Women with elevated food addiction symptoms show accelerated reactions, but no impaired inhibitory control, in response to pictures of high-calorie food-cues

Attention Affecting Response Inhibition in Overweight Adults with Food Addiction

Food addiction is associated with attention bias and response inhibition deficits, while the relationship between these two domains is unclear. Participants with body mass index (BMI) ≥ 25 and exhibiting food addiction behaviors (FA group, n = 20) were compared with healthy controls (HC group, n = 23). We examined attention-inhibition mechanisms using resting EEG microstate analysis, food-cue-evoked event-related potentials (ERPs), and non-food Go/No-Go tasks. Overweight individuals with food addiction behaviors demonstrated attentional deficits, as indicated by abnormalities in microstate D and the P100 component. Importantly, both microstate D and the P100 component significantly predicted No-Go performance, linking neurophysiological markers to behavioral inhibition. This study suggests that attention bias may be an important interaction factor of response inhibition, providing novel mechanistic insights into food addiction.

The neurocognitive correlates of non-substance addictive behaviors

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = -0.10, p =.049; β = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.

Measuring food-related inhibition with go/no-go tasks: Critical considerations for experimental design

The use of go/no-go tasks to assess inhibitory control over food stimuli is becoming increasingly popular. However, the wide variability in the design of these tasks makes it difficult to fully leverage their results. The goal of this commentary was to provide researchers with crucial aspects to consider when designing food-related go/no-go experiments. We examined 76 studies that used food-themed go/no-go tasks and extracted characteristics related to participant population, methodology, and analysis. Based on our observations of common issues that can influence study conclusions, we stress the importance for researchers to design an appropriate control condition and match stimuli between experimental conditions in terms of emotional and physical properties. We also emphasize that stimuli should be tailored to the participants under study, whether at the individual or group level. To ensure that the task truly measures inhibitory abilities, researchers should promote the establishment of a prepotent response pattern by presenting more go than no-go trials and by using short trials. Researchers should also pre-specify the criteria used to identify potentially invalid data. While go/no-go tasks represent valuable tools for studying food cognition, researchers should choose task parameters carefully and justify their methodological and analytical decisions in order to ensure the validity of results and promote best practices in food-related inhibition research.

Examination of Individual Differences in Susceptibility to Food Addiction using Alcohol and Addiction Research Domain Criteria (AARDoC): Recent Findings and Directions for the Future

Purpose of Review

Alcohol and Addiction Research Domain Criteria (AARDoC) is a transdiagnostic, circuits-based framework for studying addictive behaviors. We examined parallels in individual differences that might increase susceptibility to FA and other addictive disorders using the following units of analysis in AARDoC domains: craving, relative reinforcing value of food and attention bias in the incentive salience domain; decisional impulsivity (delay discounting) and inhibitory control (Go-No-Go, Conner’s Continuous Performance Test, and the flanker task) in the executive function domain; and emotion dysregulation and negative urgency in the negative emotionality domain.

Recent Findings

There are a number of parallels between FA and other addictions in the incentive salience and negative emotionality domains, but somewhat divergent findings in the executive function domain. Trauma appears to be an important environmental stressor in maintenance of FA.

Summary

AARDoC may be a useful organizing framework for studying addictions, including FA. Future studies should incorporate other units of analysis to better characterize FA.

Cognitive function in binge eating disorder and food addiction: A systematic review and three-level meta-analysis

BACKGROUND

An extensive body of recent research has focused on the contribution of cognitive functioning to eating behaviors. In binge eating disorder (BED) and food addiction (FA), the extent of cognitive impairment is still unclear. This study aimed to characterize, among those with BED and FA, neurocognitive functions using performances based on neuropsychological tasks in the context of neutral stimuli in adults.

METHOD

MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and gray literature (ProQuest and OpenGrey) were used to identify studies that reported neurocognitive assessments in BED or FA up to December 2019. A three-level meta-analysis was conducted.

RESULTS

A significant overall effect was found for global cognitive impairments, suggesting that individuals with BED or FA have poorer performances when completing cognitive tasks. Analyses for specific cognitive domains revealed that individuals with BED showed poorer performances at tasks assessing cognitive flexibility, inhibitory control, attention and planning. Analyses regarding FA were inconclusive due to a lack of studies. Thus, the results were described qualitatively.

CONCLUSION

Our meta-analysis highlighted the cognitive weaknesses that seem to come with BED and the necessity to integrate them in the assessment and treatment of this condition. It also stressed the lack of quality studies surrounding the cognitive features of FA.

Cigarette-specific disgust aroused by smoking warning images strengthens smokers' inhibitory control under smoking-related background in Go/NoGo task

RATIONALE

Reduced inhibitory control is more pronounced during substance-related cue exposure among addicts. However, it is inconclusive whether smokers' inhibitory control would be impaired by smoking-related background. Furthermore, few studies explored whether the cigarette-specific disgust aroused by smoking warning images would alleviate the negative effect of smoking-related cues on smokers' inhibitory control.

OBJECTIVE

Experiment 1 investigated the effect of smoking-related background on inhibitory control in cigarette smokers with a modified Go/NoGo task and experiment 2 explored whether cigarette-specific disgust aroused by smoking warning images would alleviate the negative effect of smoking-related background on smokers' inhibitory control.

METHOD

Sixty-two male participants (32 smokers and 30 non-smokers) were recruited in experiment 1 and 51 male smokers were recruited in experiment 2.

RESULTS

Experiment 1 found that compared to neutral background, smokers made more commission errors (i.e., executing a response to a no-go target) under smoking-related background, indicating that smoking-related background has a negative effect on smokers' inhibitory control. Experiment 2 found that after experiencing cigarette-specific disgust, smokers made fewer commission errors at post-mood induction than pre-mood induction, indicating that cigarette-specific disgust aroused by smoking warning images alleviates the negative effect of smoking-related background on smokers' inhibitory control.

CONCLUSIONS

These results suggest that the negative effect of smoking-related cues on smokers' inhibitory control would be alleviated by cigarette-specific disgust aroused by smoking warning images, which emphasizes the important role of cigarette-specific disgust in strengthening smokers' inhibitory control towards smoking-related cues.

The effects of combined cognitive training on prospective memory in older adults with mild cognitive impairment

This study aimed to assess the effects of combined cognitive training on prospective memory ability of older adults with mild cognitive impairment (MCI). A total of 113 participants were divided into a control group and three intervention groups. Over three months, the control group received only community education without any training, whereas for the first six weeks, an executive function training group received executive function training, a memory strategy training group received semantic encoding strategy training, and the combined cognitive training group received executive function training twice a week for the first six weeks, and semantic encoding strategy training twice a week for the next six weeks. The combined cognitive training group showed improvement on the objective neuropsychological testing (Montreal Cognitive Assessment scale). The memory strategy training group showed improvement on the self-evaluation scales (PRMQ-PM). Combined cognitive training improved the prospective memory and cognitive function of older adults with MCI.

A narrative review of reward sensitivity, rash impulsivity, and food addiction in adolescents

Adolescence represents a neurodevelopmental period characterised by heightened reward drive and weaker inhibitory control that may increase vulnerability to compulsive overconsumption of highly-palatable foods and food addiction. This narrative review aimed to summarise research investigating the presence of food addiction in adolescents and establish the role that impulsivity traits (i.e., reward sensitivity and rash impulsivity), previously linked to substance and behavioural addictions, play in contributing to food addiction in this cohort. It was found that the prevalence of food addiction was typically higher in studies that recruited adolescents who were overweight/obese or from clinical populations. Overall, impulsivity was found to be more consistently associated with food addiction, while the relationships between measures of reward sensitivity and food addiction were mixed. Findings of this review suggest trait impulsivity may contribute to food addiction in adolescents, however, further longitudinal and prospective research is recommended to confirm these findings and to investigate the potential interactive effects of reward sensitivity and rash impulsivity.

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.

Food Addiction and Cognitive Functioning: What Happens in Adolescents?

This study aimed to examine cognitive factors associated to food addiction (FA) symptoms in a non-clinical sample of adolescents. A group of 25 adolescents (12–18 years; Mean age = 15.2 years) with a high level of FA symptoms (two and more) were compared to a control group without FA symptoms (n = 25), matched on sex and age, on four Cambridge Neuropsychological Test Automated Battery (CANTAB) neuropsychological tasks (MT: Multitasking Test; OTS: One Touch Stockings of Cambridge; SST: Stop Signal Task; RVP: Rapid Visual Information Processing). They were also compared on self-reported questionnaires assessing binge eating, depressive and anxiety symptoms, impulsivity levels, as well as executive functioning difficulties. Group comparisons did not show significant differences on neuropsychological tasks’ performances. However, effect sizes’ estimates showed small to medium effect sizes on three scores: adolescents with a high level of FA symptoms showed a higher probability of an error following an incorrect answer (OTS), a higher probability of false alarm, and a poorer target sensitivity (RVP). When referring to self-reported measurements, they reported significantly more executive functioning difficulties, more binge eating, depressive symptoms and higher impulsivity levels. Overall, results suggested that cognitive difficulties related to FA symptoms seem to manifest themselves more clearly when assessing daily activities with a self-reported questionnaire, which in turn are strongly related to overeating behaviors and psychological symptoms. Future longitudinal research is needed to examine the evolution of those variables, their relationships, and contribution in obesity onset. More precisely, the present findings highlighted the importance of affective difficulties related to this condition, as well as the need to take them into account in its assessment.

Investigating the relationship between reward sensitivity, impulsivity, and food addiction: A systematic review

OBJECTIVE

The aim of the current research was to identify the extent to which reward sensitivity and impulsivity were related to food addiction.

METHOD

Forty-five studies, published from 2009 to June 2019, investigating reward sensitivity and/or impulsivity with food addiction as measured by the Yale Food Addiction Scale were reviewed.

RESULTS

Reward sensitivity, as measured by the Sensitivity to Reward (SR) scale, was positively associated with food addiction in two studies, but failed to yield consistent results in other studies when measured with the Behavioral Inhibition/Behavioral Activation Scales. Self-report impulsivity, as measured by the Barratt Impulsiveness Scale (BIS-11), was consistently associated with food addiction, with attentional impulsivity and motor impulsivity the most consistent subscales. Similarly, food addiction was also consistently associated with Negative Urgency, Positive Urgency, and Lack of Perseverance as measured by the UPPS-P Impulsive Behavior Scale. Food addiction was inconsistently associated with disinhibition, as measured by behavioral tasks, indicating food addiction appears more aligned with self-report measures of impulsivity.

CONCLUSIONS

Research in this field is dominated by university student, overweight and obese samples. Additional research is required to further tease out these relationships.

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.

Food-Cal: development of a controlled database of high and low calorie food matched with non-food pictures

BACKGROUND

Industrialization has led to more varied and attractive high-calorie foods. Health problems such as obesity and diabetes are partially attributed to eating-related self-regulation difficulties that may be caused by increasingly frequent cues for highly palatable foods. Research studies aim at understanding the factors underlying responses to food cues. This has led to the development of food stimuli databases. However, they present some limitations.

OBJECTIVES

This study aimed at providing a controlled set of pictures, including 40 food pictures with high- and low-calorie stimuli, matched with 40 non-food pictures. The second objective was to provide a ready-to-use database with normative data regarding responses and associations between demographic, anthropometric and eating-related characteristics, and picture ratings.

PARTICIPANTS

A sample of 264 participants rated the total set of pictures.

MEASURES

Attractiveness, arousal and palatability were assessed for each picture, as well as participant's current type of diet, BMI, hunger levels and eating behaviors (uncontrolled and emotional eating).

RESULTS

Image characteristics (shape, colors, luminance) were comparable between food and matched non-food pictures. Positive correlations were found between hunger levels and attractiveness, arousal and palatability of food. Uncontrolled and emotional eating was positively correlated with high-calorie food palatability, and uncontrolled eating was positively correlated with high-calorie food attractiveness. Participants who did not report any specific diet rated high-calorie foods as more attractive and arousing, whereas vegan and vegetarian participants assessed low-calorie foods as more attractive and palatable.

CONCLUSION

The Food-Cal controlled set of picture database can be considered as a useful tool for experimental research.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Food Addiction in Adolescents: Exploration of psychological symptoms and executive functioning difficulties in a non-clinical sample

Recent studies on food addiction (FA) provided a better understanding of this condition in various populations. Indeed, authors have shown that FA was nearly as prevalent in adolescents as in adults, and similar correlates were observed in both populations (disordered eating behaviors, depressive and anxiety symptoms, impulsivity). The aim of the present study was to characterize FA in adolescents, according to psychological symptoms and executive functioning difficulties. A sample of 969 adolescents, aged between 12 and 18 years old, was recruited in the Quebec City area. They completed a series of questionnaires, including the Yale Food Addiction Scale 2.0 to measure FA symptoms, the Behaviour Rating Inventory of Executive Function to measure executive functioning difficulties, as well as other self-reported questionnaires assessing psychological symptoms (depressive and anxiety symptoms, impulsivity). Group comparisons showed that adolescents with a high level of FA symptoms reported significantly more psychological symptoms (binge eating, depression, anxiety, impulsivity), and more executive functioning difficulties. Finally, the relationship between FA symptoms and executive functioning difficulties was moderated by age and sex. More precisely, the previously mentioned relationship was stronger in young teen girls. The present work provides a preliminary framework in the developmental study of FA.

The Cognitive Drivers of Compulsive Eating Behavior

Compulsivity is a central feature of obsessive-compulsive and addictive disorders, which share considerable overlap with excessive eating in terms of repetitive behavior despite negative consequences. Excessive eating behavior is characteristic of several eating-related conditions, including eating disorders [bulimia nervosa (BN), binge eating disorder (BED)], obesity, and food addiction (FA). Compulsivity is proposed to be driven by four distinct cognitive components, namely, contingency-related cognitive flexibility, task/attentional set-shifting, attentional bias/disengagement and habit learning. However, it is unclear whether repetitive behavior in eating-related conditions is underpinned by deficits in these cognitive components. The current mini-review synthesizes the available evidence for performance on compulsivity-related cognitive tasks for each cognitive domain among populations with excessive eating behavior. In three of the four cognitive domains, i.e., set-shifting, attentional bias and habit learning, findings were mixed. Evidence more strongly pointed towards impaired contingency-related cognitive flexibility only in obesity and attentional bias/disengagement deficits only in obesity and BED. Overall, the findings of the reviewed studies support the idea that compulsivity-related cognitive deficits are common across a spectrum of eating-related conditions, although evidence was inconsistent or lacking for some disorders. We discuss the theoretical and practical importance of these results, and their implications for our understanding of compulsivity in eating-related conditions.

Invasive and Non-invasive Stimulation of the Obese Human Brain

Accumulating evidence suggests that non-invasive and invasive brain stimulation may reduce food craving and calorie consumption rendering these techniques potential treatment options for obesity. Non-invasive transcranial direct current stimulation (tDCS) or repetitive transcranial magnet stimulation (rTMS) are used to modulate activity in superficially located executive control regions, such as the dorsolateral prefrontal cortex (DLPFC). Modulation of the DLPFC’s activity may alter executive functioning and food reward processing in interconnected dopamine-rich regions such as the striatum or orbitofrontal cortex. Modulation of reward processing can also be achieved by invasive deep brain stimulation (DBS) targeting the nucleus accumbens. Another target for DBS is the lateral hypothalamic area potentially leading to improved energy expenditure. To date, available evidence is, however, restricted to few exceptional cases of morbid obesity. The vagal nerve plays a crucial role in signaling the homeostatic demand to the brain. Invasive or non-invasive vagal nerve stimulation (VNS) is thus assumed to reduce appetite, rendering VNS another possible treatment option for obesity. Based on currently available evidence, the U.S. Food and Drug Administration recently approved VNS for the treatment of obesity. This review summarizes scientific evidence regarding these techniques’ efficacy in modulating food craving and calorie intake. It is time for large controlled clinical trials that are necessary to translate currently available research discoveries into patient care.

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

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

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS

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

RESULTS

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

DISCUSSION

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

Trace Amine Associated Receptor 1 (TAAR1) Modulation of Food Reward

Eating disorders and some forms of obesity are characterized by addictive-like, compulsive eating behavior which contains numerous similarities with compulsive drug use. Food intake is in part mediated by reward and reinforcement processes that can become dysregulated in these disorders. Additionally, impairments in inhibitory control regulation of reward-related responding can cause or further exacerbate binge and compulsive eating. Dysfunctions in two neurotransmitter systems in the mesocorticolimbic pathway, dopamine and glutamate, are thought to contribute to maladaptive eating behaviors. The trace amine associated receptor 1 (TAAR1) system is a promising therapeutic target for compulsive eating behavior due to the role of TAAR1 in synaptic transmission and in the modulation of dopaminergic and glutamatergic signaling. In support of this notion, the TAAR1 agonist RO5256390 was found to decrease the reinforcing effects of palatable food-cues and to reduce binge-like and compulsive-like eating of palatable food. Additionally, prolonged, intermittent access to palatable food was shown to downregulate TAAR1 in the prefrontal cortex, suggesting a potential role for TAAR1 signaling in inhibitory control processes. Research into the role of TAAR1 in addiction, including TAAR1’s ability to modulate psychostimulant reward and reinforcement, bolsters support for TAAR1 agonism as a pharmacological treatment for compulsive eating and other addictive behaviors. This review summarizes the evidence for TAAR1 agonism as a promising therapeutic for compulsive eating behavior as well as the hypothesized mechanism responsible for these effects.

Food and beverage consumption and food addiction among women in the Nurses' Health Studies

BACKGROUND AND AIMS

Previous studies have not addressed a fundamental component of a food addiction disorder: the compulsive relationship between eating and potentially positively reinforcing foods. We aimed to evaluate the association between food consumption and food addiction.

METHODS

We conducted cross-sectional analyses merging data from the Nurses' Health Study (n = 58,625) and Nurses' Health Study II (n = 65,063), two prospective cohort studies of female nurses in the United States. Diet was assessed in 2006-2007 using a food frequency questionnaire, and food addiction was assessed in 2008-2009 using the Modified Yale Food Addiction Scale.

RESULTS

The prevalence of food addiction was 5.4%. The odds of food addiction were strongest among nurses consuming 5+ servings/week (compared with <1 serving/month) of hamburgers (multivariable odds ratio (MVOR) 4.08; 95% CI, 2.66-6.25), French fries (MVOR, 2.37; 95% CI, 1.59-3.51) and pizza (MVOR, 2.49; 95% CI, 1.67-3.69). Consumption of red/processed meat, low/no fat snacks/desserts, and low calorie beverages was positively associated with food addiction, while consumption of refined grains, sugar-sweetened beverages and fruits, vegetables, and legumes was inversely associated with food addiction.

CONCLUSIONS

This epidemiologic study was the largest to examine food consumption and food addiction. Food addiction was positively associated with consumption of many hypothesized positively reinforcing foods that include a combination of carbohydrates and fats such as snacks, "fast foods," and candy bars. However, it was inversely or not associated with certain sweet foods, refined grains, and sugar-sweetened beverages, which is consistent with literature suggesting that carbohydrates (without other ingredients) are less associated with food addiction. Longitudinal analyses will help untangle the temporal order between food consumption and food addiction, as some relationships in our analyses were difficult to interpret due to the cross-sectional design.

Wanting and liking: Separable components in problematic eating behavior?

Some individuals may have an addictive-like response to certain foods, possibly contributing to problematic eating. Highly processed foods, with added fats and/or refined carbohydrates, are suggested to be most associated with addictive-like eating. The incentive sensitization theory suggests that wanting (e.g. craving) may drive compulsive drug use rather than liking (e.g. enjoyment), but it is unknown whether highly processed foods elicit similar wanting and liking patterns as drugs of abuse, or whether individual differences exist. The current study examines the association of highly processed foods with craving and liking, and whether these relationships differ by food addiction symptomology, cognitive restraint, or body mass index (BMI). Participants (n = 216) reported craving and liking for 35 foods and completed the Yale Food Addiction Scale (YFAS) and Three Factor Eating Questionnaire (TFEQ). Highly processed foods were craved more overall. Craving of highly processed foods was predicted negatively by restraint and positively by YFAS score. Liking of highly processed foods was predicted negatively by restraint and positively by BMI. In conclusion, craving and liking appear distinct with respect to highly processed foods, and may be influenced by addictive-like eating, cognitive restraint, and BMI. This suggests that the incentive sensitization framework may also be relevant for problematic food consumption, especially for individuals reporting food addiction symptoms.

Pathological Overeating: Emerging Evidence for a Compulsivity Construct

Compulsive eating behavior is a transdiagnostic construct that is characteristic of medical and psychiatric conditions such as forms of obesity and eating disorders. Although feeding research is moving toward a better understanding of the proposed addictive properties of food, the components and the mechanisms contributing to compulsive eating are not yet clearly defined or understood. Current understanding highlights three elements of compulsive behavior as it applies to pathological overeating: (1) habitual overeating; (2) overeating to relieve a negative emotional state; and (3) overeating despite aversive consequences. These elements emerge through mechanisms involving pathological habit formation through an aberrant learning process, the emergence of a negative emotional state, and dysfunctions in behavioral control. Dysfunctions in systems within neurocircuitries that comprise the basal ganglia, the extended amygdala, and the prefrontal cortex result in compulsive eating behaviors. Here, we present evidence to relate compulsive eating behavior and addiction and to characterize their underlying neurobiological mechanisms. A major need to improve understanding of compulsive eating through the integration of complex motivational, emotional, and cognitive constructs is warranted.

Self-perceived food addiction: Prevalence, predictors, and prognosis

Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived "food addiction" and its relationship to a diagnostic measure of "clinical food addiction" in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived "food addiction" was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with "non-addicts", although individuals who also received a positive "diagnosis" on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive "diagnosis" on the Yale Food Addiction Scale. Self-perceived "food addiction" was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a "food addict" may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.

Effect of drug-related cues on response inhibition through abstinence: A pilot study in male heroin abstainers

BACKGROUND

Chronic heroin use can cause a deficit of inhibitory function, leading to a loss of control over drug use. Exposure to drug-related cues is considered as one of the contributing factors. However, it is unclear whether there are dynamic changes on the effect of drug-related cues on response inhibition following prolonged abstinence.

OBJECTIVE

The present study investigated the effect of drug-related cues on response inhibition in heroin abstainers at different abstinent phases.

METHODS

26 shorter-term (2-6 months) and 26 longer-term (19-24 months) male heroin abstainers performed on a modified two-choice Oddball task, which included two conditions: in the cued condition, neutral pictures served as the background of standard stimuli (yellow frame) and heroin-related pictures served as the background of deviant stimuli (blue frame), reversed in the controlled conditions.

RESULTS

Compared to longer-term abstainers, mean reaction time (RT) for drug deviants in shorter-term abstainers was significantly longer. Shorter-term abstainers also showed markedly slower response to neutral deviants relative to drug deviants, but this tendency was not observed in longer-term abstainers. Nevertheless, both groups had similar RT for standard stimuli regardless of their paired background pictures.

CONCLUSION

Effect of drug-related cues on response inhibition remains at the early stage of abstinence; however, this effect may be reduced following a longer period of drug abstinence. Our findings highlight the importance of assessing and improving the ability of inhibiting drug-related cue reactivity during treatment.

Multidimensional assessment of impulsivity in relation to obesity and food addiction

Based on similarities between overconsumption of food and addictive drugs, there is increasing interest in "food addiction," a compulsive eating pattern defined using symptoms parallel to substance use disorders. Impulsivity, a multidimensional construct robustly linked to drug addiction, has been increasingly examined as an obesity determinant, but with mixed findings. This study sought to clarify relations between three major domains of impulsivity (i.e., impulsive personality traits, discounting of delayed rewards, and behavioral inhibition) in both obesity and food addiction. Based on the association between impulsivity and compulsive drug use, the general hypothesis was that the impulsivity-food addiction relation would be stronger than and responsible for the impulsivity-obesity relation. Using a cross-sectional dimensional design, participants (N = 181; 32% obese) completed a biometric assessment, the Yale Food Addiction Scale (YFAS), the UPPS-P Impulsive Behavior Scales, a Go/NoGo task, and measures of monetary delay discounting. Results revealed significantly higher prevalence of food addiction among obese participants and stronger zero-order associations between impulsivity indices and YFAS compared to obesity. Two aspects of impulsivity were independently significantly associated with food addiction: (a) a composite of Positive and Negative Urgency, reflecting proneness to act impulsively during intense mood states, and (b) steep discounting of delayed rewards. Furthermore, the results supported food addiction as a mediator connecting both urgency and delay discounting with obesity. These findings provide further evidence linking impulsivity to food addiction and obesity, and suggest that food addiction may be a candidate etiological pathway to obesity for individuals exhibiting elevations in these domains.

Attentional and motor impulsivity interactively predict 'food addiction' in obese individuals

BACKGROUND

Impulsivity is a multifaceted construct and constitutes a common risk factor for a range of behaviors associated with poor self-control (e.g., substance use or binge eating). The short form of the Barratt Impulsiveness Scale (BIS-15) measures impulsive behaviors related to attentional (inability to focus attention or concentrate), motor (acting without thinking), and non-planning (lack of future orientation or forethought) impulsivity. Eating-related measures appear to be particularly related to attentional and motor impulsivity and recent findings suggest that interactive effects between these two facets may play a role in eating- and weight-regulation.

METHODS

One-hundred thirty-three obese individuals presenting for bariatric surgery (77.4% female) completed the BIS-15 and the Yale Food Addiction Scale (YFAS) 2.0, which measures addiction-like eating based on the eleven symptoms of substance use disorder outlined in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

Sixty-three participants (47.4%) were classified as being 'food addicted'. Scores on attentional and motor impulsivity interactively predicted 'food addiction' status: higher attentional impulsivity was associated with a higher likelihood of receiving a YFAS 2.0 diagnosis only at high (+1 SD), but not at low (-1 SD) levels of motor impulsivity.

CONCLUSIONS

Results support previous findings showing that non-planning impulsivity does not appear to play a role in eating-related self-regulation. Furthermore, this is the first study that shows interactive effects between different impulsivity facets when predicting 'food addiction' in obese individuals. Self-regulatory failure in eating-regulation (e.g., addiction-like overeating) may particularly emerge when both attentional and motor impulsivity levels are elevated.

Reward sensitivity and food addiction in women

Sensitivity to the rewarding properties of appetitive substances has long been implicated in excessive consumption of palatable foods and drugs of abuse. Previous research focusing on individual differences in reward responsiveness has found heightened trait reward sensitivity to be associated with binge-eating, hazardous drinking, and illicit substance use. Food addiction has been proposed as an extreme form of compulsive-overeating and has been associated with genetic markers of heightened reward responsiveness. However, little research has explicitly examined the association between reward sensitivity and food addiction. Further, the processes by which individual differences in this trait are associated with excessive over-consumption has not been determined. A total of 374 women from the community completed an online questionnaire assessing reward sensitivity, food addiction, emotional, externally-driven, and hedonic eating. High reward sensitivity was significantly associated with greater food addiction symptoms (r = 0.31). Bootstrapped tests of indirect effects found the relationship between reward sensitivity and food addiction symptom count to be uniquely mediated by binge-eating, emotional eating, and hedonic eating (notably, food availability). These indirect effects held even when controlling for BMI, anxiety, depression, and trait impulsivity. This study further supports the argument that high levels of reward sensitivity may offer a trait marker of vulnerability to excessive over-eating, beyond negative affect and impulse-control deficits. That the hedonic properties of food (especially food availability), emotional, and binge-eating behavior act as unique mediators suggest that interventions for reward-sensitive women presenting with food addiction may benefit from targeting food availability in addition to management of negative affect.

Food-specific response inhibition, dietary restraint and snack intake in lean and overweight/obese adults: a moderated-mediation model

BACKGROUND/OBJECTIVES

The relationship between response inhibition and obesity is currently unclear. This may be because of inconsistencies in methodology, design limitations and the use of narrow samples. In addition, dietary restraint has not been considered, yet restraint has been reported to moderate performance on behavioural tasks of response inhibition. The aim of this study was to investigate performance on both a food-based and a neutral stimuli go/no-go task, which addresses current design limitations, in lean and overweight/obese adults. The moderating role of dietary restraint in the relationship between body composition, response inhibition and snack intake was also measured.

SUBJECTS/METHODS

Lean and overweight/obese, males and females (N=116) completed both a food-based and neutral category control go/no-go task, in a fully counterbalanced repeated-measures design. A bogus taste-test was then completed, followed by a self-report measure of dietary restraint.

RESULTS

PROCESS moderated-mediation analysis showed that overweight/obese, compared with lean, participants made more errors on the food-based (but not the neutral) go/no-go task, but only when they were low in dietary restraint. Performance on the food-based go/no-go task predicted snack intake across the sample. Increased intake in the overweight, low restrainers was fully mediated by increased errors on the food-based (but not the neutral) go/no-go task.

CONCLUSIONS

Distinguishing between high and low restrained eaters in the overweight/obese population is crucial in future obesity research incorporating food-based go/no-go tasks. Poor response inhibition to food cues predicts overeating across weight groups, suggesting weight loss interventions and obesity prevention programmes should target behavioural inhibition training in such individuals.

Shared and unique mechanisms underlying binge eating disorder and addictive disorders

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

"Food Addiction" in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals

Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity.

Methods: Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA.

Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation.

Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns.

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

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

Genetic Similarities between Compulsive Overeating and Addiction Phenotypes: A Case for "Food Addiction"?

There exists a continuous spectrum of overeating, where at the extremes there are casual overindulgences and at the other a 'pathological' drive to consume palatable foods. It has been proposed that pathological eating behaviors may be the result of addictive appetitive behavior and loss of ability to regulate the consumption of highly processed foods containing refined carbohydrates, fats, salt, and caffeine. In this review, we highlight the genetic similarities underlying substance addiction phenotypes and overeating compulsions seen in individuals with binge eating disorder. We relate these similarities to findings from neuroimaging studies on reward processing and clinical diagnostic criteria based on addiction phenotypes. The abundance of similarities between compulsive overeating and substance addictions puts forth a case for a 'food addiction' phenotype as a valid, diagnosable disorder.

Integration of reward signalling and appetite regulating peptide systems in the control of food-cue responses

Understanding the neurobiological substrates that encode learning about food-associated cues and how those signals are modulated is of great clinical importance especially in light of the worldwide obesity problem. Inappropriate or maladaptive responses to food-associated cues can promote over-consumption, leading to excessive energy intake and weight gain. Chronic exposure to foods rich in fat and sugar alters the reinforcing value of foods and weakens inhibitory neural control, triggering learned, but maladaptive, associations between environmental cues and food rewards. Thus, responses to food-associated cues can promote cravings and food-seeking by activating mesocorticolimbic dopamine neurocircuitry, and exert physiological effects including salivation. These responses may be analogous to the cravings experienced by abstaining drug addicts that can trigger relapse into drug self-administration. Preventing cue-triggered eating may therefore reduce the over-consumption seen in obesity and binge-eating disorder. In this review we discuss recent research examining how cues associated with palatable foods can promote reward-based feeding behaviours and the potential involvement of appetite-regulating peptides including leptin, ghrelin, orexin and melanin concentrating hormone. These peptide signals interface with mesolimbic dopaminergic regions including the ventral tegmental area to modulate reactivity to cues associated with palatable foods. Thus, a novel target for anti-obesity therapeutics is to reduce non-homeostatic, reward driven eating behaviour, which can be triggered by environmental cues associated with highly palatable, fat and sugar rich foods.

Response inhibition of cigarette-related cues in male light smokers: behavioral evidence using a two-choice oddball paradigm

Behavioral inhibitory control has been shown to play an important role in a variety of addictive behaviors. A number of studies involving the use of Go/NoGo and stop-signal paradigms have shown that smokers have reduced response inhibition for cigarette-related cues. However, it is not known whether male light smokers' response inhibition for cigarette-related cues is lower than that of non-smokers in the two-choice oddball paradigm. The objective of the current study was to provide further behavioral evidence of male light smokers' impaired response inhibition for cigarette-related cues, using the two-choice oddball paradigm. Sixty-two male students (31 smokers, 31 non-smokers), who were recruited via an advertisement, took part in this two-choice oddball experiment. Cigarette-related pictures (deviant stimuli) and pictures unrelated to cigarettes (standard stimuli) were used. Response inhibition for cigarette-related cues was measured by comparing accuracy (ACC) and reaction time (RT) for deviant and standard stimuli in the two groups of subjects. An analysis of variance (ANOVA) showed that in all the participants, ACC was significantly lower for deviant stimuli than for standard stimuli. For deviant stimuli, the RTs were significantly longer for male light smokers than for male non-smokers; however, there was no significant difference in RTs for standard stimuli. Compared to male non-smokers, male light smokers seem to have a reduced ability to inhibit responses to cigarette-related cues.

Food addiction in overweight and obese adolescents seeking weight-loss treatment

Some forms of overeating closely resemble addictive behaviour. The Yale Food Addiction Scale (YFAS) was developed to measure such addiction-like eating in humans and has been employed in numerous studies for examining food addiction in adults. Yet, little is known about food addiction in children and adolescents. Fifty adolescents were recruited at the beginning of treatment in a weight-loss hospital and completed the YFAS among other questionnaires. Nineteen participants (38%) received a YFAS diagnosis, who did not differ in age, body mass and gender distribution from those not receiving a diagnosis. However, those with food addiction reported more binge days, more frequent food cravings, higher eating, weight and shape concerns, more symptoms of depression and higher attentional and motor impulsivity. Eating restraint and nonplanning impulsivity did not differ between groups. Results replicate findings from studies in obese adults such that food addiction is not related to age, gender, body mass or eating restraint, but to higher eating pathology, more symptoms of depression and higher impulsivity. Furthermore, results highlight that particularly attentional impulsivity is related to 'food addiction'. Addiction-like eating appears to be a valid phenotype in a substantial subset of treatment-seeking, obese adolescents.

Food and addiction among the ageing population

Obesity among the elderly is a growing public health concern. Among the various factors that may contribute to the current rates of obesity is the rewarding aspect of highly palatable foods and beverages, which may lead to overconsumption and excess caloric intake. The present review describes recent research supporting the hypothesis that, for some individuals, the consumption these highly palatable foods and beverages may lead to the development of addictive-like behaviors. In particular, the authors consider the relevance of this hypothesis to the ageing population.