French validation of the addiction-like eating behavior scale and its clinical implication

Exploration of Food Attitudes and Management of Eating Behavior from a Psycho-Nutritional Perspective

BACKGROUND/OBJECTIVES

This study investigates the relationship between food attitudes and the management of eating behavior from a psycho-nutritional perspective, with a focus on the Health Belief Model (HBM). The objective was to explore how emotional food cravings influence different aspects of eating behavior and dietary attitudes, and to identify indirect pathways through which these cravings affect attitudes toward dieting behaviors.

METHODS

Data were collected from 659 participants using validated scales that assessed dieting tendencies, bulimia and food preoccupation, culinary behaviors, food preoccupation, expectations of positive outcomes, and emotional food cravings. Descriptive statistics, Pearson's correlations, and network analysis were employed to uncover significant associations among these variables. A sequential mediation analysis was conducted using SPSS PROCESS Macro Model 6 to identify indirect pathways.

RESULTS

The analysis revealed significant associations among the variables. Emotional food craving had a negative indirect effect on dieting attitudes through bulimia tendencies (effect size: -0.523) and a positive indirect effect through food preoccupation (effect size: 0.1006). These results highlight the complex interplay between emotional food cravings, bulimia tendencies, and food preoccupation in shaping dieting attitudes.

CONCLUSIONS

The findings emphasize the complex dynamic between emotional food cravings, bulimia tendencies, and food preoccupation, and their collective impact on dieting attitudes. This study provides insights into potential intervention strategies aimed at improving eating habits by addressing emotional food cravings and their indirect effects on dietary behavior.

Validity of the Addiction-like Eating Behavior Scale among Patients with Compulsive Eating

Food addiction (FA) and binge eating disorder (BED) co-occur and share compulsive eating symptoms. When using an FA measure, it is important to evaluate its performance in a population presenting compulsive eating. The study aims to validate the Addiction-like Eating Behavior Scale (AEBS) among a clinical sample characterized by compulsive eating and overweight/obesity and to evaluate its incremental validity over the Yale Food Addiction Scale 2.0 (YFAS). Patients seeking help for compulsive eating (n = 220), between January 2020 and July 2023, completed online questionnaires, including FA, compulsive eating, and BMI evaluations. The factor structure, internal consistency, and convergent, divergent, and incremental validity were tested. The sample had a mean age of 44.4 years old (SD = 12.7) and a mean BMI of 38.2 (SD = 8.0). The two-factor structure provided a good fit for the data, with factor loadings from 0.55 to 0.82 (except for item 15) and the internal consistency was high (ω = 0.84-0.89). The AEBS was positively correlated with the YFAS (r = 0.66), binge eating (r = 0.67), grazing (r = 0.47), craving (r = 0.74), and BMI (r = 0.26), and negatively correlated with dietary restraint (r = -0.37), supporting good convergent and divergent validity. For each measure of compulsive eating, linear regression showed that the AEBS "appetite drive" subscale had a unique contribution over the YFAS. This study provided evidence that the AEBS is a valid measure among a clinical sample of patients with compulsive eating and overweight/obesity. However, questions remain as to whether the AEBS is a measure of FA or compulsive eating.

Muscle dysmorphia from an addictive perspective: Validation of the Addiction to Body Image Inventory (ABII)

OBJECTIVES

Muscle dysmorphia (MD) is a disorder affecting mainly men and is characterized by significant dissatisfaction with muscles. The idea that MD could represent an addiction has been theoretically discussed, but no empirical data are available. Based on Foster et al. (2015) framework, the Addiction to Body Image Inventory (ABII) was developed. This study aims to validate the ABII and to evaluate its capacity to capture MD severity.

METHODS

A first community sample of 466 participants was recruited and completed the ABII and questionnaires on MD and body esteem. A second sample of 47 men at risk of MD was recruited mostly in gyms and completed the ABII and questionnaires on MD, eating and psychological symptoms.

RESULTS

With the community sample, the results showed that the ABII had a valid factorial structure, good internal consistency, and good convergent validity. With the sample of men at risk of MD, the results showed that the ABII had good convergent validity with MD and eating symptoms but not with psychological symptoms. The results of a regression model showed that the ABII explained 12% of the MD variance.

CONCLUSIONS

This study brings the first measure of addiction to body image and suggests that MD must be understood as a complex phenomenon including eating symptoms and addictive tendencies.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Evaluating Bidirectional Predictive Pathways between Dietary Restraint and Food Addiction in Adolescents

The relationship between food addiction, an important emerging construct of excessive eating pathology, and dietary restraint has yet to be fully understood. Eating disorder models commonly posit that dietary restraint exacerbates loss of control eating (e.g., binge episodes) and may also play a causal role in the development of food addiction. However, dietary restraint as a reaction to consequences of food addiction (e.g., uncontrollable eating or weight gain) represents another plausible pathway. Existing studies indicate that the association between food addiction and dietary restraint may be more significant during adolescence than adulthood, but are limited by cross-sectional study designs. A longitudinal study using an adolescent sample is ideal for investigating potential pathways underlying links between food addiction and dietary restraint. This study examined temporal pathways between food addiction and dietary restraint in a sample of one hundred twenty-seven adolescents (M = 14.8, SD = 1.1) at three timepoints spanning two years. This is the first study to examine longitudinal cross-lagged panel associations between food addiction and dietary restraint. In this adolescent sample, food addiction significantly predicted future dietary restraint (b = 0.25, SE = 0.06, p < 0.001), but dietary restraint did not significantly predict future food addiction (b = 0.06, SE = 0.05, p > 0.05). These findings support the theory that dietary restraint may be a reaction to deleterious effects of food addiction during adolescence.

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.

Addiction-like Eating in Chinese Adults: An Assessment Tool and Its Associations with Modern Eating-Related Habits

OBJECTIVES

The rapid increase in Chinese obesity rates has aroused research interest in addiction-like eating (AE); however, the unavailability of assessment tools is a major barrier to further investigation. To address the research gap, this study aimed to evaluate the psychometric properties of the Addiction-like Eating Behavior Scale (AEBS) and explore associations between AE and three modern eating-related habits (i.e., ordering delivery food, eating late-night meals and watching mukbang) among Chinese adults.

METHODS

The STROBE checklist was followed for reporting this cross-sectional study. We conducted a telephone survey with a two-stage cluster random sampling method and acquired a probability sample of 1010 community-dwelling Chinese adults (55.2% female; age: 18-88 years, M = 38.52, SD = 14.53).

RESULTS

Results confirmed the conceptualized two-factor structure of AEBS with satisfactory model fit, reliability and validity. Chinese adults reported higher levels of AE in the context of low dietary control rather than appetitive drive. These two AE factors showed significant and positive associations with modern eating-related habits.

CONCLUSIONS

The current study was the first to assess AE among Chinese adults and provided a reliable and valid assessment tool. Our correlational findings can also be utilized for designing interventions for weight management and healthy eating.