Abstract
PurposeCompelling evidence indicates that an addictive process might contribute to overeating/obesity. We hypothesize that this process consists of two components: (a) a sensory addiction to the taste, texture, and temperature of food, and (b) a motor addiction to the actions of eating (e.g., biting, chewing, crunching, sucking, swallowing). Previously, we reported a mobile health application (mHealth app) obesity intervention addressing the sensory addiction component, based on staged food withdrawal. We propose that the motor addiction component can be treated using cognitive behavioral therapy (CBT)-based strategies for body-focused repetitive behaviors (BRFB), e.g., nail biting, skin picking, and hair pulling.MethodsThe present study tested the effectiveness of CBT-based, BFRB therapies added to the staged withdrawal app. Thirty-five participants, ages 8–20, 51.4% females, mean zBMI 2.17, participated in a 4-month study using the app, followed by a 5-month extension without the app. Using staged withdrawal, participants withdrew from specific, self-identified, “problem” foods until cravings resolved; then from non-specific snacking; and lastly from excessive mealtime amounts. BFRB therapies utilized concurrently included: distractions, competing behaviors, triggers avoidance, relaxation methods, aversion techniques, and distress tolerance.ResultsLatent growth curve analysis determined that mean body weight and zBMI decreased significantly more than in a previous study that used only staged withdrawal (p < 0.01). In the 5-month follow-up, participants maintained overall weight loss.ConclusionsThis study provides further preliminary evidence for the acceptability of an addiction model treatment of obesity in youth, and that the addition of CBT-based, BFRB therapies increased the effectiveness of staged food withdrawal.Level of evidenceLevel IV, Evidence obtained from multiple time series analysis with the intervention.
Highlights
There is increasing interest in whether overeating/obesity stems from an addictive process [1,2,3], this notion is controversial [4,5,6]
Our research has focused on cognitive behavioral therapy (CBT)-based treatment for eating addiction (EA), which we conceptualize as having sensory and motor components
The study was conducted in a convenience sample of young people who responded to newspaper and radio advertisements in Seattle, Washington, for a “Smartphone app weight loss study”
Summary
There is increasing interest in whether overeating/obesity stems from an addictive process [1,2,3], this notion is controversial [4,5,6]. Food addiction (FA) connotes a substance dependence on ingredients in food, e.g., sugar, and is comparable to drug and alcohol dependence [2]. The FA construct involves addictive eating of certain foods, which are craved, sought out, and eaten in excess [2]. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity (2020) 25:1779–1787 substance dependence on food ingredients. The EA construct involves a behavioral addiction to the act of eating [7]. Schulte et al [8] challenged the EA construct, arguing that (a) behavioral addictions have no ingested component; (b) addictive-eating potential is not the same for all foods; and (c) even substance dependencies like drugs and alcohol have behavioral components
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