The role of pituitary adenylate cyclase-activating polypeptide neurons in the hypothalamic ventromedial nucleus and the cognate PAC1 receptor in the regulation of hedonic feeding.

Obesity is a health malady that affects mental, physical, and social health. Pathology includes chronic imbalance between energy intake and expenditure, likely facilitated by dysregulation of the mesolimbic dopamine (DA) pathway. We explored the role of pituitary adenylate cyclase-activating polypeptide (PACAP) neurons in the hypothalamic ventromedial nucleus (VMN) and the PACAP-selective (PAC1) receptor in regulating hedonic feeding. We hypothesized that VMN PACAP neurons would inhibit reward-encoding mesolimbic (A10) dopamine neurons via PAC1 receptor activation and thereby suppress impulsive consumption brought on by intermittent exposure to highly palatable food. Visualized whole-cell patch clamp recordings coupled with in vivo behavioral experiments were utilized in wildtype, PACAP-cre, TH-cre, and TH-cre/PAC1 receptor-floxed mice. We found that bath application of PACAP directly inhibited preidentified A10 dopamine neurons in the ventral tegmental area (VTA) from TH-cre mice. This inhibitory action was abrogated by the selective knockdown of the PAC1 receptor in A10 dopamine neurons. PACAP delivered directly into the VTA decreases binge feeding accompanied by reduced meal size and duration in TH-cre mice. These effects are negated by PAC1 receptor knockdown in A10 dopamine neurons. Additionally, apoptotic ablation of VMN PACAP neurons increased binge consumption in both lean and obese, male and female PACAP-cre mice relative to wildtype controls. These findings demonstrate that VMN PACAP neurons blunt impulsive, binge feeding behavior by activating PAC1 receptors to inhibit A10 dopamine neurons. As such, they impart impactful insight into potential treatment strategies for conditions such as obesity and food addiction.

Addiction to ultra-processed foods as a mediator between psychological stress and emotional eating during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic induced psychological distress, which is linked to emotional eating and symptoms of addiction to ultra-processed foods (UPFs). OBJECTIVE: This study aimed to investigate whether symptoms of addiction to UPFs mediate the relationship between psychological stress due to the COVID-19 pandemic and emotional eating behaviour. METHODS: A cross-sectional online study was conducted from May to November 2021 among 368 undergraduate Brazilian students. The participants answered demographic questions and completed validated scales, including the Coronavirus Stress Measure, Modified Yale Food Addiction Scale 2.0 and Emotional Eating Questionnaire. Mediation analysis was employed to examine the hypothesised relationships. RESULTS: The results revealed a significant indirect effect, indicating that symptoms of food addiction mediated the association between perceived stress during the COVID-19 pandemic and emotional eating behaviour. Specifically, 61% of the influence of perceived stress on emotional eating during the pandemic was explained by symptoms of UPF addiction. CONCLUSION: These findings suggest that addressing symptoms of UPF addiction could be pivotal in public health strategies aimed at promoting healthy eating habits among distressed undergraduate students in the post-COVID-19 era.

Reliability and validity of the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) in a sample of individuals with depressive disorders.

BACKGROUND: Food addiction (FA) is strongly associated with depressive symptoms. The reliability and validity of the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) were not previously determined in clinical samples in Brazil. This study aimed to assess the psychometric properties of the Brazilian version of the mYFAS 2.0 in adult individuals with depressive disorders. METHODS: The data stems from a survey investigating FA in a convenience sample of subjects diagnosed with a depressive disorder. Participants answered mYFAS 2.0 and scales for binge eating, depressive and anxiety symptoms, and alcohol and nicotine use. Height and weight were measured to calculate the Body Mass Index (BMI). We evaluated the factor structure, reliability, convergent, discriminant, criterion, and incremental validity. RESULTS: The sample encompassed 303 participants with a mean age of 37.03 ± 11.72 years, 84.16% of whom were women. The Cronbach's alpha for the mYFAS 2.0 was satisfactory (alpha = 0.915). The best goodness-of-fit model was a single factor, and mYFAS 2.0 showed convergent validity with binge eating and discriminant validity with the alcohol and nicotine use measures. Food addiction presented a weak positive correlation with depressive and anxiety symptoms and BMI. Three food addiction symptoms provided the best balance between sensitivity (80.95%) and specificity (74.81%). Incremental validity over binge eating symptoms was confirmed (t = 4.040, ß = 0.681, p < 0.001). CONCLUSIONS: The Brazilian mYFAS 2.0 performed satisfactorily in this clinical sample of participants with a depressive disorder. These findings suggest it may be a brief, useful, and valid food addiction screening tool for this group.

Food addiction is a dysfunctional consumption of energetically dense, hyper-palatable, and ultra-processed foods that may lead to addictive behaviors. It is associated with mental disorders such as eating, mood, and anxiety disorders, which negatively impact the quality of life for individuals affected. Therefore, healthcare providers need to assess food addiction. The Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a brief instrument consisting of 13 questions developed to assess FA. Although it was previously adapted for Brazilian Portuguese in a non-clinical sample, this is the first study in Brazil to investigate this tool in a psychiatric sample. The main aim of our study was to evaluate the psychometric properties of the Brazilian version of the mYFAS 2.0 in individuals with a Depressive Disorder. The results suggested that mYFAS 2.0 had satisfactory psychometric properties in this sample, and it may be a brief, useful, and valid scale to screen food addiction in individuals with depressive states.

Validity of the Addiction-like Eating Behavior Scale among Patients with Compulsive Eating.

Food addiction (FA) and binge eating disorder (BED) co-occur and share compulsive eating symptoms. When using an FA measure, it is important to evaluate its performance in a population presenting compulsive eating. The study aims to validate the Addiction-like Eating Behavior Scale (AEBS) among a clinical sample characterized by compulsive eating and overweight/obesity and to evaluate its incremental validity over the Yale Food Addiction Scale 2.0 (YFAS). Patients seeking help for compulsive eating (n = 220), between January 2020 and July 2023, completed online questionnaires, including FA, compulsive eating, and BMI evaluations. The factor structure, internal consistency, and convergent, divergent, and incremental validity were tested. The sample had a mean age of 44.4 years old (SD = 12.7) and a mean BMI of 38.2 (SD = 8.0). The two-factor structure provided a good fit for the data, with factor loadings from 0.55 to 0.82 (except for item 15) and the internal consistency was high (ω = 0.84-0.89). The AEBS was positively correlated with the YFAS (r = 0.66), binge eating (r = 0.67), grazing (r = 0.47), craving (r = 0.74), and BMI (r = 0.26), and negatively correlated with dietary restraint (r = -0.37), supporting good convergent and divergent validity. For each measure of compulsive eating, linear regression showed that the AEBS "appetite drive" subscale had a unique contribution over the YFAS. This study provided evidence that the AEBS is a valid measure among a clinical sample of patients with compulsive eating and overweight/obesity. However, questions remain as to whether the AEBS is a measure of FA or compulsive eating.

Caffeine consumption of medical students in Korea: amount and symptoms based on a 2023 survey.

PURPOSE: To investigate the form and level of daily caffeine intake recommended above 400 mg in medical students expected to consume caffeinated beverages to enhance their performance. METHODS: From May to June 2023, freshman through senior medical students at a medical school in Korea were administered a seven-item questionnaire designed to measure the amount of caffeine-containing foods consumed, the weekly interval between consumption, the reason for consumption, and the level of caffeine-induced symptoms experienced. RESULTS: Out of 443 students, 361 responded (81.5%). The most commonly consumed caffeine beverages were coffee (79.2%), followed by soda (33.2%), tea (27.4%), chocolate (25.2%), and energy drinks (20.5%). The estimated (average±standard deviation) daily intake was estimated to 274.6±276.5 mg, and they consumed caffeine on an average of 4.25±2.26 days per week. Students who consumed 400 mg or more of caffeine daily consumed 19.9%. The primary motivation for caffeine intake was "to improve academic performance" (60.9%) and "preferred food" (51.8%). Among the responders, 98% of them replied they had symptoms that could be caused by caffeine, in order of palpitations (47.4%), frequent urination (42.9%), anxiety (27.1%), indigestion (17.5%), and excitement (17.5%). A total of 45.7% reported two symptoms, and 24.7% reported three or more. CONCLUSION: Caffeinated beverage consumption was routine among current medical students, with 20% consuming more than the recommended daily amount. Most students experienced at least one caffeine-induced symptom, with two symptoms in half, suggesting the need for policy measures and warnings about caffeine-containing foods.

Predictive factors of weight loss in obese patients referred to an obesity specialized centre.

INTRODUCTION AND AIMS: In obese patients, long-term weight loss maintenance remains challenging. Identifying factors predicting adhesion to lifestyle therapy and weight loss would help optimizing obesity management. AIMS: to identify predictive factors of weight loss after one year of medical therapy in obese patients (primary) and predictive factors of drop-out during the year of therapy (secondary). METHODS: In this retrospective study, obese patients consulting for the first time in an obesity specialized center were included. All patients fulfilled the criteria for obesity surgery and were managed to change their lifestyle by following a 1-year therapeutical education program based on intuitive eating. Significant weight loss was defined by ≥ 5 % after 1 year. Patients were considered as dropouts, i.e. absence of adhesion to therapy, once they missed one consultation without informing the unit. Stepwise multivariable analyses determined the predictive factors. RESULTS: Of the 310 patients (mean age, 44.5 ± 11.9 yr, 79% women) included, 155 (50%) maintained their follow-up at 1 year and 37 (24%) experienced weight loss ≥5%. Male gender (odds ratio (OR) = 6.25 [95% confidence interval, 1.78; 21.92], P = 0.004), ≥5 consultations with intuitive eating (OR = 3.69 [1.14; 11.87], P = 0.03), and tobacco addiction (OR = 0.18 [0.04; 0.82], P = 0.03) were associated to weight loss ≥5%. Older age (OR = 0.97 [0.95; 0.99], P = 0.014), physical activity (OR = 0.11 [0.05; 0.24], P < 0.0001) and the patient desire for obesity surgery (OR = 0.22 [0.12; 0.41], P < 0.0001) were associated with a better adhesion to therapy. CONCLUSION: The identified predictive factors would help identifying the patients with the greater chance of losing weight and adhering to therapy. Offering more therapeutic education sessions should increase therapy success in obese patients fulfilling the criteria for obesity surgery.

Clinical Relevance of Food Addiction in Higher Weight Patients across the Binge Eating Spectrum.

Food addiction (FA) is associated with greater severity on many eating-related correlates when comorbid with binge eating disorder (BED) but no study has established this relation across the whole spectrum of binge eating, i.e., from no BED to subthreshold BED to BED diagnosis. This study aims to examine the effect of the presence of FA on the severity of eating behaviors and psychological correlates in patients without BED, subthreshold BED or BED diagnosis. Participants (n = 223) were recruited at a university center specialized in obesity and eating disorder treatment and completed a semi-structured diagnostic interview and questionnaires measuring eating behaviors, emotional regulation, impulsivity, childhood interpersonal trauma, and personality traits. They were categorized by the presence of an eating disorder (no BED, subthreshold BED, or BED) and the presence of FA. Group comparisons showed that, in patients with BED, those with FA demonstrated higher disinhibition (t(79) = -2.19, p = 0.032) and more maladaptive emotional regulation strategies (t(43) = -2.37, p = 0.022) than participants without FA. In patients with subthreshold BED, those with FA demonstrated higher susceptibility to hunger (t(68) = -2.55, p = 0.013) and less cooperativeness (t(68) = 2.60, p = 0.012). In patients without BED, those with FA demonstrated higher disinhibition (t(70) = -3.15, p = 0.002), more maladaptive emotional regulation strategies (t(53) = -2.54, p = 0.014), more interpersonal trauma (t(69) = -2.41, p = 0.019), and less self-directedness (t(70) = 2.14, p = 0.036). We argue that the assessment of FA provides relevant information to complement eating disorder diagnoses. FA identifies a subgroup of patients showing higher severity on many eating-related correlates along the binge eating spectrum. It also allows targeting of patients without a formal eating disorder diagnosis who would still benefit from professional help.

Does how individuals handle social situations exacerbate the relationship between physique anxiety and food addiction? The role of emotional expressive suppression and social avoidance and distress.

Background: Research on food addiction has increased significantly in recent years. It has been demonstrated that food addiction can lead to impairments in physiological, psychological, and social functioning in individuals. However, there is a lack of studies investigating the influence of how individuals handle social situations on food addiction and the specific mechanisms involved. Method: A cross-sectional survey was conducted with 1,151 university students, with a mean age of 21.44 (SD = 4.77) years. The sample comprised 74.46% female and 25.54% male students. Participants completed the Chinese version of the modified Yale Food Addiction Scale 2.0, the Social Physique Anxiety Scale, the Expressive Suppression Scale, and the Social Avoidance and Distress Scale. Statistical analyses were performed using SPSS 26.0 and the Process (Version 3.4) plug-in. Result: The results of the study supported our hypothesis that the association between social physique anxiety and food addiction symptoms could be partially explained by expressive suppression and social avoidance and distress. This association remained significant even after adjusting for covariates such as gender, number of cigarettes smoked per day, bedtime, education, and BMI. Specifically, more severe social physique anxiety was found to be associated with frequent use of expressive suppression and social avoidance and distress, which in turn was associated with more severe food addiction symptoms. Conclusion: This study explored the role of expression suppression and social avoidance and distress in the relationship between social physique anxiety and food addiction symptoms. The findings provide a theoretical basis for developing interventions for food addiction in college students. These interventions could include helping students develop a healthy perception of body image, encouraging emotional expression, and promoting active social participation to reduce food addiction symptoms.

The potential effect of α7 nicotinic receptors modulation on palatable food-induced dependence-like behaviors.

Background: The recent global increase in obesity rates, coupled with excessive palatable food (PF) consumption, has become a serious societal concern. Literature indicates that rewarding PF, especially upon cessation, can lead to overeating, binge eating, and compulsive eating, potentially resulting in obesity. Challenges in dietary paradigms, alongside limitations in approved treatments for eating disorders and anti-obesity medications, underscore the need to explore novel targets. In this context, α7nAChR (alpha-7 nicotinic acetylcholine receptor) may serve as a promising therapeutic target in combating food dependence and obesity. The present study aims to assess the role of α7nAChR in palatable food-induced dependence-like behaviors. Method: The study involved male C57BL/6J mice exposed to three different feeding paradigms over 6 weeks to induce obesity and food addiction. On day 43, palatable food was replaced with standard chow, and the mice received treatments (vehicle, PNU-282987 [α7nAChR agonist], or methyllycaconitine citrate [MLA; α7nAChR antagonist]). Addiction-like behaviors, including craving for palatable food, motivation-effort interaction tests, and compulsive eating-like behavior, were measured during abstinence with and without treatment. Results: The present study shows that chronic intermittent and continuous exposure to palatable food induces craving, motivation, and effort interaction behaviors as well as compulsive eating-like behaviors in palatable food-abstinent mice. Administration of the α7nAChR agonist, PNU-282987, significantly attenuated the craving behavior only in mice continuously fed palatable food (reduced calorie intake from 63.19 % to 48.21 %; p = 0.0053). Also, PNU-282987 suppressed the effort behaviors in either intermittently or continuously fed mice (significant reduction in the Δ number of active events per minute; p-values = 0.038 and 0.0098, respectively). However, it attenuated the compulsive-like eating behavior exclusively in the continuously fed group (p = 0.0433). Active and total interaction efforts were reversed by the MLA. These findings indicate the involvement of α7nAChR in dependence-like behaviors toward palatable food in mice. Conclusion: Our findings demonstrate that dependence-like behaviors toward palatable food can emerge after prolonged exposure. Mice fed on palatable food continuously exhibited more dependence-like behaviors toward palatable food, and activation of α7nAChR signaling attenuated the vulnerability to develop such behaviors.

Effects of Probiotic Supplementation Added to a Weight Loss Program on Anthropometric Measures, Body Composition, Eating Behavior, and Related Hormone Levels in Patients with Food Addiction and Weight Regain After Bariatric Surgery: A Randomized Clinical Trial.

PURPOSE: Weight regain after metabolic bariatric surgery is a common problem. Food addiction is an eating disorder that can be one of the reasons for weight regain in these patients. This study aimed to evaluate the effects of probiotic supplementation with a weight loss program and cognitive behavioral therapy (CBT) on anthropometric measures, eating behavior, food addiction, and related hormone levels, in patients with food addiction and weight regain after metabolic bariatric surgery. MATERIALS AND METHODS: This randomized, triple-blind, placebo-controlled clinical trial was conducted on patients with food addiction and weight regain after metabolic bariatric surgery. Participants (n = 50) received a weight loss program and CBT plus probiotic, or placebo for 12 weeks. Then, anthropometric measurements, biochemical markers, eating behavior, and food addiction were assessed. RESULTS: Weight and body mass index (BMI) decreased significantly in the probiotic group compared to placebo (p = 0.008, p = 0.001, respectively). Fat mass was significantly decreased in the probiotic group (p < 0.001). Moreover, a significant improvement was observed in the probiotic group's eating behavior and food addiction compared to the placebo group (p < 0.001). Serum levels of leptin decreased significantly (p = 0.02), and oxytocin serum levels increased significantly (p = 0.008) in the probiotic group compared to the placebo group. CONCLUSION: Adding probiotic supplements to the weight loss program and CBT is superior to the weight loss program and CBT alone in improving weight loss, eating behavior, and food addiction in patients with food addiction and weight regain after metabolic bariatric surgery.

Effects of Vertical Sleeve Gastrectomy on Weight Loss, Eating Behaviors, and Weight Concern Eight Months Postsurgery.

OBJECTIVES: Following vertical sleeve gastrectomy (VSG), the role of eating behaviors in weight regain remains unclear. This study aimed to examine the effects of VSG on excess weight loss (EWL) and five eating-related variables (food addiction, disinhibition, susceptibility to hunger, dietary restraint, and weight concern) while exploring their associations before and eight months post-surgery. MATERIALS AND METHODS: A sample of 76 participants who underwent VSG was recruited from a healthcare center in Quebec, Canada. Measurements included body mass index (BMI), the Eating Disorder Examination (weight concern), the Yale Food Addiction Scale (food addiction), and the Three-Factor Eating Questionnaire (disinhibition, susceptibility to hunger, and dietary restraint). T-tests were conducted between pre-surgery (T0) and eight-month post-surgery (T8), and correlations were examined between T0 and T8, within T0, and within T8. RESULTS: The mean EWL was 63.43% ± 13.14 at T8. Comparisons between T0 and T8 showed a significant decrease in food addiction, disinhibition, and susceptibility to hunger (p = 0.001-0.005). No significant differences were observed for dietary restraint and weight concerns. BMI at T0 was negatively correlated with EWL at T8 (r = -0.45). Within T0, a negative correlation was observed between food addiction and dietary restraint (r = -0.42), which changed from negative to positive within T8 (r = 0.35). CONCLUSIONS: This study confirmed that VSG is effective for weight loss and associated with a reduction in maladaptive eating behaviors. Postsurgery, individuals with greater food addiction exhibited more dietary restraint, suggesting a need for restraint among those experiencing a strong drive toward food. However, weight concerns remained high even after significant weight loss, indicating that weight loss alone may not be sufficient for change. A postsurgery medical follow-up focusing on overall well-being and lifestyle adaptation would be a crucial complement.

Psychometric Properties of the Dimensional Yale Food Addiction Scale for Children 2.0 among Portuguese Adolescents.

The dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0) was developed to provide a reliable psychometric measure for assessing food addiction in adolescents, in accordance with the updated addiction criteria proposed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5). The present study aimed to evaluate the psychometric properties of the dYFAS-C 2.0 among Portuguese adolescents and pre-adolescents and to explore the relationship between food addiction and other eating behaviors such as grazing and intuitive eating. The participants were 131 Portuguese adolescents and pre-adolescents (53.4% female and 46.6% male) aged between 10 and 15 years (Mage = 11.8) and with a BMI between 11.3 and 35.3 (MBMI z-score = 0.42). Confirmatory Factor Analysis demonstrated an adequate fit for the original one-factor model (χ2 (104) = 182; p < 0.001; CFI = 0.97; TLI = 0.97; NFI = 0.94; SRMR = 0.101; RMSEA = 0.074; 95% CI [0.056; 0.091]). Food addiction was positively correlated with higher grazing (r = 0.69, p < 0.001) and negatively correlated with lower reliance on hunger/satiety cues (r = -0.22, p = 0.015). No significant association was found between food addiction and BMI z-score, or between food addiction and age. The results support the use of dYFAS-C 2.0 as a valid and reliable measure for assessing food addiction in Portuguese adolescents and pre-adolescents. Furthermore, the findings highlight that food addiction may be part of a spectrum of disordered eating behaviors associated with control impairment. Future research with a larger sample size could further elucidate the associations between food addiction and other variables, such as psychological distress and multi-impulsive spectrum behaviors.

The Food Addiction Clinical Treatment (FACT) Manual: A Harm Reduction Treatment Approach.

While the construct of food addiction has been controversial, there is growing evidence that certain foods can activate biobehavioral and neurological mechanisms consistent with addiction to other substances. Despite increased evidence and acceptance of certain foods as addictive substances amongst the scientific community, there is a paucity of interventions available that are uniquely suited for the treatment of this condition. Further, many of the addiction and disordered eating treatment models currently utilized for food addiction are seemingly at odds, with the former often recommending complete abstinence from trigger foods and the latter promoting intake of all foods in moderation. The Food Addiction Clinical Treatment (FACT) manual was created as an alternative using an empirically supported harm-reduction model specifically targeted to treat the addiction and disordered eating features of food addiction. The purpose of the current article is to expose readers to the key tenets of the FACT manual, demonstrate the feasibility of this intervention with a sample of participants with severe food addiction, and discuss future directions for the treatment of food addiction. Positive outcomes from this intervention provide preliminary evidence for the efficacy of FACT for the treatment of food addiction with minimal negative adverse effects. Future research using randomized control trials and longer follow-up is needed to validate the FACT manual as an empirically supported treatment for food addiction.

Food addiction and the physical and mental health status of adults with overweight and obesity.

Background: Overweight and obesity now affect more than a third of the world's population. They are strongly associated with somatic diseases, in particular increasing the risk of many metabolic and cardiovascular diseases, but also with mental disorders. In particular, there is a strong association between obesity and depression. As a result, more attention is paid to the neurobiological, behavioural, and psychological mechanisms involved in eating. One of these is food addiction (FA). Research comparing lifestyle elements, physical and mental health problems of excess body weight and individuals with FA is limited and has focused on younger people, mainly students. There is also a lack of studies that relate actual metabolic parameters to FA. To better understand the problem of FA also in older adults, it is important to understand the specific relationships between these variables. Methods: A cross-sectional survey was conducted with 172 adults with overweight and obesity (82% female) aged 23-85 years. The mean age of all subjects was M = 59.97 years (SD = 11.93), the mean BMI was M = 32.05 kg/m2 (SD = 4.84), and the mean body fat was M = 39.12% (SD = 6.48). The following questionnaires were used: Food Frequency Questionnaire-6 (FFQ-6), Global Physical Activity Questionnaire (GPAQ), Three Factor Eating Questionnaire-R18 (TFEQ-R18), Yale Food Addiction Scale 2. 0 (YFAS 2.0), Zung Self-Rating Depression Scale (SDS). Body composition, anthropometry, fasting glucose, lipid profile, and blood pressure were measured. Results: A total of 22.7% of participants with overweight and obesity had symptoms of depression according to the SDS, and 18.6% met the criteria for FA according to YFAS 2.0. FA was statistically significantly more common among people up to 50 years. BMI, body fat mass, diastolic blood pressure and sedentary behaviour were statistically significantly higher in people with FA symptoms. Those who were sedentary for 301-450 min per day were significantly more likely to have depressive symptoms, and those who were sedentary for more than 450 min per day were significantly more likely to have FA symptoms. Conclusions: Our findings complement the current literature on FA, particularly in older adults and metabolic parameters, and suggest further research directions. Although our cross-sectional study design does not allow causal interpretations, increasing physical activity appears to be particularly important in the management of people with overweight or obesity and FA. This may be even more important than for people with depression alone, but future research is needed to explore these relationships further.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity.

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic.

Common psychiatric disorders (CPDs) and depression contribute significantly to the global epidemic of type 2 diabetes (T2D). We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs, promotes the establishment of emotional eating, activation of the reward system, onset of overweight and obesity and, ultimately the increased risk of developing T2D. The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexone-bupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction, but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction. We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

Bariatric-Metabolic Surgery is the Most Effective Intervention in Reducing Food Addiction Symptoms: A Systematic Review and Meta-Analysis.

There are different treatments for food addiction (FA) symptomatology, but a comprehensive review with a meta-analysis to determine the most effective intervention is lacking. The aim of this review is to investigate the efficacy of pharmacological, behavioral, and bariatric-metabolic surgical interventions in reducing FA symptomatology. Meta-analyses including 15 studies in adults showed a significantly positive effect (std mean difference in FA symptoms before vs after intervention 0.72 (0.58-0.95)), with bariatric-metabolic surgical interventions showing the highest efficacy in improving FA symptoms (1.17 (0.58-1.76) before vs after intervention). The existing evidence suggests a beneficial effect of bariatric-metabolic surgical, pharmacological, and behavioral interventions, in that order, on FA symptomatology in people with overweight/obesity. Weight loss and behavioral and lifestyle changes after surgery may be determinants in improving FA symptomatology.

A novel weight suppression score associates with distinct eating disorder and ultra-processed food symptoms compared to the traditional weight suppression measure among adults seeking outpatient nutrition counseling.

BACKGROUND: Weight suppression has been defined as diet-induced weight loss, traditionally operationalized as the difference between one's highest and current weight. This concept has been studied in the context of eating disorders, but its value in predicting treatment outcomes has been inconsistent, which may be partially attributed to its calculation. METHOD: The current study operationalizes a novel weight suppression score, reflecting the midpoint between the lowest and highest adult weights among adults (N = 287, ages 21-75, 73.9% women) seeking outpatient treatment for disordered eating. This report compared the traditional weight suppression calculation to the novel weight suppression score in a simulated dataset to model their differential distributions. Next, we analyzed shared and distinct clinical correlates of traditional weight suppression versus the novel weight suppression score using clinical intake data. RESULTS: The novel weight suppression score was significantly associated with meeting criteria for both eating disorders and ultra-processed food addiction and was more sensitive to detecting clinically relevant eating disorder symptomatology. However, the novel weight suppression score (vs. traditional weight suppression) was associated with fewer ultra-processed food addiction symptoms. CONCLUSION: The novel weight suppression score may be particularly relevant for those with eating disorders and ultra-processed food addiction, with more relevance to individual eating disorder compared to ultra-processed food addiction symptoms. Consideration of the novel weight suppression score in future research on eating behaviors should extend beyond just those with diagnosed eating disorders.

Psychosocial risk and protective factors for youth problem behavior are associated with food addiction in the Generation Z.

Objective: Food Addiction (FA) and other well-known risk behavior as substance misuse tend to co-occur and may share similar risk and protective factors. The aim of this study was to assess the association between the diagnosis/severity of FA and psychosocial domains typically related to risk behavior syndrome in a large, nationally representative community sample of Generation Z underage Italian students. Method: The sample consisted of 8,755 students (3,623 from middle schools, 5,132 from high schools). A short version of the Yale Food Addiction Scale 2.0 was administered to evaluate FA. Risk and protective factors related to demographic, personality, behavior, and family variables were examined. Stepwise multivariate logistic and linear regressions were conducted. Results: The prevalence of FA was 30.8%. Female gender, social anxiety and depression symptoms, social withdrawal risk, Internet gaming disorder, social media addiction, current substance use, social challenge engagement and experienced doxing boosted the chance of FA diagnosis, whereas eating fruit and vegetables, playing competitive sports and an average sleep duration of 7-8 h per night reduced these odds. FA severity was significantly and positively associated with trait impulsiveness, social anxiety and depressive symptoms, risk of social withdrawal, recent substance use, social media, and gaming addiction, doxing suffered and risky social challenges participation. Negative associations between the severity of FA and fruit and vegetable diet habits were found. Conclusion: Our findings confirm that FA is widespread among Italian adolescents. The associations between the diagnosis and severity of FA and psychosocial risk factors for health, including, addictive and deviant behaviors related to digital misuse, suggest its belonging to the risk behavior constellation. Health promotion schemes based on a multicomponent strategy of intervention should consider the inclusion of FA and its psychosocial correlates.