Abstract
There is mounting evidence that many highly processed foods have addictive properties, and that some cases of compulsive overeating resemble an addiction disorder. While support for the Yale Food Addiction Scale (YFAS) as a valid diagnostic tool has been impressive and continues to increase, to date, no research has examined the food-addiction construct in response to an actual food stimulus, and in relation to direct measures of appetite and food consumption. As part of a larger community-based study of overeating in healthy adults who were predominately overweight and obese (aged 25–50 years), 136 participants completed the YFAS, of whom 23 met the diagnostic criteria for food-addiction. They took part in a 2-day, double-blind, cross-over, single-dose drug challenge using a psychomotor stimulant (methylphenidate) and placebo. Participants were first assessed on ratings of appetite and food cravings after holding and tasting their favorite snack food, after which they were able to eat all or part of the snack, as they wished. Three separate repeated-measures analysis-of-variance procedures were carried out, each with two between-subjects factors (Diagnosis: food-addiction vs. non-food addiction) and (Sex: male vs. female) and 1 within-subjects factor (Days: drug vs. placebo). As anticipated, for all three dependent variables, there was a significant main effect for Days with a response decrease from placebo to the drug condition. With respect to food cravings and appetite ratings, results indicated that the food addiction group had significantly higher scores on both variables. For food consumption, there was a significant Days × Diagnosis interaction whereby the food-addiction group showed no food-intake suppression across days compared to the non-food-addiction group who demonstrated a significant decrease in snack-food consumption with methylphenidate. The finding that the food-addiction group was resistant to the food-intake suppression typically induced by a dopamine agonist supports evidence of dopamine signaling-strength differences in individuals with compulsive overeating compared to those without this disorder. This represents the first demonstration that individuals defined by their food-addiction status have a unique pattern of food-intake following a pharmacologic challenge with such agents.
Highlights
In its recently released 5th edition, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has acknowledged the existence of behavioral addictions for the first time (American Psychiatric Association, 2013)
The former reported stronger food cravings and greater appetite ratings following a taste of their favorite snack, and these differences remained stable in both the placebo and the methylphenidate conditions
With respect to food consumption, there was a significant interaction between Diagnostic Group and Days, again showing a substantial decrease in snack-food consumption in the non-foodaddiction group, while there was no change in the food-addiction group
Summary
In its recently released 5th edition, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has acknowledged the existence of behavioral addictions for the first time (American Psychiatric Association, 2013). Other excessive behaviors related to sex, exercise, eating, and shopping had been considered for inclusion, none was deemed to have sufficient peerreviewed evidence for identification as a mental health problem at the time of publication (Potenza, 2014) Of these conditions, the one receiving the most discussion and research investigation in recent years is food addiction – the rather unsuitably named syndrome describing compulsive overeating accompanied by strong cravings and extreme difficulty in abstaining from highly palatable fare. A recent qualitative study confirmed that a high proportion of obese women with and without BED endorsed DSM symptoms of substance dependence when food was the “substance” in question (Curtis and Davis, 2014) These women felt that “loss-of-control” overeating, the inability to stop this behavior despite strong wishes to do so, and extreme cravings were the characteristics of their disorder which most resembled an addiction
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