Development and validation of the modified Yale Food Addiction Scale for Children 2.0.

OBJECTIVE: Scientific interest in the concept of food addiction is growing, but more studies are needed in youth samples. Brief, psychometrically valid, and developmentally appropriate measures are needed to support the assessment of food addiction in large-scale studies of youth that need to minimize participant burden. While a brief version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) exists for adults, no comparable scale exists for youth. Thus, the current study aimed to develop a brief and valid measure of food addiction for use in youth populations (the modified YFAS for children 2.0). METHOD: Data stem from the Food Addiction Denmark (FADK) Project, where random samples of 559 adolescents from the general population and 413 adolescents from a population with mental disorder completed the 35-item original YFAS for children 2.0 (YFAS-C 2.0). An abbreviated 13-item version was developed, and the psychometric properties of the modified YFAS-C 2.0 (mYFAS-C 2.0) were then evaluated. RESULTS: The mYFAS-C 2.0 exhibited a one-factor structure and was found to have sound psychometric properties regarding internal consistency and convergent, discriminant, and incremental validity. This was evident in both the general adolescent population sample and the sample of adolescents with mental disorders. CONCLUSIONS: The mYFAS-C 2.0 provides a brief and psychometrically valid measure of food addiction for youth, which may be beneficial for study designs (e.g., epidemiological samples) that aim to minimize participant burden. Future research on the test-retest reliability of the mYFAS-C 2.0 and its psychometric properties in younger children are important next steps.

Food addiction is strongly associated with type 2 diabetes.

BACKGROUND & AIMS: Individuals can develop an addiction-like attraction towards highly processed foods, which has led to the conceptualization of food addiction, a phenotype linked to obesity. In this study, we investigated whether food addiction is associated with type 2 diabetes (T2D). METHODS: 1699 adults from the general population and 1394 adults from a population with clinically verified mental disorder completed a cross-sectional survey including the Yale Food Addiction Scale 2.0. Logistic regression was employed to examine the association between food addiction and T2D, the latter operationalized via Danish registers. RESULTS: Food addiction was strongly associated with T2D in the general population (adjusted odds ratio (AOR) = 6.7) and among individuals with mental disorder (AOR = 2.4) in a dose-response-like manner. CONCLUSION: This is the first study to demonstrate a positive association between food addiction and T2D in a general population sample. Food addiction may be a promising target for prevention of T2D.

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.

Food addiction comorbid to mental disorders in adolescents: a nationwide survey and register-based study.

PURPOSE: Adolescence is a high-risk period for development of addictive behavior. This may also apply to addiction-like eating of highly processed foods-commonly referred to as "food addiction". Adolescents with mental disorder may be at particularly elevated risk of developing food addiction as addiction often accompanies mental disorder. However, there are only few studies in adolescents investigating this potential comorbidity. Therefore, the primary aim of this study was to examine the food addiction symptom load, as measured by the dimensional Yale Food Addiction Scale for Children-version 2.0 (dYFAS-C 2.0), among adolescents with a clinically verified mental disorder. METHOD: A total of 3529 adolescents aged 13-17 were drawn from the Danish Psychiatric Central Research Register, stratified on six major diagnostic categories of mental disorders; psychotic disorders, affective disorders, anxiety disorders, eating disorders, autism spectrum disorders, and attention deficit disorders. Via their parents, these adolescents were invited to participate in a web-based survey. Data on health and socioeconomic factors from the Danish registers were linked to both respondents and non-respondents, allowing for thorough attrition analysis and estimation of weighted dYFAS-C 2.0 scores. RESULTS: A total of 423 adolescents participated in the survey (response rate 12.0%). The mean weighted dYFAS-C 2.0 total score was 13.9 (95% CI 12.6; 14.9) for the entire sample and varied substantially across the diagnostic categories being highest for those with psychotic disorder, mean 18.4 (95% CI 14.6; 14.9), and affective disorders, mean 19.4. (95% CI 16.3; 22.5). Furthermore, the dYFAS-C 2.0 total score was positively correlated with body mass index (BMI) (r = 0.33, p < 0.05). CONCLUSION: Food addiction symptomatology seems to be prevalent among adolescents with mental disorder, particularly affective and psychotic disorders. As obesity is a tremendous problem in individuals with mental disorder further investigation of food addiction in young people with mental disorder is called for. This could potentially aid in the identification of potential transdiagnostic targets for prevention and treatment of obesity in this group. LEVEL OF EVIDENCE: Level IV, Observational cross-sectional descriptive study combined with retrospective register data.

Validation of the dimensional Yale Food Addiction Scale for Children 2.0 and estimation of the weighted food addiction score in a sample of adolescents from the general population.

PURPOSE: Obesity among adolescents is becoming increasingly prevalent and "food addiction" (addiction-like attraction to foods with high content of fat and refined carbohydrates) may be a potential contributor to this development. This study aimed to investigate the psychometric properties of the dimensional Yale Food Addiction Scale for Children version 2.0 (dYFAS-C 2.0) and to estimate the weighted mean score on the dYFAS-C 2.0 (as a measure of food addiction symptom load) among adolescents from the general Danish population. METHODS: A total of 3,750 adolescents aged 13-17 were randomly drawn from the general Danish population and invited to participate in a web-based survey. Data on health and socioeconomic factors from the Danish registers were linked to both respondents and non-respondents, which allowed for analysis of attrition. The total- and sex-stratified weighted mean dYFAS-C 2.0 scores were estimated using augmented inverse probability weighted estimation. RESULTS: A total of n = 576 (15.4%) adolescents participated in survey of whom 55.6% were female. The confirmatory factor analysis of the dYFAS-C 2.0 supported a one-factor model. The dYFAS-C 2.0 total score was associated with eating pathology, BMI z-scores, and ADHD symptomatology. The weighted mean dYFAS-C 2.0 score was 12.1 (95% CI: 11.2;12.9), 15.0 (95% CI: 13.9;16.2) for females and 9.5 (95% CI: 8.3;10.6) for males. CONCLUSIONS: The dYFAS-C 2.0 appears to be a psychometrically valid tool to assess symptoms of food addiction among adolescents. Food addiction symptom severity correlated positively with eating pathology (including restrained eating), BMI z-scores, and ADHD symptomatology. Level IV, observational cross-sectional descriptive study combined with retrospective register data.

Food addiction comorbid to mental disorders: A nationwide survey and register-based study.

OBJECTIVE: Substance use disorder is highly prevalent among individuals with mental disorders. However, it remains largely unknown whether this is also the case for "food addiction"-a phenotype characterized by an addiction-like attraction to predominantly highly processed foods with a high content of refined carbohydrates and fat. Therefore, the primary aim of this study was to estimate the weighted prevalence of food addiction among individuals with mental disorders. METHOD: A total of 5,000 individuals aged 18-62 were randomly drawn from eight categories of major mental disorders from the Danish Psychiatric Central Research Register and invited to participate in an online questionnaire-based survey, which included the Yale Food Addiction Scale 2.0. Data on health care and sociodemographics from the Danish registers were linked to all invitees-enabling comprehensive attrition analysis and calculation of the weighted prevalence of food addiction. RESULTS: A total of 1,394 (27.9%) invitees participated in the survey. Across all diagnostic categories, 23.7% met the criteria for food addiction. The weighted prevalence of food addiction was highest among individuals with eating disorders (47.7%, 95%CI: 41.2-54.2), followed by affective disorders (29.4%, 95%CI: 22.9-36.0) and personality disorders (29.0%, 95%CI: 22.2-35.9). When stratifying on sex, the prevalence of food addiction was higher among women in most diagnostic categories. DISCUSSION: Food addiction is highly prevalent among individuals with mental disorders, especially in those with eating disorders, affective disorders and personality disorders. Food addiction may be an important target for efforts aimed at reducing obesity among individuals with mental disorders.

Validation of the Yale Food Addiction Scale 2.0 and estimation of the population prevalence of food addiction.

BACKGROUND & AIMS: Food addiction (FA) is likely to contribute to the global obesity epidemic. Most studies of FA have been conducted within clinical and/or highly selected populations, suggesting that prevalence estimates of FA may be biased. This is problematic as valid estimates of the population prevalence of FA is a requirement for informing and designing public health initiatives focusing on this phenotype. Therefore, we aimed to estimate the weighted prevalence of food addiction in the adult general population of Denmark. METHODS: A random sample of 5000 individuals aged 18 to 62 from the Danish population was invited to participate in a survey, which included the Yale Food Addiction Scale (YFAS 2.0) and several rating scales measuring eating pathology and other psychopathology. Health, demographic and socioeconomic data from the Danish registers were linked to all invitees to allow for attrition analysis. The analysis had three steps: I) Psychometric validation of the Danish version of YFAS 2.0 II) Attrition analysis to examine selection bias, and III) Estimation of the weighted prevalence of FA taking attrition into account. RESULTS: The confirmatory factor analysis of the YFAS 2.0 supported a one-factor model, and the scale had good internal consistency. The YFAS 2.0 score correlated with eating pathology including binge eating frequency, impulsivity and body mass index (BMI). The survey response rate was 34.0% (n = 1699) with a slight overrepresentation of respondents with higher socioeconomic status. The crude prevalence of FA was 9.0%. When taking attrition into account, the weighted prevalence of FA was 9.4% CI 95% [7.9-10.9]. CONCLUSIONS: The psychometric properties of the Danish version of the YFAS 2.0 were good. The weighted prevalence of FA was very similar to the crude prevalence estimate. This suggests that attrition may not be a large problem when estimating the prevalence of FA with the YFAS 2.0.

The Food Addiction Denmark (FADK) Project: a combined survey and register-based study.

BACKGROUND: Obesity represents a tremendous global health problem. Studies over the past decade have suggested that food addiction (FA), that is, physical cravings for certain foods - high in fat/sugar - and addiction-like overeating of these types of food, is a likely contributor to the obesity epidemic. While FA has been studied extensively, there are some significant gaps in the literature that need to be addressed: (I) Most estimates of the prevalence of FA are based on nonprobability sampling, which significantly limits the representativeness of the prevalence estimates. (II) Although addiction disorders are prevalent among individuals with mental disorders, large studies of FA among patients with clinically diagnosed mental disorders are lacking. (III) Most addiction disorders are heritable, but the familial transmission of FA remains virtually unknown. (IV) Due to a relative lack of longitudinal studies, little is known about the risk factors for and outcomes of FA. To close these gaps in the literature, we designed the Food Addiction Denmark (FADK) Project. METHODS: The FADK study is a nationwide survey with retrospective and prospective register-based elements. Four randomly sampled cohorts were invited to participate in the survey: 5000 adults and 3750 adolescents from the general population and 5000 adults and 3529 adolescents with a mental disorder. The FADK questionnaire includes the Yale Food Addiction Scale 2.0 and rating scales measuring psychopathology. Data from Danish health and socio-economic registers will be linked to all invitees. DISCUSSION: We expect that the FADK Project will contribute significantly to our understanding of FA.