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

Exploring sub-threshold food addiction in adult patients with severe obesity: a cross-sectional analysis

BACKGROUND

Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the "three-stage addiction cycle" modeling the transition from substance use to addiction.

OBJECTIVES

(1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level.

METHODS

The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected.

RESULTS

Only 18% of the 192 participants (women n = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations.

CONCLUSION

Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes.

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.

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

Dopamine regulates several functions, such as voluntary movements, spatial memory, motivation, sleep, arousal, feeding, immune function, maternal behaviors, and lactation. Less clear is the role of dopamine in the pathophysiology of type 2 diabetes mellitus (T2D) and chronic complications and conditions frequently associated with it. This review summarizes recent evidence on the role of dopamine in regulating insular metabolism and activity, the pathophysiology of traditional chronic complications associated with T2D, the pathophysiological interconnection between T2D and chronic neurological and psychiatric disorders characterized by impaired dopamine activity/metabolism, and therapeutic implications. Reinforcing dopamine signaling is therapeutic in T2D, especially in patients with dopamine-related disorders, such as Parkinson's and Huntington's diseases, addictions, and attention-deficit/hyperactivity disorder. On the other hand, although specific trials are probably needed, certain medications approved for T2D (e.g., metformin, pioglitazone, incretin-based therapy, and gliflozins) may have a therapeutic role in such dopamine-related disorders due to anti-inflammatory and anti-oxidative effects, improvement in insulin signaling, neuroinflammation, mitochondrial dysfunction, autophagy, and apoptosis, restoration of striatal dopamine synthesis, and modulation of dopamine signaling associated with reward and hedonic eating. Last, targeting dopamine metabolism could have the potential for diagnostic and therapeutic purposes in chronic diabetes-related complications, such as diabetic retinopathy.

Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours

BACKGROUND

Impaired metabolic response such as blood glucose fast fluctuations may be hypothesized in binge eating disorder (BED) and food addiction (FA) by virtue of the repetitive consumption of highly processed food. Conversely, rapid changes in plasma glucose (i.e., hypoglycemia) may trigger craving for the same food products. The investigation of early glycemic disturbances in BED and FA could enhance the understanding of the metabolic mechanisms involved in the maintenance of the disorders. Present study investigated hypoglycemia events during a 5-h-long oral glucose tolerance test (OGTT) in people with BED, FA, and the comorbid phenotype. Further, the association between the severity of eating psychopathology and the variability in hypoglycaemia events was explored.

METHODS

Two-hundred participants with high weight and no diabetes completed the extended OGTT and were screened for BED, FA, BED-FA, or no-BED/FA. The four groups were compared in hypoglycemia events, OGTT-derived measures, and eating psychopathology. The association between predictors (eating psychopathology), confounders (demographics, metabolic features), and the outcomes (hypoglycemia, early/late hypoglycemia, severe hypoglycemia, reactive hypoglycemia) was examined through logistic regression.

RESULTS

Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; χ2 = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (χ2 = 13.898, p = .003), in different times by diagnosis (FA: 210'-240'; BED: at the 270'). FA severity was the only predictor of early and reactive hypoglycemia.

CONCLUSIONS

People with BED or FA are prone to experiencing reactive hypoglycemia; FA severity may predict early and symptomatic hypoglycemia events. This can further reinforce disordered eating behaviours by promoting addictive responses, both biologically and behaviourally. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.

Emotional overeating affected nine in ten female students during the COVID-19 university closure: A cross-sectional study in France

OBJECTIVES

To estimate the proportion of female university students reporting overeating (EO) in response to emotions during the COVID-19 university closures, and to investigate social and psychological factors associated with this response to stress.

DESIGN

Online survey gathered sociodemographic data, alcohol/drugs use disorders, boredom proneness and impulsivity using validated questionnaires, and EO using the Emotional Overeating Questionnaire (EOQ) assessing eating in response to six emotions (anxiety, sadness, loneliness, anger, fatigue, happiness), whose structure remains to be determined.

PARTICIPANTS

Sample of 302 female students from Rennes University, France.

MAIN OUTCOME MEASURE

Frequencies of emotional overeating.

ANALYSIS

The frequency of emotional overeating was expressed for each emotion as percentages. Exploratory Factor analyses (EFA) were used to determine EOQ structure and provide an index of all EOQ items used for further analysis. Linear regression models were used to explore relationships between EO and others covariates.

RESULTS

Nine in ten participants reported intermittent EO in the last 28 days, mostly during 6 to 12 days, in response to Anxiety (75.5%), Sadness (64.5%), Happiness (59.9%), Loneliness (57.9%), Tiredness (51.7%), and to a lesser extent to Anger (31.1%). EFA evidenced a one-factor latent variable reflecting "Distress-Induced Overeating" positively correlated with internal boredom proneness, tobacco use, attentional impulsivity, inability to resist emotional cues, and loss of control over food intake, and negatively with age and well-being. EO was unrelated to body mass index or substance abuse.

CONCLUSION AND IMPLICATIONS

Nine in ten female students reported emotional overeating during the COVID-19 university closure. This response to stress was related to eating tendencies typical of young women, but also to personality/behavioral patterns such as boredom and impulsivity proneness. Better understanding of the mechanisms underlying EO in response to stress and lack of external/social stimulation would improve preventive interventions.

Correlates of Food Addiction and Eating Behaviours in Patients with Morbid Obesity

INTRODUCTION

Food addiction (FA) is a promising construct regarding the multifactorial aetiology of obesity and the search for therapeutic approaches. However, there is an ongoing debate regarding the overlap/differentiation with eating disorders and the classification as a substance- or behaviour-related addiction. Energy-dense foods, especially those combining carbohydrates and fat, are associated with addictive eating and suspected of playing a role in the genesis of FA. This study aims to further understand the clinical significance of FA and to identify possible therapeutic targets. A special focus is set on potentially addictive foods (combination of carbohydrates and fat).

METHODS

Based on the Yale Food Addiction Scale 2.0, a cohort of 112 German adults with morbid obesity was divided into two sub-samples (patients with and without FA), which were examined for differences in the variables listed below.

RESULTS

The prevalence of FA was 25%. Patients meeting criteria for FA showed higher degrees of hunger, emotional, binge, and night eating than patients without FA. In addition, hunger and disinhibition were found to be significant predictors of FA. FA was not associated with sex, age, body mass index (BMI), cognitive restraint, rigid and flexible control, prevalence of substance use, age of onset of obesity, stress level, level of social support, reduction of BMI during a weight loss programme, or programme withdrawal rate. There was no significant difference in the consumption of foods rich in both carbohydrates and fat, nor of fat or carbohydrates alone.

CONCLUSION

FA can be considered as a sub-phenotype of obesity, occurring in approximately 25% of obesity cases. Dysfunctional emotional coping mechanisms associated with low distress tolerance showed to be significantly related to FA and should be targeted therapeutically. Behavioural interventions should include a bio-psycho-social model. Binge eating episodes were found to be characteristic for FA and the already stated overlap between FA and binge eating behaviour can be confirmed. The results do not support a decisive difference due to a substance-related component of FA. Despite this, the existence of FA as a distinct entity cannot be excluded, as not all patients with FA exhibit binges.

Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery

PURPOSE

The aim of the present study was to determine possible associations between binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery.

METHODS

A cross-sectional study was conducted with 254 obese patients recruited from the general surgery service for bariatric procedures at the hospital affiliated with the Federal University of Pernambuco, Brazil. Evaluations were performed using the Binge Eating Scale (BES), Beck Depression Inventory, Beck Scale for Suicidal Ideation (BSSI) and a questionnaire addressing sociodemographic characteristics.

RESULTS

Most patients were women (82%), 48% had a moderate binge eating disorder, 42% a severe binge eating disorder, 32% had symptoms suggestive of mild, moderate or severe depression and 6% had suicidal ideation. Severe binge eating was positively associated with depressive symptoms (p < 0.001) and suicidal ideation (p < 0.05). Cases of severe binge eating were more frequent in young adults, but not necessarily associated with symptoms of depression or suicidal ideation in this portion of the sample.

CONCLUSIONS

The present findings underscore the need for psychological and psychiatric follow-up of obese candidates for bariatric surgery using appropriate assessment scales to guide therapeutic approaches.

LEVEL III

Evidence obtained from cross-sectional study.

Associations Between Food Addiction and Substance-Use Disorders: A Critical Overview of their Overlapping Patterns of Consumption

Purpose of Review

Research on patterns of overconsumption in individuals with food addiction (FA) has focused largely on binge eating. However, compulsive overeating can be varied and dimensional. This review focuses on the similarities between the patterns of consumption in FA and in other clinically established substance-use disorders, such as alcohol and nicotine dependence. It also highlights features that make FA unique to other addiction disorders.

Recent Findings

Overall, there is substantial evidence that binge-like overconsumption is a characteristic of various substance-use and eating disorders. Likewise, it appears that different overeating patterns can reflect addictive-like eating. One pattern may be compulsive grazing — defined as the repetitive inability to resist consumption of small amounts of food.

Summary

This review adds to the increasingly compelling picture that FA and binge-eating disorder are unique conditions, and that FA resembles other substance-use disorders. We conclude that a variety of overeating patterns can reflect addictive eating behaviours in vulnerable individuals, one of which may be compulsive grazing.

Neurobiological regulation of eating behavior: Evidence based on non-invasive brain stimulation

The prefrontal cortex is appreciated as a key neurobiological player in human eating behavior. A special focus is herein dedicated to the dorsolateral prefrontal cortex (DLPFC), which is critically involved in executive function such as cognitive control over eating. Persons with obesity display hypoactivity in this brain area, which is linked to overconsumption and food craving. Contrary to that, higher activity in the DLPFC is associated with successful weight-loss and weight-maintenance. Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation tool used to enhance self-control and inhibitory control. The number of studies using tDCS to influence eating behavior rapidly increased in the last years. However, the effectiveness of tDCS is still unclear, as studies show mixed results and individual differences were shown to be an important factor in the effectiveness of non-invasive brain stimulation. Here, we describe the current state of research of human studies using tDCS to influence food intake, food craving, subjective feeling of hunger and body weight. Excitatory stimulation of the right DLPFC seems most promising to reduce food cravings to highly palatable food, while other studies provide evidence that stimulating the left DLPFC shows promising effects on weight loss and weight maintenance, especially in multisession approaches. Overall, the reported findings are heterogeneous pointing to large interindividual differences in tDCS responsiveness.

Prevalence of food addiction and its association with anxiety, depression, and adherence to social distancing measures in Brazilian university students during the COVID-19 pandemic: a nationwide study

The study's objective was to determine the prevalence of food addiction (FA) in Brazilian university students and to verify whether there is an association with anxiety, depression, and adherence to the social distancing measures adopted during the COVID-19 pandemic. This is a nationwide cross-sectional study carried out through the application of online questionnaires. Self-reported data on age, sex, economic class, race/skin color, anthropometric data, depression diagnosis, anxiety, modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), and adherence to social distancing measures were collected. 5368 participants were included, with a mean age was 24.1 ± 6.3 years, the majority were female (n = 3990; 74.3%), and the mean BMI in our sample was 24.5 ± 5.3 kg/m². The prevalence of FA was 19.1% (95%CI: 18.0; 20.0%). An association was observed between FA with depression (PR: 1.60; 95%CI: 1.43; 1.78; p < 0.01), and anxiety (3.13; 95%CI: 2.74; 3.58; p < 0.01), but not with adherence to social distancing measures (p = 0.70). In conclusion, there was a higher prevalence of FA in Brazilian university students. Besides, university students with anxiety, depression, overweight, or obesity and females are more prone to FA.Level of evidence Level V, Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Dietary intakes among people with vs without food addiction: A systematic review and meta-analysis

BACKGROUND & AIMS

Individuals with food addiction (FA) may experience addictive behaviours like those observed in other substances of abuse, which may affect their dietary intake habits. In fact, previous studies have reported associations between FA and dietary patterns, but this evidence has not been quantitatively summarised before. Therefore, this study aimed to explore differences in dietary intakes among adults with vs without food addiction.

METHODS

A systematic-review and meta-analysis was conducted. Interventional or observational studies evaluating dietary intakes associated with FA that used the Yale Food Addiction Scale (YFAS) were explored. PubMed, WoS and SCOPUS databases were searched up to September 2021, and selected articles were confirmed manually. Potentially eligible studies were checked independently by two researchers. YFAS and dietary habits were obtained from the studies selected by the search protocol. Standardized mean differences were retrieved and random effects meta-analyses were used for those studies reporting quantitative data.

RESULTS

From 162 potentially appropriate studies, 16 studies were finally included, all of which used cross-sectional designs. FA was generally related to higher intakes of total fat, proteins, sugar, and processed/energy-dense foods. The meta-analysis revealed that this association was only statistically significant in overweighted/obese individuals (P < 0.001 in all cases), while in those studies that included the general population (all weight categories), this association was not evident (p = 0.18).

CONCLUSIONS

Being addicted to food was not associated with a higher energy intake in the general population. However, among those with overweight or obesity, FA was associated with higher energy and nutrient consumption. This provides evidence on the influence of addictive behaviours on dietary intake patterns of people with excess body weight and reinforces the concept of food addiction and its influence in the development of obesity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020212866.

Food Addiction: a Deep Dive into ‘Loss of Control’ and ‘Craving’

Purpose of Review

The majority of existing research discusses food addiction (FA) classification, which provides information for different groups and which groups may or may not be affected to differing degrees. Fewer studies report FA symptom scores, and fewer still report on individual symptoms. This paper discusses the symptoms of craving and loss of control as they are common FA symptoms that demonstrate similarities with both substance use disorders and some eating disorder pathology.

Recent Findings

Loss of control presents parallels with disordered eating, particularly binge eating disorder. Craving refers to the powerful or strong desire for something and, in contrast to lack of control, presents most overlap with substance use disorders.

Summary

While not the most common symptoms reported in published research, loss of control and craving attract attention because of parallels with substance use and eating disorder pathology, and research has increasingly focused on these symptoms in recent years.

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.

Brain Responses to Food Choices and Decisions Depend on Individual Hedonic Profiles and Eating Habits in Healthy Young Women

The way different food consumption habits in healthy normal-weight individuals can shape their emotional and cognitive relationship with food and further disease susceptibility has been poorly investigated. Documenting the individual consumption of Western-type foods (i.e., high-calorie, sweet, fatty, and/or salty) in relation to psychological traits and brain responses to food-related situations can shed light on the early neurocognitive susceptibility to further diseases and disorders. We aimed to explore the relationship between eating habits, psychological components of eating, and brain responses as measured by blood oxygen level-dependent functional magnetic resonance imaging (fMRI) during a cognitive food choice task and using functional connectivity (FC) during resting-state fMRI (rsfMRI) in a population of 50 healthy normal-weight young women. A Food Consumption Frequency Questionnaire (FCFQ) was used to classify them on the basis of their eating habits and preferences by principal component analysis (PCA). Based on the PCA, we defined two eating habit profiles, namely, prudent-type consumers (PTc, N = 25) and Western-type consumers (WTc, N = 25), i.e., low and high consumers of western diet (WD) foods, respectively. The first two PCA dimensions, PCA1 and PCA2, were associated with different psychological components of eating and brain responses in regions involved in reward and motivation (striatum), hedonic evaluation (orbitofrontal cortex, OFC), decision conflict (anterior cingulate cortex, ACC), and cognitive control of eating (prefrontal cortex). PCA1 was inversely correlated with the FC between the right nucleus accumbens and the left lateral OFC, while PCA2 was inversely correlated with the FC between the right insula and the ACC. Our results suggest that, among a healthy population, distinct eating profiles can be detected, with specific correlates in the psychological components of eating behavior, which are also related to a modulation in the reward and motivation system during food choices. We could detect different patterns in brain functioning at rest, with reduced connectivity between the reward system and the frontal brain region in Western-type food consumers, which might be considered as an initial change toward ongoing modified cortico-striatal control.

Obesity Animal Models for Acupuncture and Related Therapy Research Studies

Obesity and related diseases are considered as pandemic representing a worldwide threat for health. Animal models are critical to validate the effects and understand the mechanisms related to classical or innovative preventive and therapeutic strategies. It is, therefore, important to identify the best animal models for translational research, using different evaluation criteria such as the face, construct, and predictive validity. Because the pharmacological treatments and surgical interventions currently used for treating obesity often present many undesirable side effects, relatively high relapse probabilities, acupuncture, electroacupuncture (EA), and related therapies have gained more popularity and attention. Many kinds of experimental animal models have been used for obesity research studies, but in the context of acupuncture, most of the studies were performed in rodent obesity models. Though, are these obesity rodent models really the best for acupuncture or related therapies research studies? In this study, we review different obesity animal models that have been used over the past 10 years for acupuncture and EA research studies. We present their respective advantages, disadvantages, and specific constraints. With the development of research on acupuncture and EA and the increasing interest regarding these approaches, proper animal models are critical for preclinical studies aiming at developing future clinical trials in the human. The aim of the present study is to provide researchers with information and guidance related to the preclinical models that are currently available to investigate the outcomes of acupuncture and related therapies.

Translation of the Chinese version of the modified Yale Food Addiction Scale 2.0 and its validation among college students

BACKGROUND

Obesity prevalence has substantially increased in China over the past decade. In China, over 1 in 7 individuals meet the criteria for overall obesity, and 1 in 3 meet the criteria for abdominal obesity, obesity has become a significant problem. Studies have shown that food addiction and obesity are inextricably linked. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a brief measurement for assessing food addiction. This study aimed to explore the structure of the Chinese version of the mYFAS 2.0 and assess the occurrence of food addiction in a sample of college students in Northeast China.

METHODS

A cross-sectional design was conducted in a sample of 1099 undergraduate students in Northeast China. Participants completed the sociodemographic questionnaire, the Chinese version of the mYFAS 2.0, the Barratt Impulsiveness Scale (BIS-8), and the Self-Esteem Scale (SES) to test the hypothesis. Exploratory factor analysis and confirmatory factor analysis were performed to examine the underlying factor structure of the mYFAS 2.0. Two weeks later, 62 students who participated in the first test were recruited to evaluate the test-retest reliability.

RESULTS

The Chinese version of the mYFAS 2.0 demonstrated adequate internal consistency, good test-retest reliability and satisfactory construct validity. The results of the confirmatory factor analysis found that the Chinese version of the mYFAS 2.0 demonstrated a good fit to the two-factor solution identified by the exploratory factor analysis and showed superior fit indices compared to the one-factor model. The prevalence of food addiction in our sample was found to be in line with rates observed in other Asian and Western samples. The mYFAS 2.0 symptom count scores were correlated with BMI, the idea of dieting to lose weight, the desire to overeat, low self-esteem, and impulsivity.

CONCLUSION

The results indicate that the Chinese version of the mYFAS 2.0 has good reliability and validity, and that it can be considered a tool to evaluate the addictive eating behaviours of undergraduate students.

Discovery of a macromolecular complex mediating the hunger suppressive actions of cocaine: Structural and functional properties

Cocaine not only increases brain dopamine levels but also activates the sigma1 receptor (σ1 R) that in turn regulates orexigenic receptor function. Identification of interactions involving dopamine D1 (D1 R), ghrelin (GHS-R1a ), and σ1 receptors have been addressed by biophysical techniques and a complementation approach using interfering peptides. The effect of cocaine on receptor functionality was assayed by measuring second messenger, cAMP and Ca2+ , levels. The effect of acute or chronic cocaine administration on receptor complex expression was assayed by in situ proximity ligation assay. In silico procedures were used for molecular model building. σ1 R KO mice were used for confirming involvement of this receptor. Upon identification of protomer interaction and receptor functionality, a unique structural model for the macromolecular complex formed by σ1 R, D1 R, and GHS-R1a is proposed. The functionality of the complex, able to couple to both Gs and Gq proteins, is affected by cocaine binding to the σ1 R, as confirmed using samples from σ1 R-/- mice. The expression of the macromolecular complex was differentially affected upon acute and chronic cocaine administration to rats. The constructed 3D model is consistent with biochemical, biophysical, and available structural data. The σ1 R, D1 R, and GHS-R1a complex constitutes a functional unit that is altered upon cocaine binding to the σ1 R. Remarkably, the heteromer can simultaneously couple to two G proteins, thus allowing dopamine to signal via Ca2+ and ghrelin via cAMP. The anorexic action of cocaine is mediated by such complex whose expression is higher after acute than after chronic administration regimens.

Food addiction among morbidly obese patients: prevalence and links with obesity complications

BACKGROUND

In the context of obesity, little is known about the prevalence of food addiction nor about the phenotype of obese patients with food addiction. Objectives: To assess: (i) the prevalence of food addiction among obese patients eligible for obesity surgery; (ii) the relationship between clinical features and the complications of obesity. Methods: Consecutive patients consulting for the first time were included. The Yale Food Addiction Scale (YFAS) 2.0 questionnaire was used to diagnose food addiction and its severity. Demographics, clinical features, and obesity complications were systematically collected. Statistics: Student's test was used for numerical variables and Chi-square test or Fisher's exact test for categorical variables. Results: A total of 292 patients were included: 79% female, age (mean ± SD) 42.6 ± 13.0 yrs., body mass index (BMI) 43.2 ± 6.8 kg/m². One hundred and eight patients (37%) had food addiction: 58% severe, 33% moderate, 9% mild. Food addiction prevalence was 39% (n = 61/156) among patients eligible for obesity surgery. Food addiction was more frequent among the unemployed, compared to professionally active patients (41.0% vs. 33.5%, p = 0.046). Clinical and metabolic phenotypes and obesity complications were similar between patients with and without food addiction. Conclusion: Food addiction was present in 37% of obese patients, but was not associated with clinical features or obesity complications. Therefore, it should be systemically assessed for appropriate management.

Food Addiction and Lifestyle Habits among University Students

The prevalence of overweight and obesity is increasing in our society, with a complex, multifactorial origin, and associated with greater morbidity and mortality in the population. Food addiction (FA) is a common disorder in overweight/obese people, which appears to be increasingly common in young people. This study analyzed food addiction in a group of young university students and to examine its association with body composition, quality of sleep, adherence to the Mediterranean diet, physical activity/sedentary habits, tobacco or alcohol consumption, and health status. A total of 536 undergraduate nursing students participated in a questionnaire that included the Yale Food Addiction Scale (YFAS 2.0). Up to 6.4% of the students presented FA. Statistically significant associations were observed in the variables for sleep quality odds ratio (OR) 4.8 (95% confidence interval (CI): 1.66-13.87), anxiety/depression OR 8.71 (95% CI: 3.93-19.27), body mass index (BMI) OR 8.32 (95% CI: 3.81-18.15) and sedentary lifestyle OR 2.33 (95% CI: 1.09-5.01). A predictive model was developed after binary logistic regression (area under the ROC curve 0.84 (95% CI: 0.77-0.91). Students with FA presented higher BMI values, worse sleep quality, anxiety or depression problems, and more time spent in sedentary behaviors.