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

'Do no harm' - the impact of an intervention for addictive eating on disordered eating behaviours in Australian adults: secondary analysis of the TRACE randomised controlled trial

BACKGROUND

Designing interventions to change addictive eating behaviours is a complex process and understanding the treatment effect on co-occurring disordered eating behaviours is of importance. This study aimed to explore treatment effects of the TRACE (Targeted Research for Addictive and Compulsive Eating) intervention for addictive eating on eating disorder psychopathology, binge eating, reward driven eating and grazing behaviours.

METHODS

This study involved secondary analysis of data from a randomised control trial among 175 participants (18-85 yrs) endorsing ≥ 3 Yale Food Addiction Scale (YFAS) symptoms who were randomly allocated to (1) active intervention, (2) passive intervention, or (3) control group. Change in YFAS, EDE-Q 6.0, Binge Eating Scale, RED-X5 and Short Inventory of Grazing scores were assessed at 3-months (immediate post-intervention) and 6-months (3-months post-intervention) follow-up.

RESULTS

Using Linear Mixed Models, from baseline to 3-months there was a significant reduction in eating disorder global scores in the active intervention [mean decrease - 0.6 (95% CI: -0.8, -0.4)], but not in the passive intervention [-0.2 (95% CI: -0.5, 0.1)] or control groups [-0.1 (95% CI: -0.3, 0.1)]. In the active and passive intervention groups there were significant reductions in reward driven eating [-3.8 (95% CI: -4.9, -2.7; -2.5 (95% CI: -3.9, -1.1), respectively], compulsive grazing (-1.8 (95% CI: -2.4, -1.3); -1.1 (95% CI: -1.7, -0.5), respectively] and non-compulsive grazing scores (-1.4 (95% CI: -1.9, -1.0); -1.1 (95% CI: -1.7, -0.4), respectively], but not in the control group. The reduction in binge eating scores over time was similar for all groups. The reduction in addictive eating symptoms from baseline to 3-months was positively associated with the reduction in eating disorder global scores, binge eating, reward driven eating and grazing behaviours (rs ranged from 0.23 to 0.69).

CONCLUSION

The dietitian-led TRACE intervention which adopted a weight-neutral, harm reduction approach for the management of addictive eating in adults demonstrated positive effects on some co-occurring disordered eating behaviours. Importantly the intervention did not cause any adverse changes in the eating disorder pathologies measured.

TRIAL REGISTRATION

Australia New Zealand Clinical Trial Registry ACTRN12621001079831.

Tying Food Addiction to Uncontrolled Eating: The Roles of Eating-Related Thoughts and Emotional Eating

Background. Food addiction is often linked to overeating and difficulty in controlling eating habits. At the same time, food addiction is often associated with intense eating-related thoughts and emotional eating behaviors. However, despite extensive research on food addiction, the psychological processes that contribute to these outcomes have not been fully examined. Consequently, this study aims to fill that gap by investigating the influence of eating-related thoughts, as well as emotional eating behaviors that may precede episodes of uncontrolled eating. Methods. A cross-sectional design was used. A sample of 467 individuals was enrolled from the general population. Participants completed a battery of self-report questionnaires. A sequential mediation analysis with latent variables (i.e., structural equation modeling; SEM) using 5000 bootstrap samples and observed variables was performed. Results. The proposed model provides good fit indices. Indeed, food addiction predicts uncontrolled eating behaviors through eating-related thoughts (p < 0.001), which were also significantly associated with the emotion-driven eating patterns (p < 0.001), revealing a fully mediated model explaining 61.6% of the outcome variance (R2 = 0.616). Discussion. The findings underscore the critical influence of cognitive factors (i.e., eating-related thoughts) in driving maladaptive coping mechanisms like emotional eating. Moreover, emotional eating may act as a precursor to behaviors associated with overeating, which are often rooted in food addiction. Conclusions. Recognizing the central role of thoughts and emotions can help clinicians develop more targeted psychological interventions for those experiencing food addiction symptoms.

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.

The Italian version of the 16-item Prodromal Questionnaire (PQ-16) and its psychometric features in help-seeking ultra-high-risk subjects and in the general population

BACKGROUND

Increasing attention to the early stages of psychosis and the identification of symptomatic prodromal states have led to the development of a growing number of screening tools. The 16-item version of the Prodromal Questionnaire (PQ-16) is a worldwide used self-administered tool for this purpose. However, to date, fundamental psychometric properties of PQ-16 were not thoroughly investigated. This study aimed to examine the structural validity, measurement invariance, reliability and other psychometrical properties of the Italian version of the PQ-16 (iPQ-16) in help-seeking individuals and in the general population.

METHODS

The iPQ-16 was administered to 449 young outpatients attending six community mental health services and to 318 control participants enrolled in educational environment. Confirmatory factor analyses (CFAs), measurement invariance (MI) between the help-seeking group and the general population sample, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed. Lastly, the validity of the adopted PQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses was also tested.

RESULTS

CFAs confirmed the single-factor structure for the iPQ-16 and scalar MI was reached. The iPQ-16 showed high internal consistency, test-retest reliability, convergent validity, and acceptable diagnostic accuracy. ROC analysis suggested a score of ≥4 as best cut-off.

CONCLUSIONS

The iPQ-16 represents a valid and reliable questionnaire for the assessment of high mental risk in both Italian outpatients and general student population. It has good psychometric properties and is easy to implement as UHR screening for clinical as well as research purposes.

Validation of the Chilean version of the Yale food addiction scale 2.0 in a non-clinical sample

AIMS

The aim was to translate and culturally adapt the Yale Food Addiction Scale 2.0 (YFAS 2.0) to the Chilean population, evaluate its psychometric properties in a non-clinical sample, and assess the correlations between symptoms count of food addiction (FA) with demographic and anthropometric variables.

METHODS AND PARTICIPANTS

We evaluated 301 participants (59.1% women) with a mean age of 29.7 ± 12.4 years recruited from two universities and two businesses (non-clinical sample). The Chilean YFAS 2.0 was administered, and anthropometric measurements were carried out. The internal consistency of the items was estimated, and factor structure was tested by confirmatory factor analysis. Test-retest reliability was also examined. The correlations between symptoms count of FA and weight, waist circumference (WC), Body Mass Index (BMI), percentage of body fat (BF%), and lean mass were evaluated.

RESULTS

The Chilean YFAS 2.0 presented good internal consistency, and confirmatory factor analysis supported the one-factor structure, in accordance with the original version. The ICC indicated excellent test-retest reliability. The prevalence of FA was 10.3%, and the symptom count of FA was 2.1 ± 2.8. A small positive correlation between WC, BMI, and BF % and FA symptom count was found.

CONCLUSION

The Chilean YFAS 2.0 may be a useful tool to investigate FA in Chile. Level of evidence Level V, cross-sectional descriptive study.

Brazilian Version of the Yale Food Addiction Scale for Individuals with Severe Obesity

PURPOSE

Adapting and validating the Portuguese version of Br-YFAS 2.0-Obes to allow it to be used by the Brazilian candidates for bariatric surgery.

MATERIALS AND METHODS

This study included 329 individuals with body mass indexes (BMI) ≥ 30 kg/m2, candidates for bariatric surgery at a reference hospital in Brazil. They were given a questionnaire that identified sociodemographic data, and the YFAS 2.0 scale, Portuguese version (BR-YFAS2.0-Obes), was applied to assess their food dependence levels. The Food Craving Questionnaire - Trait: The FCQ-T-reduced was subsequently used for a correlation analysis.

RESULTS

The patients' average BMI was 41.6 ± 8.8 kg/m2. Br-YFAS2.0-Obes presented an average of 4.9 ± 3.1 for the FA diagnostic criteria. The resulting values of the Comparative Fit Index, Tucker Lewis Index, and Standardized Root Mean Square Residual were 0.990, 0.986, and 0.074, respectively. The internal consistency analysis of the 11 domains presented a Kuder-Richardson α of 0.82. The convergent validity, obtained through an analysis of the Pearson correlation coefficient, was r = 0.43 (p < 0.001). It was found that an increase in the number of Br-YFAS 2.0-Obes symptoms is associated with an increase in the FCQ-T-r mean.

CONCLUSION

Much like the YFAS 2.0 in other languages, the BR-YFAS 2.0-Obes presented adequate convergent validity, reliability, and one-factor structure results, which makes it suitable for Brazilian candidates for bariatric surgery or any individual who is within BMI >  = 30 kg/m2.

The Association between Grazing and Food Addiction: The Italian Version of the Repetitive Eating Questionnaire (Rep(Eat)-Q) and Its Relationships with Food Addiction Criteria

BACKGROUND

Among the dysfunctional eating behaviors associated with excessive food intake, a construct that is gaining increasing attention is grazing-the constant, continuous, compulsive, and repetitive consumption of small/moderate amounts of food. Furthermore, in some cases, grazing seems to indicate a dependence on food and/or eating. Currently, the Repetitive Eating Questionnaire (Rep(Eat)-Q) appears to be the only questionnaire that comprehensively measures grazing, including its repetitive and compulsive eating component. Therefore, in a sample of individuals with severe obesity, the objective of this study was twofold: (A) to evaluate the psychometric properties of the Italian version of the Rep(Eat)-Q, and (B) to analyze the association between grazing and food addiction (FA).

METHOD

A cross-sectional research design was used. A total of 402 inpatients with severe obesity (BMI > 35) were recruited. Participants underwent a series of questionnaires to investigate structural validity and convergent validity and association with FA criteria.

RESULTS

The factorial structure of the Rep(Eat)-Q is robust and showed fit indexes: CFI = 0.973; RMSEA = 0.074; 90%CI [0.056-0.091]; and SRMR = 0.029. Also, it exhibited good internal consistency and convergent validity. Furthermore, logistic regression analysis highlights a specific association between certain FA criteria and grazing.

CONCLUSIONS

The Rep(Eat)-Q can be considered to be a concise, robust, reliable, and statistically sound tool to assess repetitive eating, specifically grazing. Its strong psychometric properties offer significant advantages for both research and clinical applications. Furthermore, in a sample of individuals with severe obesity, the results suggest that individuals with problematic grazing exhibit a typical behavioral profile of subjects with FA, indicating that FA can manifest through problematic grazing as well.

Measuring Motivations to Eat Palatable Foods: Adaptation and Psychometric Properties of the Italian Version of the Palatable Eating Motives Scale (PEMS-IT)

BACKGROUND

Gaining knowledge of the various reasons behind people's consumption of highly processed foods has the potential to enhance obesity prevention initiatives and open avenues to tailor treatment approaches for obesity and binge eating at a more personalized level. This contribution aimed to test the psychometric properties and factor structure of the Palatable Eating Motives Scale (PEMS-IT) in a community sample of Italian adults.

METHODS

A confirmatory factor analysis was performed to test the factor structure of the Italian version of the PEMS (PEMS-IT) on a total of 616 respondents. Furthermore, the reliability and convergent validity analysis of the tool were evaluated.

RESULTS

The analysis confirmed the four-factor structure of PEMS-IT [(YBχ2 (164) = 537.901; p < 0.001, the CFI = 0.918, RMSEA = 0.072; 90%CI [0.065-0.078]; p(RMSEA < 0.05) < 0.001, and SRMR = 0.080] and satisfactory reliability on its subscales (Cronbach's α: 0.745-0.917). Positive correlations were also found with food addiction and binge-eating symptoms, compulsive eating behavior, and uncontrolled and emotional eating.

CONCLUSIONS

The PEMS-IT appears to be an instrument with promising psychometric properties and potential applications in clinical settings. However, it also has some limitations, and future studies could focus on improving the semantic content of the elements to increase the overall utility and precision of the instrument.

Cognitive restraint, uncontrolled eating, and emotional eating. The Italian version of the Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18): a three-step validation study

BACKGROUND

The Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18) is an extensively used questionnaire to measure three transdiagnostic features of eating behavior: cognitive restraint, uncontrolled eating, and emotional eating.

OBJECTIVE

This research aims to investigate the psychometric properties of the Italian version of the TFEQ-R-18 in three large community samples.

METHOD

Cross-sectional research designs were employed. In Study 1 (N = 537), an exploratory graph analysis (EGA) was used to examine item clustering within the TFEQ-R-18. In Study 2 (N = 645), a confirmatory factor analysis (CFA) was conducted to test its structural validity. In Study 3 (N = 346), a MANOVA was employed assessing mean differences across eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating disorder).

RESULTS

In Study 1, the EGA accurately identified the three original dimensions of the TFEQ-R-18. Study 2 showed that the Italian TFEQ-R-18 has good fit indexes (CFI = 0.989, RMSEA = 0.064; 90% CI [0.058, 0.070], SRMR = 0.062), and possesses robust psychometric properties. Study 3 reveals distinct, statistically significant differences among eating disorders.

CONCLUSION

The TFEQ-R-18 proves to be a concise and precise tool for measuring transdiagnostic eating behaviors. Its applicability in the Italian context, supported by robust psychometric properties, suggests its utility for both research and clinical purposes. The findings affirm its potential to inform interventions aimed at enhancing psychological health.

LEVEL OF EVIDENCE

Level V, descriptive study.

Assessing Discriminant Validity through Structural Equation Modeling: The Case of Eating Compulsivity

Food addiction (FA) and disordered eating behaviors related to obesity are gaining attention in clinical and research fields. The modified Yale Food Addiction Scale 2.0 (mYFAS2.0) is the gold standard questionnaire to measure FA, while another tool is the Measure of Eating Compulsivity 10 (MEC10). Discriminant validity is present when two measures of similar but distinct constructs show a correlation that is low enough for the factors to be regarded as distinct. However, the discriminant validity of these measures has never been tested. Through a cross-sectional study design, 717 inpatients (females: 56.20%, age: 53.681 ± 12.74) with severe obesity completed the MEC10, Binge Eating Scale (BES), and mYFAS2.0. A structural equation model (SEM) was fitted, freely estimating latent correlations with 95% confidence intervals (95% CI). The results confirmed the scales' excellent psychometric properties. Importantly, latent factor correlations between MEC10 and mYFAS2.0 (est = 0.783, 95% CI [0.76, 0.80]) supported their discriminant validity. In contrast, the latent correlation of MEC10 and BES (est = 0.86, 95% CI [0.84, 0.87]) exceeded the recommended thresholds, indicating the absence of discriminant validity and suggesting a potential overlap, consistent with previous evidence. In conclusion, MEC10 demonstrates excellent psychometric properties but is more a measure of BED and not FA.

Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder

Objective. The present study employs a profile analysis to identify and compare psychological features and core eating disorder (ED) symptoms in clinical samples of patients with anorexia nervosa (AN) and binge eating disorder (BED) and the general population (GP). Methods. A sample comprising 421 participants (142 patients with AN; 139 patients with BED; and 140 participants from the GP) was surveyed with the Eating Disorder Inventory-3 (EDI-3). Individuals with AN and BED were recruited and tested during their first week of a multidisciplinary inpatient program for weight loss and rehabilitation at the 'Rete DCA USL Umbria 1' (Eating Disorders Services), Italy. Results. The findings suggest distinct patterns of symptom presentation between the three samples across all the EDI-3 dimensions-with both the AN and BED groups scoring significantly higher than the GP. Patients with AN registered greater scores in all the psychological trait scales and the drive for thinness ED-specific dimension of the EDI-3 compared with their BED counterpart-which, instead, scored higher in the bulimia and body dissatisfaction subscales. These data support the transdiagnostic nature of the main risk factors for the onset and maintenance of EDs-which would vary in severity levels-and the existence of disease-specific pathways giving rise to AN and BED. Conclusion. This study for the first time compares patients with AN and BED with a non-clinical sample on main ED psychological features. This might inform classification approaches and could have important implications for the development of prevention and early intervention programs.

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.

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.

Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ)

PURPOSE

This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2).

METHODS

At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital.

RESULTS

The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable.

CONCLUSIONS

The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments.

LEVEL OF EVIDENCE

V, descriptive study.

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.

Neurobiological and neuropharmacological aspects of food addiction

This review aims to draw attention to current studies on syndromes related to food eating behavior, including food addiction, and to highlight the neurobiological and neuropharmacological aspects of food addiction toward the development of new therapies. Food addiction and eating disorders are influenced by several neurobiological factors. Changes in feeding behavior, food addiction, and its pharmacological therapy are related to complex neurobiological processes in the brain. Thus, it is not surprising that there is inconsistency among various individual studies. In this review, we assessed literature including both experimental and clinical studies regarding food addiction as a feeding disorder. We selected articles from animal studies, randomized clinical trials, meta-analyses, narrative, and systemic reviews given that, crucial quantitative data with a measure of neurobiological, neuropharmacological aspects and current therapies of food addiction as an outcome. Thus, the main goal to outline here is to investigate and discuss the association between the brain reward system and feeding behavior in the frame of food addiction in the light of current literature.

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.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

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.

Food preferences and YFAS/YFAS-C scores in schoolchildren and university students

PURPOSE

Food addiction (FA) is one of the causes of widespread obesity in modern society. It was shown that there is an age-associated increase in incidence rate of FA in adolescents/young adults. The purpose of this study was to analyze food preferences in schoolchildren and university students with FA.

METHODS

High school and university students (N = 1607; age: 17.8 ± 2.7 years; girls: 77.0%) located in four settlements of Russia anonymously took part in the study. Study participants provided personal data (age, sex, height, and weight) and completed the Yale Food Addiction Scale, the Zung Self-Rating Depression Scale and the Munich ChronoType Questionnaire. In addition, they indicated food products with which they had problems.

RESULTS

The frequency of detection of FA among university students was twice as high as among schoolchildren. University students with FA were 20.2% more likely than schoolchildren to report the symptom 'use continues despite knowledge of adverse consequences,' and 13.7% more likely to report the symptom 'tolerance.' Schoolchildren and university students with FA most often noted that foods high in sugar and fat were problematic. University students with FA also reported that foods with a high carbohydrate content were problematic.

CONCLUSION

In university students with FA, in comparison with schoolchildren with FA, there is an increase in list of problematic food products, mainly due to products with a high carbohydrate content.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model

Despite the severe psychological impact of the COVID-19 pandemic, some individuals do not develop high levels of psychological distress and can be termed resilient. Using the ecological resilience model, we examined factors promoting or hindering resilience in the COVID-19 pandemic. Of the 1034 participants (49.9±16.2 years; females 51.2%) from Italian general population, 70% displayed resilient outcomes and 30% reported moderate-severe anxiety and/or depression. A binary regression model revealed that factors promoting resilience were mostly psychological (e.g., trait resilience, conscientiousness) together with social distancing. Conversely, factors hindering resilience included COVID-19-anxiety, COVID-19-related PTSD symptoms, intolerance of uncertainty, loneliness, living with children, higher education, and living in regions where the virus was starting to spread. In conclusion, the ecological resilience model in the COVID-19 pandemic explained 64% of the variance and identified factors promoting or hindering resilient outcomes. Critically, these findings can inform psychological interventions supporting individuals by strengthening factors associated with resilience.

Examining the construct validity of food addiction severity specifiers

PURPOSE

Food addiction (FA) is related to greater body mass index (BMI), eating-disorder psychopathology, food craving, and psychosocial impairment. Less is known regarding the utility of the FA severity specifiers, as measured by the number of symptoms endorsed on the Yale Food Addiction Scale (YFAS 2.0).

METHODS

Participants (N = 1854) were recruited from Amazon Mechanical Turk to complete an online survey on eating behaviors. Participants completed self-report measures assessing FA, eating-disorder psychopathology (Eating Disorder Examination Questionnaire), and food craving (Food Craving Inventory). Based on the YFAS 2.0 specifiers, participants were classified into four FA groups: No FA (n = 1643), mild (n = 40), moderate (n = 55), and severe (n = 116).

RESULTS

There were significant differences found in age, sex, BMI, and frequency of objective binge-eating episodes (OBEs) among the FA groups. Using ANCOVA, adjusted for multiple comparisons and covariates (e.g., BMI, sex, OBEs), the No FA group reported significantly lower levels of shape concern (η² = 0.05; p < 0.001), weight concern (η² = 0.04; p < 0.001), eating concern (η² = 0.15; p < 0.001), and global eating-disorder psychopathology (η² = 0.06; p < 0.001) than mild, moderate, or severe FA groups. The No FA group reported significantly lower levels of dietary restraint (η² = 0.01; p < 0.01) than mild and severe FA groups. The severe FA group reported higher food craving scores (η² = 0.02; p < 0.001) compared to the No FA group.

CONCLUSION

Our findings parallel the severity specifiers literature for eating and substance use disorders by also indicating the limited utility of severity specifiers based on symptom count. Future research should investigate alternative targets for discriminating among levels of FA.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

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.

Psychological Differences Among Healthcare Workers of a Rehabilitation Institute During the COVID-19 Pandemic: A Two-Step Study

Introduction: Healthcare workers facing the threatening COVID-19 can experience severe difficulties. Despite the need to evaluate both the psychological distress and positive protective resources, brief and reliable assessment tools are lacking. Aim: Study 1 aimed at developing a new assessment tool to measure psychological distress and esteem in healthcare workers during the COVID-19 pandemic. Study 2 aimed to explore and compare the psychological reactions of healthcare workers of the COVID-19 and the non-COVID-19 wards. Methods: In Study 1, psychologists created 25 items based on their clinical experience. A preliminary qualitative evaluation selected the best 15 items for the new tool (CPI-HP) assessing the COVID-19 psychological impact with 2 scales: psychological distress and esteem. The CPI-HP was administered to 110 healthcare professionals to study its psychometric properties and the internal structure with exploratory graph analysis and confirmatory factor analysis. Study 2 compared two groups of healthcare professionals of the COVID-19 and non-COVID-19 departments. Results: In Study 1, the CPI-HP showed satisfying psychometric properties, and the two-factor structure was confirmed with good fit indices. In Study 2, the two groups of healthcare workers showed comparable levels of psychological distress and resilient coping, but the COVID-19 group displayed significantly higher esteem and appreciation of the experience. Discussion: All operators showed high psychological distress during the emergency, but the COVID-19 group reported higher resources, probably due to stronger group cohesion and greater esteem, perceived meaning, and own work value. Conclusion: Assessing the psychological distress and resources of healthcare professionals with specific tools is important. Psychological interventions should promote their psychological health.

Assessing Psychometric Properties of the Italian Version of the Heartland Forgiveness Scale

Despite increasing popularity and intensive worldwide use, few studies have assessed the validity and factorial structure of the Heartland Forgiveness Scale (HFS). However, scientific literature showed that the original factorial structure of the HFS was not fully replicated and—in addition—the Italian translation is still lacking. To fill this gap, this study aims to extend evidence about the original HFS factorial validity by analyzing the Italian version. The final sample was composed of 523 randomly enrolled participants [139 males (26.6%), 384 females (73.4%)] aged from 18 to 82 years (mean = 42.53, SD = 16.41) who completed the Italian version of the HFS. The confirmatory factor analysis showed good fit indices for the original hierarchical factor solution and a significant decrease in model fit was found for all of the competing models. Also, the Italian version of the HFS revealed good reliability and very good psychometrical properties. Findings suggest that the Italian version of the HFS can be considered a reliable and good psychometrically based instrument for the assessment of dispositional forgiveness of the Self, Other, and Situation.