Validation of the Italian version of the Yale Food Addiction Scale 2.0 (I-YFAS 2.0) in a sample of undergraduate students

Development and validation of the modified Yale Food Addiction Scale for Children 2.0

OBJECTIVE

Scientific interest in the concept of food addiction is growing, but more studies are needed in youth samples. Brief, psychometrically valid, and developmentally appropriate measures are needed to support the assessment of food addiction in large-scale studies of youth that need to minimize participant burden. While a brief version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) exists for adults, no comparable scale exists for youth. Thus, the current study aimed to develop a brief and valid measure of food addiction for use in youth populations (the modified YFAS for children 2.0).

METHOD

Data stem from the Food Addiction Denmark (FADK) Project, where random samples of 559 adolescents from the general population and 413 adolescents from a population with mental disorder completed the 35-item original YFAS for children 2.0 (YFAS-C 2.0). An abbreviated 13-item version was developed, and the psychometric properties of the modified YFAS-C 2.0 (mYFAS-C 2.0) were then evaluated.

RESULTS

The mYFAS-C 2.0 exhibited a one-factor structure and was found to have sound psychometric properties regarding internal consistency and convergent, discriminant, and incremental validity. This was evident in both the general adolescent population sample and the sample of adolescents with mental disorders.

CONCLUSIONS

The mYFAS-C 2.0 provides a brief and psychometrically valid measure of food addiction for youth, which may be beneficial for study designs (e.g., epidemiological samples) that aim to minimize participant burden. Future research on the test-retest reliability of the mYFAS-C 2.0 and its psychometric properties in younger children are important next steps.

Food addiction in patients on weight loss treatment

Background

Food addiction (FA) is defined as hedonic eating behavior involving the consumption of highly palatable foods (i.e., ultra processed foods in quantities beyond homeostatic energy requirements). FA is present in a subset of patients with overweight or obesity and could contribute to the response to weight loss treatments.

Aim

Determine FA in individuals that fulfil the criteria of FA as measured by the YFAS 2.0, and its association with anthropometric and body composition variables in a clinical sample of patients undergoing weight loss treatment. Also, to determine the most prevalent FA criteria.

Methods

An observational, analytical, and cross-sectional study was conducted. Sampling was non-probabilistic, convenience based. A total of 158 participants were recruited from two clinical centers (private and public) focused on managing non-communicable chronic diseases. The Chilean version of YFAS 2.0 was administrated through the online REDCap platform. Anthropometric measurements were measured, and body mass index (BMI) was calculated.

Results

The mean age was 47.8 (SD 14.9) and BMI 28.7 (SD 5.3) kg/m2. There were 12.7% patients who screened positive on the YFAS 2.0 Chilean version (3.2% for mild, 2.5% for moderate and 7.0% for severe), the mean symptom count was 2.2 (SD 2.6), with withdrawal being the most prevalent criterion (33.5%). FA patients had significantly higher body weight compared to non-FA subjects (p = 0.045). We observed a slight and significant correlation between FA symptom count and body weight (p = 0.020), waist circumference (p = 0.005), and BMI (p = 0.023).

Conclusion

This is the first study in Chile that showed that FA was present in patients undergoing weight loss treatment and was associated with anthropometric measurements. In addition, it showed that withdrawal was the most prevalent criterion. Future studies should investigate whether the presence of FA and the withdrawal criterion could contribute to suboptimal clinical response to weight loss treatment.

Psychosocial risk and protective factors for youth problem behavior are associated with food addiction in the Generation Z

Objective

Food Addiction (FA) and other well-known risk behavior as substance misuse tend to co-occur and may share similar risk and protective factors. The aim of this study was to assess the association between the diagnosis/severity of FA and psychosocial domains typically related to risk behavior syndrome in a large, nationally representative community sample of Generation Z underage Italian students.

Method

The sample consisted of 8,755 students (3,623 from middle schools, 5,132 from high schools). A short version of the Yale Food Addiction Scale 2.0 was administered to evaluate FA. Risk and protective factors related to demographic, personality, behavior, and family variables were examined. Stepwise multivariate logistic and linear regressions were conducted.

Results

The prevalence of FA was 30.8%. Female gender, social anxiety and depression symptoms, social withdrawal risk, Internet gaming disorder, social media addiction, current substance use, social challenge engagement and experienced doxing boosted the chance of FA diagnosis, whereas eating fruit and vegetables, playing competitive sports and an average sleep duration of 7-8 h per night reduced these odds. FA severity was significantly and positively associated with trait impulsiveness, social anxiety and depressive symptoms, risk of social withdrawal, recent substance use, social media, and gaming addiction, doxing suffered and risky social challenges participation. Negative associations between the severity of FA and fruit and vegetable diet habits were found.

Conclusion

Our findings confirm that FA is widespread among Italian adolescents. The associations between the diagnosis and severity of FA and psychosocial risk factors for health, including, addictive and deviant behaviors related to digital misuse, suggest its belonging to the risk behavior constellation. Health promotion schemes based on a multicomponent strategy of intervention should consider the inclusion of FA and its psychosocial correlates.

Validation and assessment of psychometric properties of the Greek Eating Behaviors Assessment for Obesity (GR-EBA-O)

INTRODUCTION

With increasing morbidity and risk of death, obesity has become a serious health problem largely attributable to difficulties in finding proper treatments for related diseases. Many studies show how detecting abnormal eating behaviors could be useful in developing effective clinical treatments. This study aims at validating the Greek version of the Eating Behaviors Assessment for Obesity (EBA-O).

METHOD

After a double English/Greek forward/backward translation of the EBA-O, 294 participants completed the Greek version (GR-EBA-O), the Eating Disorder Examination Questionnaire, the Binge Eating Scale, and the Yale Food Addiction Scale. Confirmatory factor analysis (CFA) and construct validity were calculated, and Two-way MANOVA was computed with the factors of GR-EBA-O controlling for sex and BMI categories.

RESULTS

CFA confirmed the second-order five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia) structure of the original EBA-O with excellent fit indices. GR-EBA-O factors were highly correlated. The GR-EBA-O subscales were also significantly correlated with the remaining measures, demonstrating good concurrent validity.

CONCLUSION

The Greek version of the EBA-O has demonstrated sound psychometric properties and appears a reliable and user-friendly tool to identify pathological eating behaviors in obesity.

LEVEL OF EVIDENCE

V, descriptive research.

Influence of NUCB/Nesfatin-1 Polymorphism on Treatment Response to Naltrexone/Bupropion SR in Binge Eating Disorder and Obesity

Background and Objectives: The NUCB2 gene and its polymorphisms were identified as novel players in the regulation of food intake, potentially leading to obesity (OBE) and altered eating behaviors. Naltrexone/bupropion SR (NB) showed good efficacy and tolerability for treating OBE and altered eating behaviors associated with binge eating disorder (BED). This prospective study investigates the influence of NUCB2 gene polymorphism on NB treatment response in OBE and BED. Materials and Methods: Body mass index (BMI), eating (EDE-Q, BES, NEQ, GQ, Y-FAS 2.0) and general psychopathology (BDI, STAI-S) were evaluated at baseline (t0) and after 16 weeks (t1) of NB treatment in patients with OBE and BED (Group 1; N = 22) vs. patients with OBE without BED (Group 2; N = 20). Differences were evaluated according to the rs757081 NUCB2 gene polymorphism. Results: NUCB2 polymorphism was equally distributed between groups. Although weight at t0 was higher in Group 1, weight loss was similar at t1 in both groups. BMI was not influenced by NUCB2 polymorphism. In Group 1, the CG-genotype reported significant improvement in eating psychopathology while the GG-genotype reported improvement only for FA. No differences were observed in Group 2. Conclusions: Patients diagnosed with BED and treated with NB exhibited a more favorable treatment response within the CG-genotype of the NUCB2 polymorphism.

Exploratory study of the prevalence of food addiction and its relationship with executive functioning, depression, and reinforcement sensitivity in a sample of Mexican adults

Introduction

The study of food addiction (FA) has become relevant due to its high prevalence, the negative impact on quality of life, and its association with neuropsychological and psychiatric symptoms. Several studies have provided scientific support for these associations, however, the results are contradictory. Additionally, studies have unsuccessfully elucidated the true nature of the failures in executive functioning in people with FA symptomatology, particularly when it comes to executive deficits. Therefore, the purpose of this research was to establish whether the presence of executive dysfunction, depressive symptoms and binge eating problems, as well as high reward sensitivity entails a greater severity in FA traits and high body mass index (BMI) in a sample of Mexican adults.

Methods

The sample consisted of Mexican men and women between 21-59 years (n = 36); who completed self-report questionnaires and performance tests to measure the study variables. Additionally, BMI was estimated with self-reported height and weight.

Results

Our results showed that a high number of FA symptoms were associated with higher executive dysfunction scores, greater reward sensitivity, and more severe depressive and binge eating problems. Furthermore, factors that are more strongly associated with higher scores of FA include severe executive deficits, greater activation of the punishment avoidance system, and persistence in the search for reward when the depressive symptoms increased. The factors that best explained changes in the estimated BMI of women were a decreased crystallized intellectual capacity and the inability to control food intake as the number of FA symptoms increased.

Discussion

In summary, the cognitive functioning profile characterized by general failure of the executive functioning, as well as a greater activation of the Punishment Avoidance System and persistence in the search for reward, were associated with greater severity of FA symptoms, especially when the depressive symptomatology was severe. In parallel, the psychopathology in participants associated with FA confirms the contribution of anxious and depressive symptomatology and borderline personality traits which could facilitate the expression of clinically relevant FA symptoms in women. Finally, we found that decreased crystallized intellectual capacity and inability to control food intake were linked to higher BMI when the number of FA symptoms increased.

Is Food Addiction a Specific Feature of Individuals Seeking Dietary Treatment from Nutritionists?

OBJECTIVE

Food addiction (FA) is a condition characterized by excessive and dysregulated consumption of high-energy food, and impulsivity. The diagnostic and nosological framework of FA is still controversial. Therefore, this study aimed at exploring the prevalence of FA in patients seeking help from nutritionists for weight loss, along with its relationship with eating habits, in a pool of 842 participants of both sexes.

METHOD

Eating habits and FA were assessed by, respectively, a self-administered questionnaire and the Yale Food Addiction Scale (YFAS). Statistical analysis included Chi-square for categorical variables, independent t tests to investigate continuous variables and an univariate logistic regression analysis to determine potential risk factors for FA. The relationship between FA diagnosis and potential risk factors was assessed through a stepwise logistic regression model, controlling for age, sex, and body mass index (BMI) classes.

RESULTS

Our results indicate that a prevalence of FA in our sample was 15.3%, with no difference between women and men. A higher prevalence was recorded in overweight subjects or obese. According to the YFAS criteria, women were more likely to report a persistent desire and withdrawal than men. Patients with FA compared with those without it, reported a greater number of attempts to lose weight, to self-dieting, a different mealtime repertoire, and to nibble continuously throughout the day. Moreover, the amount of carbohydrates ingested in the same meal seems to represent an eating habit significantly associated with FA.

CONCLUSIONS

Taken together, our findings show how patients seeking help from nutritionists may display some peculiar features of FA. In spite of its diagnostic controversies, it is evident that FA may play a role in obesity and may also be a feature of some psychopathological conditions. Therefore, it should be more deeply investigated and possibly specifically targeted with tailored therapeutic interventions.

The relationship of food addiction with binge eating disorder and obesity: A network analysis study

Food addiction (FA) has been associated with binge eating disorder (BED) and obesity at varying levels of severity and treatment outcomes. Despite much debate and scientific interest in FA, the mechanisms that underlie its co-occurrence with both conditions are not yet well understood. In order to understand this relationship, this study explores FA in a clinical sample of individuals with BED and obesity using network analysis (NA). A total of 303 patients (151 with BED and 152 with obesity) completed a battery of tests that investigated eating psychopathology, eating behaviours, emotional dysregulation, depression and FA. Two different NAs were conducted to investigate the interaction between these variables and FA. The BED and obesity groups were comparable in age (38 ± 14 vs. 42 ± 13 years), body mass index (38.8 ± 8.5 vs 42.4 ± 7.8), sex and demographics. According to the expected influence values, binge eating severity and depression were identified as the central nodes in both networks. In the BED group, binge eating severity was the central node and showed strong connections to both FA and grazing. In contrast, in the obesity group, depression was the central node, but its connections were weak, with only marginal associations to FA. These results suggest that FA represents an important and distinct construct of the two populations. In patients with BED, FA is intimately connected to other loss-of-control-related eating behaviours, such as binge eating and grazing. Conversely, in those with obesity, depression explains the relationship of FA with pathological eating behaviours. The presence of FA seems to be a distinguishing characteristic in the psychopathology of patients suffering from obesity with and without BED, and this could have implications for the prevention, treatment and management of these disorders.

Early maladaptive schemas and behavioural addictions: A systematic literature review

As observed in other mental health difficulties, behavioural addiction is a complex construct with several potential predisposing factors, which include biological factors (e.g., genetic predispositions), psychological factors (e.g., personality traits), and social factors (e.g., family, and social history). One factor that may play a significant role in both developing and perpetuating behavioural addiction is the activation of early maladaptive schemas (EMSs). The aim of the present review was to synthesize the evidence concerning the relationship between behavioural addiction and EMSs. A comprehensive literature search using keywords and subject headings was performed with three electronic databases, resulting in 20 studies that met the inclusion criteria. In relation to specific behavioural addiction, the 20 studies examined: binge-eating/food addiction (n = 6), sexual addiction/compulsive sexual behaviours (n = 3), multiple addictive behaviours (n = 2), internet addiction (n = 2), smartphone addiction (n = 2), social networking/Facebook addiction (n = 2), exercise dependence (n = 1), gambling (n = 1), and videogame addiction (n = 1). The patterns of association between EMS and behavioural addiction were examined in both clinical and non-clinical population. The 'Disconnection and Rejection' domain was the most strongly related schema domain across all addictive behaviours, followed by 'Impaired Limits'. The present review suggests a positive relationship between schema activation and several addictive behaviours, including addictions to gambling, gaming, social media use sex, exercise, and food. The clinical implications of the findings are discussed, but further research is needed to inform treatment plans and interventions for those who struggle with behavioural addictions.

Does food use disorder exist? Item response theory analyses of a food use disorder adapted from the DSM-5 substance use disorder criteria in a treatment seeking clinical sample

BACKGROUND

Increased consumption of food that are high in energy and sugar have been pointed as a major factor in the obesity epidemic. Impaired control of food intake and the concept of food addiction has been developed as a potential contributor. Our objective was to evaluate the dimensionality and psychometric validity of diagnostic criteria for food addiction adapted from the 11 DSM-5 substance use disorder (SUD) criteria (i.e.: Food Use Disorder (FUD) criteria), and to evaluate the influence of age, gender, and body mass index (BMI).

METHODS

Cross-sectional observational study including 508 participants (56.1% male; mean age 42.2) from outpatient treatment clinics for obesity or addiction disorders at time of admission. FUD diagnostic criteria were analyzed using confirmatory factor and 2-parameter item response theory analyses. Differential Item and Test Functioning analyses were performed across age, gender, and BMI.

RESULTS

We demonstrated the one-factor dimensionality of the criteria set. The criterion "craving" presented the strongest factor loading and discrimination parameter and the second-lowest difficulty. We found some significant uniform differential item functioning for body mass index. We found some differential test functioning for gender and BMI.

CONCLUSIONS

This study reports, for the first time, the validity of a potential Food Use Disorder (derived from the 11 DSM-5 SUD criteria adapted to food) in a sample of treatment seeking adults. This has great implications both at the clinical level and in terms of public health policy in the context of the global obesity epidemic.

Prevalence of food addiction and its association with lifestyle factors in undergraduate students from Northwest Mexico

Background: The aim of this study was to determine the prevalence of food addiction (FA) in undergraduate students from Northwest Mexico and to examine its association with lifestyle factors, eating behaviors and food consumption.Methods: This cross-sectional study included a total of 326 undergraduate students, both sexes, between 18 and 25 years of age, who were enrolled in a bachelor's degree program at a public or private university in the city of Tijuana, Baja California, Mexico. FA was assessed using the modified Yale Food Addiction Scale Version 2.0 (mYFAS 2.0). Lifestyle (sleep patterns, physical exercise, alcohol intake, and smoking) and nutritional information (eating behaviors and food frequency consumption) was obtained through a clinical history. A multivariate logistic regression model was fitted to assess the factors associated with FA.Results: The whole prevalence of FA was 12.9%. In general, mild FA was the most frequent (5.2%), followed by severe (4.3%) and moderate (3.4%) categories. In the multivariate model, insomnia conferred a higher risk for FA (OR = 2.08, 95% CI, 1.04-4.17, p = 0.040), while the habitual consumption of fruits showed a protective effect (OR = 0.50, 95% CI, 0.25-0.98, p = 0.046). Overall, the model predicted FA in 12% (R2=0.12, p = 0.011).Conclusion: The prevalence of FA is 12.9% among undergraduate students from Northwest Mexico. Although caution should be exercised, insomnia seems to increase the risk of FA, while the habitual consumption of fruits appears to have a protective role. Additional studies are needed to validate these results.

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.

Eating Compulsivity in Inpatients with Severe Obesity and the General Population: The Italian Version of the Measure of Eating Compulsivity (MEC10-IT)

This study aimed to validate and investigate the psychometric properties of the Italian version of the Measure of Eating Compulsivity-10 (MEC10-IT) in a sample of inpatients with severe obesity (Study 1), and to test the measurement invariance of the measure across non-clinical and clinical samples (Study 2). In the first study, a confirmatory factorial analysis (CFA) was conducted among 452 patients in order to confirm the factorial structure of the MEC10-IT. In the second study, the psychometric properties of the MEC10-IT were tested on 453 inpatients with severe obesity and a community sample of 311 participants. The CFA confirmed the factorial structure of the MEC10-IT among an Italian sample of adult inpatients with severe obesity (Study 1). The MEC10-IT was also demonstrated to be invariant between the clinical and the community sample and to possess good psychometric properties, as well as excellent screening abilities for classifying individuals with problematic eating behaviors (Study 2). In conclusion, the MEC10-IT could be considered as a valid and reliable tool for the assessment of compulsive eating in both non-clinical and clinical samples and represents a psychometrically sound measure for clinical and research purposes.

Psychopathological Profile Associated with Food Addiction Symptoms in Adolescents with Eating Disorders

Eating disorders are considered one of the psychiatric disorders with a higher risk of death. Food addiction, related to some food addictive-like behaviours, is often in comorbidity with eating disorders and is associated with worse psychopathology. The present study aims to outline the food addiction profile, investigated using the Yale Food Addiction Scale 2.0 (YFAS 2.0), in 122 adolescents (median age: 15.6 years) suffering from eating disorders and to investigate its association with psychopathology. Patients filled out the Youth Self Report, the Multidimensional Anxiety Scale for Children 2, The Children Depression Inventory 2, and the Eating Disorder Inventory 3 (EDI-3). Pearson's chi-square test and multiple correspondence analysis were used to identify profiles. The mean symptom count was 2.8 ± 2.7. The "withdrawal" symptom was the most frequent (51%) and the most associated with clinical scores. The diagnosis of bulimia nervosa and the EDI-3 bulimia scale resulted to be the only variables to be associated with positive YFAS 2.0 symptoms. Conversely, anorexia nervosa, restrictive and atypical, was not associated with YFAS 2.0 symptoms. In conclusion, outlining the food addiction profile of eating disorders may give information about a patient's phenotype and could help to identify specific treatment models.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Yale Food Addiction Scale 2.0 (YFAS 2.0) and modified YFAS 2.0 (mYFAS 2.0): Rasch analysis and differential item functioning

BACKGROUND

Food addiction (FA) is a prevalent concern that may manifest as poorly controlled food consumption and promote overweight/obesity. Thus, having a well-established instrument for assessment may facilitate better prevention and treatment. The current study investigated the psychometric properties of two common measures of FA (i.e., the Yale Food Addiction Scale [YFAS] 2.0 and its modified version, mYFAS 2.0) using a robust statistical analysis (Rasch model).

METHODS

In this cross-sectional study, the scales were sent to 974 students studying in higher education (60% females) in Taiwan through online media including email and social networks. Rasch modeling was used to assess dimensionality, difficulty level, and item misfit and hierarchy. Differential item functioning (DIF) was performed to examine consistency of the items across gender and weight status.

RESULTS

Rasch analysis indicated 3 items of the 35 items belonging to the YFAS 2.0 (8.6%) and none belonging to the mYFAS 2.0 were misfit. Unidimensionality and construct validity of both scales were supported by appropriate goodness-of-fit for diagnostic criteria. The person separation was 3.14 (reliability = 0.91) for the YFAS 2.0 and 2.17 (reliability = 0.82) for mYFAS 2.0, indicating the scales could distinguish participants into more than 3 strata. Only one substantial DIF was found for diagnostic criteria of "Failure to fulfill major role obligation" in the YFAS 2.0 across gender.

CONCLUSION

According to Rasch modeling, both the YFAS 2.0 and mYFAS 2.0 have acceptable construct validity in Chinese-speaking youth. Scoring methods using either diagnostic criteria or symptom counts for both the YFAS 2.0 and mYFAS 2.0 are supported by the present Rasch findings.

The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity

INTRODUCTION

The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students.

METHODS

An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity.

RESULTS

All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's α = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01).

DISCUSSION

Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction.

Validation of the Arabic version of the modified Yale Food Addiction Scale in the general population in Lebanon

BACKGROUND

Although the definition of food addiction is not agreed upon, it is characterized by eating more than expected without being hungry, not being able to visit certain places associated with overeating or unsuccessfully trying to cut down on the consumption of certain foods. The modified YFAS (mYFAS 2.0) version, instrument available to evaluate food addiction, was shown to have good psychometric properties. Our objective was to assess the psychometric properties of the Arabic version of the mYFAS (mYFAS-Ar-Leb) in the Lebanese population.

METHODS

This cross-sectional study enrolled 1268 persons residing in Lebanon (September-November 2020). The mean age of the participants was 26.18 years (SD = 11.17; min: 18; max: 85), with 65.1% females. The percentage of participants with food addiction was 226 (17.8%) in the total sample. A confirmatory factor analysis was run on the one-factor structure among the total sample.

RESULTS

The fit indices of the confirmatory factor analysis of the scale were excellent. The Cronbach's alpha value was good for the total scale. The mYFAS-Ar-Leb score was positively and strongly associated with stress, anxiety and depression.

CONCLUSION

Our study findings highlighted that the use of the mYFAS-Ar-Leb in Lebanese population might help estimate food addiction prevalence and stress on the need for effective treatment and preventive measures to craving for addictive foods.

The qualitative evaluation of the Yale Food addiction scale 2.0

BACKGROUND

The Yale Food Addiction Scale 2.0 (YFAS 2.0) operationalizes food addiction (FA) by applying the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) criteria for substance use disorder (SUD) to the overconsumption of highly processed foods. The YFAS 2.0 has been quantitatively validated across numerous populations, but has never undergone qualitative analysis.

AIMS

Using qualitative methods we aimed to determine if the interpretation YFAS 2.0 is aligned with the DSM 5 conceptualization of SUD, to determine if any items are perceived as irrelevant to the lived-experience of FA, and to determine if there are constructs central to the lived-experience of FA that are not captured by the scale.

METHODS

We interviewed 16 participants who met criteria for FA on the modified YFAS 2.0 using semi-structured interviews to understand each participants' interpretation of items on the scale and their perceptions of how the scale matched their lived-experience of FA. Reflexive thematic analysis was used to code responses and identify themes.

RESULTS

Most interpretations aligned with the DSM 5 conceptualization of SUDs. Withdrawal and tolerance-related items were subject to some misinterpretations. Participants viewed problem-focused symptoms (e.g., interpersonal problems) as the least relevant to their lived-experience. Novel themes not included on the YFAS 2.0 (e.g., emotional eating) emerged.

SUMMARY

Our study supports the validity of the YFAS 2.0 by showing consistency with the DSM 5 conceptualization of SUDs and consistency with the lived-experience of individuals who endorse FA. Future research should explore the novel themes that emerged in this study.

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

INTRODUCTION

Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O).

METHOD

Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity.

RESULTS

Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability.

STUDY 2

A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ²/df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged.

CONCLUSION

The EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive research.

Validation and Psychological Properties of the Persian Version of DSM 5 Yale Food Addiction Scale 2.0 (PYFAS 2.0) in Non-clinical Population

Background

The Yale Food Addiction Scale version 2.0 (YFAS 2.0) is used for the assessment of food addiction (FA). This research intended to evaluate the validity of the Persian translation of the questionnaire and to investigate the psychological properties and the association between FA and anthropometric indices.

Methods

In a sample of 473 nonclinical participants, FA, binge eating, and objectively measured anthropometric indices were assessed. Internal consistency, convergent, and validity of the PYFAS 2.0 were examined. Also, the factor structure (confirmatory factor analysis following the 11 diagnostic indicators in addition to the significant distress) and the construct of the scale were evaluated.

Findings

The frequencies of mild, moderate, and severe FA based on PYFAS 2.0 were 0.2%, 10%, and 5.5%, respectively. The findings supported a one-factor structure. The confirmatory factor analysis revealed a good construct validity (RMSEA=0.043, χ²=76.38, df=41, χ² (CMIN)/df=1.862, GFI=0.975, AGFI=0.957, IFI=0.986, RFI=0.958, ECVI=0.319, TLI=0.978). For both the diagnostic and symptom count versions, the PYFAS 2.0 presented acceptable internal consistency (IC) (Kuder-Richardson 20=0.99 and McDonald omega=0.91).

Conclusion

The PYFAS 2.0 was a psychometrically sound instrument in an Iranian non-clinical population. This questionnaire can be used to study FA in Persian non-clinical populations. Future research should study the psychometric characteristics of this scale in high-risk groups.

Food addiction comorbid to mental disorders in adolescents: a nationwide survey and register-based study

PURPOSE

Adolescence is a high-risk period for development of addictive behavior. This may also apply to addiction-like eating of highly processed foods-commonly referred to as "food addiction". Adolescents with mental disorder may be at particularly elevated risk of developing food addiction as addiction often accompanies mental disorder. However, there are only few studies in adolescents investigating this potential comorbidity. Therefore, the primary aim of this study was to examine the food addiction symptom load, as measured by the dimensional Yale Food Addiction Scale for Children-version 2.0 (dYFAS-C 2.0), among adolescents with a clinically verified mental disorder.

METHOD

A total of 3529 adolescents aged 13-17 were drawn from the Danish Psychiatric Central Research Register, stratified on six major diagnostic categories of mental disorders; psychotic disorders, affective disorders, anxiety disorders, eating disorders, autism spectrum disorders, and attention deficit disorders. Via their parents, these adolescents were invited to participate in a web-based survey. Data on health and socioeconomic factors from the Danish registers were linked to both respondents and non-respondents, allowing for thorough attrition analysis and estimation of weighted dYFAS-C 2.0 scores.

RESULTS

A total of 423 adolescents participated in the survey (response rate 12.0%). The mean weighted dYFAS-C 2.0 total score was 13.9 (95% CI 12.6; 14.9) for the entire sample and varied substantially across the diagnostic categories being highest for those with psychotic disorder, mean 18.4 (95% CI 14.6; 14.9), and affective disorders, mean 19.4. (95% CI 16.3; 22.5). Furthermore, the dYFAS-C 2.0 total score was positively correlated with body mass index (BMI) (r = 0.33, p < 0.05).

CONCLUSION

Food addiction symptomatology seems to be prevalent among adolescents with mental disorder, particularly affective and psychotic disorders. As obesity is a tremendous problem in individuals with mental disorder further investigation of food addiction in young people with mental disorder is called for. This could potentially aid in the identification of potential transdiagnostic targets for prevention and treatment of obesity in this group.

LEVEL OF EVIDENCE

Level IV, Observational cross-sectional descriptive study combined with retrospective register data.

Psychometric properties and convergent and divergent validity of the Portuguese Yale Food Addiction Scale 2.0 (P-YFAS 2.0)

PURPOSE

The construct of food addiction has been gaining increased attention as a research topic. Currently, the Yale Food Addiction Scale 2.0 is the only measure to operationalize the addictive-like eating behavior according to addiction criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders. The present study aimed at examining the psychometric properties of the Portuguese version of the Yale Food Addiction Scale 2.0, as well as investigating the convergent and divergent validity between this scale and the following measures: Eating Disorders Examination Questionnaire, Body Investment Scale, and Difficulties in Emotion Regulation Scale. We also sought to explore the moderator role of difficulties in emotion regulation in the relationship between food addiction and binge eating METHODS: A sample of 302 female college students (M_age = 21.37, SD = 3.24) completed self-report measures.

RESULTS

Sixteen (5.3%) participants were diagnosed as having food addiction. The confirmatory factor analysis suggested that the original one-dimensional structure is adequate to represent the Portuguese Yale Food Addiction Scale 2.0. The symptom count scores of the scale were correlated with body mass index, eating disordered behavior, body investment, and difficulties in emotion regulation. The severity level of the scale also discriminated the severity of eating disordered behaviors, body investment, and difficulties in emotion regulation. Finally, the relationship between food addiction and binge eating was moderated by difficulties engaging in goal-directed behavior when experiencing negative emotions.

CONCLUSION

The Portuguese version of the Yale Food Addiction Questionnaire 2.0 may be a useful tool to investigate food addiction.

LEVEL

IV descriptive studies.

Psychometric properties of the Chinese version of the modified Yale Food Addiction Scale version 2.0 (C-mYFAS 2.0): Prevalence of food addiction and relationship with resilience and social support

PURPOSE

This study aimed to examine the psychometric properties of the Chinese version of the modified Yale Food Addiction Scale 2.0 (C-mYFAS 2.0) and to analyze the prevalence of food addiction among Chinese college students and its relationship with resilience and social support.

METHODS

A total of 1132 Chinese college students completed the C-mYFAS 2.0, BES, EAT-26, PHQ-9, GAD-7, TFEQ-18, CD-RISC-10, and PSSS. Confirmatory factor analysis was used to evaluate the factor structure of the C-mYFAS 2.0 and psychometric properties were assessed. Test-retest reliability was evaluated in a sub-sample (n = 62). Spearman correlation and logistic regression were used to examine the relationship between resilience, social support, and food addiction.

RESULTS

The prevalence of food addiction according to the C-mYFAS 2.0 was 6.2%. Confirmatory factor analyses suggested a single-factor structure (comparative fit index = 0.961). The C-mYFAS 2.0 had good test-retest reliability and internal consistency (Kuder-Richardson's α = 0.824). Good convergent validity was indicated by correlations with binge eating, eating disorder symptoms, depressive symptoms, generalized anxiety symptoms, uncontrolled eating, emotional eating, and BMI (ps < 0.001). Appropriate divergent validity was reflected by no association with cognitive restraint. Finally, binge eating was significantly predicted by C-mYFAS 2.0, depressive symptoms, and eating disorder symptoms (ps < 0.001), confirming incremental validity. In addition, our study found that poorer resilience and social support were related to food addiction (ps < .001).

CONCLUSIONS

The C-mYFAS 2.0 is a brief but reliable and valid screening instrument for food addiction among Chinese college students. In addition, we found that resilience and social support were negatively associated with food addiction.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Very-Low-Calorie Ketogenic Diet: A Potential Treatment for Binge Eating and Food Addiction Symptoms in Women. A Pilot Study

Background: many patients who struggle to lose weight are unable to cut down certain ultra-processed, refined types of food with a high glycemic index. This condition is linked to responses similar to addiction that lead to overeating. A very-low-calorie ketogenic diet (VLCKD) with adequate protein intake could be considered a valid dietary approach. The aim of the present study was to evaluate the feasibility of a VLCKD in women with binge eating and/or food addiction symptoms. Methods: subjects diagnosed with binge eating and/or food addiction symptoms (measured with the Binge Eating Scale and the Yale Food Addiction Scale 2.0) were asked to follow a VLCKD with protein replacement for 5–7 weeks (T1) and a low-calorie diet for 11–21 weeks (T2). Self-reported food addiction and binge eating symptoms and body composition were tested at T0 (baseline) and at the end of each diet (T1 and T2 respectively); Results: five women were included in the study. Mean age was 36.4 years (SEM = 4.95) and mean BMI was 31.16 (SEM = 0.91). At T0, two cases of severe food addiction, one case of mild food addiction, one case of binge eating with severe food addiction, and one case of binge eating were recorded. Weight loss was recorded at both T1 and T2 (ranging from 4.8% to 11.6% of the initial body weight at T1 and from 7.3% to 12.8% at T2). No case of food addiction and/or binge eating symptoms was recorded at T2. Muscle mass was preserved. Conclusions: recent findings have highlighted the potential therapeutic role of ketogenic diets for the treatment of addiction to high-calorie, ultra-processed and high-glycemic food. Our pilot study demonstrates the feasibility of a ketogenic diet in women with addictive-like eating disorders seeking to lose weight.

Relationship between Negative Running Addiction and Eating Disorder Patterns in Runners

Current studies show an increase in the risk of eating disorders in runners. Since it is known that abusive exercise can be both a cause and a consequence of such developments, the main objective of the present study was to examine the risk and possible relationships between negative running addiction (NRA), as measured by the reduced and validated SAS-40 scale, and the tendency to be a compulsive eater (measured by YFAS 2.0), anorexia nervosa (AN), and/or bulimia nervosa (BN) (measured by EAT-40). This study highlights the novelty of researching the level of influence of NRA on each defined eating disorder.

METHOD

A total of 167 Spanish-speaking federated runners in cross-country and track running (42% women and 58% men), with an average age of 24 years and an average BMI of 21 kg/m2, responded to an online questionnaire that asked about sociodemographic data and the Spanish versions of the SAS-40, YFAS 2, YFAS 3, and YFAS 4. Through a quantitative methodology using logistic regressions-the coefficient of determination and Pearson's correlation coefficient-we created a sample analysis that related the significant items of the DSM-V to the results of the questionnaires administered, as well as their relationship with the practice of the sport in question and various variables of the environment.

RESULTS

The rates of CE, AN, and BN were 65, 11.4, and 16.2%, respectively. The tendency towards CE increased with a lower weight (r = 0.156, p < 0.05), not having been overweight in childhood (r = 0.151, p < 0.05), and being a long-distance runner (r = 0.123 p < 0.05). The risk of AN increased with the absence of menstruation for more than 3 months (r = 0.271 p < 0.01), having suffered from childhood obesity (r = 0.213 p < 0.05), and being underweight (r = 0.064 p < 0.05). The risk of BN increased with having suffered from childhood obesity (r = 0.194 p < 0.05), having a higher weight (r = 0.140, p < 0.05), and practicing athletics, especially the relay modality (r = 0.044 p < 0.05).

CONCLUSIONS

A considerable number of runners are at risk of suffering from some type of eating disorder. A significant relationship was observed between long-distance runners and the risk of eating disorders (AN, BN, and CE), and the association is stronger for CE than for AN and BN. Lastly, childhood experiences (such as being obese/a healthy weight) were notorious for increasing the risk of eating disorders. Further studies are needed to research each particular parameter and the relationships between the possible levels of dependence on exercise.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Validation of the dimensional Yale Food Addiction Scale for Children 2.0 and estimation of the weighted food addiction score in a sample of adolescents from the general population

PURPOSE

Obesity among adolescents is becoming increasingly prevalent and "food addiction" (addiction-like attraction to foods with high content of fat and refined carbohydrates) may be a potential contributor to this development. This study aimed to investigate the psychometric properties of the dimensional Yale Food Addiction Scale for Children version 2.0 (dYFAS-C 2.0) and to estimate the weighted mean score on the dYFAS-C 2.0 (as a measure of food addiction symptom load) among adolescents from the general Danish population.

METHODS

A total of 3,750 adolescents aged 13-17 were randomly drawn from the general Danish population and invited to participate in a web-based survey. Data on health and socioeconomic factors from the Danish registers were linked to both respondents and non-respondents, which allowed for analysis of attrition. The total- and sex-stratified weighted mean dYFAS-C 2.0 scores were estimated using augmented inverse probability weighted estimation.

RESULTS

A total of n = 576 (15.4%) adolescents participated in survey of whom 55.6% were female. The confirmatory factor analysis of the dYFAS-C 2.0 supported a one-factor model. The dYFAS-C 2.0 total score was associated with eating pathology, BMI z-scores, and ADHD symptomatology. The weighted mean dYFAS-C 2.0 score was 12.1 (95% CI: 11.2;12.9), 15.0 (95% CI: 13.9;16.2) for females and 9.5 (95% CI: 8.3;10.6) for males.

CONCLUSIONS

The dYFAS-C 2.0 appears to be a psychometrically valid tool to assess symptoms of food addiction among adolescents. Food addiction symptom severity correlated positively with eating pathology (including restrained eating), BMI z-scores, and ADHD symptomatology. Level IV, observational cross-sectional descriptive study combined with retrospective register data.

Metabolic, Affective and Neurocognitive Characterization of Metabolic Syndrome Patients with and without Food Addiction. Implications for Weight Progression

According to the food addiction (FA) model, the consumption of certain types of food could be potentially addictive and can lead to changes in intake regulation. We aimed to describe metabolic parameters, dietary characteristics, and affective and neurocognitive vulnerabilities of individuals with and without FA, and to explore its influences on weight loss progression. The sample included 448 adults (55-75 years) with overweight/obesity and metabolic syndrome from the PREDIMED-Plus cognition sub-study. Cognitive and psychopathological assessments, as well as dietary, biochemical, and metabolic measurements, were assessed at baseline. Weight progression was evaluated after a 3-year follow up. The presence of FA was associated with higher depressive symptomatology, neurocognitive decline, low quality of life, high body mass index (BMI), and high waist circumference, but not with metabolic comorbidities. No differences were observed in the dietary characteristics except for the saturated and monounsaturated fatty acids consumption. After three years, the presence of FA at baseline resulted in a significantly higher weight regain. FA is associated with worse psychological and neurocognitive state and higher weight regain in adults with metabolic syndrome. This condition could be an indicator of bad prognosis in the search for a successful weight loss process.

Food addiction assessment in a nonclinical sample of the Italian population

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Food Addiction 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.

Prevalence and correlates of food addiction: Systematic review of studies with the YFAS 2.0

BACKGROUND

Research on food addiction (FA) has been growing and increasing interest has been seen in comprehending its mechanisms and clinical and psychological correlates of this phenomena. This field of study is specially apply to understand obesity and eating behavior issues related to eating disorders (ED).

OBJECTIVES

We performed a literature review that describe recent research using the updated version of the Yale Food Addiction Scale (YFAS 2.0) or modified-YFAS (mYFAS 2.0), from the date of its publication.

METHODS

Search were performed in Web of Science, Pubmed and PsycNET databases for studies that used the YFAS 2.0 and mYFAS 2.0.

RESULTS

The studies (n = 53) investigated adaptation and validation of the scale in different cultures (n = 13), prevalence on nonclinical populations and representative samples (n = 5), food addiction in obesity samples (n = 11), in samples with ED and disordered eating (n = 10) and studies that investigated FA in association with other clinical and psychological variables (n = 14).

DISCUSSION

Studies with the YFAS 2.0 reveal higher prevalence of FA in different samples, and a great association between FA and BED, BN and obesity. Implications for diagnostic of this phenomena and the overlap between FA and other disorders are discussed.

CONCLUSIONS

The field of FA remains an open subject and effort must be implied to understand the subjective experience of addiction related to eating and food.

An open-label trial on the efficacy and tolerability of naltrexone/bupropion SR for treating altered eating behaviours and weight loss in binge eating disorder

PURPOSE

Binge eating disorder (BED) has a considerable clinical relevance by virtue of its high numerous psychiatric and medical comorbidities; among the latter, the most frequent is obesity. Available treatments for BED have shown frequent relapse of binges or weight regain in the long term. The new combination of naltrexone and bupropion sustained release (NB) has proved to be effective for weight loss among obese patients. As NB acts on hypothalamic and reward circuits, that seem involved in the pathogenesis and maintenance of BED symptoms, this study aims to evaluate the efficacy of NB in improving pathological eating behavior and losing weight in BED patients.

METHODS

In this preliminary study, 23 obese-BED patients and a control group of 20 obese non-BED patients (respectively, Groups 1 and 2) who had previously undergone at least 5 unsuccessful weight-loss programs were treated with NB in addition to modified life style. Evaluation at t0 and after 16 weeks of treatment (t1) included anthropometric measurement, eating behavior assessment and psychopathological questionnaires (EDE-Q, BES, YFAS, BDI and STAI).

RESULTS

A significant and similar weight loss (ΔBMI% ≈ 8%) was evident for both groups. Pathological eating behavior (i.e., binge, grazing, emotional eating, craving for carbohydrates, and post-dinner eating), BES score and YFAS severity significantly improved, especially among BED. NB was well tolerated and drop-out rate was low.

CONCLUSION

Treatment with NB, in addition to a reduced-calorie diet and increased physical activity, seems an effective and well-tolerated option for improving pathological eating behavior and losing weight in obese-BED patients.

LEVEL OF EVIDENCE

Level III case-control study.

Food addiction comorbid to mental disorders: A nationwide survey and register-based study

OBJECTIVE

Substance use disorder is highly prevalent among individuals with mental disorders. However, it remains largely unknown whether this is also the case for "food addiction"-a phenotype characterized by an addiction-like attraction to predominantly highly processed foods with a high content of refined carbohydrates and fat. Therefore, the primary aim of this study was to estimate the weighted prevalence of food addiction among individuals with mental disorders.

METHOD

A total of 5,000 individuals aged 18-62 were randomly drawn from eight categories of major mental disorders from the Danish Psychiatric Central Research Register and invited to participate in an online questionnaire-based survey, which included the Yale Food Addiction Scale 2.0. Data on health care and sociodemographics from the Danish registers were linked to all invitees-enabling comprehensive attrition analysis and calculation of the weighted prevalence of food addiction.

RESULTS

A total of 1,394 (27.9%) invitees participated in the survey. Across all diagnostic categories, 23.7% met the criteria for food addiction. The weighted prevalence of food addiction was highest among individuals with eating disorders (47.7%, 95%CI: 41.2-54.2), followed by affective disorders (29.4%, 95%CI: 22.9-36.0) and personality disorders (29.0%, 95%CI: 22.2-35.9). When stratifying on sex, the prevalence of food addiction was higher among women in most diagnostic categories.

DISCUSSION

Food addiction is highly prevalent among individuals with mental disorders, especially in those with eating disorders, affective disorders and personality disorders. Food addiction may be an important target for efforts aimed at reducing obesity among individuals with mental disorders.

Naturalistic and Uncontrolled Pilot Study on the Efficacy of Vortioxetine in Binge Eating Disorder With Comorbid Depression

Background: Binge eating disorder (BED) is clinically relevant by virtue of the global impairment, poor quality of life, and increased overall medical morbidity. The high comorbidity with psychiatric disorders, particularly depression, has received attention as a possible mediator of the poor outcome. Further, BED and depression share cognitive dysfunctions. This naturalistic and uncontrolled pilot study aimed at evaluating the efficacy of vortioxetine (VTX) on depressive symptoms in patients with BED, secondly the efficacy in improving a broad array of executive functions, and third to explore the effect on eating behavior and body weight. Methods: This pilot study involved 30 patients with BED and comorbid MDD, treated with VTX for 24 weeks. Assessments were run at baseline (t 0), 4 (t 1), 8 (t 2), 12 (t 3), and 24 (t 4) weeks. Changes in depressive symptoms (HDRS and BDI), executive functions, eating behaviors (binge frequency and severity, night eating, food addiction), and body weight were estimated after treatment with VTX through GLM. Results: Significant improvements emerged after treatment with VTX in: depression (HDRS p < 0.001; BDI p = 0.002) regardless the dose of VTX and first diagnosis (BED/MDD), working memory (RAVLT acquisition p = 0.01, delay recall p < 0.001, RCFT percentage of recall p = 0.01, and Attentional Matrices p = 0.05), binge days frequency (p < 0.001), binge eating severity (BES p < 0.001), night eating (p = 0.001), food addiction (YFAS 2.0 p = 0.039), and body weight (p = 0.039). The improvement in depressive symptoms was associated with the concurrent improvement in night eating as assessed by the I-NEQ. Conclusions: VTX can be a valid therapeutic choice for patients with BED with comorbid depression in controlling the depressive symptoms, working memory, and eating behavior. Indeed, by acting on affective symptoms, neurocognitive functioning, and eating behaviors, it confirms the results already obtained with VTX in other disorders, expanding them to BED.

Obesity in childhood: how to improve male adolescence incoming

INTRODUCTION

Earlier or delayed puberty can be determined by numerous causes, but the exact mechanisms are not fully known. Anyway, those may be independent from the hypothalamicpituitary-gonadal axis involvement. Certainly, obesity is one of the main factors. In fact, obesity and infertility are strongly linked. For this reason, we want to analyse the relationship between puberty and obesity and give an updated state-of-the-art starting by discussing a 14-year-old obese boy's clinical case.

EVIDENCE ACQUISITION

Literature data are conflicting. Main criticisms are related to study design and evaluation criteria. Indeed, examined populations are not homogeneous by age, Tanner stage and BMI classification. The obesity epidemic is involved in earlier puberty, and puberty seems to be anticipated in all BMI groups. Very few studies evaluate the level of adiposity in the diagnosis of obesity. However, the role of the adipose tissue is crucial for hormone synthesis and regulation. Therefore, fat mass age-related and not simply BMI has to be considered by clinicians for appropriate diagnosis.

EVIDENCE SYNTHESIS

Regarding the clinical case, in three months our patient recovered delayed pubertal development following an anti-inflammatory and antioxidant Mediterranean Diet. Loss of weight, as in decrease of fat mass but saving of lean mass, increased testicular volume and testosterone levels occurred.

CONCLUSIONS

Puberty depends on several factors, including obesity. Further studies are needed to evaluate age groups, Tanner stage, diet and lifestyle, ethnicity and above all the fat/lean mass ratio. Lack of adequate tools could hinder a clinician's ability to recognize when or if therapeutic intervention is needed.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Persian Version of the Yale Food Addiction Scale 2.0: Psychometric Analysis and Setting Cutoff Point for the Food Cravings Questionnaire-Trait-Reduced

OBJECTIVE

The aims of this study were to evaluate the psychometric properties of Persian translation of the Yale Food Addiction Scale 2.0 (YFAS 2.0) as a widely accepted questionnaire for the first time and to establish a cut off score for Food Craving Questionnaire-Trait-reduced (FCQ-T-r).

METHODS

In this cross-sectional study, 330 visitors of family physician clinics in Shiraz, a city located in south of Iran, were selected. The English version of YFAS 2.0 was translated into Persian and used in this study as well as the Persian version of FCQ-T-r.

RESULTS

Confirmatory factor analysis of YFAS-2 confirmed one dimensional structure and factor loading in all eleven symptoms was above 0.4. Internal consistency for eleven symptoms was 0.813. Prevalence of food addiction in participants was 6.7% (22 participants). BMI and FCQ-T-r questionnaire score both were positively correlated with the number of food addiction symptoms but age was negatively correlated with the number of the symptoms. The ROC curve analysis showed the best suggested cut-off point for FCQ-T-r questionnaire to detect food addiction was 32.5.

CONCLUSION

The present study confirmed validity and reliability of Persian version of YFAS-2. It is suggested that food addiction occurs in different level of food craving behavior in different food cultures or genetics.

Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population

PURPOSE

To examine the structural validity, measurement invariance, reliability, and some other psychometrical properties of the Italian version of the Yale Food Addiction Scale 2 (I-YFAS 2.0) in patients with severe obesity and the general population.

METHODS

704 participants-400 inpatients with severe obesity and 304 participants enrolled from the general population-completed the I-YFAS 2.0 and questionnaires measuring eating disorder symptoms. A first confirmatory factor analysis (CFA) tested a hierarchical structure in which each item of the I-YFAS 2.0 loaded onto one of the twelve latent symptoms/criteria which loaded onto a general dimension of Food Addiction (FA). The second CFA tested a first-order structure in which symptoms/criteria of FA simply loaded onto a latent dimension. Measurement invariance (MI) between the group of inpatients with severe obesity and the sample from the general population was also tested. Finally, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed.

RESULTS

CFAs confirmed the structure for the I-YFAS 2.0 for both the hierarchical structure and the first-order structure. Configural MI and strong MI were reached for hierarchical and the first-order structure, respectively. Internal consistencies were shown to be acceptable. Prevalence of FA was 24% in the group of inpatients with severe obesity and 3.6% in the sample from the general population.

CONCLUSIONS

The I-YFAS 2.0 represents a valid and reliable questionnaire for the assessment of FA in both Italian adult inpatients with severe obesity and the general population, and is a psychometrically sound tool for clinical as well as research purposes.

LEVEL OF EVIDENCE

Level V, descriptive study.

An evaluation of food addiction as a distinct psychiatric disorder

OBJECTIVE

To evaluate the state of the literature for whether food addiction may warrant consideration as a distinct psychiatric disorder in the Diagnostic and Statistical Manual (DSM) using Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) five criteria. This framework was utilized because it has recently been applied to examine the diagnostic utility of several eating disorder phenotypes. The criteria are: (a) at least 50 journal articles published on the proposed syndrome in the past 10 years; (b) proposal of diagnostic criteria and assessment measures; (c) clinician reliability in diagnosis; (d) cohesiveness of the proposed diagnostic criteria; and (e) differentiation from similar, existing diagnostic categories.

METHOD

For each criterion, a literature review was conducted to examine if the minimum qualification had been met, and key findings were discussed.

RESULTS

Two of the criteria (literature and differentiation) have been empirically supported to extent specified. Two criteria (diagnostic criteria and syndrome) have been partially fulfilled, due to only having self-report assessment measures and no examination of the odds ratios for meeting more than one symptom, respectively. Clinician reliability has not yet been evaluated.

DISCUSSION

The existing literature suggests that food addiction may warrant consideration as a proposed diagnostic category in the DSM, though future research is needed to fulfill Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) criteria. The development of a semi-structured interview would be an impactful contribution for addressing these gaps.

Considering Food Addiction through a Cultural Lens

Purpose of Review

Research suggests that cultural factors influence eating behaviors, however little is known about the relationship between food addiction and culture. This narrative review aimed to i) review theoretically related work on the relationship between sociocultural demographic variables, food cravings, and eating disorders; ii) review the available literature assessing cultural aspects of food addiction, specifically the rates of food addiction across the globe and notable differences in relevant sociodemographic variables: race, ethnicity, gender and acculturation level; iii) discuss the potential impact of culture on our current understanding of food addiction and future research directions emphasizing the inclusion of sociocultural variables.

Recent Findings

Preliminary data suggest that food addiction symptoms occur cross-culturally, and that there may be significant differences between sociodemographic groups. Issues related to adequate lexicalization of concepts central to food addiction (e.g., craving, addiction) and global variations in eating culture and presentation of similar constructs (e.g. binge-eating) contribute to questions raised and identify avenues for further research.

Summary

Multidimensional cultural assessment is called for to characterize food addiction among diverse groups and improve our understanding of the etiology, maintenance, and sequelae of food addiction cross-culturally.

Food Addiction in a Group of Italian Adolescents Diagnosed for Eating Disorder

Research in patients with Eating Disorders (EDs) showed high rates of Food Addiction (FA) even in restrictive subtypes. The majority of studies were conducted on adult population. The present work aimed to describe and compared FA in adolescents diagnosed for different EDs and to evaluate its association with patients' psychopathology. Patients aged 12-18 y were included in the analysis. FA was assessed using the Yale Food Addiction Scale 2.0. The rate of FA was of 49.4% in the whole sample (n = 87, F = 90.8%) and of 53.7% in patients diagnosed with restrictive anorexia nervosa. No difference in FA frequency was detected between EDs. A worse psychopathological picture was found in patients diagnosed with FA. Higher age, higher score to the Eating Attitudes Test-26 and to the Eating Disorder Inventory-3's Interoceptive Deficits scale have been detected as the major predictors of FA in our sample. FA may be considered a transnosographic construct, not linked to the subtype of ED but to patients' personal characteristics and, in particular, to age and interoceptive deficits. A worse psychopathology might be considered a risk factor for the presence of FA in EDs.

The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults

Background

Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL).

Methods

A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs.

Results

Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA.

Conclusion

Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.

Validation of the Yale Food Addiction Scale 2.0 and estimation of the population prevalence of food addiction

BACKGROUND & AIMS

Food addiction (FA) is likely to contribute to the global obesity epidemic. Most studies of FA have been conducted within clinical and/or highly selected populations, suggesting that prevalence estimates of FA may be biased. This is problematic as valid estimates of the population prevalence of FA is a requirement for informing and designing public health initiatives focusing on this phenotype. Therefore, we aimed to estimate the weighted prevalence of food addiction in the adult general population of Denmark.

METHODS

A random sample of 5000 individuals aged 18 to 62 from the Danish population was invited to participate in a survey, which included the Yale Food Addiction Scale (YFAS 2.0) and several rating scales measuring eating pathology and other psychopathology. Health, demographic and socioeconomic data from the Danish registers were linked to all invitees to allow for attrition analysis. The analysis had three steps: I) Psychometric validation of the Danish version of YFAS 2.0 II) Attrition analysis to examine selection bias, and III) Estimation of the weighted prevalence of FA taking attrition into account.

RESULTS

The confirmatory factor analysis of the YFAS 2.0 supported a one-factor model, and the scale had good internal consistency. The YFAS 2.0 score correlated with eating pathology including binge eating frequency, impulsivity and body mass index (BMI). The survey response rate was 34.0% (n = 1699) with a slight overrepresentation of respondents with higher socioeconomic status. The crude prevalence of FA was 9.0%. When taking attrition into account, the weighted prevalence of FA was 9.4% CI 95% [7.9-10.9].

CONCLUSIONS

The psychometric properties of the Danish version of the YFAS 2.0 were good. The weighted prevalence of FA was very similar to the crude prevalence estimate. This suggests that attrition may not be a large problem when estimating the prevalence of FA with the YFAS 2.0.

Development of the Modified Yale Food Addiction Scale Version 2.0 summary version in a representative sample of Czech population

BACKGROUND

Food addiction receives attention because of its participation in the rising obesity prevalence that affects the quality of life. The Czech Republic's prevalence of obesity belongs to the highest in Europe.

METHODS

We used the nationally representative non-clinical sample of 1841 respondents (N = 1841; 48,8% of men and 51.2% of women). Participants filled the sociodemographic questionnaire, Czech version of mYFAS 2.0 and the Relationship Questionnaire (RQ) to test the hypothesis.

RESULTS

Confirmatory Factor Analysis showed that the single-factor model of Czech version of mYFAS 2.0 had adequate fit indices (χ² (55) = 9670.8, p <  0.001; CFI, TLI > 0.95; SRMR < 0.07; and RMSEA < 0.08). The sample reliability in our research corresponded to Cronbach's α = 0.89 (95% CI 0.88-0.90). The youngest population (aged 15-19) had a significantly higher score of mYFAS 2.0, than the older age groups. People living alone scored significantly higher than the married respondents. The middle-income groups scored significantly lower in mYFAS 2.0 than the lowest income group. Occasional (social) smokers showed a higher mYFAS 2.0 score in comparison with non-smokers. A difference regarding attachment styles has also been revealed, respondents characterized by insecure attachment styles showed a higher YFAS score.

CONCLUSION

The findings reinforce future work on the Czech version of mYFAS 2.0, including validation and using mYFAS 2.0 to explore food addiction and its related variables and attachment styles in the Czech environment.

The Modified Yale Food Addiction Scale 2.0: Validation Among Non-Clinical and Clinical French-Speaking Samples and Comparison With the Full Yale Food Addiction Scale 2.0

OBJECTIVES

The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) was designed to assess food addiction using a shorter version than the YFAS 2.0. We lack data about the psychometric properties of the mYFAS 2.0 in patients with obesity, as well as studies comparing the psychometric properties of the mYFAS 2.0 versus the full YFAS 2.0. This study aimed to validate the French-language mYFAS 2.0 in a non-clinical population (study 1, n = 250), to determine the yet unknown psychometric properties of this scale in patients with obesity (study 2, n = 345), and to compare the full YFAS 2.0 and the mYFAS 2.0 in terms of food addiction (FA) prevalence and symptoms detection in both populations.

METHOD

Study 1 included 250 non-clinical individuals (non-underweight and non-obese persons screened negative for eating disorders). Study 2 included 345 bariatric surgery candidates recruited in three centers (Québec, Canada; Reims and Tours, France). The mYFAS 2.0 structure was investigated using confirmatory factorial analyses with tetrachoric correlations. Convergent validity was tested using the full YFAS 2.0, the Binge Eating Scale (both studies), the revised 18-item Three Factor Eating Questionnaire (study 1), the Beck Depression Inventory (study 2), and the body mass index (BMI; both studies).

RESULTS

The mYFAS 2.0 was unidimensional, and had adequate (study 1: KR-20 = .78) and acceptable (study 2: KR-20 = .73) internal consistency. In study 1, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, BMI, binge eating, cognitive restraint, uncontrolled eating and emotional eating; in study 2, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, binge eating, depression, but not BMI. Participants endorsed fewer symptoms with the mYFAS 2.0 than with the YFAS 2.0; FA prevalences were similar between questionnaires in the non-clinical, but not in the clinical sample. A FA 'diagnosis' and risk of binge eating disorder were associated but did not completely overlap.

CONCLUSIONS

The mYFAS 2.0 has close psychometric properties to the YFAS 2.0 in non-clinical and clinical samples. However, the use of the mYFAS 2.0 in bariatric surgery candidates might lead to a significant underestimation of FA prevalence and number of FA symptoms.

Assessment of food addiction using the Yale Food Addiction Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance

The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study was the first to investigate the factor structure, psychometric properties, and clinical significance of the YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. Data were analysed from 220 community-based participants who met criteria for "probable BED" based on self-report symptom frequency. Classification of food addiction (FA) was met by 42.3% of the sample. The YFAS 2.0 exhibited a unidimensional structure, adequate internal consistency, and convergent and incremental validity. YFAS 2.0 scores contributed the largest percentage of unique variance in psychological distress and impairment over other BED features (overvaluation of weight and shape, binge eating, BMI), highlighting the clinical significance of the FA construct in BED. Support for the validity and reliability of the YFAS 2.0 in individuals with BED-like symptoms was found. Findings also suggest that the presence of FA may represent a more disturbed group of BED characterised by greater general and eating disorder-specific psychopathology. Our findings overall highlight the potential need to screen and assess addictive-like eating behaviours during interventions for BED.