Food addiction and bariatric surgery: a systematic review of the literature

The burden of overweight/obesity and weight-related behaviors attributable to food addiction in emerging adults

While food addiction has been positively associated with excess weight and disordered eating behaviors, this has not been examined in representative samples of emerging adults, who are at elevated risk for these outcomes. This study investigated relationships of food addiction with weight outcomes, weight perception, and weight-control behaviors in emerging adults and estimated the population attributable fraction to food addiction. Data from an observational cohort study were collected in seven annual waves from 2010 to 2016. A nationally representative sample of 2785 10th grade students was recruited from schools within each U.S. census region (73% participation) (mean ± SD baseline age = 16.3 ± 0.5years). Wave 7 retention was 81% (n = 2323, 60% female, mean ± SD = 22.6 ± 0.5 years). Outcomes included current BMI, BMI change from baseline - wave 7, increased weight status in wave 7 (increased weight status from baseline-wave 7), perceived overweight, dieting, any weight-control behavior, and extreme weight-control behaviors. Food addiction was measured in wave 7 using the modified Yale Food Addiction Scale. Relative risk of the outcomes associated with food addiction, and population attributable fraction, were estimated using adjusted log-binomial or robust Poisson regression analyses accounting for the complex survey design. Food addiction prevalence was 4.7%. Participants with food addiction were primarily females (91%); food addiction was uncorrelated with other sociodemographics. Food addiction was associated with 48%-167% increased RR for all outcomes, but these were attenuated after adjustment for confounders (31%-64%). The population attributable fraction for food addiction ranged from 2% (high wave 7 BMI) - 5% (extreme weight-control behaviors). Although the population attributable fraction estimates indicate that the public health burden of these outcomes attributable to food addiction may be relatively minor, food addiction may signal the presence of several adverse mental health symptoms.

Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality

BACKGROUND AND AIMS

Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up.

METHODS

A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk.

RESULTS

A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04-1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07-1.85)] and used other drugs (OR=2.65 [95% CI: 1.74-4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25-7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86-14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67-6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025).

CONCLUSIONS

The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.

Effects of Vertical Sleeve Gastrectomy on Weight Loss, Eating Behaviors, and Weight Concern Eight Months Postsurgery

OBJECTIVES

Following vertical sleeve gastrectomy (VSG), the role of eating behaviors in weight regain remains unclear. This study aimed to examine the effects of VSG on excess weight loss (EWL) and five eating-related variables (food addiction, disinhibition, susceptibility to hunger, dietary restraint, and weight concern) while exploring their associations before and eight months post-surgery.

MATERIALS AND METHODS

A sample of 76 participants who underwent VSG was recruited from a healthcare center in Quebec, Canada. Measurements included body mass index (BMI), the Eating Disorder Examination (weight concern), the Yale Food Addiction Scale (food addiction), and the Three-Factor Eating Questionnaire (disinhibition, susceptibility to hunger, and dietary restraint). T-tests were conducted between pre-surgery (T0) and eight-month post-surgery (T8), and correlations were examined between T0 and T8, within T0, and within T8.

RESULTS

The mean EWL was 63.43% ± 13.14 at T8. Comparisons between T0 and T8 showed a significant decrease in food addiction, disinhibition, and susceptibility to hunger (p = 0.001-0.005). No significant differences were observed for dietary restraint and weight concerns. BMI at T0 was negatively correlated with EWL at T8 (r = -0.45). Within T0, a negative correlation was observed between food addiction and dietary restraint (r = -0.42), which changed from negative to positive within T8 (r = 0.35).

CONCLUSIONS

This study confirmed that VSG is effective for weight loss and associated with a reduction in maladaptive eating behaviors. Postsurgery, individuals with greater food addiction exhibited more dietary restraint, suggesting a need for restraint among those experiencing a strong drive toward food. However, weight concerns remained high even after significant weight loss, indicating that weight loss alone may not be sufficient for change. A postsurgery medical follow-up focusing on overall well-being and lifestyle adaptation would be a crucial complement.

Current perspectives on brain circuits involved in food addiction-like behaviors

There is an emerging view that the increased availability of energy-dense foods in our society is contributing to excessive food consumption which could lead to food addiction-like behavior. Particularly, compulsive eating patterns are predominant in people suffering from eating disorders (binge-eating disorder, bulimia and anorexia nervosa) and obesity. Phenotypically, the behavioral pattern exhibits a close resemblance to individuals suffering from other forms of addiction (drug, sex, gambling). Growing body of evidence in neuroscience research is showing that excessive consumption of energy-dense foods alters the brain circuits implicated in reward, decision-making, control, habit formation, and emotions that are central to drug addiction. Here, we review the current understanding of the circuits of food addiction-like behaviors and highlight the future possibility of exploring those circuits to combat obesity and eating disorders.

Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

BACKGROUND

Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed.

OBJECTIVES

The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB).

SETTING

Integrated multispecialty health system, United States.

METHODS

Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared.

RESULTS

Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m).

CONCLUSIONS

Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort.

Obesity surgery and neural correlates of human eating behaviour: A systematic review of functional MRI studies

Changes in eating behaviour including reductions in appetite and food intake, and healthier food cue reactivity, reward, hedonics and potentially also preference, contribute to weight loss and its health benefits after obesity surgery. Functional magnetic resonance imaging (fMRI) has been increasingly used to interrogate the neural correlates of eating behaviour in obesity, including brain reward-cognitive systems, changes after obesity surgery, and links with alterations in the gut-hormone-brain axis. Neural responses to food cues can be measured by changes in blood oxygen level dependent (BOLD) signal in brain regions involved in reward processing, including caudate, putamen, nucleus accumbens, insula, amygdala, orbitofrontal cortex, and top-down inhibitory control, including dorsolateral prefrontal cortex (dlPFC). This systematic review aimed to examine: (i) results of human fMRI studies involving obesity surgery, (ii) important methodological differences in study design across studies, and (iii) correlations and associations of fMRI findings with clinical outcomes, other eating behaviour measures and mechanistic measures. Of 741 articles identified, 23 were eligible for inclusion: 16 (69.6%) longitudinal, two (8.7%) predictive, and five (21.7%) cross-sectional studies. Seventeen studies (77.3%) included patients having Roux-en-Y gastric bypass (RYGB) surgery, six (26.1%) vertical sleeve gastrectomy (VSG), and five (21.7%) laparoscopic adjustable gastric banding (LAGB). The majority of studies (86.0%) were identified as having a very low risk of bias, though only six (27.3%) were controlled interventional studies, with none including randomisation to surgical and control interventions. The remaining studies (14.0%) had a low risk of bias driven by their control groups not having an active treatment. After RYGB surgery, food cue reactivity often decreased or was unchanged in brain reward systems, and there were inconsistent findings as to whether reductions in food cue reactivity was greater for high-energy than low-energy foods. There was minimal evidence from studies of VSG and LAGB surgeries for changes in food cue reactivity in brain reward systems, though effects of VSG surgery on food cue reactivity in the dlPFC were more consistently found. There was consistent evidence for post-operative increases in satiety gut hormones glucagon-like-peptide 1 (GLP-1) and peptide YY (PYY) mediating reduced food cue reactivity after RYGB surgery, including two interventional studies. Methodological heterogeneity across studies, including nutritional state, nature of food cues, post-operative timing, lack of control groups for order effects and weight loss or dietary/psychological advice, and often small sample sizes, limited the conclusions that could be drawn, especially for correlational analyses with clinical outcomes, other eating behaviour measures and potential mediators. This systematic review provides a detailed data resource for those performing or analysing fMRI studies of obesity surgery and makes suggestions to help improve reporting and design of such studies, as well as future directions.

Co-occurrence of food addiction, obesity, problematic substance use, and parental history of problematic alcohol use

OBJECTIVE

The present study investigates the rates of co-occurrence among food addiction (FA), problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping), parental history of problematic alcohol use, and obesity as an important step to understanding whether an addictive-like eating phenotype exists.

METHOD

A community sample of 357 U.S. adults (49.7% male, 77.6% White, Mage 40.7) completed the Yale Food Addiction Scale 2.0 (YFAS2.0), the Alcohol Use Disorders Identification Test, the Cannabis Use Disorders Identification Test, the Fagerstrom Test for Nicotine Dependence, the E-Cigarette Dependence Scale, the Family Tree Questionnaire, and demographic/self-report body mass index questions through Amazon Mechanical Turk. Risk ratios (RRs; unadjusted and adjusted for sociodemographic covariates) were calculated using modified Poisson's regression.

RESULTS

Risk of FA was higher in participants with problematic alcohol use (RR = 2.13, 99% CI [1.32, 3.45]), smoking (RR = 1.86, 99% CI [0.82, 3.36]), cannabis use (unadjusted; RR = 2.22, 99% CI [1.17, 4.18]), vaping (RR = 2.71, 99% CI [1.75, 4.21]), and parental history of problematic alcohol use (RR = 2.35, 99% CI [1.46, 3.79]). Risk of FA in participants with obesity was only higher in adjusted models (RR = 1.87, 99% CI [1.06, 3.27]). Obesity was not significantly associated with problematic substance use and parental history of problematic alcohol use.

CONCLUSIONS

FA, but not obesity, co-occurred with problematic substance use and a parental history of problematic alcohol use. Results support the conceptualization of FA as an addictive disorder. The inclusion of FA as an addictive disorder in diagnostic frameworks is an important area of future consideration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Towards precision medicine in bariatric surgery prescription

Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.

Associations of Food Addiction Symptomatology and Disordered Eating Behaviors in a Pre-Surgical Bariatric Population

The construct of food addiction (FA) has been highly debated in recent years particularly in the fields of disordered eating, medical weight management, and bariatric surgery. Some researchers have argued that FA symptoms are distinct, highly prevalent, and present a barrier for patients seeking medical treatment for obesity. The purpose of this study is to evaluate the cross-sectional associations between FA symptomatology, binge eating disorder (BED) and other appetitive traits, as well as dietary quality in a sample of adults with obesity seeking bariatric surgery. This post hoc analysis was conducted on a prospectively collected dataset from August 2020 to August 2022 at a single academic medical center. Descriptive statistics were used to characterize the sample. Additional analyses included: correlation coefficients, multivariable linear regression, and analysis of variance. A total of 587 patients were included in this analysis with low average scores for FA symptoms (mean: 1.48; standard deviation (SD): 2.15). Those with no BED symptoms had the lowest average FA symptoms scores (mean: 0.87; SD: 1.52) and those with both bingeing and LOCE had the highest average scores (mean: 3.35; SD: 2.81). This finding supports the hypothesis that, while related, FA and BED may represent different cognitions and behaviors.

Prevalence and Correlates of Food Addiction in Bariatric Surgery Candidates and Its Effect on Bariatric Surgery Outcome: A Prospective Observational Study

PURPOSE

Studies have shown a high prevalence of food addiction (FA) in bariatric surgery candidates. This study examines prevalence of FA prior to and one year after bariatric surgery and the determinants of preoperative FA. Additionally, this study investigates how preoperative variables affect excess weight loss (EWL) one year after bariatric surgery.

MATERIALS AND METHODS

This prospective observational study included 102 patients at an obesity surgery clinic. Self-report measures, including demographic characteristics, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the Depression Anxiety Stress Scale (DASS-21), and the Dutch Eating Behavior Questionnaire (DEBQ) were used two weeks before and one year after surgery.

RESULTS

The FA prevalence among bariatric surgery candidates decreased from 43.6% before surgery to 9.7% one year after surgery. Among independent variables, female gender and anxiety symptoms were associated with FA (OR = 4.20, 95% CI: 1.35-24.16, p = 0.028 and OR = 5.29, 95% CI: 1.49-18.81, p = 0.010, respectively). Only gender had a significant association with %EWL after surgery (p = 0.022); females had a higher mean %EWL than males.

CONCLUSION

FA is common among candidates for bariatric surgery, especially in women and participants with anxiety symptoms. The prevalence of FA, emotional eating, and external eating decreased after bariatric surgery.

Food addiction and binge eating disorder are linked to shared and unique deficits in emotion regulation among female seeking bariatric surgery

BACKGROUND

Problematic eating behaviors can indicate obesity-related problems. Food addiction (FA) is not classified as an official diagnosis. However, given the many commonalities between FA and binge-eating disorder (BED) within the context of obesity, it is imperative to conduct a comparative investigation. The current study aimed to identify overlapping and distinctive features in emotion dysregulation as an underlying mechanism and emotional eating as a clinical feature among four groups of females with obesity seeking bariatric surgery.

METHODS

Data on emotion dysregulation and emotional eating were derived from the total 128 Females with obesity seeking bariatric surgery (Mage = 38.91 ± 10.59, MBMI = 42.10 kg/m2 ± 4.43) divided into four groups: those with FA (n = 35), BED (n = 35), BED + FA (n = 31) and a control group of individuals with obesity only (OB; n = 27), using well-established measures.

RESULTS

Regarding descriptive statistics, the BED + FA group showed the highest levels of emotional dysregulation (M = 111.09) and emotional eating (M = 46.80), while the OB group acquired the lowest scores (M = 70.44 and M = 27.29, respectively). Univariate analyses of variance revealed significant differences between the four groups in terms of emotion dysregulation F(3, 124) = 24.63, p < .01 and emotional eating F(3, 124) = 26.26, p < .01. All of the emotion dysregulation domains revealed significant differences too. Pairwise comparisons using Bonferroni post hoc tests did not reveal any significant differences between BED + FA and BED groups, while all of our other hypotheses regarding this matter were confirmed.

CONCLUSIONS

The study found that individuals with obesity and comorbid BED exhibit greater emotional dysregulation compared to those with OB or FA, indicating a need to assess BED in individuals with obesity. Emotion dysregulation may be linked to increased BED and FA, but those with BED seem more affected by limited access to emotion regulation strategies. These findings support the notion that PEBs are associated with emotion dysregulation and underscore the need for tailored interventions that target emotion regulation skills before and after bariatric surgery.

Effects of probiotic supplementation with weight reducing intervention on anthropometric measures, body composition, eating behavior, and related hormone levels in patients with food addiction and weight regain after bariatric surgery: a study protocol for a randomized clinical trial

BACKGROUND

One of the unfortunate events after bariatric surgery is the weight regain, which occurs in some patients. Food addiction is an eating disorder related to the brain-intestinal axis and can be effective in weight regain after bariatric surgery. In addition, the gut microbiome plays a vital role in eating behaviors, including food addiction. So, this study will aim to evaluate the effects of probiotic supplementation with a weight-reducing diet and cognitive behavioral therapy on anthropometric measures, body composition, eating behavior, and related hormone levels, leptin, oxytocin, and serotonin, in patients with food addiction and weight regain after bariatric surgery.

METHODS

We will carry out a triple-blinded randomized clinical trial for 12 weeks to evaluate the effect of probiotic supplementation with a weight-reducing diet and cognitive behavioral therapy on anthropometric measures, body composition, eating behavior, and related hormone levels including leptin, oxytocin, and serotonin, in patients with food addiction and weight regain after bariatric surgery.

DISCUSSION

Based on the available evidence, probiotic supplementation by modifying the intestinal microbiome can improve food addiction and subsequent weight loss.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20220406054437N1 Registered on 2022-06-01.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

Problematic alcohol use in post-bariatric patients - a qualitative study

BACKGROUND

Research shows an increased risk of alcohol use disorders in post-bariatric patients. This study aims to gain insight into what post-bariatric patients receiving treatment for substance use think are the possible causes for developing problematic alcohol consumption after surgery.

MATERIAL AND METHOD

Ten in-depth interviews were held with post-bariatric patients receiving treatment for substance use in 2020 (six men and four women). The data material was transcribed and analysed using the stepwise deductive-inductive (SDI) method.

RESULTS

The participants first started to experience problematic alcohol consumption after bariatric surgery. They described new, intense feelings of intoxication and how their body responded differently to alcohol. Alcohol now functioned as an appetite stimulant, pain reliever and food replacement. Most participants had positive experiences during the initial post-operative period, but they described an ambivalence towards their bodily changes and an increased mental vulnerability in the years following the surgery.

INTERPRETATION

The new effect and function of alcohol after the procedure may have made the participants more vulnerable to problematic alcohol consumption.

Disordered Eating Behaviors Related to Food Addiction/Eating Addiction in Inpatients with Obesity and the General Population: The Italian Version of the Addiction-like Eating Behaviors Scale (AEBS-IT)

PURPOSE

The purpose of this research is to test the psychometric properties and factorial structure of the Addiction-like Eating Behaviors Scale (AEBS) in an Italian sample of adults with severe obesity seeking treatment for weight reduction and the general population, and to examine the measurement invariance of the tool by comparing a clinical and a nonclinical sample.

METHODS

A confirmatory factor analysis (CFA) was initially conducted to test the factorial structure of the Italian version of the AEBS (AEBS-IT) on a total of 953 participants. Following this, the measurement invariance and psychometric properties of the tool AEBS-IT were assessed on both inpatients with severe obesity (n = 502) and individuals from the general population (n = 451). Reliability and convergent validity analysis were also run.

RESULTS

CFA revealed a bi-factor structure for the AEBS-IT, which also showed good reliability and positive correlations with food addiction (through the mYFAS2.0 symptom count), binge-eating symptoms, compulsive eating behavior, and dysfunctional eating patterns and the individuals' body mass index (BMI). Moreover, the tool was invariant across populations.

CONCLUSION

This study provided evidence that the AEBS-IT is a valid and reliable measure of FA in both clinical and nonclinical samples.

Psychopathology predicts mental but not physical bariatric surgery outcome at 3-year follow-up: a network analysis study

PURPOSE

This study aimed to explore the psychopathological variables that may predict bariatric surgery outcomes after 3 years.

METHODS

One hundred ninety-six candidates for bariatric surgery completed self-report questionnaires to assess eating attitudes, eating disorder (ED)-related psychopathology, affective symptoms, interpersonal and psycho-social functioning. One-hundred patients repeated this assessment 3 years after bariatric surgery. A network analysis was run including the pre-surgical measurements in the network. A composite score derived from the combination of the most central network nodes, as well as clinical and socio-demographical variables, was included in a multivariate regression analysis with weight loss, ED psychopathology and psycho-social functioning as outcomes.

RESULTS

Depression, stress, and shape concerns were the most central network nodes. The composite network score predicted higher ED psychopathology and worse psycho-social functioning at 3-year follow-up, but not weight loss. Higher age, restricting type of bariatric surgery and higher pre-operative BMI were further predictors of reduced weight loss and greater ED psychopathology.

CONCLUSIONS

Affective symptoms and shape concern play a central role in the psychopathology of candidates to bariatric surgery and predict post-surgery ED psychopathology and psycho-social functioning. These variables may allow to identify patients with higher pre-operative risk and in need of further psycho-social interventions.

LEVEL OF EVIDENCE

III, evidence obtained from well-designed cohort study.

Psychometric assessment of Persian translation of Yale Food Addiction Scale Version 2.0 (YFAS 2.0) in Iranian college students

BACKGROUND

Food addiction at the individual level causes physical and mental health problems, impairs individuals' social functioning, and causes dysfunction in the family system. Therefore, a tool to identify this behavioral disorder is one of the health requirements of communities. This research aimed to investigate the psychometric assessment of the Persian translation of Yale Food Addiction Scale Version 2.0 (YFAS 2.0) in Iranian college students.

METHOD

This research was cross-sectional descriptive, and 451 students were selected by convenience sampling method. Yale Food Addiction Scale Version 2.0 (YFAS 2.0), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Food Craving Questionnaire-Trait, reduced (FCQ-T-r) were used to collect data.

RESULTS

The confirmatory factor analysis indicated that single-factor model provides a good fit to data (SRMR = 0.078; CFI = 0.94; NFI = 0.92; IFI = 0.94; RFI = 0.91; GFI = 0.90; RMSEA = 0.078). The YFAS's 2.0 positive correlations with three DASS-21 subscales ranged from 0.30 to 0.39, and Food Craving Questionnaire-Trait, reduced (FCQ-T-r) ranged from 0.58 to 0.72. All correlations were statistically significant, indicating acceptable convergent validity (P < 0.01).

CONCLUSION

The validity of the Persian questionnaire translation has been confirmed. Researchers and specialists can use this scale to diagnose food addiction for research or diagnostic purposes in Iranian society.

Gut-brain mechanisms underlying changes in disordered eating behaviour after bariatric surgery: a review

Bariatric surgery results in long-term weight loss and an improved metabolic phenotype due to changes in the gut-brain axis regulating appetite and glycaemia. Neuroendocrine alterations associated with bariatric surgery may also influence hedonic aspects of eating by inducing changes in taste preferences and central reward reactivity towards palatable food. However, the impact of bariatric surgery on disordered eating behaviours (e.g.: binge eating, loss-of-control eating, emotional eating and 'addictive eating'), which are commonly present in people with obesity are not well understood. Increasing evidence suggests gut-derived signals, such as appetitive hormones, bile acid profiles, microbiota concentrations and associated neuromodulatory metabolites, can influence pathways in the brain implicated in food intake, including brain areas involved in sensorimotor, reward-motivational, emotional-arousal and executive control components of food intake. As disordered eating prevalence is a key mediator of weight-loss success and patient well-being after bariatric surgery, understanding how changes in the gut-brain axis contribute to disordered eating incidence and severity after bariatric surgery is crucial to better improve treatment outcomes in people with obesity.

PROBIOTIC SUPPLEMENTATION ATTENUATES BINGE EATING AND FOOD ADDICTION 1 YEAR AFTER ROUX-EN-Y GASTRIC BYPASS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

AIM

The use of probiotics as adjuvants in the treatment of eating disorders, known as psychobiotics, has already been investigated as a means of modulating the microbiota-gut-brain axis. This study aimed to assess the effect of probiotic supplementation on binge eating and food addiction in subjects after Roux-en-Y gastric bypass surgery.

METHODS

This is a randomized, double-blind, placebo-controlled trial involving 101 patients who received probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) or placebo supplements for 90 days after bariatric surgery, starting on the seventh postoperative day. They were evaluated preoperatively (T0) and postoperatively at 90 days (T1) and 1 year (T2) after surgery. The Yale Food Addiction Scale (YFAS) and Binge Eating Scale (BES) were applied to assess food addiction and binge eating, respectively.

RESULTS

Before surgery, one-third of the patients presented with a food addiction and binge eating diagnosis. The number of symptoms of YFAS and the BES score decreased significantly in both groups at T1 compared to T0. However, a significant effect of treatment with probiotics was observed 1 year after surgery (T2). Both the number of symptoms of food addiction and the binge eating score were lower in the probiotic group than in the placebo group (p=0.037 and p=0.030, respectively).

CONCLUSION

The use of probiotic supplementation for 90 days in the immediate postoperative period may decrease food addiction symptoms and binge eating score up to 1 year after surgery compared to controls.

Food Addiction in Application to Obesity Management

Nascent and rapidly growing research into defining the concept of "food addiction" (FA) in relation to obesity is currently underway. Food addiction is present in a subset of patients who are overweight or have obesity, and its presence is associated with other psychosocial disorders such as depression, anxiety, eating disorders, impulse control disorders, and lower quality of life. Food addiction is associated with higher intake of and preference for highly processed foods that have addictive-like properties such as cravings, reward sensitivity, and impaired control. Food addiction is associated with less weight loss in patients with obesity utilizing diet and lifestyle-related interventions. In clinical practice, identifying the subset of patients with obesity with FA-related psychosocial constraints and continued emphasis on avoiding highly processed foods may improve obesity and weight management outcomes. Food addiction is thought to be an addictive-like phenotype.Food addiction is noted to have significant overlap with substance use disorder (SUD) and other eating disorders, but is currently not classified a diagnosis by DSM-IV and DSM-V criteria.Food addiction has similarities to SUD, such as cravings, reduced control over intake, increased impulsivity and altered reward-sensitivity.The Yale Food Addiction Scale, which is a clinical scale modeled by the DSM-IV and DSM-V criteria for SUD, has been used to quantify and study FA.

Proof of Concept for a Mindfulness-Informed Intervention for Eating Disorder Symptoms, Self-Efficacy, and Emotion Regulation among Bariatric Surgery Candidates

Up to 64% of patients seeking bariatric (weight-loss) surgery report eating disorder (ED) symptoms (addictive-like eating, binge eating, emotional eating, grazing) that can interfere with post-surgical weight loss. This prospective proof-of-concept study aimed to evaluate the impact of a pre-surgical mindfulness-informed intervention (MII) on ED symptoms and potential mechanisms-of-action to inform optimization of the intervention. Surgery-seeking adults attended four, 2-hour, MII sessions held weekly. Participants completed validated questionnaires assessing ED symptoms, eating self-efficacy, emotion regulation, and mindful eating pre-MII, post-MII, and at a 12-week follow-up. The MII consisted of mindfulness training, with cognitive, behavioral, and psychoeducational components. Fifty-six patients (M = 47.41 years old, 89.3% female) participated. Improvements in addictive-like eating, binge eating, emotional eating, and grazing were observed from pre- to post-MII. ED symptom treatment gains were either maintained or improved further at 12-week follow-up. Eating self-efficacy and emotion regulation improved from pre-MII to follow-up. Scores on the mindful eating questionnaire deteriorated from pre-MII to follow-up. In mediation analyses, there was a combined indirect effect of emotion regulation, eating self-efficacy, and mindful eating on grazing and binge eating, and an indirect effect of emotion regulation on emotional eating and addictive-like eating. Participation in the MII was associated with improvements in ED symptoms and some mechanisms-of-action, establishing proof-of-concept for the intervention. Future work to establish the MII's efficacy in a randomized controlled trial is warranted.

Food Addiction and Binge Eating Impact on Weight Loss Outcomes Two Years Following Sleeve Gastrectomy Surgery

BACKGROUND

Emerging evidence suggest that problematic eating behaviors such as food addiction (FA) and binge eating (BE) may alter following bariatric surgery (BS) and impact weight outcomes. We aimed to examine the prevalence of FA and BE and their associations with weight outcomes 2 years post-sleeve gastrectomy (SG).

METHODS

Forty-five women (mean age 32.4 ± 10.9 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at pre-, 3-, 6-, 12-, and 24-month post-SG. Data collected included anthropometrics, nutritional intake, and lifestyle patterns. The Yale Food Addiction Scale (YFAS) and the Binge Eating Scale (BES) were used to characterize FA and BE, respectively.

RESULTS

Pre-surgery FA and BE were identified in 40.0% and 46.7% of participants, respectively. Following SG, FA and BE prevalence was 10.0%, 5.0%, 29.4%, and 14.2% (P = 0.007), and 12.5%, 4.9%, 18.4%, and 19.4% (P < 0.001) at 3, 6, 12, and 24 months, respectively. Women with BE at baseline gained significantly more weight from the nadir compared to non-BE women at baseline (P = 0.009). There was no relationship between FA at baseline and weight (P = 0.090). Weight regained from the nadir positively correlated with BES scores at baseline (r = 0.374, P = 0.019).

CONCLUSIONS

FA and BE tend to decrease during the early postoperative period, but remains in a notable rates return by 2 years post-SG. Moreover, pre-surgical BE was related to higher weight-regain. Proper management pre-BS should include a comprehensive eating pathologies assessment, as these pathologies may remain or re-emerge post-surgery and lead to worse weight outcomes.

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery

Weight regain after bariatric surgery is associated with problematic eating behaviors that have either recurred after a period of improvement or are new-onset behaviors. Problematic eating behaviors after bariatric surgery have been conceptualized in different ways in the literature, such as having a food addiction and experiencing a loss of control of eating. The intersection of these constructs appears to be driven overeating defined as patients' experiences of reduced control of their eating which results in overeating behavior. The purpose of this review is to define patient experiences of driven overeating through the behavioral expression of emotion-based eating, reward-based eating, and executive functioning deficits-namely impulsivity-which is associated with weight regain after having bariatric surgery. Delineating concepts in this way and determining treatment strategies accordingly may reduce distress related to the inevitable return of increased hunger, cravings, portion sizes, and tolerance for highly palatable foods after surgery. Along with standard behavioral weight maintenance strategies, topics including acceptance, motivation, emotion-based eating, reward-based/impulsive eating, physical activity, and self-compassion are discussed. These concepts have been adapted for patients experiencing weight regain after having bariatric surgery and may be particularly helpful in attenuating driven overeating and weight regain.

All in the Family: Child and Adolescent Weight Loss Surgery in the Context of Parental Weight Loss Surgery

Background: Bariatric surgery is the most effective current treatment option for patients with severe obesity. More children and adolescents are having surgery, many whose parents have also had surgery. The current study examines whether parental surgery status moderates the association between perceived social support, emotional eating, food addiction and weight loss following surgery, with those whose parents have had surgery evidencing a stronger relationship between the psychosocial factors and weight loss as compared to their peers. Methods: Participants were 228 children and adolescents undergoing sleeve gastrectomy between 2014 and 2019 at one institution. Children and adolescents completed self-report measures of perceived family social support, emotional eating, and food addiction at their pre-surgical psychological evaluation. Change in body mass index (BMI) from pre-surgery to 3, 6, and 12 months post-surgery was assessed at follow-up clinic visits. Parents reported their surgical status as having had surgery or not. Results: There were no differences in perceived family support, emotional eating, or food addiction symptoms between those whose parents had bariatric surgery and those whose parents did not. There were some moderating effects of parent surgery status on the relationship between social support, emotional eating/food addiction, and weight loss following surgery. Specifically, at 3 months post-surgery, higher change in BMI was associated with lower perceived family support only in those whose parents had not had surgery. More pre-surgical food addiction symptoms were associated with greater weight loss at 3 months for those whose parents had not had surgery, whereas this finding was true only for those whose parents had surgery at 12 months post-surgery. Conclusions: Children and adolescents whose parents have had bariatric surgery may have unique associations of psychosocial factors and weight loss. More research is needed to determine mechanisms of these relationships.

Impact of Bariatric Surgery on the Healthy Eating Index, Binge Eating Behavior and Food Craving in a Middle Eastern Population: A Lebanese Experience

Even though bariatric surgeries (BS) are on the rise in Lebanon and the Middle East, the changes in diet quality, binge eating, and food cravings in this region are poorly studied peri-operatively. This cross-sectional study aimed to assess binge eating behaviors, food craving and the Healthy Eating Index (HEI) in Lebanese patients who underwent BS in a duration that exceeds 6 months. Evaluation included a dietary assessment of usual diet preoperatively and postoperatively. It included the collection of information on sociodemographic, anthropometric and surgical variables, as well as the administration of dietary recalls and questionnaires to calculate the HEI score, the Binge Eating Scale (BES) and the Food Craving Inventory (FCI). Participants (n = 60) were mostly females (85%) who had undergone sleeve gastrectomy (90%), with a mean duration since BS of 2.4 ± 1.8 years. Despite improvements in their HEI scores, 97% of the participants remained in the worst category. The frequency of participants in the severe BES category dropped markedly postoperatively from 78% to 5% (p < 0.01). Food craving followed a similar trend, with scores dropping from 50 ± 36 pre-surgery to 30 ± 25 post surgery (p < 0.01). Weight regain, prevalent among 40% of participants, was predicted by BES. Despite the improvement in BES and FCI, HEI improvement remained shy. Future interventions should validate findings in other countries and assess means for optimizing HEI scores among BS patients in the Middle East region.

No addiction transfer from preoperative food addiction to other addictive behaviors during the first year after bariatric surgery

OBJECTIVE

The aim of the present study was to investigate whether the remission of preoperative food addiction is associated with increases or new onset of other addictions within the first year following bariatric surgery.

METHODS

One hundred and twenty-five bariatric surgery patients were assessed before surgery (t1) and at 6 months (t2) and 1 year (t3) follow-ups. The assessments included the Yale Food Addiction Scale 2.0 (YFAS 2.0) and standardized questionnaires to measure symptoms of problematic alcohol use, gambling disorder, internet-use disorder, buying-shopping disorder, hypersexual disorder and exercise dependence.

RESULTS

Forty-nine (39.2%) patients were assigned to the food addiction (FA⁺ ) and 76 patients (60.8%) to the non-food addiction group (FA^- ) based on their preoperative YFAS scores. Overall, BMI and symptoms of food addiction decreased significantly from baseline to follow-ups. Preoperative food addiction status was not associated with postoperative increases or new onset of other addictions. Elevated symptoms of buying-shopping disorder, internet-use and hypersexual behaviour at baseline in the FA⁺ -group decreased over time and were comparable to the FA^- -group at follow-ups.

CONCLUSION

The 'addiction transfer' or 'cross addiction' hypothesis was not supportive for alcohol addiction, gambling addiction or other behaviours that may be addictive. Further studies are needed that investigate larger samples and longer observation periods, as well as other substance-use disorders.

Weight Loss Outcomes and Lifestyle Patterns Following Sleeve Gastrectomy: an 8-Year Retrospective Study of 212 Patients

PURPOSE

Sleeve gastrectomy (SG) is an effective treatment for extreme obesity; however, long-term weight loss outcomes remain largely understudied. We aimed to examine the long-term weight changes following SG and patient characteristics and lifestyle patterns related to weight loss outcomes.

MATERIALS AND METHODS

Data from medical records of patients operated in a tertiary university medical center between 2008 and 2014 were reviewed, along with information derived from a telephone questionnaire. Information included the following: current medical status, medications, side effects, behavior, lifestyle habits, and weight changes.

RESULTS

A total of 212 patients (69.3% females) were included, with a median follow-up duration of 8 years post-SG. Mean age and baseline body mass index (BMI) of participants were 39.7 ± 12.0 years and 42.2 ± 4.9 kg/m², respectively. Mean BMI, percentage excess weight loss, and percentage total body weight loss were 33.1 ± 6.1, 55.5 ± 27.5%, and 21.7 ± 10.7%, respectively. Higher baseline BMI was found to be the strongest independent predictor for insufficient weight loss (OR = 0.90, P = 0.001, 95% CI 0.85, 0.96). Sweetened beverage intake, usage of psychiatric medications, higher initial BMI, and lower age were significant predictors for increased weight gain from nadir weight (P < 0.0001, P = 0.005, P = 0.035, and P < 0.0001, respectively).

CONCLUSIONS

SG patients were found to maintain a notable long-term weight loss. Nevertheless, weight regain and insufficient weight loss were prevalent in the long-term post-operative period, and were related to certain lifestyle patterns. Clinical practice should emphasize the relationship between post-operative weight loss outcomes and specific behaviors. Efforts should be made to educate patients on the need for lifelong follow-up and support.

French validation of the addiction-like eating behavior scale and its clinical implication

PURPOSE

The first conception of food addiction (FA) as substance addiction, measured by the Yale Food Addiction Scale (YFAS), is controversial. Some proposed that FA would be better conceptualized with a behavioral approach. In accordance with this conceptualization, Ruddock and colleagues published a new self-reported scale for food addiction, the Addiction-like Eating Behavior Scale (AEBS). Overall, preliminary validation of the scale demonstrated good psychometric properties with a community sample. The aim of the present study is twofold, to validate the French-Canadian version of the AEBS with a community sample and to examine how well the instrument fits into a clinical sample with overweight/obesity.

METHODS

A community sample (N = 466) and a clinical sample with overweight/obesity seeking help for their eating difficulties (N = 126) completed an online survey regarding FA, binge eating, dietary restraint, depression, and BMI. Factor analysis, internal consistency, and construct validity were assessed.

RESULTS

With the community sample, factorial structure, and psychometric properties of the AEBS were replicated. With the clinical sample, proper convergent validity was demonstrated with the YFAS 2.0 and binge eating, and proper divergent validity was demonstrated with dietary restraint. Among the clinical sample, AEBS explain similar variance of BMI and depression level when compared to YFAS 2.0.

CONCLUSION

This study provided evidence that the French-Canadian version of the AEBS is a valid measure of food addiction, but it did not permit to establish advantages over YFAS 2.0 with a clinical sample. Clinical implications of the AEBS and FA characteristic are discussed.

LEVEL OF EVIDENCE

Level V, cross-sectional, descriptive study.

Food addiction assessment in a nonclinical sample of the Italian population

OBJECTIVE

Discussion about the potential addictive role of certain types of food and their link with obesity has recently increased. Researchers have developed instruments to specifically assess food addiction (FA). The aim of this pilot study was to investigate the prevalence of food addiction in a nonclinical sample of the Italian population.

METHODS

All participants (n = 148: 46 males, 102 females) completed the Yale Food Addiction Scale 2.0 (YFAS 2.0) and provided self-reported measures and demographic information. They were divided into three age groups.

RESULTS

The prevalence of FA was 15.5% of our sample (82.6% of the subjects diagnosed with FA were female). The FA symptoms mean was 1.90 (SD = 2.87). In both sexes, participants aged 18-30 had the highest diagnosis of FA, with 52.1% of all FA subjects being females aged 18-30. According to the Body Mass Index (BMI), all the males diagnosed with FA were overweight or obese, as were most (63.2%) of the FA females.

CONCLUSIONS

Future food education policies could consider FA assessment together with that of other eating disorders, even among nonclinical subjects in order to anticipate diagnosis and improve treatment.

Food Addiction Disorder 2 Years After Sleeve Gastrectomy; Association with Physical Activity, Body Composition, and Weight Loss Outcomes

PURPOSE

Food addiction (FA) following bariatric surgery (BS) has received a burst of attention in recent years due to its important contribution to obesity. Therefore, this study was conducted to explore the prevalence of FA disorder and its predictors 2 years after laparoscopic sleeve gastrectomy (LSG) and assess its relationship with physical activity (PA), body composition, and weight outcomes.

MATERIALS AND METHODS

Four hundred fifty individuals who had undergone LSG 2 years prior to the study were enrolled. FA was diagnosed using the Yale Food Addiction Scale (YFAS). The collected data included body composition (fat mass (FM), fat-free mass (FFM)), PA, and nutritional intakes.

RESULTS

Eighty-nine subjects (about 20%) met the criteria for FA disorder. FA patients had significantly lower PA (p = 0.04) and higher weight (p < 0.001), BMI (p < 0.001), FM, and FFM (p = 0.01) compared to those without FA. Regarding weight and body composition changes, the finding reveals that FA patients (vs. non-FA) had a significantly less excess weight loss (EWL%) (p < 0.001) and total weight loss (TWL%) (p = 0.05) as well as a higher FFM loss (kg) (p = 0.04) (linear regression analysis). A younger age (p trend = 0.01), higher BMI (p trend = 0.04), and more excess weight (p trend = 0.03) were related to higher odds of FA disorder at second year after LSG (logistic regression analysis).

CONCLUSION

The results showed that FA was highly prevalent 2 years after LSG. In addition, FA disorder was associated with negative long-term outcomes following LSG. Younger individuals with more excess weight and higher BMI at baseline are more vulnerable to FA.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

Binge Eating After Bariatric Surgery in Patients Assisted by the Reference Service in a Brazilian Hospital and the Correlation with Weight Loss

PURPOSE

Identify, 18 months after bariatric surgery, the binge eating variation and its relation with weight regain or loss.

MATERIALS AND METHODS

Cross-sectional, retrospective study with 108 patients, assisted by an obesity walk-in clinic of a specialized hospital in São Paulo (Brazil), who had undergone bariatric surgery a minimum of 18 months previously. The anthropometric and clinic data were collected from medical records, and binge eating symptoms were evaluated with the application of the Binge Eating Scale (BES). Scale outcomes were related to weight regain and loss at the application moment.

RESULTS

The average age (standard error) of the sample was 47 years (±0.91) and 93% were female. Patients had lost 52.2% of their body weight and regained 4.7% of their weight 18 months after the surgery. The elapsed surgical time (> 50 months) was associated with a higher gross weight (p<0.0001).

CONCLUSIONS

Bariatric surgery has been shown to be effective for improving diabetes mellitus as well as for controlling obesity. The variation in binge eating intensity 18 months after bariatric surgery is a factor that interferes in the amount of weight regained. The presence of binge eating symptoms negatively affects the % total weight loss (%TWL).

Psychopathology, disordered eating, and impulsivity in patients seeking bariatric surgery

BACKGROUND

Most patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6-18 months after surgery. However, 20%-30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contribute to suboptimal weight loss and/or postoperative psychosocial distress.

OBJECTIVE

Assess psychosocial functioning, eating behavior, and impulsivity in patients seeking bariatric surgery.

SETTING

Two university hospitals.

METHODS

Validated interviews and questionnaires. Impulsivity assessed via computer program.

RESULTS

The present study included a larger (n = 300) and more racially diverse (70% non-White) sample than previous studies of these relationships. Forty-eight percent of participants had a current psychiatric diagnosis and 78% had at least 1 lifetime diagnosis. Anxiety disorders were the most common current diagnosis (25%); major depressive disorder was the most common lifetime diagnosis (44%). Approximately 6% of participants had a current alcohol or substance use disorder; 7% had a positive drug screen before surgery. A current psychiatric diagnosis was associated with greater symptoms of food addiction and night eating. Current diagnosis of alcohol use disorder or a lifetime diagnosis of anxiety disorders was associated with higher delay discounting.

CONCLUSION

The study identified high rates of psychopathology and related symptoms among a large, diverse sample of bariatric surgery candidates. Psychopathology was associated with symptoms of disordered eating and higher rates of delay discounting, suggesting impulse control issues.

Long-Term Prevalence of Food Addiction Among Bariatric Surgery Patients: Influence on Metabolic and Psychological Outcomes

Background: We wanted to assess the prevalence of individuals with food addiction (FA) among bariatric surgery (BS) patients at long term and to determine if there was any relationship between FA and both clinical and psychological outcomes at the time of the evaluation. Methods: Participants were evaluated for the presence of FA with the Yale Food Addiction Scale 2.0. Results: Of 134 subjects, 32 (23.9%) included met criteria for FA. The frequency of patients with depression at the time of the evaluation was greater among subjects with FA (34.4% vs. 11.8%; P = 0.006). The score obtained with the Beck Depression Inventory at the time of the evaluation was greater among subjects with FA (14.8 ± 11.5 vs. 6 ± 6.5; P < 0.0001). The frequency of subjects with FA who had criteria for binge eating disorder at the time of the evaluation was significantly greater (56.3% vs. 20.5%; P < 0.001). Patients with FA scored higher in the Lattinen index for chronic pain at the time of the evaluation (8.7 ± 5.9 vs. 5.8 ± 5.4; P = 0.014). However, clinical outcomes were similar between the two groups. Conclusions: Routine screening for FA at long term postoperatively should be recommended to improve psychological outcomes of BS.

Reward-related gustatory and psychometric predictors of weight loss following bariatric surgery: a multicenter cohort study

BACKGROUND

Reward sensitivity has been proposed as a potential mediator of outcomes for bariatric surgery.

OBJECTIVES

We aimed to determine whether gustatory and psychometric measures of reward-related feeding are predictors of bariatric-induced weight loss.

METHODS

A multicenter longitudinal cohort study was conducted in patients scheduled for bariatric surgery (surgical group), assessed at baseline and 2 follow-up assessments. Predictions of % weight loss from baseline (%WL) according to baseline gustatory measures, including intensity and pleasantness ratings of sweet and other tastants, and psychometric measures of reward-related feeding behavior, including hedonic hunger scores, were assessed with multivariable linear regression. Exploratory analyses were conducted to test for associations between %WL and changes in gustatory and psychophysical measures, as well as for comparisons with data from patients on the surgery waiting list (control group).

RESULTS

We included 212 patients, of whom 96 in the surgical group and 50 in the control group were prospectively assessed. The groups were similar at baseline and, as expected, bariatric surgery resulted in higher %WL (BTreatment-Time  = 2.4; 95% CI: 2.1-2.8; P  < 0.0001). While variation in gustatory measures did not differ between groups, in the surgery group baseline sweet intensity predicted %WL at the primary endpoint (11 to 18 months postoperatively; β = 0.2; B = 0.2, 95% CI: 0.02 to 0.3; P  = 0.02), as did hedonic hunger scores (β = -0.2; B = -2.0, 95% CI: -3.8 to -0.3; P  = 0.02). Furthermore, at this endpoint, postsurgical reduction of sweet taste intensity and acceptance of sweet foods were associated with %WL (β = -0.3; B = -3.5, 95% CI: -5.8 to -1.3; P  = 0.003, and β = -0.2; B = -4.7, 95% CI: -8.5 to -0.8; P  = 0.02, respectively). The use of sweet intensity as a predictor of weight change was confirmed in another bariatric cohort.

CONCLUSIONS

Sweet intensity ratings and hedonic hunger scores predict %WL after surgery. The variability of sweet intensity ratings is also associated with %WL, further suggesting they may reflect physiological processes that are variably modulated by bariatric surgery, influencing clinical outcomes.

A review of the psychosocial aspects of clinically severe obesity and bariatric surgery

For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Validation of the Yale Food Addiction Scale 2.0 in Patients Seeking Bariatric Surgery

BACKGROUND

The Yale Food Addiction Scale (YFAS) was developed in 2009 to assess food addiction (FA); a revised version was released in 2016 (YFAS 2.0). The objective of this study was to determine the statistical and clinical validity of the YFAS 2.0 in adults seeking bariatric surgery.

METHODS

Patients who underwent a preoperative psychological evaluation in preparation for bariatric surgery from 2015 to 2018 were included. The YFAS 2.0 was administered as part of routine clinical care and validated against an assessment battery of standardized clinical measures. Statistical analyses included chi-square and Wilcoxon rank sum tests and calculation of Spearman's rank correlation coefficients.

RESULTS

Overall, 1061 patients were included. Mean age and BMI were 47.5 ± 12.9 years and 46.9 ± 13.4 kg/m², respectively. There were 196 (18%) patients who screened positive on the YFAS 2.0 (21% mild, 23% moderate, and 56% severe FA). The YFAS 2.0 demonstrated strong convergent validity where patients who met criteria for FA had significantly increased levels of binge eating (p < 0.001), emotional eating (p < 0.001), and lower self-efficacy (p < 0.001). Discriminant validity was demonstrated by lack of association with alcohol use (p = 0.319). The YFAS 2.0 was significantly correlated with total scores for depression (p < 0.001), anxiety (p < 0.001), bipolar disorder symptoms (p < 0.001), and trauma history (p < 0.001).

CONCLUSIONS

The prevalence of FA in a large sample of patients seeking bariatric surgery was consistent with previous literature. These data suggest that the YFAS 2.0 is psychometrically valid, demonstrating strong construct validity, and is a clinically useful measure of FA severity in patients pursuing bariatric surgery.

Oral Processing, Satiation and Obesity: Overview and Hypotheses

Increasing the speed of eating or decreasing the amount of chewing of a test meal significantly decreases its satiation, increases concomitant caloric intake, and influences entero-endocrine secretion. Speed of eating is a strong risk factor for obesity and longitudinal studies suggest an etiological relationship. Individuals with obesity have an increase in bite size, less chewing per bite, decreased satiation, and greater food intake. Oral processing in terms of bite size and amount of chewing per gram of food is influenced by food texture and textural complexity. Soft foods increase bite size and decrease chewing per gram of food and meal duration compared to hard foods. An ultra-processed diet can lead to greater weight gain than a non-processed diet and a significant increase in eating rate. Many children with obesity are noted by their parents to have persistent hunger on a questionnaire and this is often extreme. Results of attempts to change eating behavior have been mixed in terms of producing long-term changes in eating behavior and body weight. It is hypothesized that there may be a unidirectional relationship between changes in oral processing, satiation and weight gain. However, the presence of persistent hunger can produce a vicious cycle that may exacerbate obesity and make treatment difficult. The increased energy density of foods as found particularly in ultra-processed foods also influences energy intake and obesity.

Symptoms of bipolar disorder are associated with lower bariatric surgery completion rates and higher food addiction

BACKGROUND

Bipolar disorder (BP) is highly comorbid with obesity, however, little is known about how BP might be associated with bariatric surgery outcomes.

METHODS

In this retrospective clinical cohort study, 1034 patients completed a psychological evaluation, and screening positive for possible BP was defined as a score ≥7 and moderate disability on the Mood Disorders Questionnaire. Food addiction (FA), subthreshold binge eating disorder (BED), and illegal drug use were also assessed using standardized questionnaires.

RESULTS

The 54 (5.2%) patients screening positive for BP were less likely to have bariatric surgery compared to 980 (94.8%) patients who screened negative for BP (5 patients or 9.3% vs 273 patients, or 27.9%). Patients with possible BP also had significantly higher prevalence of FA (37% vs 13.2%), subthreshold BED (29.6% vs 8.3%) and illegal drug use (7.4% vs 2.1%).

CONCLUSIONS

In this retrospective clinical cohort study, patients who screened positive for BP had a higher prevalence of food addiction, subthreshold binge eating disorder and recent illegal drug use. They also demonstrated lower completion rates for having bariatric surgery. Clearly, more needs to be learned about how to help patients with symptoms of bipolar disorder manage their obesity and behavioral challenges.

Process Evaluation of a Personality Targeted Intervention for Addictive Eating in Australian Adults

Addictive eating prevalence is estimated at 15-20% in studied populations, and is associated with concurrent mental health conditions and eating disorders as well as overweight and obesity. However, few evidence-based interventions targeting addictive eating are available. The further development of evidence-based interventions requires assessment of intervention feasibility and efficacy. This study aimed to determine the feasibility, including intervention delivery and program acceptability, of FoodFix; a personality targeted intervention for the treatment of addictive eating behaviours in Australian adults. Participants (n = 52) were randomised to intervention (n = 26) or wait-list control groups (n = 26) and received three personalised telehealth sessions with an Accredited Practising Dietitian over seven weeks. Intervention delivery was assessed by tracking adherence to scheduled timing of intervention sessions. Program acceptability of participants was assessed via an online process evaluation survey and program acceptability of intervention providers was assessed via semi-structured phone interviews. In total, 79% of participants adhered to scheduled timing for session two and 43% for session three, defined as within one week (before/after) of the scheduled date. Further, 21% of participants completed the process evaluation survey (n = 11). The majority of participants were extremely/very satisfied with FoodFix (n = 7, 63%). Intervention providers (n = 2) expressed that they felt adequately trained to deliver the intervention, and that the overall session format, timing, and content of FoodFix was appropriate for participants. These findings highlight the importance of assessing intervention feasibility to further understand intervention efficacy.

Emotion perception and theory of mind in obesity: a systematic review on the impact of social cognitive deficits on dysfunctional eating behaviors

The aim of this paper was to summarize our current understanding of emotion perception and Theory of Mind (ToM) in obesity and how they relate to dysfunctional eating behaviors (DEB), frequently found in candidates for bariatric surgery. The literature was searched using the electronic databases PsychInfo, Medline, and Web of Science databases, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, included participants suffering from obesity and evaluation with tasks assessing social cognition, such as emotion recognition and perception, as well as ToM. Twelve studies analyzed for this systematic review suggest that deficits in such social cognitive domains may lie behind many emotional and social difficulties present in people with obesity, be they bariatric or not, which usually favor DEB. Our review suggests that people with obesity of all ages score significantly less than controls on instruments assessing emotion recognition and ToM, justifying a possible relationship between social cognitive impairments and dysfunctional eating behaviors, such as binges, emotional eating, and addition to food, frequently seen in people with obesity. These findings have important implications for our understanding of the social cognitive foundations of eating behavior in individuals with obesity. They can help not only the presurgical behavioral assessment, but also guide postoperative follow-up of this population.

Meeting of Minds around Food Addiction: Insights from Addiction Medicine, Nutrition, Psychology, and Neurosciences

This review, focused on food addiction (FA), considers opinions from specialists with different expertise in addiction medicine, nutrition, health psychology, and behavioral neurosciences. The concept of FA is a recurring issue in the clinical description of abnormal eating. Even though some tools have been developed to diagnose FA, such as the Yale Food Addiction Scale (YFAS) questionnaire, the FA concept is not recognized as an eating disorder (ED) so far and is even not mentioned in the Diagnostic and Statistical Manuel of Mental Disorders version 5 (DSM-5) or the International Classification of Disease (ICD-11). Its triggering mechanisms and relationships with other substance use disorders (SUD) need to be further explored. Food addiction (FA) is frequent in the overweight or obese population, but it remains unclear whether it could articulate with obesity-related comorbidities. As there is currently no validated therapy against FA in obese patients, FA is often underdiagnosed and untreated, so that FA may partly explain failure of obesity treatment, addiction transfer, and weight regain after obesity surgery. Future studies should assess whether a dedicated management of FA is associated with better outcomes, especially after obesity surgery. For prevention and treatment purposes, it is necessary to promote a comprehensive psychological approach to FA. Understanding the developmental process of FA and identifying precociously some high-risk profiles can be achieved via the exploration of the environmental, emotional, and cognitive components of eating, as well as their relationships with emotion management, some personality traits, and internalized weight stigma. Under the light of behavioral neurosciences and neuroimaging, FA reveals a specific brain phenotype that is characterized by anomalies in the reward and inhibitory control processes. These anomalies are likely to disrupt the emotional, cognitive, and attentional spheres, but further research is needed to disentangle their complex relationship and overlap with obesity and other forms of SUD. Prevention, diagnosis, and treatment must rely on a multidisciplinary coherence to adapt existing strategies to FA management and to provide social and emotional support to these patients suffering from highly stigmatized medical conditions, namely overweight and addiction. Multi-level interventions could combine motivational interviews, cognitive behavioral therapies, and self-help groups, while benefiting from modern exploratory and interventional tools to target specific neurocognitive processes.

Food Addiction and Binge Eating During One Year Following Sleeve Gastrectomy: Prevalence and Implications for Postoperative Outcomes

BACKGROUND

Food addiction and binge eating are common among individuals with obesity. However, a paucity of studies prospectively examined the prevalence and implications of food addiction before and post-bariatric surgery. We aimed to examine the prevalence of food addiction and binge eating before and after sleeve gastrectomy (SG) and to assess their associations with behavioral and weight loss outcomes.

METHODS

We followed at 3 (M3), 6 (M6), and 12 (M12) months postoperative, 54 women who underwent SG. Data collected including anthropometrics, nutritional intake, food tolerance, and physical activity measures. The Yale Food Addiction Scale and the Binge Eating Scale were used to characterize food addiction and binge eating, respectively.

RESULTS

The mean baseline age and BMI were 32.1 ± 11.1 years and 44.9 ± 4.9 kg/m², respectively. Pre-surgery, food addiction, and binge eating were identified in 40.7% and 48.1% of patients, respectively. The prevalence of food addiction decreased significantly up to M6, but increased to 29.3% at M12. The prevalence of binge eating decreased significantly through the follow-up up to 17.4% at M12. Those who met criteria for food addiction at M12 achieved significantly lower excess weight loss at M12 compared with those not meeting this criterion (P = 0.005). Food addiction scores at M12 negatively correlated with weekly physical activity (r = - 0.559; P < 0.001) and food tolerance scores (r = - 0.428; P = 0.005).

CONCLUSIONS

The reduction in food addiction observed at M6 was not maintained at M12. Food addiction at M12 was associated with poorer weight loss, eating, and lifestyle behaviors. Clinical practice should focus on the psychological aspects associated with obesity.

Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy

The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample.

Food Addiction among Female Patients Seeking Treatment for an Eating Disorder: Prevalence and Associated Factors

The concept of "food addiction" (FA) has aroused much focus because of evidence for similarities between overeating and substance use disorders (SUDs). However, few studies have explored this concept among the broad spectrum of eating disorders (ED), especially in anorexia nervosa (AN). This study aimed to assess FA prevalence in ED female patients and to determine its associated factors. We recruited a total of 195 adult women with EDs from an ED treatment center. The prevalence of FA diagnosis (Yale Food Addiction Scale) in the whole ED sample was 83.6%; AN restrictive type (AN-R), 61.5%; AN binge-eating/purging type (AN-BP), 87.9%; bulimia nervosa (BN), 97.6%; and binge-eating disorder (BED), 93.3%. The most frequently met criteria of FA were "clinically significant impairment or distress in relation to food", "craving" and "persistent desire or repeated unsuccessful attempts to cut down". An FA diagnosis was independently associated with three variables: presence of recurrent episodes of binge eating, ED severity, and lower interoceptive awareness. In showing an overlap between ED and FA, this study allows for considering EDs, and AN-R in particular, from an "addictive point of view", and thus for designing therapeutic management that draws from those proposed for addictive disorders.

A Longitudinal Preliminary Study of Addiction-Like Responses to Food and Alcohol Consumption Among Individuals Undergoing Weight Loss Surgery

Reductions in addiction-like food behaviors and increases in alcohol intake have been reported after weight loss surgery. However, no studies have tracked these measures in combination and prospectively. In this preliminary study, 27 participants underwent bariatric surgery (Roux-en-Y gastric bypass (RYGB) (n = 10) and sleeve gastrectomy (SG) (n = 6)), dietary weight loss (n = 6), or no treatment (n = 5). Participants were weighed, completed the Yale Food Addiction Scale (YFAS), and reported alcohol intake frequency before intervention and at 4 and 24 months after baseline. At 24 months, only the surgery group showed significant reductions in BMI. Between baseline and 24 months, YFAS scores decreased (p = .006) and alcohol intake increased in the surgery group (p = .005). Significant changes were not observed in the diet or no treatment groups.