Breadth of substance use is associated with the selection of a larger food portion size via elevated impulsivity.

Substance use is associated with altered or elevated food consumption and disordered eating. In the present study we examined whether breadth (variety) of drug use was associated with elevated portion size in a general population sample as it was in persons in recovery from substance use disorder. Furthermore, measures of emotional eating, impulsivity, food misuse, food craving were taken as possible mediators and reward responsiveness was examined as a potential moderator of this association. 444 adults (48.6 % women, mean age of 47.8 years) completed an online study in which they were asked to make judgements of ideal portion size for 6 different foods using a validated online tool that allowed participants to adjust the portion size of images of foods. Ideal portion size has been identified as a strong predictor of actual consumption. Participants were also asked to report the number of substances used in the past and provide anthropometric information. The results confirmed that breadth of drug use was associated with selection of higher portion size. Reward responsiveness was not a moderator of this relationship. Of the tested mediators, only impulsivity mediated the association between breadth of drug use and portion size. The results show that impulsivity may underlie the association between eating and substance use.

Food selection in a buffet scenario by persons in recovery from substance use disorder: Testing a parallel mediation model including impulsivity, food craving, and breadth of drug use.

Elevated food cravings and higher food consumption and body weight have been reported in studies of people in recovery from substance use disorder (SUD). In a previous study, SUD recovery status predicted the energy from selected food images in a virtual buffet meal, most strongly in those with high reward responsiveness. The present study was conducted to determine which psychological variables might mediate the relationship between SUD recovery status and food selection and to replicate the finding that reward responsiveness moderated this relationship. In an online study, 216 women and men (109 in recovery from SUD) were asked to choose from among 16 food images in an all-you-can-eat buffet scenario. Food craving, impulsivity, "food addiction", irrational food beliefs, anhedonia, and breadth of drug use were examined as potential mediators while reward responsiveness was examined as a potential moderator. The amount of energy in the selected foods was the outcome variable. Results indicated that breadth of drug use was a mediator; being in SUD recovery predicted higher variety of drug use which predicted higher food selection. However, reward responsiveness did not moderate the relationship between SUD recovery status and energy from the selected foods. Exploratory analysis indicated that lack of premeditation, a measure of impulsivity, with food craving partially mediated the relationship between breadth of drug use and energy from selected foods and that lack of premeditation fully mediated it for sweet foods. The results confirm an association between substance use and food selection and suggest a mechanism via impulsivity.

The role of irrational beliefs in the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating in two general student samples.

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and negative mood. The purpose of this study was to examine whether irrational beliefs mediate this relationship along with previously reported mediators such as depression and impulsivity. Irrational beliefs trigger negative automatic thoughts which are believed, in cognitive behavior therapies, to be a source of psychopathology. Challenges brought about by symptoms of ADHD may lead to habitual emotion-eliciting thought patterns which, in turn, could lead to negative mood and disordered eating. Undergraduate students (N = 127) completed online questionnaires assessing ADHD symptoms and disordered eating and several potential mediators including irrational beliefs, depression, impulsivity, interoceptive accuracy, and reward responsiveness. The results, which were replicated in a second study (N = 254), indicated that irrational beliefs and depression mediated the relationship between ADHD symptoms and disordered eating. In the second study, impulsivity due to negative urgency was also a mediator. These findings support the theory that the symptoms of ADHD lead to enhancement of irrational beliefs, depression, and negative urgency which are linked to disordered eating.

Adult attachment anxiety is associated with night eating syndrome in UK and US-based samples: Two cross-sectional studies.

Previous research has shown that "attachment anxiety" is a robust predictor of disinhibited eating behaviours and that this relationship is underpinned by difficulties in managing emotion. Night eating syndrome (NES), a proposed eating disorder characterized by evening hyperphagia, nocturnal awakenings to eat, and morning anorexia, is also associated with eating to manage emotion. Across two studies (N = 276 & N = 486), we considered a relationship between attachment anxiety and NES. In Study 1, we hypothesised (pre-registered) that attachment anxiety would predict NES score and that this relationship would be mediated by disinhibited eating. Participants were asked to complete questionnaire measures of attachment orientation, disinhibited eating (emotional and uncontrolled eating) and NES. Our parallel mediation model confirmed a direct relationship between attachment anxiety and NES (p < .001) and showed an indirect path via both emotional (95% CI: 0.15-0.63) and uncontrolled eating (95% CI: 0.001-0.36). In Study 2, we showed that fear of negative evaluation of eating significantly mediated a reversed relationship between attachment anxiety and NES (95% CI: 0.02-0.04). Finally, across both studies we used a novel tool to assess "eating to cope". We showed a relationship with emotional eating but failed to show a robust relationship with NES. Attachment orientation may represent a potential intervention target for night eating syndrome. Future research should consider a longitudinal approach to strengthen our understanding of directionality amongst these factors.

Self-reported emotional eaters consume more food under stress if they experience heightened stress reactivity and emotional relief from stress upon eating.

Group data means from individuals who self-assess as emotional eaters do not reliably show increased food intake in response to stress or negative emotions. This inconsistency in predictive validity of self-reported emotional eating (EE) could be attributable to unconsidered moderation of the relationship between self-reported EE and behavioral measures of EE. Greater emotional relief from stress by eating may provide enhanced negative reinforcement and promote future EE in response to stress as a form of self-medication. Thus, we predicted that greater emotional relief from stress by eating (decrease in negative affect from stress to post-eating) would moderate the extent to which heightened stress reactivity (measured by systolic blood pressure, SBP) moderates the relationship between self-reported EE and food intake post-stress. We also hypothesized that self-reported EE would not predict greater food consumption on the rest day. 43 undergraduate women completed online assessments of eating behaviors. Participants were given snacks to eat after a mental stress task (TSST) or rest period on separate days in counterbalanced order. Our prediction was supported, as the moderated moderation model (PROCESS model 3) was highly significant on the stress day. Self-reported EE predicted increased food intake post-stress only under conditions of high stress reactivity and high emotional relief. On the rest day, self-reported EE predicted greater snack food intake only when SBP was high. This conditional increased intake substantiates stress as a promoter of snack food consumption for women with greater EE. Overall, our findings identified factors that may distinguish the subset of self-reported emotional eaters who are more likely to display EE behaviors in a laboratory setting, yet further studies are needed to directly test whether negative reinforcement via emotional relief from stress by eating drives enhanced EE following stress.

Factor structure of the Night Eating Diagnostic Questionnaire (NEDQ) and an evaluation of the diagnostic criteria of the night eating syndrome.

BACKGROUND: The Night Eating Diagnostic Questionnaire (NEDQ) is a validated assessment of the night eating syndrome (NES) based on the proposed diagnostic criteria. While past results show that NEDQ is associated with psychopathology and body mass index (BMI), the relationships between the proposed NES diagnostic criteria and psychopathology and BMI have not been investigated. Thus, the relationships between the proposed NES diagnostic criteria and factors previously associated with NES, namely depression, "food addiction" (FA), sleep quality, and BMI were examined. Finally, the NEDQ factor structure was examined for the first time in order to determine whether the NEDQ is assessing NES appropriately. METHODS: The NEDQ, depression, sleep quality, and FA questionnaires were administered to a sample of older community members (n = 468) and a student sample (n = 254). Principal Components Analysis (PCA) was performed to examine the factor structure of the NEDQ. The relationships between the proposed diagnostic criteria and depression, sleep quality, FA, and BMI were examined using multiple regression. RESULTS: The proposed NES criteria were highly intercorrelated. PCA revealed a single factor solution for the NEDQ. In the community sample, depression was associated with the presence of five of nine proposed diagnostic criteria while poor sleep quality and FA were associated with the presence of seven and six criteria respectively. In the community sample, only the sleep problems and impairment/distress criteria were positively associated with BMI. In the student sample, fewer criteria were associated with psychopathology, and no criteria were associated with BMI. CONCLUSIONS: These findings support the proposed criteria for diagnosis of NES. All proposed criteria were associated with at least one psychopathology measure. BMI was only associated with the sleep problems and impairment/distress criteria in the community sample. The PCA finding of a single factor indicates that the NEDQ is a cohesive assessment of NES, and that the NEDQ is a good measure of NES criteria.

Food Addiction Is Associated with Irrational Beliefs via Trait Anxiety and Emotional Eating.

Irrational beliefs (IB) are believed, in cognitive behavioral therapies, to be a prime cause of psychopathologies including anxiety, depression, problem eating, and alcohol misuse. "Food addiction" (FA), which has been modeled on diagnostic criteria for substance use disorder, and emotional eating (EE) have both been implicated in the rise in overweight and obesity. Both FA and EE are associated with anxiety. Thus, in the present study, the hypothesis that IB is associated with FA and with EE was tested. Furthermore, possible mediation of these relationships by trait anxiety and depression (and EE for IB and FA) was examined. The responses of 239 adult participants to questionnaires measuring FA, IB, EE, depression, trait anxiety, and anthropometrics were recorded. The results revealed that IB was significantly positively correlated with FA and EE (and depression and trait anxiety). Furthermore, only EE mediated the effect of IB on FA and this was not moderated by BMI. Finally, trait anxiety (but not depression) mediated the effect of IB on EE. Exploratory analysis revealed a significant serial mediation such that IB predicted higher FA via elevated trait anxiety and emotional eating in that order. The results of this study suggest that IB may be a source of the anxiety that is associated with EE and FA and suggest that clinicians may find IB a target for treatment of those persons who report experiences of EE and FA. IB may play a role in food misuse that leads to elevated BMI.

Food selection, food craving, and body mass index in persons in treatment for substance use disorder.

Studies of persons in treatment for substance use disorder (SUD) frequently report significant body weight gain and higher food consumption. It is unclear what psychological variables might mediate a relationship between SUD treatment status and food selection. To examine the association between SUD treatment status and food selection, 212 men and women (104 in treatment for SUD) were asked, in an online survey, to choose from among 16 food images in an imagined all-you-can-eat buffet scenario. Food craving, emotional eating (EE), impulsivity, and drugs used were examined as potential mediators while reward responsiveness (RR) was examined as a potential moderator. The amount of energy from foods selected was the predicted variable. Results indicated that those in treatment for SUD had significantly higher food cravings, positive EE, and attentional and motor impulsivity (but not RR or negative EE) which were (with the exception of RR) not correlated with energy selected from food images. Those in SUD treatment selected more energy (M = 2655.10 kcal, SEM = 156.97) from food images than those in the control group (M = 2221.52 kcal, SEM = 112.29), t(188) = -2.25, p = 0.026. In a multiple regression moderation analysis, SUD treatment status (ß = 419.58, p = 0.029) and RR (ß = 39.23, p = 0.016) were significant predictors of energy from foods selected. The amount of energy selected from food images predicted by SUD treatment status was dependent on values of RR. Mean BMI was not significantly higher for the SUD group but there were more participants with BMI values over 29 and fewer with BMI between 25 and 29 in the SUD treatment group. While the cause remains unclear, the results show that persons in treatment for SUD and with higher RR do select more energy from food images in a meal scenario.

Self-perceived food addiction: Prevalence, predictors, and prognosis.

Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived "food addiction" and its relationship to a diagnostic measure of "clinical food addiction" in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived "food addiction" was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with "non-addicts", although individuals who also received a positive "diagnosis" on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive "diagnosis" on the Yale Food Addiction Scale. Self-perceived "food addiction" was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a "food addict" may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.

Is it time to consider the "food use disorder?"

In the contemporary milieu, the term "addiction" brings to mind issues of physical dependence, uncontrolled behavior, psychoactive substances, and disease. Thus, the use of the term "food addiction" which has become common in research on binge eating and obesity, suggests a disease state characterized by craving, compulsive eating and, possibly, the presence of food constituents with drug-like properties which weaken the will power to abstain from consumption. In this commentary, the case is made that, following the trends in substance use disorder terminology, adoption of "food use disorder" as a term for compulsive eating associated with subjective loss of control may foster continued research in this area without the connotations suggested by "food addiction."

Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its relationship with depression, sleep quality, "food addiction", and body mass index.

Night eating syndrome (NES) is commonly assessed using the Night Eating Questionnaire (NEQ), a validated scale of symptom severity, which does not assess all diagnostic criteria. The Night Eating Diagnostic Questionnaire (NEDQ) assesses all diagnostic criteria, but has not been fully validated. The study purpose was to establish convergent validity for the NEDQ with the NEQ. It was also expected that higher NEDQ scores would be associated with elevated depression, poorer sleep quality, "food addiction," and BMI as in other studies of NES. Students (n = 254) and community members (n = 468) were administered the NEQ, NEDQ, Pittsburgh Sleep Quality Index, Zung Self-report Depression Scale (SDS), and the Yale Food Addiction Scale (YFAS). Convergent validity between the NEDQ and the NEQ was demonstrated; the scores were significantly positively correlated. There was good agreement between the NEDQ and the NEQ in diagnosis of NES; 56% of those diagnosed by the NEDQ met the threshold score on the NEQ, while the other 44% did not. Only 5 participants out of 33 who met the NEQ threshold score for NES did not meet the NEDQ diagnostic criteria. MANOVA revealed that higher NEDQ was associated with higher SDS and YFAS scores and poorer sleep quality. Full-syndrome NES by the NEDQ was associated with higher BMI in the community group unlike the student group. Scores on all the other questionnaires were higher in the community group. The discrepancies between NEDQ and NEQ diagnosis may be due to differences in construction of the questionnaires and specifically due to the NEDQ being designed for diagnosis. The NEQ provides a convenient global score for NES severity, whereas the NEDQ, which shows convergent validity with the NEQ, provides clinically useful diagnostic categories.

"Food addiction" is associated with night eating severity.

Night eating syndrome (NES) and "food addiction" (FA) are associated with elevated body mass index (BMI) and disturbed eating behavior. The present study was conducted to examine whether NES is associated with FA, and whether BMI, depression and sleep quality contribute to any relationship between NES and FA. Two groups were studied: a sample of 254 university students and a sample of 244 older adults. All completed the Yale Food Addiction Scale (YFAS), the Night Eating Questionnaire (NEQ), the Zung Self-report Depression Scale, and the Pittsburgh Sleep Quality Index, and BMI was computed from height and weight. In both samples, higher global NEQ scores were significantly correlated with more FA symptoms, elevated depression, and poorer sleep quality, and these correlations were significantly higher in the older adult sample than in the younger student sample. Higher BMI was significantly correlated with NEQ score only in the older adult sample. The hypothesis that the prediction of NEQ by YFAS was moderated by BMI and group membership (moderated moderation) was tested; while the prediction of NEQ by YFAS was not moderated by BMI, elevated YFAS predicted higher NEQ in the adult sample than it did in the student sample. In addition, multiple regression revealed that "continued use of food despite adverse effects" was the sole FA symptom predictive of NES symptoms in students while in older adults food tolerance was the only predictor of NES. Thus, NES appears to be associated with FA, more strongly in an older community sample; higher food tolerance in NES may contribute to a desire to eat late in the evening and/or when awakening at night.

Paved with good intentions: Paradoxical eating responses to weight stigma.

Because body weight is largely seen as controllable, weight stigma-the social devaluation of those who are overweight-is not subject to the social norms that condemn open expression of racism and sexism. Indeed, rejection of peers based on perceptions of excess weight is normative. Since weight stigma is internalized, popular views (and often the views of physicians) have suggested that increasing the salience of weight stigma might produce a reduction in overeating and/or an increase in physical activity. However, that perspective is not rooted in scientific evidence. Recent randomized controlled designs demonstrate that stigma may promote overeating. Correlational evidence suggests that self-reported stigma experience is associated with risk for binge eating and decreased interest in physical exercise and dieting, for children and adults. In addition to reviewing these research studies, this paper examines the potential for intersectionality of stigma across multiple social identities and considers alternatives to stigmatizing weight loss interventions.

Alcohol, Appetite and Loss of Restraint.

Alcoholic beverages have long been associated with feasts, celebration and marking special events. Today, it is commonplace to consume alcoholic beverages before, with and/or after a meal. Alcohol provides additional pleasure to the meal and enhances appetite. However, consuming an alcoholic beverage with or before a meal is associated with poor short-term energy compensation; energy from alcohol is additive to total energy intake with the added property of stimulating further eating. Limiting alcohol intake is an obvious means to reduce total energy intake for those who wish to lose weight. However, dieters and restrained eaters drink more and report greater binge drinking than unrestrained eaters despite employing cognitive strategies to reduce their intake. Increased intake may be attributable to greater attentional bias to alcohol related cues as well as to food cues, since these are more salient to those limiting intake. Alcohol increases energy intake in dieters, in part due to abandonment of restraint (disinhibition) and consumption of forbidden items including alcohol exacerbates attempts to resist temptation. Paradoxically, links between binge drinking or increased drinking frequency to overweight and obesity may be mediated by dietary restraint. Efforts to limit food and alcohol intake for weight control appear to be unsuccessful and have the net effect of promoting overconsumption. The potential role of restrained eating in the association between alcohol, appetite and obesity has been overlooked by much of the current research and further investigation of this is therefore warranted.

The role of emotional eating and stress in the influence of short sleep on food consumption.

Short sleep duration is associated with elevated body mass index (BMI) and increased energy consumption. The present studies were conducted to determine what role emotional eating and stress might play in these relationships. The first was an exploratory questionnaire study in which sleep quality and duration were measured in conjunction with the Dutch Eating Behavior Questionnaire in 184 women. Emotional and external eating scores were significantly higher in those who reported poor sleep quality (but were not related to sleep duration). In a second study of 64 women who were provided with snacks in the laboratory under stressed and control conditions, elevated food consumption was observed in those who scored high on emotional eating and who reported short sleep (a significant stress × emotional eating × sleep duration interaction) but not in those who reported poor sleep quality. No effects were found in liking or wanting of food and few effects were found on appetite. BMI was not related to sleep duration or sleep quality in either study. The results suggest that the relationship between short sleep and elevated food consumption exists in those who are prone to emotional eating. An external stressor elevated consumption in normal sleepers to the level observed in short sleepers, however, it did not significantly elevate consumption in short sleepers. Future examinations of the effects of sleep duration and quality on food consumption should examine emotional eating status.

Night eating is associated with emotional and external eating in college students.

The night eating syndrome (NES) consists of evening hyperphagia and/or nocturnal eating and has been associated with depressed mood that worsens in the evening. However, it is not consistently related to elevated BMI. The present study was conducted to examine whether a relationship exists between NES and emotional, external, and restrained eating. BMI and sleep quality were also obtained. A sample of 246 students completed the Night Eating Diagnostic Questionnaire (NEDQ), Night Eating Syndrome History and Inventory (NESHI), Sleep Quality Index (SQI), and Dutch Eating Behavior Questionnaire (DEBQ), containing subscales for emotional, external, and restrained eating. They also provided demographic information, including height and weight. Participants were grouped by severity of NES features using the NEDQ and NESHI: normal, mild night eater, moderate night eater, and full night eater syndrome. MANOVA was used to compare DEBQ subscores for the groups; those in the full syndrome category had significantly higher emotional eating scores and external eating scores than those in the normal and mild categories. There was no difference in restrained eating between the normal and full syndrome groups. Those with moderate and full syndrome NES symptoms also reported significantly lower sleep quality. No significant relationship was found between NES and BMI. The results show that NES is associated with more eating in response to negative mood and in response to food cues.

Drug use is associated with elevated food consumption in college students.

Higher food consumption, particularly of sweets, has been reported by substance-dependent persons in various stages of treatment but no investigation of substance use and actual food consumption has been conducted in non-dependent persons. Sixty-two male and female college students completed the Core Alcohol and Drug Survey and the amount of each of six snack foods (including both sweet and savory items) they consumed were measured. Participants also rated appetite before and after eating and rated the pleasantness of and desire to eat each food. Hierarchical multivariate regression revealed that, while controlling for the influence of BMI and intermeal interval, frequency and breadth of substance use significantly predicted elevated food consumption and elevated ratings of hunger and desire to eat. Furthermore, the link between breadth of drug use and food consumption was mediated by higher desire to eat and not by pleasantness of the food. The relationship between substance use and eating behavior may not be restricted only to those in recovery or treatment for persons diagnosed with substance use disorders.

Emotional Appetite Questionnaire. Construct validity and relationship with BMI.

The Emotional Appetite Questionnaire (EMAQ) comprises ratings of tendency to eat in response to both positive and negative, emotions and situations. To assess construct validity, the responses of 232 male and female participants to the EMAQ subscales were correlated with the subscales of the Dutch Eating Behavior Questionnaire (DEBQ), which has been extensively validated. In addition, the EMAQ scores were correlated with BMI. Convergent validity was demonstrated by a significant positive correlation between the negative emotions and situations scores of the EMAQ and the emotional eating subscale score of the DEBQ (DEBQ-E). Moreover, discriminant validity was demonstrated by low correlations of EMAQ positive emotions and situations scores with the DEBQ-E score. For the study sample, the EMAQ negative scores were significantly positively correlated with BMI, and the EMAQ positive scores were significantly inversely correlated with BMI. As BMI increased so did reported negative emotional and situational eating whereas as BMI decreased, reported positive emotional and situational eating increased. Although causality cannot be inferred from correlations, eating more under negative emotions may contribute to being overweight whereas eating less may contribute to being underweight. The EMAQ was shown to have construct validity, and emotional eating was significantly correlated with BMI.