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Wiss DA, LaFata EM. Ultra-Processed Foods and Mental Health: Where Do Eating Disorders Fit into the Puzzle? Nutrients 2024; 16:1955. [PMID: 38931309 PMCID: PMC11206753 DOI: 10.3390/nu16121955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Ultra-processed foods (UPFs) like pastries, packaged snacks, fast foods, and sweetened beverages have become dominant in the modern food supply and are strongly associated with numerous public health concerns. While the physical health consequences of UPF intake have been well documented (e.g., increased risks of cardiometabolic conditions), less empirical discussion has emphasized the mental health consequences of chronic UPF consumption. Notably, the unique characteristics of UPFs (e.g., artificially high levels of reinforcing ingredients) influence biological processes (e.g., dopamine signaling) in a manner that may contribute to poorer psychological functioning for some individuals. Importantly, gold-standard behavioral lifestyle interventions and treatments specifically for disordered eating do not acknowledge the direct role that UPFs may play in sensitizing reward-related neural functioning, disrupting metabolic responses, and motivating subsequent UPF cravings and intake. The lack of consideration for the influences of UPFs on mental health is particularly problematic given the growing scientific support for the addictive properties of these foods and the utility of ultra-processed food addiction (UPFA) as a novel clinical phenotype endorsed by 14-20% of individuals across international samples. The overarching aim of the present review is to summarize the science of how UPFs may affect mental health, emphasizing contributing biological mechanisms. Specifically, the authors will (1) describe how corporate-sponsored research and financial agendas have contributed to contention and debate about the role of UPFs in health; (2) define UPFs and their nutritional characteristics; (3) review observed associations between UPF intake and mental health conditions, especially with depression; (4) outline the evidence for UPFA; and (5) describe nuanced treatment considerations for comorbid UPFA and eating disorders.
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Affiliation(s)
- David A. Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
- Nutrition in Recovery LLC, 1902 Westwood Blvd. #201, Los Angeles, CA 90025, USA
| | - Erica M. LaFata
- Center for Weight Eating and Lifestyle Science, Drexel University, 3201 Chestnut Street, Philadelphia, PA 19104, USA;
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Skinner JA, Leary M, Whatnall M, Collins RA, Pursey KM, Verdejo-Garcia A, Hay PJ, Baker AL, Hides L, Paxton SJ, Wood LG, Colyvas K, Collins CE, Burrows TL. A three-arm randomised controlled trial of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program). Appetite 2024; 195:107211. [PMID: 38215944 DOI: 10.1016/j.appet.2024.107211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
There is a substantial research base for addictive eating with development of interventions. The current 3-arm RCT aimed to investigate the efficacy of the TRACE (Targeted Research for Addictive and Compulsive Eating) program to decrease addictive eating symptoms and improve mental health. Participants (18-85 yrs) endorsing ≥3 addictive eating symptoms were randomly allocated to 1) active intervention, 2) passive intervention, or 3) control group. Primary outcome was change in addictive eating symptoms 3-months post-baseline measured by the Yale Food Addiction Scale. Depression, anxiety and stress were also assessed. A total of 175 individuals were randomised. Using Linear Mixed Models, from baseline to 3-months, there was significant improvement in symptom scores in all groups with mean decrease of 4.7 (95% CI: -5.8, -3.6; p < 0.001), 3.8 (95% CI: -5.2, -2.4; p < 0.001) and 1.5 (95% CI: -2.6, -0.4; p = 0.01) respectively. Compared with the control group, participants in the active intervention were five times more likely to achieve a clinically significant change in symptom scores. There was a significant reduction in depression scores in the active and passive intervention groups, but not control group [-2.9 (95% CI: -4.5, -1.3); -2.3 (95% CI: -4.3, -0.3); 0.5 (95% CI: -1.1, 2.1), respectively]; a significant reduction in stress scores within the active group, but not passive intervention or control groups [-1.3 (95% CI: -2.2, -0.5); -1.0 (95% CI: -2.1, 0.1); 0.4 (95% CI: -0.5, 1.2), respectively]; and the reduction in anxiety scores over time was similar for all groups. A dietitian-led telehealth intervention for addictive eating in adults was more effective than a passive or control condition in reducing addictive eating scores from baseline to 6 months. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12621001079831.
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Affiliation(s)
- Janelle A Skinner
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Mark Leary
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Rebecca A Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Kirrilly M Pursey
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2751, Australia; Mental Health Services, South Western Sydney Local Health District, Camden and Campbelltown Hospitals, NSW, 2560, Australia
| | - Amanda L Baker
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Leanne Hides
- School of Psychology, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Susan J Paxton
- Department of Psychology and Counselling, Latrobe University, Melbourne, VIC, 3086, Australia
| | - Lisa G Wood
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia; School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kim Colyvas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Tracy L Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia.
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Criscuolo M, Cinelli G, Croci I, Chianello I, Caramadre AM, Tozzi AE, Zanna V. Psychopathological Profile Associated with Food Addiction Symptoms in Adolescents with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3014. [PMID: 36833707 PMCID: PMC9960227 DOI: 10.3390/ijerph20043014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Eating disorders are considered one of the psychiatric disorders with a higher risk of death. Food addiction, related to some food addictive-like behaviours, is often in comorbidity with eating disorders and is associated with worse psychopathology. The present study aims to outline the food addiction profile, investigated using the Yale Food Addiction Scale 2.0 (YFAS 2.0), in 122 adolescents (median age: 15.6 years) suffering from eating disorders and to investigate its association with psychopathology. Patients filled out the Youth Self Report, the Multidimensional Anxiety Scale for Children 2, The Children Depression Inventory 2, and the Eating Disorder Inventory 3 (EDI-3). Pearson's chi-square test and multiple correspondence analysis were used to identify profiles. The mean symptom count was 2.8 ± 2.7. The "withdrawal" symptom was the most frequent (51%) and the most associated with clinical scores. The diagnosis of bulimia nervosa and the EDI-3 bulimia scale resulted to be the only variables to be associated with positive YFAS 2.0 symptoms. Conversely, anorexia nervosa, restrictive and atypical, was not associated with YFAS 2.0 symptoms. In conclusion, outlining the food addiction profile of eating disorders may give information about a patient's phenotype and could help to identify specific treatment models.
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Affiliation(s)
- Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Ileana Croci
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
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Leary M, Pursey K, Verdejo-García A, Skinner J, Whatnall MC, Hay P, Collins C, Baker AL, Burrows T. Designing an online intervention for adults with addictive eating: a qualitative integrated knowledge translation approach. BMJ Open 2022; 12:e060196. [PMID: 35672064 PMCID: PMC9174813 DOI: 10.1136/bmjopen-2021-060196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms. OBJECTIVES The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist. DESIGN This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews. PARTICIPANTS This study included researchers, clinicians, consumers and health professionals. PRIMARY OUTCOME MEASURE The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial. RESULTS A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients. CONCLUSION Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.
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Affiliation(s)
- Mark Leary
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kirrilly Pursey
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Janelle Skinner
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan C Whatnall
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Phillipa Hay
- Western Sydney University, Penrith South, New South Wales, Australia
| | - Clare Collins
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Tracy Burrows
- College of Health Medicine and Wellbeing, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Characteristics of individuals seeking addictive eating treatment. Eat Weight Disord 2021; 26:2779-2786. [PMID: 33646515 DOI: 10.1007/s40519-021-01147-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE There is increasing interest in food addiction and its potential treatment. However, little is known about the characteristics of people seeking addictive eating treatment, which is important to develop appropriate treatment and referral pathways. The aim was to describe the characteristics of individuals seeking addictive eating treatment and examine differences between eligible participants who did and did not engage in treatment. METHODS Participants interested in an addictive eating treatment were recruited to an online screening survey. The 55-item survey included demographic questions, body satisfaction; weight-loss attempts; the modified Yale Food Addiction Survey (mYFAS); the Binge Eating Scale and mental health outcomes (DASS-21). RESULTS Individuals seeking addictive eating treatment (n = 309) were predominantly female (61%), from the obese BMI category (67%) and had accessed a range of services for weight loss (97%). Using multiple logistic regression, participants with higher mYFAS scores were more likely to engage in treatment (AOR 1.68; 95% CI 1.12-2.52), while participants with higher DASS total scores were less likely to engage in treatment (AOR 0.97; 95% CI 0.95-0.99). CONCLUSION This study indicates considerable interest from consumers in seeking addictive eating treatment. Individuals who did not engage in treatment displayed higher mental health comorbidity, suggesting that higher mental health symptomatology may be a barrier to treatment. Future qualitative research is needed to provide an in-depth understanding of the reasons for seeking and engaging in addictive eating treatment, as well as to identify the optimal treatments and referral pathways. LEVEL OF EVIDENCE Level IV.
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Skinner J, Jebeile H, Burrows T. Food addiction and mental health in adolescents: a systematic review. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:751-766. [PMID: 34174201 DOI: 10.1016/s2352-4642(21)00126-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
The intersection between eating behaviours and mental health has garnered substantial attention in recent years. For this Review, we systematically reviewed the available research to find out the prevalence of food addiction as measured by the Yale Food Addiction Scale, and to investigate its association with mental health-related outcomes in adolescents. Eight databases were searched using keywords from Jan 1, 2009, to Aug 5, 2020, to identify studies reporting a Yale Food Addiction Scale diagnosis or symptom score, or both. In total, 27 studies were included. The prevalence of a food addiction diagnosis ranged from 2·6% to 49·9% in non-clinical and clinical populations, and prevalence was higher in women and adolescents with a higher weight status. Food addiction was associated with disordered eating, depressive and anxiety symptoms, and a poorer quality of life and self-esteem. These associations have important implications for the assessment and management of eating behaviours and mental health in adolescents. Transdiagnostic prevention and management intervention strategies could be explored.
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Affiliation(s)
- Janelle Skinner
- Nutrition and Dietetics, School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - Tracy Burrows
- Nutrition and Dietetics, School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.
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Whatnall M, Skinner J, Verdejo-Garcia A, Carter A, Brown RM, Andrews ZB, Dayas CV, Hardman CA, Loxton N, Sumithran P, Burrows T. Symptoms of Addictive Eating: What Do Different Health Professions Think? Behav Sci (Basel) 2021; 11:bs11050060. [PMID: 33925846 PMCID: PMC8145409 DOI: 10.3390/bs11050060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
The symptoms of addictive eating are often debated, with some overlap in symptoms with substance addictions or other disorders such as binge eating disorder. This study explored the levels of agreement with symptoms of addictive eating among different health professions, the conditions they provide advice for, and the population group/s they work with. An online cross-sectional survey was conducted in February-April 2020 including 142 health professionals (87% female, 65% residing in Australia, 28% each working in private practice/hospital settings). Of these, 47% were dietitians, 20% psychologists/psychotherapists/counsellors, 16% other health practitioners (e.g., social workers), 13% health researchers, and 5% medical professionals. Agreement with 11 statements relating to addictive eating symptoms was assessed on a scale of 1/strongly disagree to 5/strongly agree (e.g., certain foods produce physiological effects in the brain rewards system). Differences in agreement by health profession were assessed by one-way analysis of variance. There were significant differences in agreement with individual statements between health professions. Psychologists, psychotherapists, and counsellors reported lower agreement to statements relating to physiological effects in the reward system, withdrawal symptoms, and over-eating to alleviate stress/anxiety, than other professions (p < 0.05). Those providing advice for disordered eating only reported lower agreement across statements compared with those providing advice for overweight/obesity or both (p < 0.001). There were minimal differences based on the population group/s that health professionals work with. There is some agreement among health professionals regarding addictive eating symptoms, however, this differs by profession and the conditions they treat. This study provides a novel perspective on health professionals' views on addictive eating symptoms, and there is a need for more research to explore the concepts further.
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Affiliation(s)
- Megan Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Janelle Skinner
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Robyn M. Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
| | - Zane B. Andrews
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
- Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Chris V. Dayas
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW 2305, Australia
| | - Charlotte A. Hardman
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK;
| | - Natalie Loxton
- School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia;
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD 4072, Australia
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, VIC 3084, Australia;
- Department of Endocrinology, Austin Health, Heidelberg Heights, VIC 3081, Australia
| | - Tracy Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
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Advances and Future Directions in the Clinical Utility of Food Addiction. Nutrients 2021; 13:nu13020708. [PMID: 33672293 PMCID: PMC7926947 DOI: 10.3390/nu13020708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
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