The effectiveness of the TRACE online nutrition intervention in improving dietary intake, sleep quality and physical activity levels for Australian adults with food addiction: a randomised controlled trial.

BACKGROUND: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three-arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian-led telehealth intervention at 3 months. METHODS: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non-core foods were reported. RESULTS: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) -0.0 to 12.9], p = 0.049), non-core foods (-6.4%/day [95% CI -12.9 to 0.0], p = 0.049), sweetened drinks (-1.7%/day [95% CI -2.9 to -0.4], p = 0.013), takeaway foods (-2.3%/day [95% CI -4.5 to -0.1], p = 0.045) and sodium (-478 mg/day [95% CI -765 to -191 mg], p = 0.001). CONCLUSIONS: A dietitian-led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

On the prevalence of 'food addiction' in persons with bulimia nervosa.

A meta-analysis by Praxedes and colleagues published in this journal reports that the prevalence of 'food addiction' as measured with the Yale Food Addiction Scale is lower than 50% in persons with bulimia nervosa and higher in persons with binge eating disorder. However, closely examining the supplementary material of that article reveals that these numbers cannot possibly be correct. Instead, most studies indicate that the prevalence of 'food addiction' is higher than 80% in persons with bulimia nervosa and, thus, higher than in persons with other eating disorders.

A three-arm randomised controlled trial of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program).

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.

Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

BACKGROUND: Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed. OBJECTIVES: The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). SETTING: Integrated multispecialty health system, United States. METHODS: Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared. RESULTS: Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m). CONCLUSIONS: Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort.

Confirmatory factor analysis and gender invariance of Persian version of the modified Yale food addiction scale (mPYFAS) 2.0: insight from a large scale Iranian sample.

BACKGROUND: The Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) was developed with the primary objective of evaluating food addiction (FA). The present study aimed to undertake the translation, pilot testing, and evaluation of the psychometric properties of the mYFAS 2.0 within the Persian-speaking population. METHODS: The transcultural adaptation of the mYFAS 2.0 to the Persian language was conducted. Data collection was carried out through an anonymous online questionnaire. Participants completed the Persian versions of the mYFAS 2.0, Binge Eating Scale (BES), Barratt Impulsivity Scale (BIS-11), and Connor-Davidson Resilience Scale (CD-RISC). The assessment encompassed the evaluation of internal consistency reliability, factor structure, as well as convergent and discriminant validity of the aforementioned questionnaires. RESULTS: Confirmatory factor analysis revealed that the single-factor model of the Persian translation of mYFAS 2.0 performed satisfactorily, with comparative fit index (CFI) and Tucker-Lewis index (TLI) values exceeding 0.95, standardized root mean square residual (SRMR) less than or equal to 0.09, and root mean square error of approximation (RMSEA) below 0.03. The internal consistency and composite reliability of the mYFAS 2.0 were favorable in the entire sample, as well as in both male and female groups, with alpha (α) values of 0.83, ordinal alpha (αord) of 0.93, and composite reliability (CR) of 0.86. Additionally, significant relationships were observed between the total score of BES (r = 0.59, p < 0.001), BIS-11 (r = - 0.16, p < 0.001), and CD-RISC (r = 0.22, p < 0.001) with mYFAS 2.0-diagnosed FA presence, severity, and symptom count. CONCLUSIONS: The Persian version of the mYFAS 2.0 exhibited satisfactory psychometric properties.

In this study, researchers developed a Persian version of the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) to assess food addiction in Persian-speaking individuals. They translated and tested the scale's reliability and validity through an online survey with 9606 Persian speaking participants. The results showed that the Persian mYFAS 2.0 performed well, with a reliable single-factor model. The internal consistency and reliability were good across the entire sample and in both male and female groups. The relationships between mYFAS 2.0 and other scales measuring binge eating, impulsivity, and resilience were significant. The findings suggest that the Persian version of mYFAS 2.0 is a reliable tool for assessing food addiction in the Persian-speaking population. The study used statistical analyses like confirmatory factor analysis, indicating the scale's robustness. Overall, the psychometric properties of the Persian mYFAS 2.0 were satisfactory, providing a valuable instrument for researchers and healthcare professionals studying and addressing food addiction in this population. The study contributes to cross-cultural research and enhances our understanding of food addiction in diverse linguistic communities.

Leptin, but not ghrelin, is associated with food addiction scores in a population-based subject sample.

Background: Ghrelin and leptin are both peptide hormones and act as opposing players in the regulation of hunger, satiety and energy expenditure. Leptin reduces appetite and feelings of hunger and is secreted mainly by adipocytes, while ghrelin increases appetite and food intake and reduces metabolic rate. Both hormones have been implicated in addictive disorders. Ghrelin was shown to have pro-addictive effects while leptin's role in addiction yields more conflicting results. Their involvement in the regulation of both food intake and addictive behaviors make them interesting candidates when investigating the regulation of food addiction. However, only few human studies have been performed and large-scale studies are lacking to date. We aimed to investigate the association between total ghrelin and leptin serum levels with scores in the Yale Food Addiction Scale (YFAS). Methods: Subjects were recruited in the LIFE Adult cohort. 909 subjects were included in the analysis and we performed univariate multiple linear regression models, adjusted for age, sex (in total group analyses only), alcohol consumption, smoking status, BMI scores, cortisol concentrations, Center for Epidemiological Studies Depression Scale (CES-D) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) sum scores. The dependent variable was the YFAS score. Results: In men, leptin serum levels showed a significant positive association (standardized ß = 0.146; p = 0.012) with the YFAS score. This finding was confirmed in an extreme-group comparison: men in the highest quartile of leptin levels had significantly higher YFAS sum scores than men in the lowest quartile (1.55 vs. 1.18; p = 0.00014). There was no association with YFAS sum score in the total group (standardized ß = -0.002; p = 0.974) or in women (standardized ß = -0.034; p = 0.674). Total serum ghrelin showed no association with YFAS sum score neither in the total group (standardized ß = -0.043; p = 0.196) nor in men (n = 530; standardized ß = -0.063; p = 0.135) or women (n = 379; standardized ß = -0.035; p = 0.494). Conclusion: Our findings are in line with previous literature and suggest that total ghrelin serum levels are not associated with food addiction scores. Leptin had been previously shown to be associated with food addiction and we confirmed this finding for men in a large, population-based approach.

Food addiction and its relationship with other eating behaviours among Spanish university students.

BACKGROUND: Food addiction (FA) is characterised by symptoms such as loss of control over food consumption, inability to reduce consumption despite the desire to do so, and continued consumption despite negative consequences. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a widely used instrument to assess FA. OBJECTIVES: To validate the Spanish mYFAS 2.0; to analyse the relationships between FA with other eating behaviours, sociodemographic variables, and Body Mass Index (BMI); and to test the eating-related variables that account for the variance in FA. METHODS: The sample consisted of 400 university students (Mage = 24.16, SDage = 6.12; 51% female), who completed the mYFAS 2.0 and measures of eating-related constructs. RESULTS: A confirmatory factor analysis (CFA) supported the one-factor structure of the mYFAS 2.0. The scale showed good internal consistency (α = .78), and good convergent validity with the mYFAS. FA was related to eating styles, binge eating, and bulimia. No differences in FA were observed between males and females, and there was no association between FA and BMI. In addition, younger participants scored higher on FA than older participants. The eating-related variables explain 54.7% of the variance in FA. CONCLUSIONS: The mYFAS 2.0 is a valid and reliable scale to assess FA in the Spanish population. The positive and significant relationship of variables related to eating (eating styles, binge eating and bulimia) with FA was demonstrated. These variables were indicated by those at high risk of FA.

Psychometric validation of the full Yale food addiction scale for children 2.0 among adolescents from the general population and adolescents with a history of mental disorder.

OBJECTIVE: Food addiction is a phenotype characterised by an addiction-like attraction to highly processed foods. Adolescence is a sensitive period for developing addictive disorders. Therefore, a valid measure to assess food addiction in adolescents is needed. Accordingly, the aim of the study was to establish a categorical scoring option for the full version of the Yale Food Addiction Scale for Children 2.0 (YFAS-C 2.0), and to psychometrically validate the full YFAS-C 2.0. METHOD: The data stem from the Food Addiction Denmark (FADK) Project. Random samples of 3750 adolescents from the general population aged 13-17 years, and 3529 adolescents with a history mental disorder of the same age were invited to participate in a survey including the full version of the YFAS-C 2.0. A confirmatory factor analysis was carried out and the weighted prevalence of food addiction was estimated. RESULTS: The confirmatory factor analysis of the YFAS-C 2.0 supported a one-factor model in both samples. The weighted prevalence of food addiction was 5.0% in the general population, and 11.2% in the population with a history of mental disorder. CONCLUSIONS: The full version of the YFAS-C 2.0 is a psychometrically valid measure for assessing clinically significant food addiction in adolescents.

Relationships between alexithymia and food addiction: The Finnish version of Yale Food Addiction Scale and preliminary test of its psychometric properties.

Background: It has long been suggested that addictive behaviors are associated with alexithymia, a personality trait characterized by difficulties in emotional awareness and expression. However, little is known about the role of alexithymia in food addiction. Objectives: The aim of this study was to investigate the relationship between alexithymia and food addiction. As part of the study, the validity of the Finnish version of Yale Food Addiction Scale (YFAS-F) was also investigated. Methods: The sample consisted of 360 parents from the FinnBrain Birth Cohort Study. The structural validity of the YFAS-F was evaluated by confirmatory factor analysis (CFA). Exploratory factor analysis (EFA) was used to explore the structure when proposed models were not supported by CFA. The associations of alexithymia as measured by the 20-item Toronto Alexithymia Scale and food addiction were examined using regression analyses followed by structural equation modeling. Results: Higher alexithymia was associated with more food addiction by conducting linear regression analysis (B = 0.013, p = 0.011) and structural equation modeling (ß = 0.24, p < 0.001). Furthermore, a single-factor model for the 8 criteria of the YFAS-F was supported by CFA and showed acceptable internal reliability (KR-20 = 0.72), and a three-factor solution for the 20 items of the scale was suggested by EFA with good internal reliability (McDonald's ω = 0.91 for the YFAS-F, 0.91 for component 1, 0.87 for component 2, and Spearman-Brown coefficient = 0.89 for component 3). Conclusion: The current study determined a significant relationship between alexithymia and food addiction, which suggests alexithymia as a relevant factor for food addiction and may provide clinical implications for interventions. Moreover, the YFAS-F appeared to be a valid and reliable tool to evaluate food addiction in our Finnish general population sample. Further studies on the psychometric properties of the YFAS-F in more diverse populations are recommended.

The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity.

Introduction: The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students. Methods: An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity. Results: All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's α = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01). Discussion: Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction.

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents.

Adolescence is considered an important period of neurodevelopment. It is a time for the emergence of psychosocial vulnerabilities, including symptoms of depression, eating disorders, and increased engagement in unhealthy eating behaviours. Food addiction (FA) in adolescents is an area of study where there has been substantial growth. However, to date, limited studies have considered what demographic characteristics of adolescents may predispose them to endorse greater symptoms of FA. Studies have found a variety of factors that often cluster with and may influence an adolescent's eating behaviour such as sleep, level of self-control, and parenting practices, as well as bullying. Therefore, this study investigated a range of socio-demographic, trait, mental health, and lifestyle-related profiles (including self-control, parenting, bullying, and sleep) as proximal factors associated with symptoms of FA, as assessed via the Yale Food Addiction Scale for Children (YFAS-C) in a large sample of Australian adolescents. Following data cleaning, the final analysed sample included 6587 students (age 12.9 years ± 0.39; range 10.9-14.9 years), with 50.05% identifying as male (n = 3297), 48.5% as female (n = 3195), 1.02% prefer not to say (n = 67), and 0.43% as non-binary (n = 28). Self-control was found to be the most significant predictor of total FA symptom score, followed by female gender, sleep quality, and being a victim of bullying. Universal prevention programs should therefore aim to address these factors to help reduce the prevalence or severity of FA symptoms within early adolescent populations.

The Modified Yale Food Addiction Scale May Be Simplified and Diagnostically Improved: The Same Prevalence but Different Severity and Risk Factors of Food Addiction among Female and Male Students.

The Yale Food Addiction Scale (YFAS) is the most commonly used scale for measuring food addiction (FA). The previous approach to the YFAS and its subsequent versions assumed dichotomization of items, separating addiction symptoms and clinical significance items, and factorial validity testing on a subset of items. In this paper, we discuss the drawbacks associated with these procedures. In addition, we present a different analytical approach to investigate the validity of the modified YFAS (mYFAS) along with an alternative scoring method that overcomes limitations related to the previous approach. After establishing the structure of the mYFAS, we investigated the potential antecedents and consequences of FA separately for men and women. The sample consisted of 1182 Polish undergraduate students (613 women, 559 men, 10 missing values on gender) with a mean age of 20.33 years (SD = 1.68; range: 18-36). They were asked to complete self-report questionnaires measuring FA, personality traits (Big Five), self-esteem, narcissism, self-efficacy, social anxiety, loneliness, and well-being indicators. Due to the low content, factorial, and clinical validity, the first three items were excluded from the Polish version of the mYFAS. The six-item mYFAS demonstrated measurement invariance, allowing for meaningful comparisons between genders and yielded almost identical prevalence rates for men and women. The hierarchical multiple regression analysis showed that, narcissism, and social anxiety predicted FA in both genders, whereas important gender differences in antecedents were also noted. In addition, FA was associated with body mass index (BMI) and most of the well-being indicators, even after controlling for relevant variables. The findings suggest that our modified analytical approach allows researchers to measure FA using a valid, useful, and simple tool.

Can a Behavioral Weight-Loss Intervention Change Adolescents' Food Addiction Severity?

Objective: This study examines changes in the Yale Food Addiction Scale symptom count over a 24-week, weight-loss mobile Health (mHealth) intervention incorporating elements of addiction medicine. Methods: Adolescents (n = 117) with obesity (15.5 ± 1.3 years; 66% Hispanic) were randomized to the following: (1) mHealth intervention (AppAlone), (2) mHealth intervention+coaching (AppCoach), or (3) in-person intervention (Control). A multivariate mixed Poisson regression model was used to evaluate changes in symptom counts across intervention arms after adjusting for sex, age, depressive symptomatology, stress, and executive function. Results: After the intervention, 57% of adolescents showed a decrease in symptom count (median change: -0.3 [0 to -1.5]), with a significant change by intervention arm in the intention-to-treat analysis (p = 0.045). There was a positive linear relationship between change in symptom count and change in depressive symptomatology (p < 0.01) and stress (p < 0.01), with no association with change in weight (p = 0.3). Discussion: Both mHealth and in-person obesity interventions seemed to confer benefits in food addiction symptomatology associated with change in mood and stress. Clinical Trial Registration number: NCT035008353.

Food addiction symptoms are related to neuroaffective responses to preferred binge food and erotic cues.

It has been proposed that some individuals succumb to maladaptive eating behaviors because, like those with addiction, they attribute high incentive salience to food-associated cues. Here, we tested whether women that attribute high incentive salience to food-associated cues report high food addiction symptomatology. In 76 college women, we assessed self-reported food addiction symptoms using the Yale Food Addiction Scale and we recorded event-related potentials (ERPs, a direct measure of brain activity) to preferred food, erotic, unpleasant, and neutral images. We used the amplitude of the late positive potential (LPP, a component of the ERPs) as an index of the incentive salience attributed to the images. Using a multivariate classification algorithm (k-means cluster analysis), we identified two neuroaffective reactivity profiles that have been previously associated with individual differences in the tendency to attribute incentive salience to cues and with differences in vulnerability to addictive behaviors. Results showed that women with elevated LPP responses to preferred food cues relative to erotic images report higher food addiction symptoms than women with low LPP responses to preferred food cues relative to other motivationally relevant stimuli. These results support the hypothesis that individual differences in the tendency to attribute incentive salience to food cues play an important role in modulating food addiction symptomatology.

Psychometric properties of the Chinese version of the modified Yale Food Addiction Scale version 2.0 (C-mYFAS 2.0): Prevalence of food addiction and relationship with resilience and social support.

PURPOSE: This study aimed to examine the psychometric properties of the Chinese version of the modified Yale Food Addiction Scale 2.0 (C-mYFAS 2.0) and to analyze the prevalence of food addiction among Chinese college students and its relationship with resilience and social support. METHODS: A total of 1132 Chinese college students completed the C-mYFAS 2.0, BES, EAT-26, PHQ-9, GAD-7, TFEQ-18, CD-RISC-10, and PSSS. Confirmatory factor analysis was used to evaluate the factor structure of the C-mYFAS 2.0 and psychometric properties were assessed. Test-retest reliability was evaluated in a sub-sample (n = 62). Spearman correlation and logistic regression were used to examine the relationship between resilience, social support, and food addiction. RESULTS: The prevalence of food addiction according to the C-mYFAS 2.0 was 6.2%. Confirmatory factor analyses suggested a single-factor structure (comparative fit index = 0.961). The C-mYFAS 2.0 had good test-retest reliability and internal consistency (Kuder-Richardson's α = 0.824). Good convergent validity was indicated by correlations with binge eating, eating disorder symptoms, depressive symptoms, generalized anxiety symptoms, uncontrolled eating, emotional eating, and BMI (ps < 0.001). Appropriate divergent validity was reflected by no association with cognitive restraint. Finally, binge eating was significantly predicted by C-mYFAS 2.0, depressive symptoms, and eating disorder symptoms (ps < 0.001), confirming incremental validity. In addition, our study found that poorer resilience and social support were related to food addiction (ps < .001). CONCLUSIONS: The C-mYFAS 2.0 is a brief but reliable and valid screening instrument for food addiction among Chinese college students. In addition, we found that resilience and social support were negatively associated with food addiction. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Highly processed food addiction: A concept analysis.

AIM: This concept analysis aims to clarify the highly processed food addiction (HPFA) concept and discuss its implications for treating obesity. BACKGROUND: Emerging empirical evidence suggests addictive-like eating may contribute to obesity in some individuals, increasing interest in HPFA's role in obesity. Clarifying the HPFA concept will aid in developing individualized interventions for patients with obesity and HPFA. DESIGN: This concept analysis followed Walker and Avant's approach. The case studies are of participants in a study that included individuals with and without HPFA (Yale Food Addiction Scale 2.0-diagnosed). DATA SOURCE: We searched PubMed, CINAHL, PsychInfo, and Ebscohost databases. Keywords were "food addiction" and "food addiction concept." REVIEW METHODS: Criteria included recent reviews and empirical studies that measured HPFA and focused on HPFA characteristics and/or treatment implications. RESULTS: The model case displayed all 11-substance use disorder (SUD) symptoms and clinical significance, supporting a severe HPFA diagnosis. The contrary case was negative for all YFAS 2.0 symptoms and clinical significance and did not eat compulsively or experience cravings. The borderline case met the minimum symptom criteria for severe HPFA but not clinical significance. Clinical interviews may help determine whether such individuals truly exhibit addictive-like eating behaviors. CONCLUSIONS: Growing empirical evidence and our case studies support the HPFA concept and the utility of the YFAS/YFAS 2.0 for identifying a distinct subset of individuals with overweight/obesity who may benefit from interventions developed to treat established SUDs. Future research should examine HPFA separately and in relation to obesity and eating disorders and include longitudinal studies and gender-balanced samples.

Food addiction among morbidly obese patients: prevalence and links with obesity complications.

Background: In the context of obesity, little is known about the prevalence of food addiction nor about the phenotype of obese patients with food addiction. Objectives: To assess: (i) the prevalence of food addiction among obese patients eligible for obesity surgery; (ii) the relationship between clinical features and the complications of obesity. Methods: Consecutive patients consulting for the first time were included. The Yale Food Addiction Scale (YFAS) 2.0 questionnaire was used to diagnose food addiction and its severity. Demographics, clinical features, and obesity complications were systematically collected. Statistics: Student's test was used for numerical variables and Chi-square test or Fisher's exact test for categorical variables. Results: A total of 292 patients were included: 79% female, age (mean ± SD) 42.6 ± 13.0 yrs., body mass index (BMI) 43.2 ± 6.8 kg/m2. One hundred and eight patients (37%) had food addiction: 58% severe, 33% moderate, 9% mild. Food addiction prevalence was 39% (n = 61/156) among patients eligible for obesity surgery. Food addiction was more frequent among the unemployed, compared to professionally active patients (41.0% vs. 33.5%, p = 0.046). Clinical and metabolic phenotypes and obesity complications were similar between patients with and without food addiction. Conclusion: Food addiction was present in 37% of obese patients, but was not associated with clinical features or obesity complications. Therefore, it should be systemically assessed for appropriate management.

Adição por comida: prevalência e fatores associados em um estudo de base populacional no Rio de Janeiro / Food addiction: prevalence and factors associated in a population-based study in Rio de Janeiro

Adição por comida caracteriza-se por uma perda de controle sobre o consumo de certos tipos de alimentos, na maioria das vezes hiperpalatáveis, e por tentativas fracassadas de ultrapassar o problema alimentar apesar das consequências adversas. A tese atual descreve a prevalência de adição por comida e fatores associados (socioeconómicos, demográficos, estilos de vida, estado nutricional, comorbilidades psiquiátricas e clínicas) em uma amostra representativa da cidade do Rio de Janeiro, Brasil. Este é um estudo transversal que utiliza dados do Compulsão alimentar no Rio -Binge Eating in Rio Survey, um inquérito domiciliar que incluiu 2.297 indivíduos dos 18 aos 60 anos. Os participantes forneceram informações sociodemográficas, antropométricas, sobre o estilo de vida, comorbidades clínicas e psiquiátricas. O instrumento utilizado para avaliar a adição por comida foi a escala modificada de adição por comida de Yale 2.0. A entrevista foi aplicada face-a-face. E os dados foram coletados entre setembro de 2019 e fevereiro de 2020. Prevalência e respectivos intervalos de confiança de 95% (95%CI) foram estimados considerando o peso da amostral e o desenho complexo do inquérito. Foram utilizados modelos de regressão logística para estimar a razão de chance entre as comorbidades psiquiátricas, clínicas e adição por comida. Os modelos foram ajustados para potenciais variáveis de confusão, sexo, idade e IMC. A prevalência de Adição por comida foi de 2,78% (95%CI 1,40 a 4,17) e, foi classificada como leve em 17% dos casos, moderada em 36% e como severa em 46%. A prevalência de adição por comida nas mulheres foi superior à dos homens, 4,08% vs 1,39 (p=0.001), com tendência decrescente com a idade (p=0,017). Quanto ao IMC, adição por comida foi mais prevalente entre aqueles com IMC mais elevado 6,76 % (IC95%CI 4,19 a 10,70) em comparação com aqueles com IMC normal 0,69% (IC95%CI 0,31 a 1,53). Entre aqueles que tinham adição por comida, a prevalência de sintomas psiquiátricos foi de: 75,41% com sintomas de depressão, 77,05% com sintomas de ansiedade, 19,7% de transtorno de compulsão alimentar, 32,79% de transtorno de déficit de atenção e hiperatividade, e 19,7% de consumo de álcool. Adição por comida foi associada a todas as comorbidades psiquiátricas, tanto nos modelos brutos como nos modelos ajustados. Entre as morbidades clínicas, os modelos brutos e ajustados mostraram uma associação entre adição por comida e uma maior chance de diabetes, AVC, asma, asma crônica, dores de cabeça, problemas musculares, e refluxo gastroesofágico. Quanto à força da associação, aumentou quando ajustado para problemas crônicos da coluna vertebral e IMC. Como observado em outros países, a adição por comida foi mais frequente nas mulheres e nos indivíduos mais jovens; associou-se à obesidade, também a IMC mais elevado, a comorbidades psiquiátricas e a várias comorbidades clínicas.

Food addiction (FA) is characterized by a loss of control, causing overeating of certain kinds of foods, most often hyperpalatable foods, and failed attempts to overcome the eating problem despite adverse consequences. The current thesis describes the prevalence of FA and associated factors (socioeconomic, demographic, lifestyle, nutritional status, psychiatric and clinical comorbidities) in a representative sample of the city of Rio de Janeiro, Brazil. This is a cross sectional study using data from the Binge Eating in Rio Survey, a household survey that included 2.297 individuals from 18 to 60 years. The participants will provide sociodemographic information, lifestyle, clinical comorbidities, and psychiatrics. The instrument used to evaluate the FA will be the Modified Yale Food Addiction Scale 2.0. The interview was applied face-to face. Data were collected from September 2019 to February 2020. Prevalence and respective 95% confidence intervals (95%CI) were estimated considering the sample weight. In analyses were performed logistic regression models to estimate odd ratios between psychiatric and clinical comorbidities. Models were an adjustment for potential confounder variables, gender, age, and Body Mass Index (BMI). The prevalence of FA according to YFAS 2.0 was 2.78% and, 17.42% was classified as mild, 36.49% as moderate, 46.09% as severe. The prevalence of FA in women was higher than men, 4.08% vs 1.39% (p=0.001), and with a decreasing trend with age (p=0.017). Regarding the BMI, FA was more prevalent among those with a higher BMI 6.76 % (95%CI 4.19 to 10.70) compared those in the normal BMI range 0.69% (9is 5%CI 0.31 to 1.53). Among those who had a FA, the prevalence of psychiatric symptoms was as follows: 75.41% with symptoms of Depression, 77.05% symptoms of Anxiety, 19.7% Binge Eating Disorder, 32.79% Attention Deficit Hyperactivity Disorder symptoms, and 19.7% alcohol use. Food addiction was associated with all psychiatric morbidities in both the crude and adjusted models. Among the clinical morbidities the unadjusted and crude models showed an association between food addiction and an increased chance of diabetes, stroke, asthma, chronic asthma, headaches, muscle problems, and gastroesophageal reflux. Regarding the increase of association, when adjusted for chronic spinal problems and BMI increases the OR values: FA was a prevalent condition in Brazil, more frequent in women and younger individuals, and associated also with higher BMI as observed in studies from high income countries. Furthermore, it shows that they constitute a group with specific characteristics and deserve special attention in this regard. FA was associated with psychiatric comorbidity and several clinical comorbidities in our sample.

The impact of food addiction behaviours on the treatment of overweight students.

The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, ß = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.