The relationship among food addiction, negative mood, and eating-disordered behaviors in patients seeking to have bariatric surgery

Effects of bariatric surgeries on Binge eating disorders, Food addiction, and eating behaviors: A comprehensive systematic review of RCTs

Different types of bariatric surgery have emerged as a major and most effective treatment for obesity. With the rapid growth of bariatric surgery in this decade, it is crucial to understand the postoperative outcomes, especially eating-related outcomes, such as non-preexisting eating disorders, food addiction, emotional eating, and eating behaviors. This systematic review of RCTs seeks to evaluate the impact of various bariatric surgery procedures on eating behaviors, eating disorders, and food addiction to better understand their post-operative effects and guide future clinical practice. Following the 2015 PRISMA guidelines, a systematic review was conducted using PubMed/Medline, Scopus, and WOS databases through May 2024. After assessing 1158 full-text articles, 14 studies were selected based on the established criteria. Based on the obtained results, bariatric surgery significantly improved eating behaviors and weight concerns among patients. Eating behavior was assessed by various questionnaires, such as TFEQ and PFS, across different types of bariatric surgeries, including RYGB, SG, LSG, DJBL, and LAGB. While some studies found varying degrees of improvements across different surgical procedures, the general trend suggests that bariatric surgery can lead to significant improvements in eating behaviors. In conclusion, bariatric surgery appears to influence eating behaviors, food addiction, and binge eating disorders by altering the gut microbiota, gut hormones, and brain regions associated with appetite. However, there is no significant difference in these outcomes among different types of surgery.

Food Addiction 5 and 10 Years Following Metabolic and Bariatric Surgery: a Prospective Observational Study

BACKGROUND

Food addiction (FA) is prevalent among individuals undergoing metabolic and bariatric surgery (MBS), but few studies have investigated the prevalence and correlates of post-surgical FA over longer periods. We report an observational, longitudinal study investigating prevalence of post-surgical FA at 5 and 10 years following MBS.

METHODS

Participants in the Oslo Bariatric Surgery Study (OBSS) completed the modified Yale Food Addiction Scale 2.0 (mYFAS) and measures of psychological functioning and weight outcomes (% total weight loss: %TWL and % weight recurrence: %WR) at 5 and 10 years follow-up.

RESULTS

N = 173 of 224 (23% lost-to-follow-up) participants (73% women, 93.6% Roux-en-Y gastric bypass) completed the mYFAS 2.0 at 5 years and 10 years following MBS. The prevalence of FA was 12.9% at 5 years and 8.4% at 10 years after MBS. A higher number of FA symptoms at 5 years significantly predicted less %TWL and lower psychological functioning at 10 years. At 10 years, the majority of individuals with FA had moderate or severe symptoms and 3% were new-onset cases of FA. Higher FA at 10 years was concurrently associated with less %TWL, greater %WR, and lower psychological functioning at the 10-year follow-up (p's < 0.001).

CONCLUSIONS

The prevalence of FA decreased from 12.9 to 8.4% between 5 and 10 years following MBS. We observed prospective and concurrent associations between FA symptoms and poorer weight loss and mental health outcomes. The presence of post-operative FA may be an important target for continued assessment and follow-up care to improve longer-term outcomes.

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

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

Exploring the prevalence and symptom presentation of food addiction among Norwegian bariatric surgery patients: associations with depression, dysregulated eating, and postoperative weight loss

BACKGROUND

Pathological eating and addictive processes are linked to obesity. Food addiction (FA) involves hedonic eating of highly palatable foods, accompanied by addictive symptoms like craving, loss-of-control (LOC) eating, and withdrawal. The main objectives of this study were to assess FA prevalence and symptoms in bariatric surgery candidates, and its relationship with depression, dysregulated eating, and 1- year postoperative weight loss (WL).

METHODS

Data from 69 bariatric surgery patients (74% female, 26% male, ) were analysed. Self-report measures including Yale Food Addiction Scale (YFAS) 2.0, Eating Disorder Examination-Questionnaire (EDE-Q), Repetitive Eating Questionnaire [Rep(eat)-Q] and Hospital Anxiety and Depression Scale (HADS) were administered pre-surgery and at 1-year follow-up.

RESULTS

The mean preoperative YFAS symptom score was 2.2. (SD = 2.59). 16% of the sample met YFAS diagnostic criteria for FA. Top reported FA criteria were "substance taken in larger amount than intended" (33%), "persisted desire or repeated unsuccessful attempts to quit" (29%), and "use in physically hazardous situations" (23%). The YFAS symptom scores correlated significantly with the frequency of LOC binge eating, depression and repetitive eating scores, but showed no correlation with age or BMI. Preoperative YFAS symptom scores did not significantly predict % WL at 1-year follow-up.

CONCLUSIONS

Our findings align with previous research, indicating that preoperative FA symptoms is unrelated to preoperative BMI and total %WL, but linked to eating pathology, such as LOC binge eating and grazing, as well as depression in bariatric surgery candidates.

Metabolic and Bariatric Surgery Patients' Preoperative Dieting Attempts and Associations With Postoperative Outcomes

Purpose

Pre-operative eating disorders are well documented within the metabolic and bariatric surgery (MBS) population, yet subthreshold dieting attempts are less understood. The objectives of this study were to define and categorize patients' preoperative dieting attempts, and to determine how attempts are associated with postoperative outcomes, eating disorders, and demographics.

Materials and Methods

Three hundred twenty-one patients (81.0% female; 68.3% White) who had MBS (57.3% Roux-en-Y) between 2019 and 2020 were included. Preoperative dieting attempt responses were categorized as provider-managed, non-medically managed, and self-directed attempts; subtypes of dieting methods (e.g., low calorie) were described. Descriptive analyses were conducted for attempt categories and subtypes, and between attempts and readmissions, complications, eating disorders, and demographics. ANOVAs determined associations between attempts and %TWL at 6 and 12 months.

Results

Patients reported an average of five to six preoperative dieting attempts; self-directed attempts were the most common (91.9%), and exercise was the most common subcategory (70.7%). Patients with  ≥ 1 provider-managed attempt were less likely to experience a complication (p < 0.001) and more likely to experience readmission (p = 0.018). Patients with 1 self-directed attempt were less likely to experience a complication (p = 0.045) and readmission (p < 0.001). Patients who experienced  ≥ 2 low fat diet attempts were more likely to have complications (p < 0.001) and readmissions (p = 0.008); patients with  ≥ 2 VLCD attempts were more likely to have a complication (p < 0.001). Patients who experienced  ≥ 2 non-medically managed attempts had higher preoperative BMIs (p = 0.03).

Discussion

Given that patients engaged in frequent dieting attempts that fall outside formal assessments, future work should seek to expand pre-operative assessments.

Chrono-Nutritional Patterns, Medical Comorbidities, and Psychological Status in Patients with Severe Obesity

Chrono-nutrition studies dietary habits and their role in the onset of metabolic diseases. The aim of this study is to describe chrono-nutritional patterns based on the analysis of the eating habits of patients with severe obesity during the 24-h cycle and investigate a possible relationship between these profiles, the comorbidities, and the psychological status. From the overall evaluation of the chrono-nutritional profiles of 173 patients with severe obesity, four predominant eating patterns were obtained with a refined statistical model. A regression analysis was performed to determine the relationship between chrono-nutritional patterns, medical comorbidities, and psychological status. Profile 1 was the most frequent (46.2%) and characterised by the regular presence of the three main meals. The distribution of the chrono-nutritional profiles did not vary with BMI. Chrono-nutritional profiles affected predominantly psychological variables, with lower performances among chrono-nutritional profiles 3 (to eat during all the 24-h, with nibbling and snacking also during the night) and 4 (like the fourth but without night-eating). This finding could be useful in the assessment and treatment of patients with obesity, allowing the identification of patients with a higher probability of suffering from a psychopathological condition simply by knowing the patients' dietary profiles.

Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies

Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.

Towards precision medicine in bariatric surgery prescription

Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.

Correlates of Food Addiction and Eating Behaviours in Patients with Morbid Obesity

INTRODUCTION

Food addiction (FA) is a promising construct regarding the multifactorial aetiology of obesity and the search for therapeutic approaches. However, there is an ongoing debate regarding the overlap/differentiation with eating disorders and the classification as a substance- or behaviour-related addiction. Energy-dense foods, especially those combining carbohydrates and fat, are associated with addictive eating and suspected of playing a role in the genesis of FA. This study aims to further understand the clinical significance of FA and to identify possible therapeutic targets. A special focus is set on potentially addictive foods (combination of carbohydrates and fat).

METHODS

Based on the Yale Food Addiction Scale 2.0, a cohort of 112 German adults with morbid obesity was divided into two sub-samples (patients with and without FA), which were examined for differences in the variables listed below.

RESULTS

The prevalence of FA was 25%. Patients meeting criteria for FA showed higher degrees of hunger, emotional, binge, and night eating than patients without FA. In addition, hunger and disinhibition were found to be significant predictors of FA. FA was not associated with sex, age, body mass index (BMI), cognitive restraint, rigid and flexible control, prevalence of substance use, age of onset of obesity, stress level, level of social support, reduction of BMI during a weight loss programme, or programme withdrawal rate. There was no significant difference in the consumption of foods rich in both carbohydrates and fat, nor of fat or carbohydrates alone.

CONCLUSION

FA can be considered as a sub-phenotype of obesity, occurring in approximately 25% of obesity cases. Dysfunctional emotional coping mechanisms associated with low distress tolerance showed to be significantly related to FA and should be targeted therapeutically. Behavioural interventions should include a bio-psycho-social model. Binge eating episodes were found to be characteristic for FA and the already stated overlap between FA and binge eating behaviour can be confirmed. The results do not support a decisive difference due to a substance-related component of FA. Despite this, the existence of FA as a distinct entity cannot be excluded, as not all patients with FA exhibit binges.

Prevalence and Correlates of Food Addiction in Bariatric Surgery Candidates and Its Effect on Bariatric Surgery Outcome: A Prospective Observational Study

PURPOSE

Studies have shown a high prevalence of food addiction (FA) in bariatric surgery candidates. This study examines prevalence of FA prior to and one year after bariatric surgery and the determinants of preoperative FA. Additionally, this study investigates how preoperative variables affect excess weight loss (EWL) one year after bariatric surgery.

MATERIALS AND METHODS

This prospective observational study included 102 patients at an obesity surgery clinic. Self-report measures, including demographic characteristics, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the Depression Anxiety Stress Scale (DASS-21), and the Dutch Eating Behavior Questionnaire (DEBQ) were used two weeks before and one year after surgery.

RESULTS

The FA prevalence among bariatric surgery candidates decreased from 43.6% before surgery to 9.7% one year after surgery. Among independent variables, female gender and anxiety symptoms were associated with FA (OR = 4.20, 95% CI: 1.35-24.16, p = 0.028 and OR = 5.29, 95% CI: 1.49-18.81, p = 0.010, respectively). Only gender had a significant association with %EWL after surgery (p = 0.022); females had a higher mean %EWL than males.

CONCLUSION

FA is common among candidates for bariatric surgery, especially in women and participants with anxiety symptoms. The prevalence of FA, emotional eating, and external eating decreased after bariatric surgery.

Food addiction and binge eating disorder are linked to shared and unique deficits in emotion regulation among female seeking bariatric surgery

BACKGROUND

Problematic eating behaviors can indicate obesity-related problems. Food addiction (FA) is not classified as an official diagnosis. However, given the many commonalities between FA and binge-eating disorder (BED) within the context of obesity, it is imperative to conduct a comparative investigation. The current study aimed to identify overlapping and distinctive features in emotion dysregulation as an underlying mechanism and emotional eating as a clinical feature among four groups of females with obesity seeking bariatric surgery.

METHODS

Data on emotion dysregulation and emotional eating were derived from the total 128 Females with obesity seeking bariatric surgery (Mage = 38.91 ± 10.59, MBMI = 42.10 kg/m2 ± 4.43) divided into four groups: those with FA (n = 35), BED (n = 35), BED + FA (n = 31) and a control group of individuals with obesity only (OB; n = 27), using well-established measures.

RESULTS

Regarding descriptive statistics, the BED + FA group showed the highest levels of emotional dysregulation (M = 111.09) and emotional eating (M = 46.80), while the OB group acquired the lowest scores (M = 70.44 and M = 27.29, respectively). Univariate analyses of variance revealed significant differences between the four groups in terms of emotion dysregulation F(3, 124) = 24.63, p < .01 and emotional eating F(3, 124) = 26.26, p < .01. All of the emotion dysregulation domains revealed significant differences too. Pairwise comparisons using Bonferroni post hoc tests did not reveal any significant differences between BED + FA and BED groups, while all of our other hypotheses regarding this matter were confirmed.

CONCLUSIONS

The study found that individuals with obesity and comorbid BED exhibit greater emotional dysregulation compared to those with OB or FA, indicating a need to assess BED in individuals with obesity. Emotion dysregulation may be linked to increased BED and FA, but those with BED seem more affected by limited access to emotion regulation strategies. These findings support the notion that PEBs are associated with emotion dysregulation and underscore the need for tailored interventions that target emotion regulation skills before and after bariatric surgery.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders

PURPOSE

The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity.

METHODS

The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised.

RESULTS

Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive-compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale.

CONCLUSION

Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Food Addiction and Binge Eating Impact on Weight Loss Outcomes Two Years Following Sleeve Gastrectomy Surgery

BACKGROUND

Emerging evidence suggest that problematic eating behaviors such as food addiction (FA) and binge eating (BE) may alter following bariatric surgery (BS) and impact weight outcomes. We aimed to examine the prevalence of FA and BE and their associations with weight outcomes 2 years post-sleeve gastrectomy (SG).

METHODS

Forty-five women (mean age 32.4 ± 10.9 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at pre-, 3-, 6-, 12-, and 24-month post-SG. Data collected included anthropometrics, nutritional intake, and lifestyle patterns. The Yale Food Addiction Scale (YFAS) and the Binge Eating Scale (BES) were used to characterize FA and BE, respectively.

RESULTS

Pre-surgery FA and BE were identified in 40.0% and 46.7% of participants, respectively. Following SG, FA and BE prevalence was 10.0%, 5.0%, 29.4%, and 14.2% (P = 0.007), and 12.5%, 4.9%, 18.4%, and 19.4% (P < 0.001) at 3, 6, 12, and 24 months, respectively. Women with BE at baseline gained significantly more weight from the nadir compared to non-BE women at baseline (P = 0.009). There was no relationship between FA at baseline and weight (P = 0.090). Weight regained from the nadir positively correlated with BES scores at baseline (r = 0.374, P = 0.019).

CONCLUSIONS

FA and BE tend to decrease during the early postoperative period, but remains in a notable rates return by 2 years post-SG. Moreover, pre-surgical BE was related to higher weight-regain. Proper management pre-BS should include a comprehensive eating pathologies assessment, as these pathologies may remain or re-emerge post-surgery and lead to worse weight outcomes.

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery

Weight regain after bariatric surgery is associated with problematic eating behaviors that have either recurred after a period of improvement or are new-onset behaviors. Problematic eating behaviors after bariatric surgery have been conceptualized in different ways in the literature, such as having a food addiction and experiencing a loss of control of eating. The intersection of these constructs appears to be driven overeating defined as patients' experiences of reduced control of their eating which results in overeating behavior. The purpose of this review is to define patient experiences of driven overeating through the behavioral expression of emotion-based eating, reward-based eating, and executive functioning deficits-namely impulsivity-which is associated with weight regain after having bariatric surgery. Delineating concepts in this way and determining treatment strategies accordingly may reduce distress related to the inevitable return of increased hunger, cravings, portion sizes, and tolerance for highly palatable foods after surgery. Along with standard behavioral weight maintenance strategies, topics including acceptance, motivation, emotion-based eating, reward-based/impulsive eating, physical activity, and self-compassion are discussed. These concepts have been adapted for patients experiencing weight regain after having bariatric surgery and may be particularly helpful in attenuating driven overeating and weight regain.

The Assessment of Food Addiction and the Yale Food Addiction Scale in Bariatric Surgery Populations

Food addiction (FA) appears among bariatric weight loss surgery candidates who struggle to control the intake of hyperpalatable/refined foods have high rates of psychopathology and related health problems. Despite this, prevalence rates of FA in the bariatric sector are reported as low or variable. We investigated the prevalence of FA and the applicability of conventionally used metrics for 166 pre-surgery candidates from a weight management centre (USA) and a major metropolitan hospital (Australia). Self-report measures assessed FA (Yale Food Addiction Scale (YFAS)), body mass index (BMI), disordered eating, addictive personality, psychopathology, and diet. Consistent with prior research, standard YFAS scoring, requiring the endorsement of a distress/impairment (D/I) criterion (FA + D/I), yielded a FA prevalence rate of 12.7%, compared to 37.3% when D/I was omitted (FA − D/I). We compared profiles for those with FA using each scoring method against those ‘without’, who did not meet a minimum of three YFAS symptoms (non-FA ≤ 2). Both methods differentiated those with and without FA on addictive traits, disordered eating and hyperpalatable food consumption. Only FA + D/I differentiated markers of psychological distress or impairment, including depression, anxiety and quality of life. Results indicate a need for further FA research in bariatric settings.

Poorer mental health and sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum: an observational cohort study

BACKGROUND

Depression, stress, and poor-quality sleep are common during pregnancy and postpartum, but the relationship of these factors with reward-related eating is not well understood. This observational cohort study examines associations of depression, stress, and sleep quality with self-reported reward-related eating in pregnancy and postpartum.

METHODS

Participants were enrolled at < 12 weeks gestation and followed through 1 year postpartum. Self-reported measures obtained at baseline and 23-31 weeks postpartum included the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index; reward-related eating measures included the Power of Food Scale (assessing hedonic hunger), modified Yale Food Addiction Scale (assessing addictive-like eating), and frequency and intensity of cravings. Linear and logistic regression models estimated associations of depressive symptoms, stress, and sleep quality with reward-related eating during pregnancy and postpartum, as well as change in each predictor with change in outcome.

RESULTS

During pregnancy, greater depressive symptoms (β ± SE = 0.03 ± 0.01, p < .01), higher stress (0.03 ± 0.01, p < .01), and worse sleep quality (0.03 ± 0.01, p = 0.03) were associated with greater hedonic hunger. Similarly, greater depressive symptoms (OR = 1.08, 95% CI: 1.02, 1.14, p = .01), higher stress (OR = 1.09, 95% CI: 1.04, 1.14, p = <.01), and worse sleep quality (OR = 1.09, 95% CI: 1.00, 1.18, p = .04) were associated with greater odds of addictive-like eating. These associations were also significant in postpartum except that sleep quality was not associated with hedonic hunger. Greater depressive symptoms (β ± SE = 0.06 ± 0.02, p < .01; 0.08 ± 0.02, p = <.01), higher stress (0.04 ± 0.01, p < .01; 0.06 ± 0.02, p < .01), and worse sleep quality (0.11 ± 0.03, p < .01; 0.13 ± 0.03, p < .01) during pregnancy were associated with stronger and more frequent cravings, respectively. Increased depressive symptoms from pregnancy to postpartum was associated with increased hedonic hunger (β ± SE = 1.17 ± 0.57, p = 0.01) and addictive-like eating (0.88 ± 0.33, p = 0.01), and increased stress was associated with increased hedonic hunger (1.71 ± 0.76, p = 0.02). Change in stress was not associated with change in addictive-like eating and change in sleep quality was not associated with change in either hedonic hunger or addictive-like eating.

CONCLUSIONS

Greater depressive symptoms, perceived stress, and poorer sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum, suggesting that efforts to improve diet during and after pregnancy may benefit from addressing mental health and sleep.

TRIAL REGISTRATION

Clinicaltrials.gov Registration ID - NCT02217462 . Date of registration - August 13, 2014.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery

OBJECTIVE

Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating).

METHODS

A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight.

RESULTS

IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight.

CONCLUSIONS

Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.

Restarting Elective Bariatric and Metabolic Surgery Under a Security Protocol During the COVID-19 Pandemic-a Prospective Observational Cohort Study

Background

During the SARS-CoV-2 pandemic, in order to protect the patient and to save hospital beds, cancelation of elective surgeries has become a great challenge. Considering that obesity is a chronic disease and the possible effect imposed by quarantine on weight gain with worsening rates of obesity and metabolic comorbidities, the creation of a protocol for a safe return to bariatric surgery became essential.

Objective

The aim of this study was to identify the incidence of new-onset severe acute respiratory syndrome coronavirus (SARS-CoV-2) symptoms in patients who underwent bariatric procedures during the declining curve period.

Setting

Private practice

Methods

A prospective observational cohort study was conducted and included patients with indications for bariatric surgery during the decreasing curve period of the SARS-CoV-2 pandemic who underwent surgery under a hospital security protocol. Patients were asked to answer a questionnaire and had a swab PCR test for SARS-CoV-2 detection. The primary outcome measure was the presence of 14-day and 30-day postoperative symptoms associated with COVID-19. Mortality was also analyzed.

Results

Three hundred patients with negative RT-PCR were operated on from May to June 2020. Seventeen patients had their surgery postponed because of a positive RT-PCR test or close contact. None of the patients developed new-onset SARS-CoV-2 symptomatic infection after 30 days of observation. No deaths were reported. Eleven had complications not related to SARS-CoV-2.

Conclusions

Even though this population may have a poorer outcome when infected with SARS-CoV-2, this security protocol has shown that the procedure can be safely performed during the outbreak.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

Psychopathology, disordered eating, and impulsivity in patients seeking bariatric surgery

BACKGROUND

Most patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6-18 months after surgery. However, 20%-30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contribute to suboptimal weight loss and/or postoperative psychosocial distress.

OBJECTIVE

Assess psychosocial functioning, eating behavior, and impulsivity in patients seeking bariatric surgery.

SETTING

Two university hospitals.

METHODS

Validated interviews and questionnaires. Impulsivity assessed via computer program.

RESULTS

The present study included a larger (n = 300) and more racially diverse (70% non-White) sample than previous studies of these relationships. Forty-eight percent of participants had a current psychiatric diagnosis and 78% had at least 1 lifetime diagnosis. Anxiety disorders were the most common current diagnosis (25%); major depressive disorder was the most common lifetime diagnosis (44%). Approximately 6% of participants had a current alcohol or substance use disorder; 7% had a positive drug screen before surgery. A current psychiatric diagnosis was associated with greater symptoms of food addiction and night eating. Current diagnosis of alcohol use disorder or a lifetime diagnosis of anxiety disorders was associated with higher delay discounting.

CONCLUSION

The study identified high rates of psychopathology and related symptoms among a large, diverse sample of bariatric surgery candidates. Psychopathology was associated with symptoms of disordered eating and higher rates of delay discounting, suggesting impulse control issues.

Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19)

The outbreak of the coronavirus disease 2019 (Covid-19) has become an evolving worldwide health crisis. With the rising prevalence of obesity and diabetes has come an increasing awareness of their impacts on infectious diseases, including increased risk for various infections, post-infection complications and mortality from critical infections. Although epidemiological and clinical characteristics of Covid-19 have been constantly reported, no article has systematically illustrated the role of obesity and diabetes in Covid-19, or how Covid-19 affects obesity and diabetes, or special treatment in these at-risk populations. Here, we present a synthesis of the recent advances in our understanding of the relationships between obesity, diabetes and Covid-19 along with the underlying mechanisms, and provide special treatment guidance for these at-risk populations.

Validation of the Yale Food Addiction Scale 2.0 in Patients Seeking Bariatric Surgery

BACKGROUND

The Yale Food Addiction Scale (YFAS) was developed in 2009 to assess food addiction (FA); a revised version was released in 2016 (YFAS 2.0). The objective of this study was to determine the statistical and clinical validity of the YFAS 2.0 in adults seeking bariatric surgery.

METHODS

Patients who underwent a preoperative psychological evaluation in preparation for bariatric surgery from 2015 to 2018 were included. The YFAS 2.0 was administered as part of routine clinical care and validated against an assessment battery of standardized clinical measures. Statistical analyses included chi-square and Wilcoxon rank sum tests and calculation of Spearman's rank correlation coefficients.

RESULTS

Overall, 1061 patients were included. Mean age and BMI were 47.5 ± 12.9 years and 46.9 ± 13.4 kg/m², respectively. There were 196 (18%) patients who screened positive on the YFAS 2.0 (21% mild, 23% moderate, and 56% severe FA). The YFAS 2.0 demonstrated strong convergent validity where patients who met criteria for FA had significantly increased levels of binge eating (p < 0.001), emotional eating (p < 0.001), and lower self-efficacy (p < 0.001). Discriminant validity was demonstrated by lack of association with alcohol use (p = 0.319). The YFAS 2.0 was significantly correlated with total scores for depression (p < 0.001), anxiety (p < 0.001), bipolar disorder symptoms (p < 0.001), and trauma history (p < 0.001).

CONCLUSIONS

The prevalence of FA in a large sample of patients seeking bariatric surgery was consistent with previous literature. These data suggest that the YFAS 2.0 is psychometrically valid, demonstrating strong construct validity, and is a clinically useful measure of FA severity in patients pursuing bariatric surgery.

Symptoms of bipolar disorder are associated with lower bariatric surgery completion rates and higher food addiction

BACKGROUND

Bipolar disorder (BP) is highly comorbid with obesity, however, little is known about how BP might be associated with bariatric surgery outcomes.

METHODS

In this retrospective clinical cohort study, 1034 patients completed a psychological evaluation, and screening positive for possible BP was defined as a score ≥7 and moderate disability on the Mood Disorders Questionnaire. Food addiction (FA), subthreshold binge eating disorder (BED), and illegal drug use were also assessed using standardized questionnaires.

RESULTS

The 54 (5.2%) patients screening positive for BP were less likely to have bariatric surgery compared to 980 (94.8%) patients who screened negative for BP (5 patients or 9.3% vs 273 patients, or 27.9%). Patients with possible BP also had significantly higher prevalence of FA (37% vs 13.2%), subthreshold BED (29.6% vs 8.3%) and illegal drug use (7.4% vs 2.1%).

CONCLUSIONS

In this retrospective clinical cohort study, patients who screened positive for BP had a higher prevalence of food addiction, subthreshold binge eating disorder and recent illegal drug use. They also demonstrated lower completion rates for having bariatric surgery. Clearly, more needs to be learned about how to help patients with symptoms of bipolar disorder manage their obesity and behavioral challenges.

Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity

PURPOSE

After bariatric surgery (BS) a significant minority of patients do not reach successful weight loss or tend to regain weight. In recent years, interest for the psychological factors that predict post-surgical weight loss has increased with the objective of developing interventions aimed to ameliorate post-surgical outcomes. In the present study, predictive models of successful or poor weight loss 12 months after BS were investigated considering pre-surgery level of psychopathological symptoms, dysfunctional eating behaviors and trait impulsivity at baseline (pre-surgery).

METHODS

Sixty-nine patients with morbid obesity canditates for laparoscopic sleeve gastrectomy were assessed regarding metabolic and psychological dimensions. Successful post-surgery weight loss was defined as losing at least 50% of excess body weight (%EWL).

RESULTS

Logistic models adjusted for patient sex, age and presence of metabolic diseases showed that the baseline presence of intense psychopathological symptoms and low attentional impulsivity predict poor %EWL (< 50%), as assessed 12-month post-surgery.

CONCLUSIONS

The present findings suggest that intensity of general psychopathology and impulsivity, among other psychological factors, might affect post-surgery %EWL. Conducting adequate psychological assessment at baseline of patients candidates for BS seems to be crucial to orient specific therapeutic interventions.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The Clinical Utility of Food Addiction: Characteristics and Psychosocial Impairments in a Treatment-Seeking Sample

Little is known about the characteristics of individuals seeking treatment for food addiction (FA), and the clinical utility of FA has yet to be established. To address these gaps, we examined (i) the demographic, eating pathology, and psychiatric conditions associated with FA and (ii) whether FA is associated with psychosocial impairments when accounting for eating-related and other psychopathology. Forty-six patients seeking treatment for FA completed self-report questionnaires and semi-structured clinical interviews. The majority of the sample were women and self-identified as White, with a mean age of 43 years. Most participants (83.3%) presented with a comorbid psychiatric condition, most commonly anxiety and mood disorders, with a mean of 2.31 comorbid conditions. FA was associated with binge eating severity and anxiety symptoms, as well as psychological, physical, and social impairment. In regression analyses controlling for binge eating severity, food cravings, depression, and anxiety, FA remained a significant predictor only of social impairment. Taken together, the results suggest that individuals seeking treatment for FA are likely to present with significant comorbid conditions, in particular anxiety disorders. The results of the present research provide evidence for the clinical utility of FA, particularly in explaining social impairment.

Food Addiction and Binge Eating During One Year Following Sleeve Gastrectomy: Prevalence and Implications for Postoperative Outcomes

BACKGROUND

Food addiction and binge eating are common among individuals with obesity. However, a paucity of studies prospectively examined the prevalence and implications of food addiction before and post-bariatric surgery. We aimed to examine the prevalence of food addiction and binge eating before and after sleeve gastrectomy (SG) and to assess their associations with behavioral and weight loss outcomes.

METHODS

We followed at 3 (M3), 6 (M6), and 12 (M12) months postoperative, 54 women who underwent SG. Data collected including anthropometrics, nutritional intake, food tolerance, and physical activity measures. The Yale Food Addiction Scale and the Binge Eating Scale were used to characterize food addiction and binge eating, respectively.

RESULTS

The mean baseline age and BMI were 32.1 ± 11.1 years and 44.9 ± 4.9 kg/m², respectively. Pre-surgery, food addiction, and binge eating were identified in 40.7% and 48.1% of patients, respectively. The prevalence of food addiction decreased significantly up to M6, but increased to 29.3% at M12. The prevalence of binge eating decreased significantly through the follow-up up to 17.4% at M12. Those who met criteria for food addiction at M12 achieved significantly lower excess weight loss at M12 compared with those not meeting this criterion (P = 0.005). Food addiction scores at M12 negatively correlated with weekly physical activity (r = - 0.559; P < 0.001) and food tolerance scores (r = - 0.428; P = 0.005).

CONCLUSIONS

The reduction in food addiction observed at M6 was not maintained at M12. Food addiction at M12 was associated with poorer weight loss, eating, and lifestyle behaviors. Clinical practice should focus on the psychological aspects associated with obesity.

Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy

The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample.

Associations of gastric volumes, ingestive behavior, calorie and volume intake, and fullness in obesity

Whereas gastric emptying significantly predicts calorie intake, the association between gastric capacity and satiation and satiety is unclear. To study the associations between gastric volumes and ingestive behaviors with satiation and satiety in obesity, 62 healthy adult obese patients (57 female) with no eating disorders underwent measurements of satiety, as determined by kilocalories of ingestion at a buffet meal, and satiation by volume to comfortable fullness (VTF) and maximum tolerated volume (MTV), while drinking Ensure (30 mL/min). Fasting and postprandial gastric volumes were measured by validated single-photon emission computed tomography. We also measured eating [Weight Efficacy Life-Style Questionnaire score (WEL)] and exercise behaviors associated with obesity. Spearman correlation-assessed relationships of measured traits and linear regression analysis to identify predictors of satiation or satiety. The participants were aged 38 ± 10.1 yr and the body mass index (BMI) 36.8 ± 4.8 kg/m². Fasting gastric volume was significantly correlated with VTF (r_s = 0.3, P = 0.03), but not with MTV or buffet meal kilocalorie ingestion. Regression analysis identified sex (P = 0.02, with males having significantly higher fasting gastric volume) and fasting gastric volume (0.04) as predictors of higher VTF. An increase in fasting gastric volume of 50 mL resulted in a 6-mL increase in VTF. Buffet meal intake was inversely related to the ability to resist the urge to eat; factors associated with ingestive behavior (increase in total WEL score) significantly correlated with satiety and gastric accommodation (P < 0.05). Gastric capacity during fasting is associated with calorie intake to the point of comfortable fullness; factors associated with ingestive behavior are associated with satiety and gastric accommodation.NEW & NOTEWORTHY Buffet meal intake was inversely related to the ability to resist the urge to overeat. Factors associated with ingestive behavior significantly correlated with satiety and gastric accommodation. Gastric capacity during fasting is associated with calorie intake to the point of comfortable fullness; factors associated with ingestive behavior are associated with satiety and gastric accommodation.

Examining Food Addiction and Acculturation Among a Hispanic Bariatric Surgery-Seeking Participant Group

OBJECTIVE

This study examined food addiction (FA) and acculturation among a Hispanic bariatric surgery-seeking sample.

SETTING

University hospital.

METHOD

Four hundred forty-four (n = 215 English-speaking; n = 229 Spanish-speaking) Hispanic adults seeking bariatric surgery completed established self-report measures examining food addiction and acculturation.

RESULTS

35.8% met criteria for FA, which was significantly associated with acculturation level to the USA. Participants who endorsed greater acculturation also endorsed a significantly higher level of FA symptoms compared with those who endorsed less acculturation. Acculturation level was significantly associated with FA and BMI.

CONCLUSIONS

FA rate in this bariatric surgery-seeking Hispanic patient group is similar to rates reported among bariatric candidates of varying ethnic backgrounds. Our results suggest a relationship between FA symptom expression and acculturation to the USA. Improving understanding of the onset and progression of severity of FA symptoms may have clinical implications for Hispanic patients seeking bariatric surgery.

Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates

OBJECTIVE

The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index.

METHOD

59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant.

RESULTS AND CONCLUSIONS

A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.

Uncontrolled eating: a unifying heritable trait linked with obesity, overeating, personality and the brain

Many eating-related psychological constructs have been proposed to explain obesity and overeating. However, these constructs, including food addiction, disinhibition, hedonic hunger, emotional eating, binge eating and the like all have similar definitions, emphasizing loss of control over intake. As questionnaires measuring the constructs correlate strongly (r > 0.5) with each other, we propose that these constructs should be reconsidered to be part of a single broad phenotype: uncontrolled eating. Such an approach enables reviewing and meta-analysing evidence obtained with each individual questionnaire. Here, we describe robust associations between uncontrolled eating, body mass index (BMI), food intake, personality traits and brain systems. Reviewing cross-sectional and longitudinal data, we show that uncontrolled eating is phenotypically and genetically intertwined with BMI and food intake. We also review evidence on how three psychological constructs are linked with uncontrolled eating: lower cognitive control, higher negative affect and a curvilinear association with reward sensitivity. Uncontrolled eating mediates all three constructs' associations with BMI and food intake. Finally, we review and meta-analyse brain systems possibly subserving uncontrolled eating: namely, (i) the dopamine mesolimbic circuit associated with reward sensitivity, (ii) frontal cognitive networks sustaining dietary self-control and (iii) the hypothalamus-pituitary-adrenal axis, amygdala and hippocampus supporting stress reactivity. While there are limits to the explanatory and predictive power of the uncontrolled eating phenotype, we conclude that treating different eating-related constructs as a single concept, uncontrolled eating, enables drawing robust conclusions on the relationship between food intake and BMI, psychological variables and brain structure and function.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Food addiction, in obese patients seeking bariatric surgery, is associated with higher prevalence of current mood and anxiety disorders and past mood disorders

The current cross-sectional study investigates the prevalence of the food addiction (FA) phenotype and its association with psychiatric disorders in bariatric surgery candidates. It also investigates the eating behavior characteristics associated with FA and the association between FA and loss of control over specific foods high in sugar, salt and/or fat. We included 128 bariatric surgery candidates and we assessed FA (YFAS 2.0), mood and anxiety disorders, suicidality, eating disorders (current bulimia nervosa and current anorexia nervosa), alcohol and tobacco use disorders (MINI 5.0.0, beck depression inventory, AUDIT, Fagerström Test for Nicotine Dependence) and eating behavior (DEBQ). Prevalence of FA in our sample was 25%. FA was significantly associated with higher prevalence of current mood and anxiety disorders and past mood disorders, higher current suicidality but not with eating disorders and alcohol use disorder. FA was significantly associated with higher emotional eating, and with loss of control over consumption of foods high in fat, sugar and/or salt, but not of fruits, vegetables or grain products. Our results provide arguments for considering psychiatric disorders and suicidality in FA and for considering FA as an addictive disorder in obese patients, with many risk factors in common with other addictions.

Establishing a food addiction diagnosis using the Yale Food Addiction Scale: A closer look at the clinically significant distress/functional impairment criterion

The concept of food addiction (FA) represents a set of problematic eating behaviors related to overeating. According to the Yale Food Addiction Scale (YFAS), which was based on the DSM-IV-TR substance dependence diagnostic criteria, a FA diagnosis is assigned when at least three criteria and the criterion evaluating clinically significant distress and/or functional impairment are endorsed. Considering the decisive role of this last criterion, the present study aimed to investigate its endorsement among individuals suffering from severe obesity and awaiting bariatric surgery. A total of 146 individuals were recruited at the Quebec Heart and Lung Institute and were invited to complete various questionnaires. Differences between individuals who endorsed at least three FA criteria and reported distress/impairment (FA+D/I; N = 24) and individuals who endorsed at least three FA criteria but did not report distress/impairment (FA-D/I; N = 27) were examined. Results revealed that 16% of the total sample fulfilled a FA diagnosis when considering the clinically significant distress/functional impairment criterion; however, this prevalence rate climbed to 35% when removing the inclusion of distress/impairment. Furthermore, individuals from the FA+D/I group showed more FA symptomatology and hedonic hunger, but did not statistically differ from the FA-D/I group on expected markers of psychological distress (depressive symptoms and quality of life). Lastly, the experience of withdrawal symptoms and hedonic hunger were found to be the best predictors of the endorsement of the distress/impairment criterion. This study underlines the impact of this criterion in establishing a FA diagnosis and highlights the importance of considering alternative ways to interpret findings from the YFAS when dealing with clinical samples.

Evaluation of disordered eating tendencies in young adults

PURPOSE

It was aimed to determine the prevalence of high disordered eating tendencies and its relationship with food addiction, emotional eating and self esteem in participants at 18 and 33 years age group.

METHODS

This study was planned as a cross-sectional study and conducted with 1359 young adult volunteers (M = 386, F = 973) with an average age of 22.4 ± 2.84 years. Eating Attitudes Test-26 (EAT-26), Yale Food Addiction Scale (YFAS), Emotional Appetite Questionnaire (EMAQ) and Rosenberg Self-Esteem Scale (RSES) were used. EAT-26 score above 20 was considered as eating disorders risk cutoff.

RESULTS

Participants with disordered eating tendencies have higher rates (22.4%) of food addiction compared to participants without high disordered eating tendencies (7.2%). There is no difference for EMAQ and YFAS scores; however, there is a significant difference for RSES and EAT-26 scores according to gender. A positive association of EAT-26 with YFAS and EMAQ-negative scores and a negative association of EAT-26 with RSES and EMAQ-positive were found.

DISCUSSION

There is association among EAT-26, YFAS, and Rosenberg Self-Esteem Scale, and Emotional Appetite Questionnaire scores. This study provides information for future studies about high disordered eating tendencies, food addiction and mood that are thought to be important in young adults.

LEVEL OF EVIDENCE

Level V (cross-sectional descriptive study).

An examination of the mechanisms and personality traits underlying food addiction among individuals with severe obesity awaiting bariatric surgery

PURPOSE

The aetiology underlying addiction has often been investigated to shed more light on the factors contributing to the development and maintenance of various disorders. In the field of addictive eating behaviours, data on the aetiological factors related to food addiction (FA) in the bariatric context remain scarce. The present study aimed to explore mechanisms and variables underlying FA among individuals suffering from severe obesity and awaiting bariatric surgery.

METHODS

Participants (N = 146) were recruited at the Quebec Heart and Lung Institute during their pre-operative visit and were invited to complete questionnaires. Participants with and without FA were compared on reward sensitivity, impulsivity, emotion dysregulation, and personality traits.

RESULTS

Findings showed that bariatric candidates with FA (16%) presented more emotion dysregulation, more harm avoidance, and less self-directedness. Further exploration showed that the association between harm avoidance and the number of FA criteria endorsed was mediated by emotion dysregulation, while the association between self-directedness and the number of FA criteria endorsed was mediated by reward sensitivity.

CONCLUSIONS

These results indicate that an inability to regulate affect by strategies other than eating highly palatable food, in a context where negative affect and long-term goals can hardly be sustained, underlies a diagnostic of FA among bariatric candidates. From a clinical standpoint, the presence of a double vulnerability leading to FA symptomatology could help design better-targeted interventions to maximise weight loss maintenance in the bariatric context.

LEVEL OF EVIDENCE

Level V, descriptive study.

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

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

Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: A latent profile analysis

OBJECTIVE

The efficacy of bariatric surgery has been proven; however, a subset of patients fails to achieve expected long-term weight loss postoperatively. As differences in surgery outcome may be influenced by heterogeneous psychological profiles in prebariatric patients, previous subtyping models differentiated patients based on temperament traits. The objective of this study was to expand these models by additionally considering emotion dysregulation and disinhibited eating behaviors for subtyping, as these factors were associated with maladaptive eating behaviors and poor postbariatric weight loss outcome.

METHOD

Within a prospective multicenter registry, N = 370 prebariatric patients were examined using interview and self-report questionnaires. A latent profile analysis was performed to identify subtypes based on temperament traits, emotion dysregulation, and disinhibited eating behaviors.

RESULTS

Five prebariatric subtypes were identified with specific profiles regarding self-control, emotion dysregulation, and disinhibited eating behaviors. Subtypes were associated with different levels of eating disorder psychopathology, depression, and quality of life. The expanded model increased variance explanation compared to temperament-based models.

CONCLUSION

By adding emotion dysregulation and disinhibited eating behaviors to previous subtyping models, specific prebariatric subtypes emerged with distinct psychological deficit patterns. Future investigations should test the predictive value of these subtypes for postbariatric weight loss and health-related outcomes.

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.