Is There a Relationship Between Food Addiction, Dietary Quality and Metabolic Parameters in Obese Adults?: A Cross-Sectional Study Example

Background: Although depressive symptoms have been linked to poor diet quality, little is known about this relationship among overweight and obese adults in rural Kentucky where rates of cardiovascular disease (CVD) are high. Identifying the impact of depressive symptoms on diet quality by obesity status may aid in identifying those at highest risk for CVD due to poor dietary habits. Purpose: To determine if obesity moderates the association between depressive symptoms and diet quality in overweight and obese rural adults at high risk for CVD. Methods: Rural adults in Kentucky (n=948; age=53±15; 73% female; 96% Caucasian; body mass index [BMI]=34±7; 67% obese) completed an assessment of depressive symptoms using the 9-item Patient Health Questionnaire and diet quality using a food frequency questionnaire that generated the 2005 Healthy Eating Index score. They were grouped into overweight (BMI 25-29.99kg/m 2 ) and obese (BMI ≥30kg/m 2 ) groups. Multiple linear regression was used to determine the moderation effect by entering the interaction term of depressive symptoms and obesity level. Results: Depressive symptom scores were higher in obese adults than overweight adults (5.9 ± 4.8 vs. 4.6 ± 4.1, p<0.001). Depressive symptoms predicted poor diet quality (B= -0.618, p<0.001, R 2 =0.019). The interaction between depressive symptoms and obesity status was significant (Figure 1) in predicting diet quality and indicated the relationship between depressive symptoms and poor diet quality was stronger in the overweight group than obese group. Conclusion: Although obese rural Kentuckians have more depressive symptoms, the negative impact of depressive symptoms on diet quality is stronger among those who are overweight. Treating depressive symptoms may facilitate healthy eating in this population, particularly those who are overweight.

Measures Used with Populations with Food Insecurity: A Call for Increased Psychometric Validation

GENERAL COMMENTARY article Front. Psychiatry, 26 June 2012 | https://doi.org/10.3389/fpsyt.2012.00064

Objective To observe the effects of bariatric surgery and the status of food addiction on obese patients with type 2 diabetes mellitus (T2DM) . Methods A total of 76 obese T2DM patients who had undergone bariatric surgery (operation group, n=38) or traditional medical treatment (control group, n=38) were enrolled from January 2010 to November 2015. The food addiction status was investigated by five core questions of Yale Food Addiction Scale (YFAS) (Q1: eating much more than planned when eating certain foods; Q2: spending time in dealing with negative feelings from consumed certain foods so often or in such large quantities; Q3: consuming the same types or the same amount of food even though having emotional and/or physical problems; Q4: appearance of withdrawal symptoms when cut down or stopped eating certain foods (for example: developing physical symptoms, feeling agitated, or feeling anxious); Q5: behavior with respect to food and eating causes significant distress). Blood glucose, obesity and the food addiction status were investigated. The data of YFAS were analyzed by McNemar test within groups while inter-group comparisons by rank sum test. Results Compared with control group, fasting plasma glucose [(5.6±1.0) vs (7.7±2.0)mmol/L], glycated hemoglobin A1c [(6.1±0.6)% vs (7.3±1.2)%], and body mass index [ (28±4) vs (34±4) kg/m2] were significantly improved in operation group (z=2.38-6.70, all P<0.05). After surgery, all five questions (Q1-Q5) for food addiction were significantly improved compared with preoperation (s=13.00-28.00, all P<0.05). Compared with control group, the three questions (Q1, Q2, Q3) were greatly improved in operation group (z=2.85-3.29, all P<0.05). The average difference between the operation group and the control group was Q1: 0.71 vs 0.34, Q2: 0.73 vs 0.32, Q3: 0.65 vs 0.29, respectively. Conclusion Compared with traditional medical treatment, bariatric surgery may significantly improve the food addiction of obese patients with T2DM in addition to lower blood sugar, body weight. Key words: Diabetes mellitus, type 2; Obesity; Bariatric surgery; Food addiction

The Yale Food Addiction Scale (YFAS) measures addiction-like eating of palatable foods based on the seven diagnostic criteria for substance dependence in the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Most recently, a new version of the YFAS has been developed based on the revised eleven diagnostic criteria for substance use disorder in DSM-5. This YFAS 2.0 was translated into German and used among other measures in a study with 455 university students (89% female) and in a study with 138 obese patients presenting for bariatric surgery (78% female). In the student sample, the one-factorial structure of the English version could be replicated and internal consistency was α = 0.90. The diagnostic threshold for ‘food addiction’ was met by 10% of the sample. ‘Food addiction’ diagnoses were associated with higher body mass, binge eating frequency, trait food craving, and attentional impulsivity as well as with lower perceived self-regulatory success in dieting. In the obese sample, the diagnostic threshold for ‘food addiction’ was met by 47% of participants. Again, ‘food addiction’ symptomatology was associated with higher binge eating frequency and attentional impulsivity. However, those with a ‘food addiction’ diagnosis did not differ from those without a diagnosis in body mass. To conclude, psychometric properties of the English YFAS 2.0 were replicated for the German YFAS 2.0. Prevalence rates and correlates of ‘food addiction’ as measured with the YFAS 2.0 were similar to those found with the previous version of the YFAS. Thus, the German YFAS 2.0 appears to be a reliable measure that can be used for the investigation of addiction-like eating behavior, analogous to the original version of the YFAS and the English YFAS 2.0.

Background‘Food addiction’ shares a similar neurobiological and behavioral framework with substance addiction. However whether, and to what degree, ‘food addiction’ contributes to obesity in the general population is unknown.Objectivesto assess 1) the prevalence of ‘food addiction’ in the Newfoundland population; 2) if clinical symptom counts of ‘food addiction’ were significantly correlated with the body composition measurements; 3) if food addicts were significantly more obese than controls, and 4) if macronutrient intakes are associated with ‘food addiction’.DesignA total of 652 adults (415 women, 237 men) recruited from the general population participated in this study. Obesity was evaluated by Body Mass Index (BMI) and Body Fat percentage measured by dual-energy X-ray absorptiometry. ‘Food addiction’ was assessed using the Yale Food Addiction Scale and macronutrient intake was determined from the Willet Food Frequency Questionnaire.ResultsThe prevalence of ‘food addiction’ was 5.4% (6.7% in females and 3.0% in males) and increased with obesity status. The clinical symptom counts of ‘food addiction’ were positively correlated with all body composition measurements across the entire sample (p<0.001). Obesity measurements were significantly higher in food addicts than controls; Food addicts were 11.7 (kg) heavier, 4.6 BMI units higher, and had 8.2% more body fat and 8.5% more trunk fat. Furthermore, food addicts consumed more calories from fat and protein compared with controls.ConclusionOur results demonstrated that ‘food addiction’ contributes to severity of obesity and body composition measurements from normal weight to obese individuals in the general population with higher rate in women as compared to men.

Background/Aims: To assess the prevalence and correlates of addictive-like eating behavior in Germany. Methods: The German version of the Yale Food Addiction Scale (YFAS) 2.0 was used to investigate, for the first time, the prevalence of ‘food addiction' in a representative sample aged 18-65 years (N = 1,034). Results: The prevalence of ‘food addiction' measured by the YFAS 2.0 was 7.9%. Individuals meeting criteria for ‘food addiction' had higher BMI and were younger than individuals not meeting the threshold. Underweight (15.0%) and obese (17.2%) individuals exhibited the highest prevalence rate of ‘food addiction'. Addictive-like eating was not associated with sex, education level, or place of residence. Conclusion: YFAS 2.0 ‘food addiction' was met by nearly 8% of the population. There is a non-linear relationship between addictive-like eating and BMI, with the highest prevalence among underweight and obese persons. These findings suggest that ‘food addiction' may be a contributor to overeating but may also reflect a distinct phenotype of problematic eating behavior not synonymous with obesity. Further, the elevated prevalence of YFAS 2.0 ‘food addiction' among underweight individuals may reflect an overlap with eating disorders and warrants attention in future research.

La dépendance alimentaire (DA) apparait comme un construit prometteur et pourrait même constituer un sous-type plus sévère du trouble accès hyperphagiques (TAH). Cette étude vise à examiner la sévérité psychopathologique selon la présence ou l’absence de DA et TAH. L'échantillon comprend 158 adultes avec surpoids ou obésité (IMC moyen = 38,12 kg/m2, ÉT = 7,74) qui consultent pour des problèmes liés au poids et à l’alimentation. Ils ont complété une entrevue diagnostique et des questionnaires portant sur les comportements alimentaires (Yale Food Addiction Scale 2.0, Three Factors Eating Questionnaire, Binge Eating Scale, Grazing Questionnaire, Food Craving Questionnaire-Trait, reduced), la satisfaction corporelle (Body-Esteem Scale), les symptômes dépressifs (Beck Depression Inventory-II) et les traits de personnalité (Temperament and Character Inventory). Ils ont été séparés en quatre groupes : aucun diagnostic (n=42), DA (n=57), TAH (n=8) et DA+TAH (n=51). Des M/ANOVAs ont été effectuées en comparant le groupe sans diagnostic, DA et DA+TAH, compte tenu du faible nombre de participants dans le groupe TAH. Pour les comportements alimentaires, la satisfaction corporelle et les symptômes dépressifs, le groupe DA montre une sévérité supérieure au groupe sans diagnostic et le groupe DA+TAH montre une sévérité encore plus élevée par rapport aux deux autres groupes. Pour les traits de la personnalité, les groupes DA+TAH présentent plus d’évitement du danger et moins de détermination que le groupe sans diagnostic. Bien que l’étude ne permette pas d’établir un lien de causalité, elle suggère que la combinaison de la DA+TAH est associée à une sévérité psychopathologique plus importante.

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

Men are more likely than women to have subthreshold overeating disorders. Lifestyle plays a role as a determinant, while chronotype is an emerging factor. Chronotype explains the natural preferences of wakefulness and activity throughout the day: evening chronotypes (E-Types), those most productive in the evening, have been linked with unhealthy dietary patterns and a higher propensity to substance addiction than morning types (M-Types). We carried out a cross-sectional study on 750 overweight or obese adults (70% females, 48 ± 10 years, BMI 31.7 ± 5.8 kg/m2). The Binge-Eating Scale, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the reduced Morningness-Eveningness Questionnaire (rMEQ), and the MEDAS questionnaire were used to assess binge eating, food addiction, chronotype, and adherence to the Mediterranean diet, respectively. No differences in BES binge-eating and FA food-addiction scores occurred between chronotypes, but we found significant interactions between sex × rMEQ score. While women showed the same prevalence for binge eating and food addiction across all chronotypes, binge eating and food addiction risk increased with reducing rMEQ score in men, indicating that being male and E-Type increases the risk association of binge eating and/or food addiction prevalence. chronotype is associated with binge eating and food addiction in men, emphasizing the link between chronobiology and sex differences as determinants in appetite and eating behaviour dysregulation and in overweight and obesity.

Introduction. Research on food addiction has increased in recent years, but there are few studies focusing on college-attending young adults, who may be at risk of developing food addiction due to the stress of the college environment. Additionally, causes and characteristics of food addiction are under-explored. Aim. This dissertation aims to 1) determine the impact of adverse childhood experiences (ACEs) and other early life influences on the development of food addiction in college-attending young adults and 2) determine the psychosocial and behavioral characteristics of young adults with food addiction. Methods. A sequential explanatory mixed-methods design was used for aims 1 and 2, in which quantitative data is collected first, analyzed, and then qualitative data is then collected. An online, cross-sectional survey was distributed to students attending a university in Appalachia in fall 2021. Food addiction was measured using the Yale Food Addiction Scale 2.0 (YFAS 2.0). Childhood trauma, depression, anxiety, stress, social support, post-traumatic stress disorder (PTSD), emotion regulation, coping styles, eating disorder symptoms, eating styles, diet quality, and anticipated effects of food were measured using validated tools. Demographic data and self-reported height and weight were also collected. For Aim 1, logistic regression was used to determine the impact of ACEs on the development of food addiction while controlling for other potential influences. For Aim 2, Kruskal-Wallis H was used to determine differences in mean scores of psychosocial and behavioral variables between those with and without food addiction. All quantitative analysis was analyzed using JMP Pro Version 16.0. For Aims 1 and 2, participants who met the criteria for food addiction were invited to participate in interviews that elicited more information on their causes and symptoms. Interviews were transcribed verbatim and thematic analysis was conducted using NVIVO software. Results. Respondents (n=1645) had a 21.9% prevalence of food addiction (5.7% mild, 4.7% moderate, 11.5% severe). For Aim 1, only depression remained a significant predictor of food addiction (OR = 3.33, 95% CI 2.19, 5.05). Thematic analysis found that many participants grew up in restrictive eating environments characterized by diet culture, while others had positive memories associated with mealtime. Participants often stated symptoms emerged when transitioning to college or when mental health worsened. For Aim 2, participants with food addiction had significantly higher ACEs, depression, anxiety, stress, emotion dysregulation, use of negative coping mechanisms, eating disorder symptoms, emotional eating, disinhibition when eating, negative expectations after eating healthy or junk food, and intake

‘Food addiction’. What happens in childhood?

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 exam-ined clinical samples. All studies used YFAS scoring results to define food addiction. The prevalence of food addiction ac-cording 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 con-cepts currently used to examine behavioral addictions.

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessOvereating Is an Addiction, Brain Imaging ShowsJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:16 Sep 2011https://doi.org/10.1176/pn.46.18.psychnews_46_18_2_1AbstractCredit: Monkey Business Images/ShutterstockIt's amazing what the prospect of a chocolate milkshake can do to individuals who live to eat. Certain areas of their brains that are known to be involved in drug craving shift into gear. This is the finding of Ashley Gearhardt, a doctoral student in clinical psychology at Yale University, and her colleagues. And the results of their research, which appeared in the August Archives of General Psychiatry, suggest that an overwhelming urge to eat is no less than a form of addiction. And these results, along with those from other addiction researchers (Psychiatric News, April 15), appear to validate the view of Nora Volkow, M.D., head of the National Institute on Drug Abuse, who asserted in 2007 that some forms of obesity are due to an addiction to food. Gearhardt and colleagues recruited 48 healthy young women for their study. The women had been enrolled in a program to help people achieve and maintain a healthy weight on a long-term basis. The women were on average 21 years old and ranged in weight from lean to obese. The researchers gave the subjects a questionnaire that measures food addiction—the Yale Food Addiction Scale. The instrument asks respondents to rate the extent to which they agree with questions such as "I find that when I start eating certain foods, I end up eating much more than planned," "I find myself continuing to consume certain foods even though I am no longer hungry," and "I eat to the point where I feel physically ill." The subjects were then shown a picture of a chocolate milkshake and promised delivery of a real one. After that, their brain activity was visualized with functional magnetic resonance imaging. The scientists then looked to see whether there was any link between subjects' food addiction scores and their brain activity. There was. The higher subjects' food addiction scores were, the greater their brain activity in the anterior cingulate cortex, the medial orbitofrontal cortex, the amygdala, and the caudate. These brain areas have also been implicated in drug craving. Thus it looks as if an overwhelming urge to eat may be a form of food addiction, and that food addiction in turn may contribute to obesity, the researchers believe. "I was surprised by the strength of our findings—all medium and large effects—because we excluded all [study candidates] who met a clinical threshold for eating disorders," Gearhardt told Psychiatric News. "If we had included such people, we would likely have had even stronger findings." However, no significant correlation was found between food-addiction scores on the questionnaire and subjects' body mass index. In other words, some of the lean subjects, not just the obese ones, scored high on this instrument. "It is possible that some individuals experience compulsive eating behavior, but engage in compensatory behaviors to maintain a lower weight," Gearhardt and her team suggested. "An alternative possibility is that lean participants who endorse food addiction are at risk for future weight gain. Given the young age of the sample, on average 21 years, the probability of future weight gain may be especially likely." Regarding clinical implications of their findings, Gearhardt said, "I think our research suggests that clinical techniques used in addiction such as motivational interviewing or cue-exposure response-prevention may be particularly effective for some people struggling with eating-related issues. It also highlights the impact that addictive foods may have on the reward system in the brain, which could suggest the use of pharmacology, like opioid antagonists, to treat eating problems." Gearhardt and her group are next planning to conduct a study that looks at food addiction and neural response to food advertising, she said. Food-addiction behaviors have been demonstrated in both lab animals and humans in a wide range of studies, Mark Gold, M.D., chair of psychiatry at the University of Florida and a food-addiction researcher, told Psychiatric News. Yet most clinicians have not been able to capitalize on these findings, because there has been no way to reliably identify who is and who isn't a food addict, he said. But now there is, he said, because "this study has provided the first neurobiological validation of the use of the Yale food addiction instrument in obese and normal individuals." The study was funded by the National Institutes of Health.An abstract of "Neural Correlates of Food Addiction" is posted at <http://archpsyc.ama-assn.org/cgi/content/short/68/8/808>. ISSUES NewArchived

Corrigendum to “Validation of the Yale Food Addiction Scale among a weight-loss surgery population” [Eating Behaviors 14(2013) 216–219