Response to "How much does the Addiction-Like eating behaviour scale add to the debate regarding food versus eating addictions?"

Western Diet: Implications for Brain Function and Behavior

The Western diet (WD) pattern characterized by high daily intake of saturated fats and refined carbohydrates often leads to obesity and overweight, and it has been linked to cognitive impairment and emotional disorders in both animal models and humans. This dietary pattern alters the composition of gut microbiota, influencing brain function by different mechanisms involving the gut-brain axis. In addition, long-term exposure to highly palatable foods typical of WD could induce addictive-like eating behaviors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation associated with chronic stress, anxiety, and depression. In turn, chronic stress modulates eating behavior, and it could have detrimental effects on different brain regions such as the hippocampus, hypothalamus, amygdala, and several cortical regions. Moreover, obesity and overweight induce neuroinflammation, causing neuronal dysfunction. In this review, we summarize the current scientific evidence about the mechanisms and factors relating WD consumption with altered brain function and behavior. Possible therapeutic interventions and limitations are also discussed, aiming to tackle and prevent this current pandemic.

Translation and validation of the addiction-like Eating Behavior Scale from English to Portuguese in Brazil

Eating addiction is an important condition related to obesity. The Addiction-like Eating Behavior Scale (AEBS) was recently validated in English to evaluate addictive eating behaviors. To perform the translation, cultural adaptation, and validation of the AEBS scale to Portuguese to identify eating addictions in the Brazilian population. The AEBS translation, adaptation, and validation followed previously published criteria, including the steps of translation, back translation, evaluation by a committee of judges, and a pretest with 40 students. Subsequently, 150 students from the Medical School at the Recife Campus of the Federal University of Pernambuco were tested using the AEBS-Portuguese version (AEBS-p). Of these, 37 were evaluated a second time for a test-retest analysis. For data collection, 5 instruments were used: the AEBS-p, a modified version of the Yale Food Addiction Scale 2.0 (mYFAS 2.0)-Portuguese version, the Patient Health Questionnaire-9, the Binge Eating Scale (BES), and the Socio-demographic Questionnaire. The AEBS-p showed good reliability, based on a significant internal consistency value (Cronbach's alpha = 0.91), and good correlation in the test-retest evaluation. A committee of judges considered the content validity appropriate. Convergent validation was positive with the mYFAS 2.0 and BES (p < 0.001). The AEBS-p showed a significant correlation with body mass index (BMI) (p < 0.001) and significantly predicted variance in BMI that was accounted for by both the mYFAS 2.0 and BES (p = 0.022). The AEBS-p demonstrated good reliability and validity for evaluating addictive eating behaviors in the Brazilian population.

Food addiction, eating addiction and eating disorders

The concept of food addiction is currently a highly debated subject within both the general public and the scientific communities. The term food addiction suggests that individuals may experience addictive-like responses to food, similar to those seen with classic substances of abuse. An increasing number of studies have established the prevalence and correlates of food addiction. Moreover, food addiction may be associated with obesity and disordered eating. Thus, intervening on food addiction may be helpful in the prevention and therapy of obesity and eating disorders. However, controversy exists about if this phenomenon is best defined through paradigms reflective of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) substance-related disorders (e.g. food addiction) or non-substance-related disorders (e.g. eating addiction) criteria. This review paper will give a brief summarisation of the current state of research on food addiction, a more precise definition of its classification, its differentiation from eating addiction and an overview on potential overlaps with eating disorders. Based on this review, there is evidence that food addiction may represent a distinct phenomenon from established eating disorders such as bulimia nervosa or binge-eating disorder. Future studies are needed to further examine and establish orthogonal diagnostic criteria specific to food addiction. Such criteria must differentiate the patterns of eating and symptoms that may be similar to those of eating disorders to further characterise food addiction and develop therapy options. To date, it is too premature to draw conclusions about the clinical significance of the concept of food addiction.