Relationship of food addiction to weight loss and attrition during obesity treatment

The prognostic role of food addiction for weight loss treatment outcomes in individuals with overweight and obesity: A systematic review and meta-analysis

Food addiction (FA) could be a potential prognostic factor of weight loss intervention outcomes. This systematic review with meta-analysis aimed to (1) estimate this prognostic effect of FA diagnosis and symptom count in individuals with overweight or obesity and (2) explore potential sources of heterogeneity based on properties of the weight loss intervention, study, and sample (e.g., age, gender, ethnicity). We searched PubMed, PsycINFO, and Web of Science for studies reporting on associations between pre-intervention FA (assessed with the Yale Food Addiction Scale) and weight outcomes after weight loss intervention in individuals with overweight or obesity without a medically diagnosed eating disorder. Twenty-five studies met inclusion criteria, including 4904 individuals (71% women, Mage = 41 years, BMI = 40.82 kg/m2), k = 18 correlations of weight loss with FA symptom count, and k = 21 mean differences between FA diagnosis groups. Pooled estimates of random-effects meta-analyses found limited support for a detrimental effect of FA symptom count and diagnosis on weight loss intervention outcomes. Negative associations with FA increased for behavioral weight loss interventions and among more ethnically diverse samples. More research on the interaction of FA with pre-existing mental health problems and environmental factors is needed.

Ultra-Processed Food Addiction: A Research Update

PURPOSE OF REVIEW

Detail recent advancements in the science on ultra-processed food (UPF) addiction, focusing on estimated prevalence rates and emerging health disparities; progress towards identifying biological underpinnings and behavioral mechanisms; and implications for weight management.

RECENT FINDINGS

Notable developments in the field have included: (1) estimating the global prevalence of UPF addiction at 14% of adults and 15% of youths; (2) revealing health disparities for persons of color and those with food insecurity; (3) observing altered functioning across the brain-gut-microbiome axis; (4) providing early evidence for UPF withdrawal; and (5) elucidating poorer weight management outcomes among persons with UPF addiction. The breadth of recent work on UPF addiction illustrates continued scientific and public interest in the construct and its implications for understanding and treating overeating behaviors and obesity. One pressing gap is the lack of targeted interventions for UPF addiction, which may result in more optimal clinical outcomes for this underserved population.

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.

Group therapy to reduce maladaptive eating behaviors in people with overweight or obesity: Does food addiction impact the treatment response?

BACKGROUND

Given that the presence of food addiction worsens the clinical portrait in people with overweight or obesity, it could also impact the treatment response. The objective was to explore the moderating effect of baseline food addiction (FA) on the treatment response. The associations between changes in FA symptoms and other maladaptive eating behaviors were also examined.

METHODS

Sixty adults with overweight or obesity were recruited and took part in a 12-session group therapy for compulsive eating. They completed questionnaires on FA and three treatment outcomes (binge eating, grazing, and depressive symptoms). Participants were split into two groups according to their number of baseline FA symptoms (no/mild FA vs. moderate/severe FA) and were compared on all outcomes at four measurement points (baseline, mid-treatment, post-treatment, and 6-month follow-up). Correlations between changes in FA symptoms and all three outcomes from pre- to post-treatment were performed.

RESULTS

Group and treatment effects were significant for binge eating and grazing but not for depressive symptoms. Interaction effects were not significant for the three outcomes. The reduction in FA symptoms from pre- to post-treatment was positively associated with the reduction in binge eating (r = 0.49) and grazing (r = 0.55).

CONCLUSIONS

People with moderate/severe FA maintained higher maladaptive eating behaviors than people with no/mild FA from the beginning to the end of the treatment. Progression through treatment followed the same pattern for both groups, suggesting that baseline FA did not have a moderating effect. People with moderate/severe FA would likely benefit from a longer treatment.

The effect of β-caryophyllene on food addiction and its related behaviors: A randomized, double-blind, placebo-controlled trial

Food addiction (FA) is a psychological construct that may be involved in the etiology of obesity. The cannabinoid system is involved in the addictive-like food preferences by acting on the dopaminergic pathway of the brain. β-caryophyllene is a dietary cannabinoid that is a cannabinoid type 2 (CB2) receptor agonist. This study explored the impacts of β-caryophyllene supplementation on eating behavior, appetite, mental health, anthropometric parameters, body composition, and some hormones related to appetite in women with obesity diagnosed with FA. Women with obesity and FA, diagnosed by the Yale Food Addiction Scale Score (YFAS-S) ≥3, were randomly allocated to receive a β-caryophyllene softgel (n = 26) (100 mg/daily with meal) or placebo (n = 26) for 8 weeks. Anthropometric measurements, body composition, eating behavior, biochemical markers, dietary intake, appetite, stress, anxiety, and depression were evaluated during the study period. β-caryophyllene administration significantly reduced YFAS-S compared to the placebo group (changes in FA score: 1.5 ± 0.9 vs. - 0.7 ± 1.4; corrected P = 0.05). Serum levels of orexin-A significantly decreased in the β-caryophyllene group (p = 0.02); however, no significant difference was observed compared to the placebo group (corrected P = 0.09). β-caryophyllene supplementation had no significant effect on body composition, anthropometric indices, appetite, eating behavior, dietary intake, physical activity level, mental health, and levels of oxytocin and neuropeptide Y (NPY), compared to the placebo. β-caryophyllene supplementation may have beneficial effects on improving YFAS-S in women with obesity diagnosed with FA. TRIAL REGISTRATION: Iranian Registry of Clinical Trials identifier: IRCT20200914048712N1.

Highly processed food addiction: A concept analysis

AIM

This concept analysis aims to clarify the highly processed food addiction (HPFA) concept and discuss its implications for treating obesity.

BACKGROUND

Emerging empirical evidence suggests addictive-like eating may contribute to obesity in some individuals, increasing interest in HPFA's role in obesity. Clarifying the HPFA concept will aid in developing individualized interventions for patients with obesity and HPFA.

DESIGN

This concept analysis followed Walker and Avant's approach. The case studies are of participants in a study that included individuals with and without HPFA (Yale Food Addiction Scale 2.0-diagnosed).

DATA SOURCE

We searched PubMed, CINAHL, PsychInfo, and Ebscohost databases. Keywords were "food addiction" and "food addiction concept."

REVIEW METHODS

Criteria included recent reviews and empirical studies that measured HPFA and focused on HPFA characteristics and/or treatment implications.

RESULTS

The model case displayed all 11-substance use disorder (SUD) symptoms and clinical significance, supporting a severe HPFA diagnosis. The contrary case was negative for all YFAS 2.0 symptoms and clinical significance and did not eat compulsively or experience cravings. The borderline case met the minimum symptom criteria for severe HPFA but not clinical significance. Clinical interviews may help determine whether such individuals truly exhibit addictive-like eating behaviors.

CONCLUSIONS

Growing empirical evidence and our case studies support the HPFA concept and the utility of the YFAS/YFAS 2.0 for identifying a distinct subset of individuals with overweight/obesity who may benefit from interventions developed to treat established SUDs. Future research should examine HPFA separately and in relation to obesity and eating disorders and include longitudinal studies and gender-balanced samples.

Food Addiction and Its Relationship to Weight- and Addiction-Related Psychological Parameters in Individuals With Overweight and Obesity

Background and Aims: It is assumed that a relevant subgroup of individuals experiences an addiction-like eating behaviour (Food Addiction), characterized by an impaired control over eating behaviour, emotional eating and food craving. Individuals experiencing Food Addiction partially share common symptomatology with Binge-Eating-Disorder and Bulimia Nervosa. The aim of this study was to investigate the prevalence of Food Addiction, general psychopathology, and associations with weight- and addiction-related constructs in individuals with overweight and obesity, who did not suffer from Binge-Eating-Disorder or Bulimia Nervosa.

Methods:N=213 (67.1% female; M_BMI=33.35kg/m², SD_BMI=3.79kg/m²) participants who were included in a weight loss program (I-GENDO project) reported BMI and completed questionnaires before the start of the treatment. Food Addiction severity, depressive symptoms, alcohol use disorder, internet use disorder, psychological distress, impulsivity personality trait, impulsive and emotional eating behaviour, food related inhibitory control, weight bias internalization, and self-efficacy were assessed.

Results: The prevalence of Food Addiction was 15% with higher, although not statistically significant, prevalence in female (18.2%) compared to male (8.6%) participants. Food Addiction was associated with higher BMI at baseline assessment, low self-esteem, impulsive and emotional eating behaviour, weight bias internalization, and deficits in food-related inhibitory control. In addition, correlations were found between Food Addiction and severity of depressive symptoms, internet use disorder, and psychological distress.

Conclusion: A relevant subgroup of participants experiences Food Addiction even when controlling for Binge-Eating-Disorder and Bulimia Nervosa. Future studies are warranted that investigate whether Food Addiction affects treatment success.

Current Intervention Treatments for Food Addiction: A Systematic Review

Research on the concept of food addiction (FA) has steadily grown and, based on a widely used self-report, FA is estimated to affect between 16-20% of the adult population. However, there are few interventions available for people with self-reported FA, and their efficacy is unclear. The primary aim of the review was to examine the efficacy of different interventions, including behavioural/lifestyle, medication and surgical approaches, for reducing symptoms and/or changing diagnosis of FA among adolescents and adults. A secondary aim was to examine the influence of sex as a moderator of intervention effects. A systematic search was performed from 2008-2020 to identify studies that used the YFAS to assess the effectiveness of interventions on FA. Nine studies were identified (n = 7 adults, n = 2 adolescents) including a total of 812 participants (range 22-256) with an average of 69% females per study. The types of interventions included medications (n = 3), lifestyle modification (n = 3), surgical (n = 2) and behavioural (n = 1), with FA being assessed as a secondary outcome in all studies. Five studies in adults reported a significant reduction in FA symptoms or diagnosis from pre to post-intervention, two when compared to a control group and three in the intervention group only. Efficacious interventions included: medication (combination of naltrexone and bupropion, as well as pexacerfont), bariatric surgery and lifestyle modification. No significant changes in FA were reported in adolescent studies. Given few studies were identified by the review, there is insufficient evidence to provide clear recommendations for practice; however, some interventions show potential for reducing self-reported FA outcomes in adults. Future research should explore the longer-term efficacy of interventions and the effectiveness of treatments with sufficient sample sizes.

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction

Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (n = 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA.

Longitudinal Changes in Food Addiction Symptoms and Body Weight among Adults in a Behavioral Weight-Loss Program

Interest in food addiction (FA) has increased, but little is known about its clinical implications or potential treatments. Using secondary analyses from a randomized controlled trial, we evaluated the associations between changes in FA, body weight, and “problem food” consumption during a 22-month behavioral weight-loss program consisting of an initial four-month in-person intervention, 12-month extended-care, and six-month follow-up (n = 182). Food addiction was measured using the Yale Food Addiction Scale. “Problem foods” were identified from the literature and self-reporting. Multilevel modeling was used as the primary method of analysis. We hypothesized that reductions in problem food consumption during the initial treatment phase would be associated with long-term (22-month) FA reductions. As expected, we found that reductions in problem foods were associated with greater initial reductions in FA symptoms; however, they were also associated with a sharper rebound in symptoms over time (p = 0.016), resulting in no significant difference at Month 22 (p = 0.856). Next, we hypothesized that long-term changes in FA would be associated with long-term changes in body weight. Although both FA and weight decreased over time (ps < 0.05), month-to-month changes in FA were not associated with month-to-month changes in weight (p = 0.706). Instead, higher overall FA (i.e., mean scores over the course of the study) were associated with less weight loss (p = 0.008) over time. Finally, we hypothesized that initial reductions in problem food consumption would be associated with long-term reductions in weight, but this relationship was not significant (ps > 0.05). Given the complexity of the findings, more research is needed to identify interventions for long-term changes in FA and to elucidate the associations between problem foods, FA, and weight.

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.

The combined effects of probiotics and restricted calorie diet on the anthropometric indices, eating behavior, and hormone levels of obese women with food addiction a randomized clinical trial

BACKGROUND AND AIM

Food addiction (FA) is an important contributor to obesity. Alterations in gut microbiota (GM) diversity and composition have also been proposed to play a pivotal role in obesity pathogenesis. This trial aimed to assess the effects of probiotic supplementation on the anthropometric indices, eating behavior, and hormone levels of obese women with FA.

METHODS

This randomized, double-blind, placebo-controlled clinical trial was conducted among obese women with FA. Participants (n = 62) received a restricted calorie diet (RCD) plus either probiotic, or placebo for 12 weeks. Anthropometric measurements, biochemical markers, eating behavior and appetite were assessed during the study period.

RESULTS

Probiotics administration significantly reduced weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), body fat percentage (BFP), and trunk fat percentage (TFP) compared to the placebo group (p < 0.001). Also, a significant improvement was observed in eating behavior in the probiotic group compared to the placebo group (p < 0.001).Serum levels of oxytocin increased and NPY decreased significantly in the probiotic group compared to the placebo group (p = 0.02, p = 0.002, respectively). Moreover, leptin level significantly decreased in the probiotic group compared to the baseline values (p < 0.001), while probiotics did not cause a greater significant reduction in leptin level, compared to the placebo group.

CONCLUSION

Multi-probiotic supplementation may have beneficial effects on anthropometric indices, eating behavior, and some appetite-regulating hormones in obese women with FA.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20131228015968N5.

Low carbohydrate ketogenic therapy as a metabolic treatment for binge eating and ultraprocessed food addiction

PURPOSE OF REVIEW

The aim of this study was to highlight the recent advancements and future directions for potential use of a low carbohydrate ketogenic dietary approach to treat binge eating and ultraprocessed food addiction. Herein, we explore proposed mechanisms of why a diet low in refined carbohydrates, processed sugar and higher fat content may be helpful in alleviating symptoms.

RECENT FINDINGS

Emerging evidence suggests there may be a metabolic role in development of maladaptive eating. These findings broaden our understanding of eating psychopathology causes. Ultraprocessed, refined or high glycemic index carbohydrates are a possible trigger mediating neurochemical responses similar to addiction. The carbohydrate-insulin model of obesity supports observations of these foods triggering abnormal blood sugar and insulin spikes subsequently leading to changes in metabolic and neurobiological signaling. This results in overeating symptoms and hunger exacerbation, which differs from observed effects of healthy fat consumption and lack of similar insulin spikes. As supported in recent case series, significantly reducing or abstaining from these addictive-like ultraprocessed foods and highly refined carbohydrates could be considered a treatment approach.

SUMMARY

The current review highlights recent and pertinent evidence with respect to theoretical and practical application of low carbohydrate ketogenic therapeutic approaches for ultraprocessed food addiction and binge eating symptoms. VIDEO ABSTRACT:.

Food Addiction in Sleeve Gastrectomy Patients with Loss-of-Control Eating

OBJECTIVE

Food addiction and binge eating share overlapping and non-overlapping features; the presence of both may represent a more severe obesity subgroup among treatment-seeking samples. Loss-of-control (LOC) eating, a key marker of binge eating, is one of the few consistent predictors of suboptimal weight outcomes post-bariatric surgery. This study examined whether co-occurring LOC eating and food addiction represent a more severe variant post-bariatric surgery.

METHODS

One hundred thirty-one adults sought treatment for weight/eating concerns approximately 6 months post-sleeve gastrectomy surgery. The Eating Disorder Examination-Bariatric Surgery Version assessed LOC eating, picking/nibbling, and eating disorder psychopathology. Participants completed the Yale Food Addiction Scale (YFAS), the Beck Depression Inventory-Second Edition (BDI-II), and the Short-Form Health Survey-36 (SF-36).

RESULTS

17.6% met food addiction criteria on the YFAS. Compared to those without food addiction, the LOC group with food addiction reported significantly greater eating disorder and depression scores, more frequent nibbling/picking and LOC eating, and lower SF-36 functioning.

CONCLUSION

Nearly 18% of post-operative patients with LOC eating met food addiction criteria on the YFAS. Co-occurrence of LOC and food addiction following sleeve gastrectomy signals a more severe subgroup with elevated eating disorder psychopathology, problematic eating behaviors, greater depressive symptoms, and diminished functioning. Future research should examine whether this combination impacts long-term bariatric surgery outcomes.

Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series

BACKGROUND

Many patients with obesity and comorbid binge eating symptoms present with the desire to lose weight. Although some studies suggest that dietary restriction can exacerbate binge eating, others show dietary restriction is associated with significant reductions in binge eating. The effect of a particular type of dieting on binge eating, the ketogenic diet (a high fat, moderate protein, very low carbohydrate diet), is not known.

CASE PRESENTATIONS

We report on the feasibility of a low-carbohydrate ketogenic diet initiated by three patients (age 54, 34, and 63) with obesity (average BMI 43.5 kg/m2) with comorbid binge eating and food addiction symptoms. All patients tolerated following the ketogenic diet (macronutrient proportion 10% carbohydrate, 30% protein, and 60% fat; at least 5040 kJ) for the prescribed period (e.g., 6-7 months) and none reported any major adverse effects. Patients reported significant reductions in binge eating episodes and food addiction symptoms including cravings and lack of control as measured by the Binge-Eating Scale, Yale Food Addiction Scale, or Yale-Brown Obsessive-Compulsive Scale modified for Binge Eating, depending on the case. Additionally, the patients lost a range of 10-24% of their body weight. Participants reported maintenance of treatment gains (with respect to weight, binge eating, and food addiction symptoms) to date of up to 9-17 months after initiation and continued adherence to diet.

CONCLUSIONS

Although the absence of control cases precludes conclusions regarding the specific role of ketogenic diets versus other forms of dietary restriction, this is the first report to demonstrate the feasibility of prescribing a ketogenic diet for patients with obesity who report binge eating and food addiction symptoms. Further research should seek to reproduce the observed effects in controlled trials as well as to explore potential etiologies.

Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12-Month Weight Gain in the DIETFITS Trial

OBJECTIVE

The purpose of this study was to examine correlates of failure-trial attrition and weight gain-in a randomized clinical weight-loss trial.

METHODS

The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial included 609 adults (18-50 years; BMI 28-40). Participants were randomized to a 12-month healthy low-fat or healthy low-carbohydrate diet for weight loss. At baseline, participants completed psychosocial, demographic, and anthropometric measures. Stepwise logistic regressions identified baseline factors associated with (1) study attrition and (2) among trial completers, weight gain at 12 months.

RESULTS

Having higher baseline food addiction and self-efficacy was linked to treatment failure. Being younger, not having a college education, having higher outcome expectations and quality of life, and having lower social functioning and self-control increased the odds of trial attrition. Identifying as other than non-Hispanic white; not being married or cohabitating; having higher cognitive restraint and self-control; and having lower amotivation, family encouragement, and physical limitations increased the odds of gaining weight by treatment's end.

CONCLUSIONS

Participants' baseline psychosocial and demographic factors may support or impede successful weight loss. Trialists should attend to these factors when designing treatments in order to promote participants' likelihood of completing the trial and achieving their weight-loss goals.

Disordered Eating Among Individuals with Excess Weight: a Review of Recent Research

PURPOSE OF REVIEW

The purpose of this review was to examine different forms of disordered eating among individuals with excess weight, including their rates, correlates, and psychosocial treatments.

RECENT FINDINGS

Binge eating/binge eating disorder, loss of control eating, emotional eating, and food addiction are all fairly prevalent among individuals with excess weight. They appear to share many of the same correlates, including broader eating disorder psychopathology, body/shape/weight concerns, depression, anxiety, and low self-esteem. Behavioral, cognitive-behavioral, and third-wave (e.g., acceptance, mindfulness) therapies appear effective in improving binge eating, loss of control eating, emotional eating, associated features (e.g., weight and shape concerns), and psychological distress (e.g., depression). Certain forms of disordered eating are elevated among individuals with excess weight, and psychosocial interventions have been found effective in improving symptomatology. Empirical research examining the efficacy of treatments for food addiction is lacking, and greatly needed given both its rate and controversy.

The Food Addiction Construct May Do More Harm Than Good: Weight Controllers Are Athletes, Not Addicts

Food addiction has become a popular notion in the media and scientific community, with many proposing that an addiction to food causes obesity. An article published in this journal in December 2017 by Tompkins et al. asserted that food addiction poses a barrier to the treatment of adolescent obesity. This review questions some of the methods, results, and perspectives offered by Tompkins et al. It also considers the extant evidence overall about this construct. The data about food addiction provide minimal support for the discriminant validity of this conceptualization relative to depressed binge eating. We believe that the evidence suggests that the potential harm outweighs the benefits of encouraging researchers, clinicians, and especially obese people to view food addiction as a cause of obesity or a barrier to effective weight management. Ultimately, this review concludes that the construct of food addiction does not serve the interests of those striving to lose weight permanently (i.e., weight controllers) nearly as well as an alternative perspective: weight controllers are athletes, not food addicts.

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy

SETTING

In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied.

OBJECTIVES

To explore the influence of abnormal EB on the outcome of sleeve gastrectomy.

BACKGROUND

Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired.

METHODS

This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters.

RESULTS

The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found.

CONCLUSION

LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

Systematic Review of Food Addiction as Measured with the Yale Food Addiction Scale: Implications for the Food Addiction Construct

BACKGROUND

The concept of food addiction attracts much interest in the scientific community. Research is mainly based on the Yale Food Addiction Scale (YFAS), a tool developed to assess food addiction. Substance use disorder criteria have been used to develop this scale.

OBJECTIVE

The aim of this paper was to review the clinical significance of food addiction diagnoses made with the YFAS and to discuss the results in light of the current debate on behavioral addictions.

METHODS

We performed a systematic review of the studies that assessed food addiction with the YFAS published between January 2014 and July 2017 by searching the electronic databases PsycINFO, MEDLINE, and PsycARTICLES.

RESULTS

Sixty publications were included in the analysis. Thirty-three studies examined nonclinical samples and 27 examined clinical samples. All studies used YFAS scoring results to define food addiction. The prevalence of food addiction according to the YFAS varied largely by the studied samples. In general, a higher body mass index and the presence of eating disorders (EDs), especially binge eating disorder (BED), were associated with higher YFAS scores.

CONCLUSION

The concept of food addiction has not been established to this day although it can be grouped with other EDs such as BED. More research is needed to understand this behavior and the differences between food addiction and other EDs. The criteria for food addiction should be revisited in light of the concepts currently used to examine behavioral addictions.

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.

Food addiction among Spanish-speaking Latino/as residing in the United States

OBJECTIVE

This study examined food addiction, assessed by the Yale Food Addiction Scale (YFAS), and associated features among a participant group of Spanish-speaking Latino/as residing in the United States.

METHOD

Participants were 140 Spanish-speaking Latino/as (n = 77 female) who participated in an anonymous web-based survey. Mean age and body mass index (BMI) were 31.87 (SD = 9.12) years and 28.34 (SD = 7.14) kg/m², respectively. Participants completed a battery of established self-report measures assessing food addiction, binge-eating and eating-disorder psychopathology (Eating Disorder Examination-Questionnaire; EDE-Q), depressive symptoms (Patient Health Questionnaire-2; PHQ-2), and mental and physical functioning (MOS Short Form Health Survey; SF-12).

RESULTS

Of the 140 participants, 25 (17.9%) exceeded the clinical threshold of food addiction; no significant differences were observed between those categorized with versus without food addiction in age, sex, or race. YFAS scores were significantly correlated with EDE-Q overvaluation, EDE-Q dissatisfaction, BMI, SF-12, and the PHQ-2 (all p-values < .01). Categorical analyses revealed similar findings with participants categorized with clinical levels of food addiction being significantly more likely to meet clinical levels of overvaluation of weight/shape, and reporting significantly greater frequency of binge-eating, depressive symptoms, and poorer overall mental health than those not meeting food addiction criteria (all p-values < .05).

CONCLUSION

Our findings for this Spanish-speaking participant group are generally consistent with those reported in a meta-analysis of English-speaking individuals in suggesting that higher YFAS scores are associated with greater disturbances in eating psychopathology. Future studies should examine whether level of acculturation might contribute to differences in food addiction symptoms and associated psychopathology among Spanish-speaking Latino/as.

Effects of addictive-like eating behaviors on weight loss with behavioral obesity treatment

To examine the relationship between food cravings and food addiction as defined by the Yale Food Addiction Scale (YFAS) and to assess the effects of these variables on weight loss during a 14-week group lifestyle modification program. Data were from 178 participants who were prescribed a 1000-1200 kcal/day portion-controlled diet and provided with weekly group lifestyle modification sessions. Participants completed the Food Craving Inventory and YFAS pre- and post-treatment. Weight was measured weekly. Participants with YFAS-defined food addiction (6.7%) reported more frequent overall food cravings relative to those without food addiction. More frequent food cravings at baseline were associated with less weight loss over the 14 weeks. Analyzed categorically, participants in the highest tertile of baseline food cravings lost 7.6 ± 0.5% of initial weight, which was significantly less compared to those in the lowest tertile who lost 9.1 ± 0.5%. Percent weight loss did not differ significantly between participants with YFAS-defined food addiction (6.5 ± 1.2%) and those who did not meet criteria (8.6 ± 0.3%). Addictive-like eating behaviors significantly declined from pre- to post-treatment. Participants with frequent food cravings lost less weight than their peers. Targeted interventions for food cravings could improve weight loss in these individuals. Few participants met YFAS-defined criteria for food addiction. Addictive-like eating behaviors tended to decline during behavioral weight loss, but neither baseline nor change in YFAS scores predicted weight loss.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS

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

RESULTS

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

DISCUSSION

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

Food Addiction: A Barrier for Effective Weight Management for Obese Adolescents

BACKGROUND

Findings from studies of food addiction in adults suggest those with food addiction are less successful in weight-loss interventions. Little is known about food addiction in obesity treatment-seeking adolescents; therefore, the purpose of this study was to explore the prevalence of food addiction and correlates of food addiction symptoms in obese adolescents entering an outpatient, weight management program.

METHODS

Obese adolescents (n = 26) were administered the Yale Food Addiction Scale for Children (YFAS-C), measures of appetitive responsiveness, and health-related quality of life (HRQOL) before and following a 12-week, outpatient, behavioral weight management program. Descriptive statistics and correlations between YFAS-C symptoms and study variables were performed and further examined with linear regression. Baseline differences were compared between those meeting criteria for food addiction to those who did not (independent t-tests) and pre-postweight management program changes were examined (paired t-tests).

RESULTS

30.7% met criteria for food addiction and 50% reported ≥3 symptoms. Number of YFAS-C symptoms was correlated with appetitive responsiveness (r = 0.57, p < 0.05) and inversely correlated with all domains of HRQOL (r = 0.47-0.53, p < 0.05). Attrition rate was higher in adolescents with food addiction compared to those without (62.5% vs. 44.4%, p < 0.05).

CONCLUSIONS

Adolescents with food addiction or with a higher number of food addiction symptoms may warrant additional resources to support adherence to and retention with a weight management program. Implementing screening measures for food addiction before enrolling in a weight management program may be an effective strategy to identify adolescents who may benefit from adjunct modalities.

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

Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the prognostic significance of pre-operative food addiction. Thus, this article provides a systematic review and synthesis of the literature on food addiction and bariatric surgery. Articles were identified through PubMed and SCOPUS databases, resulting in a total of 19 studies which assessed food addiction among pre-bariatric and/or post-bariatric surgery patients using the Yale Food Addiction Scale. Most studies were cross-sectional, and only two studies prospectively measured food addiction both pre-operatively and post-operatively. The presence of pre-surgical food addiction was not associated with pre-surgical weight or post-surgical weight outcomes, yet pre-surgical food addiction was related to broad levels of psychopathology. The relationship between food addiction and substance misuse among individuals undergoing bariatric surgery is mixed. In addition, very few studies have attempted to validate the construct of food addiction among bariatric surgery patients. Results should be interpreted with caution due to the methodological limitations and small sample sizes reported in most studies. Future rigorous research with larger and more diverse samples should prospectively examine the clinical utility and validity of the food addiction construct following bariatric surgery.

Food for Thought: Reward Mechanisms and Hedonic Overeating in Obesity

PURPOSE OF REVIEW

This review examines the food addiction model and the role of food hedonic pathways in the pathogenesis and treatment of obesity.

RECENT FINDINGS

The hedonic pathway interacts with the obesogenic environment to override homeostatic mechanisms to cause increase in body weight. Weight gain sustained over time leads to "upward setting" of defended level of body-fat mass. There are neurobiological and phenotypic similarities and differences between hedonic pathways triggered by food compared with other addictive substances, and the entity of food addiction remains controversial. Treatment for obesity including pharmacotherapy and bariatric surgery impacts on neural pathways governing appetite and hedonic control of food intake. The food addiction model may also have significant impact on public health policy, regulation of certain foods, and weight stigma and bias. Recent rapid progress in delineation of food hedonic pathways advances our understanding of obesity and facilitates development of effective treatment measures against the disease.

Predictors of successful long-term weight loss maintenance: a two-year follow-up

BACKGROUND

Weight regain is a common problem following weight loss intervention, with most people who seek treatment for obesity able to lose weight, but few able to sustain the changes in behavior required to prevent subsequent weight regain. The identification of factors that predict which patients will successfully maintain weight loss or who are at risk of weight regain after weight loss intervention is necessary to improve the current weight maintenance strategies. The aim of the present study is identify factors associated with successful weight loss maintenance by women with overweight or obesity who completed group cognitive behavioral treatment (CBT) for weight loss.

METHODS

Ninety women with overweight or obesity completed a 7-month weight loss intervention. The data of 86 who completed follow-up surveys 12 and 24 months after the end of the treatment was analyzed. Depression, anxiety, binge eating, food addiction, and eating behaviors were assessed before and after the weight loss intervention. Participants who lost at least 10% of their initial weight during the weight loss intervention and had maintained the loss at the month 24 follow-up were defined as successful.

RESULTS

The intervention was successful for 27 participants (31.3%) and unsuccessful for 59 (68.6%). Multiple logistic regression analysis extracted larger weight reduction during the weight loss intervention, a lower disinhibition score, and a low food addiction score at the end of the weight loss intervention as associated with successful weight loss maintenance.

CONCLUSION

The results suggest that larger weight reduction during the weight loss intervention and lower levels of disinhibition and food addiction at the end of the weight loss intervention predicted successful weight loss maintenance.

TRIAL REGISTRATION

Trial registry name: Development and validation of effective treatments of weight loss and weight-loss maintenance using cognitive behavioral therapy for obese patients. Registration ID: UMIN000006803 Registered 1 January 2012. URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000008052.

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores

Background

Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases.

Methods

In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type.

Results

Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases.

Conclusions

Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases.

Trial registration

ClinialTrials.gov: NCT02774330. Registered May 4, 2016 (retrospectively registered).

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0531-x) contains supplementary material, which is available to authorized users.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence and psychosocial correlates of food addiction in persons with obesity seeking weight reduction

INTRODUCTION

Food addiction is a controversial concept. The potential influence of food addiction on patients' psychosocial functioning and well-being has not been well established. The purpose of this study was to examine the relationships between psychosocial functioning (depressive symptoms and health-related quality of life [HRQOL]) and food addiction as measured by the Yale Food Addiction Scale (YFAS). We also explored whether food addiction contributed additional variance in explaining psychosocial functioning, beyond demographic and clinical factors (e.g., binge eating).

METHODS

The sample included 178 participants (mean age=44.2±11.2years; BMI=40.9±5.9kg/m²; 88.2% female; 70.8% Black) with obesity seeking treatment for weight loss. Participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey, Impact of Weight on Quality of Life-Lite, Patient Health Questionnaire, YFAS, and Questionnaire on Eating and Weight Patterns-5.

RESULTS

Twelve (6.7%) participants met criteria for food addiction, with 4 (33.3%) of these participants having co-occurring binge eating disorder. After adjusting for covariates, the number of food addiction symptoms accounted for 6.5% to 16.3% of additional variance in general HRQOL, 5.0% to 21.5% in weight-related HRQOL, and 19.1% in symptoms of depression.

CONCLUSIONS

In this treatment-seeking sample of participants, we found a low prevalence of food addiction, suggesting that addictive-like eating is unlikely to be a causal mechanism for most people with obesity. However, individuals who met criteria for food addiction had reduced psychosocial functioning compared to those who did not meet criteria. Individuals with addictive-like eating may require additional psychosocial support.

Food addiction and the outcome of bariatric surgery at 1-year: Prospective observational study

PURPOSES

The objectives of the current study were to determine the prevalence of food addiction in bariatric surgery candidates and whether food addiction is associated with weight loss after bariatric surgery.

METHODS

This prospective observational study was performed on morbidly obese patients who had been found suitable for bariatric surgery. Follow-up was conducted at the 6 and 12 month post-surgery. The Yale Food Addiction Scale (YFAS) was used to determine food addiction.

RESULTS

One hundred seventy-eight patients were included. Pre-operative food addiction was found in 57.8% of patients. Food addiction prevalence decreased at the 6 and 12 month follow ups, to 7.2% and 13.7% respectively. There were no statistically differences between those with food addiction and those without addiction with regard to weight loss measured as percent of excess BMI at the 12 month follow-up.

CONCLUSION

Food addiction as measured by the YFAS decreases significantly after bariatric surgery. The presence of food addiction before surgery was not associated with weight loss as measured EBL%. However, in view of the increase in BMI, 2 years after surgery longer follow up studies are warranted.

Successful customer intercept interview recruitment outside small and midsize urban food retailers

BACKGROUND

Customer intercept interviews are increasingly used to characterize food purchases at retail food outlets and restaurants; however, methodological procedures, logistical issues and response rates using intercept methods are not well described in the food environment literature. The aims of this manuscript were to 1) describe the development and implementation of a customer intercept interview protocol in a large, NIH-funded study assessing food purchases in small and midsize food retailers in Minneapolis and St. Paul, Minnesota, 2) describe intercept interview response rates by store type and environmental factors (e.g., neighborhood socioeconomic status, day/time, weather), and 3) compare demographic characteristics (e.g., gender, race/ethnicity) of participants versus non-participants.

METHODS

After a pilot phase involving 28 stores, a total of 616 interviews were collected from customers exiting 128 stores in fall 2014. The number of eligible customers encountered per hour (a measure of store traffic), participants successfully recruited per hour, and response rates were calculated overall and by store type, neighborhood socio-economic status, day and time of data collection, and weather. Response rates by store type, neighborhood socio-economic status, time and day of data collection, and weather, and characteristics of participants and non-participants were compared using chi-square tests.

RESULTS

The overall response rate was 35 %, with significantly higher response rates at corner/small grocery stores (47 %) and dollar stores (46 %) compared to food-gas marts (32 %) and pharmacies (26 %), and for data collection between 4:00-6:00 pm on weekdays (40 %) compared to weekends (32 %). The distribution of race/ethnicity, but not gender, differed between participants and non-participants (p < 0.01), with greater participation rates among those identified as Black versus White.

CONCLUSIONS

Customer intercept interviews can be successfully used to recruit diverse samples of customers at small and midsize food retailers. Future community-based studies using customer intercept interviews should collect data sufficient to report response rates and consider potential differences between the racial/ethnic composition of the recruited sample and the target population.

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

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

Shared and unique mechanisms underlying binge eating disorder and addictive disorders

Scientific interest in "food addiction" is growing, but the topic remains controversial. One critique of "food addiction" is its high degree of phenotypic overlap with binge eating disorder (BED). In order to examine associations between problematic eating behaviors, such as binge eating and "food addiction," we propose the need to move past examining similarities and differences in symptomology. Instead, focusing on relevant mechanisms may more effectively determine whether "food addiction" contributes to disordered eating behavior for some individuals. This paper reviews the evidence for mechanisms that are shared (i.e., reward dysfunction, impulsivity) and unique for addiction (i.e., withdrawal, tolerance) and eating disorder (i.e., dietary restraint, shape/weight concern) frameworks. This review will provide a guiding framework to outline future areas of research needed to evaluate the validity of the "food addiction" model and to understand its potential contribution to disordered eating.

A Systematic Review of the Application And Correlates of YFAS-Diagnosed 'Food Addiction' in Humans: Are Eating-Related 'Addictions' a Cause for Concern or Empty Concepts?

The proposition of so-called 'food addiction' (FA) in the scientific literature has stimulated a recent surge in research and debate. The concept of FA is controversial, and opinion is divided. Many of the findings depend upon the use of a single instrument called the Yale Food Addiction Scale (YFAS). This review systematically examined FA, as defined by the YFAS, reported in 40 experimental human studies published in or after 2009. The results indicated that much of the literature makes the supposition that food addiction is an accepted neurobiological disease, consistent with substance use disorders; an interpretation based on very limited data. This raises the question as to whether those individuals who meet the YFAS criteria for diagnosis are truly 'addicted' to food or if they experience significant impairment to their psychological wellbeing and quality of life as would be expected in clinically recognised addictive disorders. At the present time, little research has investigated the extent to which a psychometric self-assessment of FA symptomatology can elucidate a harmful relationship with target foods in the diet. A positive YFAS diagnosis is usually positively associated with BMI and strongly linked with the presence of binge eating, but certain exceptions within the literature were revealed. Further clarification is required as to whether so-called FA is sufficiently different to existing conditions and traits to warrant classification as a distinctive disease phenotype rather than an expression of strong habits and preferences.

The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review

Obesity is a global issue and it has been suggested that an addiction to certain foods could be a factor contributing to overeating and subsequent obesity. Only one tool, the Yale Food Addiction Scale (YFAS) has been developed to specifically assess food addiction. This review aimed to determine the prevalence of food addiction diagnosis and symptom scores, as assessed by the YFAS. Published studies to July 2014 were included if they reported the YFAS diagnosis or symptom score and were published in the English language. Twenty-five studies were identified including a total of 196,211 predominantly female, overweight/obese participants (60%). Using meta-analysis, the weighted mean prevalence of YFAS food addiction diagnosis was 19.9%. Food addiction (FA) diagnosis was found to be higher in adults aged >35 years, females, and overweight/obese participants. Additionally, YFAS diagnosis and symptom score was higher in clinical samples compared to non-clinical counterparts. YFAS outcomes were related to a range of other eating behavior measures and anthropometrics. Further research is required to explore YFAS outcomes across a broader spectrum of ages, other types of eating disorders and in conjunction with weight loss interventions to confirm the efficacy of the tool to assess for the presence of FA.

Food addiction in the light of DSM-5

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

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

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

Correlates of food addiction in obese individuals seeking bariatric surgery

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

Bariatric surgery-induced weight loss causes remission of food addiction in extreme obesity

OBJECTIVE

To test the hypotheses that bariatric surgery-induced weight loss: induces remission of food addiction (FA), and normalizes other eating behaviors associated with FA.

METHODS

Forty-four obese subjects (BMI= 48 ± 8 kg/m(2) ) were studied before and after ∼20% weight loss induced by bariatric surgery (25 Roux-en-Y gastric bypass, 11 laparoscopic adjustable gastric banding, and eight sleeve gastrectomy). We assessed: FA (Yale Food Addiction Scale), food cravings (Food Craving Inventory), and restrictive, emotional and external eating behaviors (Dutch Eating Behavior Questionnaire).

RESULTS

FA was identified in 32% of subjects before surgery. Compared with non-FA subjects, those with FA craved foods more frequently, and had higher scores for emotional and external eating behaviors (all P-values <0.01; all Cohen's d >0.8). Surgery-induced weight loss resulted in remission of FA in 93% of FA subjects; no new cases of FA developed after surgery. Surgery-induced weight loss decreased food cravings, and emotional and external eating behaviors in both groups (all P-values < 0.001; all Cohen's d ≥ 0.8). Restrictive eating behavior did not change in non-FA subjects but increased in FA subjects (P < 0.01; Cohen's d>1.1).

CONCLUSION

Bariatric surgery-induced weight loss induces remission of FA and improves several eating behaviors that are associated with FA.