OF EVIDENCE

Level V (cross-sectional descriptive study).

Eating-related Psychopathology and Food Addiction in Adolescent Psychiatric Inpatients

OBJECTIVE

Our aims were to investigate the relationship between food addiction and mental disorders including eating disorders (ED), eating-related psychopathology and body mass index-standard deviation score in a sample of adolescent psychiatric inpatients.

METHODS

Food addiction was assessed with the Yale Food Addiction Scale (YFAS). Eating-related psychopathology was measured with the Three-Factor Eating Questionnaire (TFEQ). Psychiatric diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The sample consisted of n = 242 adolescent psychiatric inpatients, of which n = 37 (15.3%) met criteria for an ED. Multiple regression analysis was used to examine the association between YFAS symptom count, TFEQ scales and ED controlling for age and gender.

RESULTS

Food addiction frequency was 16.5%, and the mean YFAS symptom count was 2.39 (SD: 1.60). In patients with food addiction, TFEQ scale scores were significantly higher than patients without food addiction. Frequency of ED was 42.9% in patients with and 9.9% in patients without food addiction. The TFEQ subscales disinhibition and hunger as well as diagnosis of ED were associated with YFAS symptom count.

DISCUSSION

Food addiction in adolescent psychiatric inpatients occurs with rates higher than those seen in community samples of children, adolescents and adults. Food addiction might be associated with eating styles related to susceptibility to hunger and feelings of loss of control. The implications of high-YFAS scores in restricting-type anorexia nervosa warrant further investigations to explore which and how the respective items are interpreted in this ED subgroup. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

A graduated food addiction classifications approach significantly differentiates depression, anxiety and stress among people with type 2 diabetes

AIMS

To examine differences in depression, anxiety, and stress across people with type 2 diabetes mellitus (t2d) classified according to a four level processed food addiction (PFA) severity indicator dichotomy.

METHODS

Four hundred and eight participants with a t2d diagnoses completed an online survey including the Yale Food Addiction Scale (YFAS) and the DASS-21. Based on YFAS symptom counts participants were classified as either: non-PFA; mild-PFA; moderate-PFA; or severe-PFA.

RESULTS

Multivariate, λ=0.422, F(9,978.51)=46.286, p<0.001, n_p²=0.250, and univariate analyses of variance demonstrated that depression F(3,408)=159.891, p<0.001, n_p²=0.543, anxiety F(3,408)=127.419, p<0.001, n_p²=0.486, and stress scores F(3,408)=129.714, p<0.001, n_p²=0.491, significantly and meaningfully increased from one PFA classification level to the next. Furthermore, the proportion of participants with more severe classifications of depression χ² (12)=297.820, p<0.001, anxiety χ² (12)=271.805, p<0.001, and stress χ² (12)=240.875, p<0.001, were significantly higher in the more severe PFA groupings.

CONCLUSION

For people with t2d, PFA is an important and meaningful associate of depression, anxiety, and stress, and that the adopted four level PFA severity indicator dichotomy is valid and useful.

A graduated food addiction classification approach significantly differentiates obesity among people with type 2 diabetes

This study examined a graduated severity level approach to food addiction classification against associations with World Health Organization obesity classifications (body mass index, kg/m²) among 408 people with type 2 diabetes. A survey including the Yale Food Addiction Scale and several demographic questions demonstrated four distinct Yale Food Addiction Scale symptom severity groups (in line with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) severity indicators): non-food addiction, mild food addiction, moderate food addiction and severe food addiction. Analysis of variance with post hoc tests demonstrated each severity classification group was significantly different in body mass index, with each grouping being associated with increased World Health Organization obesity classifications. These findings have implications for diagnosing food addiction and implementing treatment and prevention methodologies of obesity among people with type 2 diabetes.

Psychometric properties of the Portuguese version of the Yale Food Addiction Scale

PURPOSE

Rising rates of obesity have been recently associated to the novel concept of food addiction (FA). The Yale Food Addiction Scale (YFAS) is the most widely used measure for examining FA (1) and analysis of its reliability and validity is expected to facilitate empirical research on the construct. Here, we tested the psychometric properties of a Portuguese version of the YFAS (P-YFAS), establishing its factor structure, reliability and construct validity.

METHODS

Data were obtained from 468 Portuguese individuals, 278 sampled from non-clinical populations, and 190 among obese candidates for weight-loss surgery. A battery of self-report measures of eating behavior was applied.

RESULTS

Confirmatory factor analysis verified a one-factor structure with acceptable fit, with item analysis suggesting the need to eliminate item 24 from the P-YFAS. Internal consistency (KR-20 = .82) and test-retest stability were adequate. Correlation analyses supported convergent and divergent validity of the P-YFAS, particularly in the clinical sample. Both FA symptom count and diagnosis, according to the P-YFAS, adequately discriminated between samples, with classification of FA met by 2.5 and 25.8% of the participants in the non-clinical and clinical samples, respectively.

CONCLUSIONS

These findings reinforce the use of P-YFAS in non-clinical and clinical populations. Future directions for extending YFAS validation are discussed.

Effects of a food-specific inhibition training in individuals with binge eating disorder-findings from a randomized controlled proof-of-concept study

PURPOSE

Impulsivity might contribute to the development and maintenance of obesity and eating disorders. Patients suffering from binge eating disorder (BED) show an impulsive eating pattern characterized by regular binge eating episodes. Novel behavioral interventions increasing inhibitory control could improve eating behavior in BED. We piloted a novel food-specific inhibition training in individuals with BED.

METHODS

N = 22 BED patients according to SCID-I were randomly assigned to three sessions of a training or control condition. In both conditions, pictures of high-caloric food items were presented in peripheral vision on a computer screen while assessing gaze behavior. The training group had to suppress the urge to turn their gaze towards these pictures (i.e., to perform antisaccades). The control group was allowed to freely explore the pictures. We assessed self-reported food craving, food addiction, and wanting/liking of food pictures pre- and post-intervention.

RESULTS

Twenty participants completed the study. The training proved to be feasible and acceptable. Patients of the training group significantly improved inhibitory control towards high-caloric food stimuli. Both groups reported a significantly lower number of binge eating episodes in the last four weeks after termination of the study. No changes were found in food craving, food addiction, liking, and wanting ratings.

CONCLUSIONS

A food-specific inhibition training could be a useful element in the treatment of BED and other eating disorders; however, larger efficacy studies in patient samples are needed to investigate the efficacy of this and similar training approaches.

Validation of the French Version of the DSM-5 Yale Food Addiction Scale in a Nonclinical Sample

OBJECTIVE

The Yale Food Addiction Scale (YFAS) is the only questionnaire that assesses food addiction (FA) based on substance dependence criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision. Following recent updating of addiction criteria, a new DSM-5 version (YFAS 2.0) has been developed. Our study tested the psychometric properties of the French YFAS 2.0 in a nonclinical population.

METHOD

We assessed 330 nonclinical participants for FA (French YFAS 2.0), eating behaviour, and eating disorder (Binge Eating Scale, Emotional Overeating Questionnaire, Three-Factor Eating Questionnaire-R18, Questionnaire on Eating and Weight Patterns-Revised, Eating Disorder Diagnostic Scale). We tested the scale's factor structure (confirmatory factor analysis based on 11 diagnostic criteria), internal consistency, and construct and incremental validity.

RESULTS

Prevalence of FA was 8.2%. Our results supported a 1-factor structure similar to the US version. In both its diagnostic and symptom count versions, the YFAS 2.0 had good internal consistency (Kuder-Richardson alpha was 0.83) and was associated with body mass index (BMI), binge eating, uncontrolled and emotional eating, binge eating disorder, and cognitive restraint. FA predicted BMI above and beyond binge eating frequency. Females had a higher prevalence of FA than males but not more FA symptoms.

CONCLUSIONS

We validated a psychometrically sound French version of the YFAS 2.0 in a nonclinical population, in both its symptom count and diagnostic versions. Future studies should investigate psychometric properties of this questionnaire in clinical populations potentially at risk for FA (that is, patients with obesity, diabetes, hypertension, or other metabolic syndrome risk factors).

Food cravings in everyday life: An EMA study on snack-related thoughts, cravings, and consumption

Food craving refers to an intense desire to consume a specific food and is regularly experienced by the majority of individuals. Yet, there are interindividual differences in the frequency and intensity of food craving experiences, which is often referred to as trait food craving. The characteristics and consequences of trait and state food craving have mainly been investigated in questionnaire-based and laboratory studies, which may not reflect individuals' behavior in daily life. In the present study, sixty-one participants completed the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) as measure of trait food craving, followed by seven days of Ecological Momentary Assessment (EMA), during which they reported snack-related thoughts, craving intensity, and snack consumption at five times per day. Results showed that 86 percent of reported snacks were high-caloric, with chocolate-containing foods being the most often reported snacks. Individuals with high FCQ-T-r scores (high trait food cravers, HCs) thought more often about high-calorie than low-calorie snacks whereas no differences were found in individuals with low FCQ-T-r scores (low trait food cravers, LCs). Further, the relationship between craving intensity and snack-related thoughts was stronger in HCs than in LCs. Higher craving intensity was associated with more consumption of snacks and again this relationship was stronger in HCs than in LCs. Finally, more snack-related thoughts were related to more frequent consumption of snacks, independent of trait food craving. Thus, HCs are more prone to think about high-calorie snacks in their daily lives and to consume more snack foods when they experience intense cravings, which might be indicative of a heightened responding towards high-calorie foods. Thus, trait-level differences as well as snack-related thoughts should be targeted in dietary interventions.

Prevalence of 'Food Addiction' as Measured with the Yale Food Addiction Scale 2.0 in a Representative German Sample and Its Association with Sex, Age and Weight Categories

BACKGROUND/AIMS

To assess the prevalence and correlates of addictive-like eating behavior in Germany.

METHODS

The German version of the Yale Food Addiction Scale (YFAS) 2.0 was used to investigate, for the first time, the prevalence of 'food addiction' in a representative sample aged 18-65 years (N = 1,034).

RESULTS

The prevalence of 'food addiction' measured by the YFAS 2.0 was 7.9%. Individuals meeting criteria for 'food addiction' had higher BMI and were younger than individuals not meeting the threshold. Underweight (15.0%) and obese (17.2%) individuals exhibited the highest prevalence rate of 'food addiction'. Addictive-like eating was not associated with sex, education level, or place of residence.

CONCLUSION

YFAS 2.0 'food addiction' was met by nearly 8% of the population. There is a non-linear relationship between addictive-like eating and BMI, with the highest prevalence among underweight and obese persons. These findings suggest that 'food addiction' may be a contributor to overeating but may also reflect a distinct phenotype of problematic eating behavior not synonymous with obesity. Further, the elevated prevalence of YFAS 2.0 'food addiction' among underweight individuals may reflect an overlap with eating disorders and warrants attention in future research.

Attentional and motor impulsivity interactively predict 'food addiction' in obese individuals

BACKGROUND

Impulsivity is a multifaceted construct and constitutes a common risk factor for a range of behaviors associated with poor self-control (e.g., substance use or binge eating). The short form of the Barratt Impulsiveness Scale (BIS-15) measures impulsive behaviors related to attentional (inability to focus attention or concentrate), motor (acting without thinking), and non-planning (lack of future orientation or forethought) impulsivity. Eating-related measures appear to be particularly related to attentional and motor impulsivity and recent findings suggest that interactive effects between these two facets may play a role in eating- and weight-regulation.

METHODS

One-hundred thirty-three obese individuals presenting for bariatric surgery (77.4% female) completed the BIS-15 and the Yale Food Addiction Scale (YFAS) 2.0, which measures addiction-like eating based on the eleven symptoms of substance use disorder outlined in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

Sixty-three participants (47.4%) were classified as being 'food addicted'. Scores on attentional and motor impulsivity interactively predicted 'food addiction' status: higher attentional impulsivity was associated with a higher likelihood of receiving a YFAS 2.0 diagnosis only at high (+1 SD), but not at low (-1 SD) levels of motor impulsivity.

CONCLUSIONS

Results support previous findings showing that non-planning impulsivity does not appear to play a role in eating-related self-regulation. Furthermore, this is the first study that shows interactive effects between different impulsivity facets when predicting 'food addiction' in obese individuals. Self-regulatory failure in eating-regulation (e.g., addiction-like overeating) may particularly emerge when both attentional and motor impulsivity levels are elevated.

Assessing the psychometric properties of two food addiction scales

BACKGROUND

While food addiction is well accepted in popular culture and mainstream media, its scientific validity as an addictive behavior is still under investigation. This study evaluated the reliability and validity of the Yale Food Addiction Scale and Modified Yale Food Addiction Scale using data from two community-based convenience samples.

METHODS

We assessed the internal and test-retest reliability of the Yale Food Addiction Scale and Modified Yale Food Addiction Scale, and estimated the sensitivity and negative predictive value of the Modified Yale Food Addiction Scale using the Yale Food Addiction Scale as the benchmark. We calculated Cronbach's alphas and 95% confidence intervals (CIs) for internal reliability and Cohen's Kappa coefficients and 95% CIs for test-retest reliability.

RESULTS

Internal consistency (n=232) was marginal to good, ranging from α=0.63 to 0.84. The test-retest reliability (n=45) for food addiction diagnosis was substantial, with Kappa=0.73 (95% CI, 0.48-0.88) (Yale Food Addiction Scale) and 0.79 (95% CI, 0.66-1.00) (Modified Yale Food Addiction Scale). Sensitivity and negative predictive value for classifying food addiction status were excellent: compared to the Yale Food Addiction Scale, the Modified Yale Food Addiction Scale's sensitivity was 92.3% (95% CI, 64%-99.8%), and the negative predictive value was 99.5% (95% CI, 97.5%-100%).

CONCLUSIONS

Our analyses suggest that the Modified Yale Food Addiction Scale may be an appropriate substitute for the Yale Food Addiction Scale when a brief measure is needed, and support the continued use of both scales to investigate food addiction.

General Habit Propensity Relates to the Sensation Seeking Subdomain of Impulsivity But Not Obesity

According to dual-system theory, instrumental learning and performance depend on the balance between goal-directed and habitual action control. Overreliance on habits has been argued to characterize clinical conditions such as drug addiction or obsessive-compulsive disorder as well as obesity and excessive impulsivity. A tendency toward habitual action control in obesity has already been indicated in the food domain. However, impairments might not be restricted to eating behavior. This has been suggested by domain-general obesity-associated disturbances in executive function as well as alterations in corticostriatal circuits underlying the goal-directed and habitual systems. In this study we examined the balance of goal-directed and habitual action control in a sample of normal-weight, overweight, and obese participants (n = 105) using the slips-of-action test in a non-food context. We tested for continuous or group-based associations between body weight status (BMI) and the devaluation sensitivity index (DSI), a parameter representing the balance of the goal-directed and habitual systems in action control. As personality differences in the domain of impulsivity might affect this relationship, we also examined whether the interaction between BMI and self-reported impulsivity, based on the UPPS Impulsive Behavior Scale, was related to the DSI. In addition to that, we tested for direct, i.e., weight status independent, relationships between UPPS subdomains of impulsivity and the DSI. We failed to find evidence for a relationship between weight status and sensitivity to devaluation as indexed by the DSI. However, independent of weight status, we observed lower sensitivity to devaluation in sensation seekers, a subtype of impulsivity. To conclude, behavioral flexibility in the sense of disturbances in the balance between the habitual and goal-directed systems seems to be unaffected by weight status in a non-food context. Consequently, stimuli and behavior might not be generally excessively linked in overweight or obesity. However, according to ceiling effects we cannot rule out subtle effects the paradigm was not able to disentangle. Further, future studies are needed to clarify the role of specific subtypes of obesity (e.g., food addiction). The indicated habit propensity in sensation seekers may account for previous reports of weak avoidance behavior and risky decision making.

The German Version of the Dutch Eating Behavior Questionnaire: Psychometric Properties, Measurement Invariance, and Population-Based Norms

The Dutch Eating Behavior Questionnaire is an internationally widely used instrument assessing different eating styles that may contribute to weight gain and overweight: emotional eating, external eating, and restraint. This study aimed to evaluate the psychometric properties of the 30-item German version of the DEBQ including its measurement invariance across gender, age, and BMI-status in a representative German population sample. Furthermore, we examined the distribution of eating styles in the general population and provide population-based norms for DEBQ scales. A representative sample of the German general population (N = 2513, age ≥ 14 years) was assessed with the German version of the DEBQ along with information on sociodemographic characteristics and body weight and height. The German version of the DEQB demonstrates good item characteristics and reliability (restraint: α = .92, emotional eating: α = .94, external eating: α = .89). The 3-factor structure of the DEBQ could be replicated in exploratory and confirmatory factor analyses and results of multi-group confirmatory factor analyses supported its metric and scalar measurement invariance across gender, age, and BMI-status. External eating was the most prevalent eating style in the German general population. Women scored higher on emotional and restrained eating scales than men, and overweight individuals scored higher in all three eating styles compared to normal weight individuals. Small differences across age were found for external eating. Norms were provided according to gender, age, and BMI-status. Our findings suggest that the German version of the DEBQ has good reliability and construct validity, and is suitable to reliably measure eating styles across age, gender, and BMI-status. Furthermore, the results demonstrate a considerable variation of eating styles across gender and BMI-status.

[Food addiction: Definition, measurement and limits of the concept, associated factors, therapeutic and clinical implications]

Addictions, which are characterized by the inability to control a behavior despite existence of physical or psychological consequences, have biological, psychological and social determinants. Although the possibility of developing an addiction to some psychoactive substances (e.g. alcohol, tobacco, cannabis) and to gambling (i.e., gambling disorder) is now well demonstrated, the possibility to develop a non-drug addiction (i.e., behavioral addiction) to certain behaviors which provide pleasure (e.g. eating, having sex, buying things) is still in debate. The concept of food addiction, which refers to people who exhibit substance dependence criteria in relation to some high-fat and high-sugar foods, was recently proposed by applying substance dependence DSM criteria to eating behavior. To assess food addiction, the Yale Food Addiction Scale is now the only self-administered questionnaire (diagnosis and estimate of the number of symptoms of food addiction). Prevalence for food addiction is higher in overweight and obese patients, and in patients with certain psychopathological characteristics (i.e., depression, Attention Deficit Hyperactivity Disorder, high impulsivity), in patients who are single and in patients with neurobiological alterations in the reward system. However, it is still unclear whether food addiction is necessary associated with subsequent increase in body weight and/or obesity. An increasing number of studies demonstrated that drug addiction and food addiction shares some similar clinical, neurobiological and psychopathological and sociocultural risk factors. To test the pertinence to include food addiction as an addiction, it would be interesting to conduct future studies in patients who may experience harms related to their food addiction, including not only patients with obesity, but also patients with metabolic syndrome, type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, stroke, or coronary heart disease. Food addiction is a clinical and multidimensional concept which requires integrated care with psychotherapy, pharmacological and social lines of approach. This concept has also practical implications in terms of prevention and public health (e.g., prevention, brief interventions, possible law enforcement regarding some kinds of food which could present some addictive properties).

Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients

OBJECTIVE

Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation.

METHOD

Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling.

RESULTS

The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms.

DISCUSSION

Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

The stability of 'food addiction' as assessed by the Yale Food Addiction Scale in a non-clinical population over 18-months

The Yale Food Addiction Scale (YFAS) is a widely used tool to assess the behavioural indicators of addictive-like eating. No studies, however, have used a longitudinal design to determine whether these addictive-like eating behaviours are a stable or transient phenomenon in a community-based population. This study aimed to evaluate whether food addiction Diagnosis and Symptom scores as assessed by the YFAS remain stable over 18-months in a non-clinical population. Young adults aged 18-35 years were recruited from the community to a web-based survey in 2013. The survey included demographics, anthropometrics and the YFAS. Participants who volunteered to be recontacted for future research were invited to complete the same survey 18-months later. The YFAS scoring outputs Diagnosis and Symptom scores were tested for agreement and reliability between the two time points. Of the 303 participants who completed the original survey and agreed to be recontacted, 69 participants (22.8% of those recontacted, 94% female, 67% normal weight at baseline) completed the 18-month follow-up survey. At baseline, thirteen participants met the YFAS predefined criteria for Diagnosis, while eleven participants met these criteria at the 18-month follow-up. YFAS Diagnosis was found to have moderate agreement [K = .50, 95% CI (.23, .77)] between the two time points while Symptom scores had good agreement [K = .70, 95% CI (.54, .83)]. Intraclass correlation coefficients were interpreted as moderate over the 18-month period for both the Diagnosis [ICC = .71, 95% CI (.45, .88)] and Symptom scores [ICC = .72, 95% CI (.58, .82)]. YFAS assessed food addiction Diagnosis and Symptom scores were found to be relatively stable over 18-months in a non-clinical population of predominantly female, young adults. Future research is required to determine the impact of behavioural weight loss interventions on YFAS assessed addictive-like eating.

The Chinese version of the Yale Food Addiction Scale: An examination of its validation in a sample of female adolescents

INTRODUCTION

The present study developed and tested a Chinese version of the Yale Food Addiction Scale (YFAS-R-C) in a sample of female normal-school students, with the aim of producing a psychometrically sound tool for assessing food addiction in female adolescents.

METHODS

A preliminary study of 72 normal-school students tested the YFAS-R-C and collected suggestions to improve it. Twenty days later, the formal YFAS-R-C, the Binge Eating Scale (BES), Eating Attitude Test (EAT-26), BIS/BAS Reactivity (BIS/BAS) scale, and Regulatory Emotional Self-efficacy (RES) scale were administrated to a sample of 950 normal-school students. Test-retest reliability was assessed in 53 students who took the YFAS-R-C twice.

RESULTS

The single factor structure of the YFAS-R-C could be confirmed in our study. The internal consistency (KR-20) for 21 original items (0.857) and diagnostic criteria (0.75) were good. Confirmatory factor analysis verified a one-factor structure with an acceptable fit. The test-retest reliability of the YFAS-R-C was good, with interclass correlations of 0.72 for symptom items and 0.69 for the diagnostic criteria. The YFAS-R-C had good convergent and discriminant validity: symptom and diagnosis versions both had significant correlations with measures of related eating behavior constructs (BES and EAT-26), but had no or moderate correlations with measures of related, yet separate constructs (BIS/BAS and RES).

DISCUSSION

The results indicate the YFAS-R-C has a good psychometric validity to differentiate population with and without food addiction in a group of female normal-school students. Future studies should validate the YFAS-R-C in diverse samples.

[Food addiction - substance use disorder or behavioral addiction?]

This article looks at food addiction as a subject situated between psychiatry, neurobiology, nutritional science, internal medicine, food industry, and public health. Essentially, the question is whether or not individual nutritional components can induce physical dependence, similar to the well-known effects of drugs such as alcohol and cocaine, or whether food addiction is rather a behavioral addiction. The literature describes many overlaps as well as differences of substance-based and non-substance-based addiction in both clinical and neurobiological terms. Until recently it was argued that food addiction appears only in the realms of obesity and eating disorders (e.g., binge-eating disorder, BED). Some studies, however, described the prevalence of food addiction symptoms and diagnoses independent of overweight or that they were in subjects who do not fulfill the criteria for BED. This article sums up the controversial discussion about the phenomenological and neurobiological classification of food addiction. Implications of food addiction for children and adolescents as well as public-health-related issues are also discussed.

Food addiction in overweight and obese adolescents seeking weight-loss treatment

Some forms of overeating closely resemble addictive behaviour. The Yale Food Addiction Scale (YFAS) was developed to measure such addiction-like eating in humans and has been employed in numerous studies for examining food addiction in adults. Yet, little is known about food addiction in children and adolescents. Fifty adolescents were recruited at the beginning of treatment in a weight-loss hospital and completed the YFAS among other questionnaires. Nineteen participants (38%) received a YFAS diagnosis, who did not differ in age, body mass and gender distribution from those not receiving a diagnosis. However, those with food addiction reported more binge days, more frequent food cravings, higher eating, weight and shape concerns, more symptoms of depression and higher attentional and motor impulsivity. Eating restraint and nonplanning impulsivity did not differ between groups. Results replicate findings from studies in obese adults such that food addiction is not related to age, gender, body mass or eating restraint, but to higher eating pathology, more symptoms of depression and higher impulsivity. Furthermore, results highlight that particularly attentional impulsivity is related to 'food addiction'. Addiction-like eating appears to be a valid phenotype in a substantial subset of treatment-seeking, obese adolescents.

Psychometric properties of the Italian Yale Food Addiction Scale in overweight and obese patients

AIM

To assess the dimensionality and psychometric properties of an Italian version of the Yale Food Addiction Scale (YFAS) in a sample of obese/overweight patients attending low-energy diet therapy.

METHODS

Participants were 300 overweight and obese patients who were admitted to a private medical center in Rome, Italy. Controls were 300 (231 women and 69 men) adults from the general population. All of the participants were administered the YFAS and the binge eating scale (BES).

RESULTS

The one-factor model of the YFAS reported in previous studies did not fit the data χ(2)(209) = 466.69, p < 0.001, root mean square error of approximation (RMSEA) = 0.07; 90% CI: 0.06/0.08; comparative fit index (CFI) = 0.91; weighted root mean square residual (WRMR) = 1.40]. Through item analysis, it was suggested that five items (items #10, #11, #22, #24, and #25) with low item-total correlations should be removed from the measure. A 16-item one-factor model revealed a better fit to the data (χ(2)(104) = 174.56; p < 0.001; RMSEA = 0.05; 90% CI: 0.04/0.07; CFI = 0.96), although the WRMR was slightly higher than that suggested as an indicator of good fit (WRMR = 1.01). The YFAS-16 had satisfactory internal consistency; it was able to discriminate obese patients from controls and strongly correlated with BES scores.

CONCLUSION

The YFAS-16 assesses all of the "symptoms" represented in the original version and has satisfactory psychometric properties, although the percentage of food addiction diagnoses according to the YFAS-16 is lower than the percentage of diagnoses according to the original version of the questionnaire.

Hormonal and dietary characteristics in obese human subjects with and without food addiction

The concept of food addiction (FA) is a potentially important contributing factor to the development of obesity in the general population; however, little is known about the hormonal and dietary differences between obesity with and without FA. Therefore, the aim of our study was to explore potential biomarkers, including various hormones and neuropeptides, which regulate appetite and metabolism, and dietary components that could potentially differentiate obesity with and without FA. Of the 737 adults recruited from the general Newfoundland population, 58 food-addicted and non-food-addicted overweight/obese individuals (FAO, NFO) matched for age, sex, BMI and physical activity were selected. A total of 34 neuropeptides, gut hormones, pituitary polypeptide hormones and adipokines were measured in fasting serum. We found that the FAO group had lower levels of TSH, TNF-α and amylin, but higher levels of prolactin, as compared to NFO group. The total calorie intake (per kg body weight), the dietary intake of fat (per g/kg body weight, per BMI and per percentage of trunk fat) and the percent calorie intake from fat and carbohydrates (g/kg) was higher in the FAO group compared to the NFO group. The FAO subjects consumed more sugar, minerals (including sodium, potassium, calcium and selenium), fat and its components (such as saturated, monounsaturated and trans fat), omega 3 and 6, vitamin D and gamma-tocopherol compared to the NFO group. To our knowledge, this is the first study indicating possible differences in hormonal levels and micro-nutrient intakes between obese individuals classified with and without food addiction. The findings provide insights into the mechanisms by which FA could contribute to obesity.

Nonnormative eating behavior and psychopathology in prebariatric patients with binge-eating disorder and night eating syndrome

BACKGROUND

Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study sought to investigate the prevalence of BED and NES and associations with various forms of nonnormative eating behavior and psychopathology in prebariatric patients. Within a consecutive multicenter registry study, patients in 6 bariatric surgery centers in Germany were recruited.

METHODS

Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures.

RESULTS

Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Co-morbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge-eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED.

CONCLUSION

BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with nonnormative eating behavior and psychopathology point to their clinical significance and discriminant validity.

Food addiction in the light of DSM-5

The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and-dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if "diagnosing" food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction.

Hormonal and neural mechanisms of food reward, eating behaviour and obesity

With rising rates of obesity, research continues to explore the contributions of homeostatic and hedonic mechanisms related to eating behaviour. In this Review, we synthesize the existing information on select biological mechanisms associated with reward-related food intake, dealing primarily with consumption of highly palatable foods. In addition to their established functions in normal feeding, three primary peripheral hormones (leptin, ghrelin and insulin) play important parts in food reward. Studies in laboratory animals and humans also show relationships between hyperphagia or obesity and neural pathways involved in reward. These findings have prompted questions regarding the possibility of addictive-like aspects in food consumption. Further exploration of this topic may help to explain aberrant eating patterns, such as binge eating, and provide insight into the current rates of overweight and obesity.

Correlates of food addiction in obese individuals seeking bariatric surgery

Recent evidence suggests that palatable, high-calorie foods may have an addictive potential. Accordingly, obesity and overconsumption of such foods have been associated with addiction-like eating behaviour. The present study investigated whether individuals with obesity can be classified as food-addicted and which factors would differentiate between food-addicted and non-addicted individuals. We administered the German version of the Yale Food Addiction Scale and other questionnaires to obese individuals seeking bariatric surgery (N = 96). Results showed that 40% of the sample could be diagnosed as food-addicted. Food-addicted individuals reported more frequent food cravings, higher eating disorder psychopathology and more depressive symptoms than the non-addicted group. Age, body mass and gender distribution did not differ between groups. The food addiction group had higher attentional but similar motor and non-planning impulsivity, and had lower scores on the Alcohol Use Disorders Identification Test (AUDIT) compared with the non-addicted group. Scores on the AUDIT were associated with impulsivity in the non-addicted group only. We conclude that the prevalence of food addiction is higher in candidates for bariatric surgery compared with the general population and obese individuals not seeking bariatric surgery. A diagnosis of food addiction is associated with higher eating pathology and depression. Moreover, only attentional impulsivity, but not other dimensions of impulsivity, is associated with addictive eating. Finally, food addiction and impulsivity interactively predicted alcohol use, suggesting a crucial role of psychological variables and eating style in determining alcohol consumption in pre-bariatric patients, independent of body mass.