Executive functioning and psychological symptoms in food addiction: a study among individuals with severe obesity

Food addiction (FA) has recently emerged as a new field in the study of obesity. Previous studies have contributed to identifying psychological correlates of FA. However, few researchers have examined the cognitive profile related to this condition; up until now, attentional biases related to food cues and a poorer performance monitoring have been observed. The present study aimed to examine the psychological profile and executive functioning related to FA in individuals with severe obesity and awaiting bariatric surgery. Participants (N = 86) were split into two groups, according to their level of FA symptoms (low FA vs high FA). Groups were compared on questionnaires measuring binge eating, depression and anxiety symptoms, and impulsivity as well as on measures reflecting executive functioning (D-KEFS and BRIEF-A). The relationship between FA groups and patterns of errors during the D-KEFS' Color-Word Interference Test was further analyzed. Individuals within the high FA group reported significantly more binge eating, depressive and anxiety symptoms, and more metacognitive difficulties. They also tended to show a poorer inhibition/cognitive flexibility score and a typical pattern of errors, characterized by an increased number of errors as the tasks' difficulty rose as opposed to a decreased number of errors, which characterizes an atypical pattern of errors. The present results show that the inability to learn from errors or past experiences is related to the severity of FA and overall impairments.Level of evidence Level V, descriptive study.

Establishing a food addiction diagnosis using the Yale Food Addiction Scale: A closer look at the clinically significant distress/functional impairment criterion

The concept of food addiction (FA) represents a set of problematic eating behaviors related to overeating. According to the Yale Food Addiction Scale (YFAS), which was based on the DSM-IV-TR substance dependence diagnostic criteria, a FA diagnosis is assigned when at least three criteria and the criterion evaluating clinically significant distress and/or functional impairment are endorsed. Considering the decisive role of this last criterion, the present study aimed to investigate its endorsement among individuals suffering from severe obesity and awaiting bariatric surgery. A total of 146 individuals were recruited at the Quebec Heart and Lung Institute and were invited to complete various questionnaires. Differences between individuals who endorsed at least three FA criteria and reported distress/impairment (FA+D/I; N = 24) and individuals who endorsed at least three FA criteria but did not report distress/impairment (FA-D/I; N = 27) were examined. Results revealed that 16% of the total sample fulfilled a FA diagnosis when considering the clinically significant distress/functional impairment criterion; however, this prevalence rate climbed to 35% when removing the inclusion of distress/impairment. Furthermore, individuals from the FA+D/I group showed more FA symptomatology and hedonic hunger, but did not statistically differ from the FA-D/I group on expected markers of psychological distress (depressive symptoms and quality of life). Lastly, the experience of withdrawal symptoms and hedonic hunger were found to be the best predictors of the endorsement of the distress/impairment criterion. This study underlines the impact of this criterion in establishing a FA diagnosis and highlights the importance of considering alternative ways to interpret findings from the YFAS when dealing with clinical samples.