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.

Role of Worry in Addiction: Implication of Metacognitive Beliefs and Type 2 Worry.

INTRODUCTION: According to the self-medication hypothesis, worriers use substances to cope with their symptoms; however, some published results have challenged this hypothesis. The aim of this study is to show if worry increases the risk of SUD when it is negatively appraised by negative metacognitive beliefs. METHOD: We recruited three samples: 68 patients with a severe AUD, 27 patients dependent on eating and 42 control participants. We used the Yale Food Addiction Scale-2, the Metacognitions Questionnaire-65, the UPPS-P Impulsive Behaviour Scale and the Anxiety Thoughts Inventory. RESULTS: We confirmed a direct effect of worries and metaworry on alcohol (AUD) and eating addiction (EA), but our multivariate analyses revealed that metacognitive beliefs and metaworry are the most robust predictors of alcohol and eating addiction. DISCUSSION: We reported substance-related differences in the relationship between worry and addiction. AUD is related to the metacognitive activity set in motion by worries while EA is associated with a maladaptive form of worry (meta-worry) where worries are negatively interpreted.

Adult attention-deficit/hyperactivity disorder among alcohol use disorder inpatients is associated with food addiction and binge eating, but not BMI.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is associated with binge eating (BE), food addiction (FA), and obesity/higher BMI in individuals without alcohol use disorder (AUD). ADHD is highly prevalent in patients with AUD, but it is unknown whether the presence of comorbid AUD might change the nature of the association between ADHD, BE, FA and BMI (food and alcohol may either compete for the same brain neurocircuitry or share vulnerability risk factors). Here, we filled this gap by testing the association between ADHD and FA/BE in adult patients hospitalized for AUD, with the strength of simultaneously assessing childhood and adult ADHD. We also investigated the association between ADHD and BMI, and the other factors associated with BMI (FA/BE, AUD severity). METHODS: We included 149 AUD inpatients between November 2018 and April 2019. We assessed both childhood and adulthood ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (modified Yale Food Addiction Scale 2.0), BE (Binge Eating Scale), and BMI and AUD (clinical assessment). RESULTS: In multivariable analyses adjusted for age, adult ADHD was associated with higher BE scores (p = .048), but not significant BE (9% vs. 7%; p = .70). ADHD was also associated with FA diagnosis and the number or FA symptoms, with larger effect size for adult (ORs: 9.45[95%CI: 2.82-31.74] and 1.38[1.13-1.69], respectively) than childhood ADHD (ORs: 4.45[1.37-14.46] and 1.40[1.13-1.75], respectively). In multivariable analysis, BMI was associated with both significant BE (p < .001) and FA diagnosis (p = .014), but not adult ADHD nor AUD severity. CONCLUSION: In patients hospitalized for AUD, self-reported adult ADHD was associated with FA and BE, but not BMI. Our results set the groundwork for longitudinal research on the link between ADHD, FA, BE, and BMI in AUD inpatients.

Treatment of the sensory and motor components of urges to eat (eating addiction?): a mobile-health pilot study for obesity in young people.

PURPOSE: Compelling evidence indicates that an addictive process might contribute to overeating/obesity. We hypothesize that this process consists of two components: (a) a sensory addiction to the taste, texture, and temperature of food, and (b) a motor addiction to the actions of eating (e.g., biting, chewing, crunching, sucking, swallowing). Previously, we reported a mobile health application (mHealth app) obesity intervention addressing the sensory addiction component, based on staged food withdrawal. We propose that the motor addiction component can be treated using cognitive behavioral therapy (CBT)-based strategies for body-focused repetitive behaviors (BRFB), e.g., nail biting, skin picking, and hair pulling. METHODS: The present study tested the effectiveness of CBT-based, BFRB therapies added to the staged withdrawal app. Thirty-five participants, ages 8-20, 51.4% females, mean zBMI 2.17, participated in a 4-month study using the app, followed by a 5-month extension without the app. Using staged withdrawal, participants withdrew from specific, self-identified, "problem" foods until cravings resolved; then from non-specific snacking; and lastly from excessive mealtime amounts. BFRB therapies utilized concurrently included: distractions, competing behaviors, triggers avoidance, relaxation methods, aversion techniques, and distress tolerance. RESULTS: Latent growth curve analysis determined that mean body weight and zBMI decreased significantly more than in a previous study that used only staged withdrawal (p < 0.01). In the 5-month follow-up, participants maintained overall weight loss. CONCLUSIONS: This study provides further preliminary evidence for the acceptability of an addiction model treatment of obesity in youth, and that the addition of CBT-based, BFRB therapies increased the effectiveness of staged food withdrawal. LEVEL OF EVIDENCE: Level IV, Evidence obtained from multiple time series analysis with the intervention.

Adulthood and childhood ADHD in patients consulting for obesity is associated with food addiction and binge eating, but not sleep apnea syndrome.

INTRODUCTION: The exact mechanisms underlying the established association between ADHD and obesity remain unclear. Food addiction and binge eating may contribute to this link. We examined for the first time the association between childhood/adult ADHD and food addiction/binge eating in patients with obesity, as well as the association between ADHD and sleep apnea syndrome. METHODS: We included 105 obese patients from the Nutrition Department of the University Hospital of Tours (France) between January and December 2014. We assessed categorical diagnoses of childhood/adulthood ADHD (semi-structured interview DIVA 2.0), food addiction (Yale Food Addiction Scale 2.0), binge eating (Binge Eating Scale), obstructive sleep apnea (clinical assessment), and BMI (clinical assessment). RESULTS: Patients with adult ADHD were at significantly higher risk of food addiction than patients without adult ADHD (28.6% vs. 9.1%; p = .016). Adult and childhood ADHD were significantly associated with self-reported food addiction, food addiction scores and binge eating scores, with a larger effect size for adult (ORs: 4.00 [1.29-12.40], 1.37 [1.14-1.65] and 1.08 [1.03-1.14], respectively) than childhood (ORs: 3.32 [1.08-10.23], 1.29 [1.08-1.55] and 1.06 [1.01-1.11], respectively) ADHD. ADHD diagnosis was not significantly correlated to obstructive sleep apnea. Mean age of onset of ADHD preceded mean age of onset of obesity. CONCLUSION: ADHD diagnosis is associated with food addiction and binge eating, with a larger effect size for adult than childhood ADHD. Our results provide a strong rationale for further longitudinal research on the link between ADHD, food addiction, binge eating and obesity, paving the way for evidence-based therapeutic interventions for these patients.

Food Addiction is Associated with Higher Neuroticism, Lower Conscientiousness, Higher Impulsivity, but Lower Extraversion in Obese Patient Candidates for Bariatric Surgery.

BACKGROUND: The "food addiction" phenotype identifies a subpopulation of individuals experiencing substance-dependence symptoms toward specific foods. In the current debate on whether the "food addiction" phenotype should be considered as an addictive disorder, assessment of the personality traits associated with this phenotype would provide arguments for or against the "food addiction" phenotype and its inclusion in the "substance-related and addictive disorder" category. OBJECTIVES: To assess the personality characteristics associated with the "food addiction" phenotype in obesity surgery candidates (i.e., big five personality dimensions, alexithymia and impulsivity). METHODS: We assessed food addiction (Yale Food Addiction Scale), personality dimensions (Big Fig Inventory), impulsivity (Barratt Impulsiveness Scale-11th version) and alexithymia (Toronto Alexithymia Scale-20 items) in 188 bariatric surgery candidates recruited between July 2013 and November 2015 in the Nutrition Department of the University Hospital of Tours. We used chi-squared tests and Student's tests or Mann-Whitney-U-tests to determine the factors associated with food addiction. RESULTS: Prevalence of current food addiction was 16.5%. Patients with (vs. without) food addiction had lower conscientiousness (p = .047), higher neuroticism and lower extraversion (ps < 0.001), but there was no difference in terms of agreeableness (p = 0.42) or openness (p = 0.16). They were more frequently single (p = .021) and reported higher alexithymia (ps < .001) and higher impulsivity sub-scores (ps<.05). Conclusions/Importance: Food addiction shares personality traits with substance-related disorders (regarding neuroticism, conscientiousness, impulsivity, alexithymia), and one distinctive trait (low extraversion). This study provides additional data that enrich the discussion on whether the "food addiction" phenotype should be included or not in the "substance-related and addictive disorder" category.

Linking drug and food addiction: an overview of the shared neural circuits and behavioral phenotype.

Despite a lack of agreement on its definition and inclusion as a specific diagnosable disturbance, the food addiction construct is supported by several neurobiological and behavioral clinical and preclinical findings. Recognizing food addiction is critical to understanding how and why it manifests. In this overview, we focused on those as follows: 1. the hyperpalatable food effects in food addiction development; 2. specific brain regions involved in both food and drug addiction; and 3. animal models highlighting commonalities between substance use disorders and food addiction. Although results collected through animal studies emerged from protocols differing in several ways, they clearly highlight commonalities in behavioral manifestations and neurobiological alterations between substance use disorders and food addiction characteristics. To develop improved food addiction models, this heterogeneity should be acknowledged and embraced so that research can systematically investigate the role of specific variables in the development of the different behavioral features of addiction-like behavior in preclinical models.

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.

Current Intervention Treatments for Food Addiction: A Systematic Review.

Research on the concept of food addiction (FA) has steadily grown and, based on a widely used self-report, FA is estimated to affect between 16-20% of the adult population. However, there are few interventions available for people with self-reported FA, and their efficacy is unclear. The primary aim of the review was to examine the efficacy of different interventions, including behavioural/lifestyle, medication and surgical approaches, for reducing symptoms and/or changing diagnosis of FA among adolescents and adults. A secondary aim was to examine the influence of sex as a moderator of intervention effects. A systematic search was performed from 2008-2020 to identify studies that used the YFAS to assess the effectiveness of interventions on FA. Nine studies were identified (n = 7 adults, n = 2 adolescents) including a total of 812 participants (range 22-256) with an average of 69% females per study. The types of interventions included medications (n = 3), lifestyle modification (n = 3), surgical (n = 2) and behavioural (n = 1), with FA being assessed as a secondary outcome in all studies. Five studies in adults reported a significant reduction in FA symptoms or diagnosis from pre to post-intervention, two when compared to a control group and three in the intervention group only. Efficacious interventions included: medication (combination of naltrexone and bupropion, as well as pexacerfont), bariatric surgery and lifestyle modification. No significant changes in FA were reported in adolescent studies. Given few studies were identified by the review, there is insufficient evidence to provide clear recommendations for practice; however, some interventions show potential for reducing self-reported FA outcomes in adults. Future research should explore the longer-term efficacy of interventions and the effectiveness of treatments with sufficient sample sizes.

Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review.

Food addiction is considered an important link for a better understanding of psychiatric and medical problems triggered by dysfunctions of eating behaviors, e. g., obesity, metabolic syndrome, binge eating disorder, or bulimia nervosa. At behavioral level, food addiction has high degrees of similarity with other eating disorders, a phenomenon that creates difficulties in finding specific diagnostic criteria. Food addiction has been also described as "eating addiction" or "eating dependence" by several researchers, who placed the emphasis on the behavior and not on the food itself. High-sodium foods, artificially flavored-foods, rich carbohydrate- and saturated fats-containing foods are triggers for the activation of the same neural pathways, therefore they act similarly to any drug of abuse. Food addiction is considered a disorder based on functional negative consequences, associated distress and potential risks to both psychological well-being and physical health. A clinical scale was validated for the quantification of the eating addiction severity, namely the Yale Food Addiction Severity Scale (YFAS), constructed to match DSM IV criteria for substance dependence. Using this instrument, a high prevalence of food addiction was found in the general population, up to 20% according to a meta-analytic research. The pathogenesis of this entity is still uncertain, but reward dysfunction, impulsivity and emotion dysregulation have been considered basic mechanisms that trigger both eating dysfunctions and addictive behaviors. Genetic factors may be involved in this dependence, as modulators of higher carbohydrate and saturate fat craving. Regarding the existence of potential therapeutic solutions, lorcaserin, antiepileptic drugs, opioid antagonists, antiaddictive agents are recommended for obesity and eating disorders, and they may be intuitively used in food addiction, but clinical trials are necessary to confirm their efficacy. In conclusion, a better understanding of food addiction's clinical profile and pathogenesis may help clinicians in finding prevention- and therapeutic-focused interventions in the near future.

Sugars and Sweet Taste: Addictive or Rewarding?

The notion of food "addiction" often focuses on the overconsumption of sweet tasting foods or so-called sugar "addiction". In the extreme, some have suggested that sugar and sweet tastes elicit neural and behavioral responses analogous to those observed with drugs of abuse. These concepts are complicated by the decades long uncertainty surrounding the validity and reproducibility of functional magnetic resonance imaging (fMRI) methodologies used to characterize neurobiological pathways related to sugar and sweet taste stimuli. There are also questions of whether sweet taste or post-ingestion metabolic consequences of sugar intake would lead to addiction or excessive caloric intake. Here, we present a focused narrative review of literature related to the reward value of sweet taste which suggests that reward value can be confounded with the construct of "addictive potential". Our review seeks to clarify some key distinctions between these constructs and questions the applicability of the addiction construct to human over-eating behaviors. To adequately frame this broad discussion requires the flexibility offered by the narrative review paradigm. We present selected literature on: techniques used to link sugar and sweet tastes to addiction neurobiology and behaviors; sugar and sweet taste "addiction"; the relationship of low calorie sweetener (LCS) intake to addictive behaviors and total calorie intake. Finally, we examined the reward value of sweet tastes and contrasted that with the literature describing addiction. The lack of reproducibility of fMRI data remains problematic for attributing a common neurobiological pathway activation of drugs and foods as conclusive evidence for sugar or sweet taste "addiction". Moreover, the complicated hedonics of sweet taste and reward value are suggested by validated population-level data which demonstrate that the consumption of sweet taste in the absence of calories does not increase total caloric intake. We believe the neurobiologies of reward value and addiction to be distinct and disagree with application of the addiction model to sweet food overconsumption. Most hypotheses of sugar "addiction" attribute the hedonics of sweet foods as the equivalent of "addiction". Further, when addictive behaviors and biology are critically examined in totality, they contrast dramatically from those associated with the desire for sweet taste. Finally, the evidence is strong that responses to the palatability of sweets rather than their metabolic consequences are the salient features for reward value. Thus, given the complexity of the controls of food intake in humans, we question the usefulness of the "addiction" model in dissecting the causes and effects of sweet food over-consumption.

Translation and validation of the addiction-like Eating Behavior Scale from English to Portuguese in Brazil.

Eating addiction is an important condition related to obesity. The Addiction-like Eating Behavior Scale (AEBS) was recently validated in English to evaluate addictive eating behaviors. To perform the translation, cultural adaptation, and validation of the AEBS scale to Portuguese to identify eating addictions in the Brazilian population. The AEBS translation, adaptation, and validation followed previously published criteria, including the steps of translation, back translation, evaluation by a committee of judges, and a pretest with 40 students. Subsequently, 150 students from the Medical School at the Recife Campus of the Federal University of Pernambuco were tested using the AEBS-Portuguese version (AEBS-p). Of these, 37 were evaluated a second time for a test-retest analysis. For data collection, 5 instruments were used: the AEBS-p, a modified version of the Yale Food Addiction Scale 2.0 (mYFAS 2.0)-Portuguese version, the Patient Health Questionnaire-9, the Binge Eating Scale (BES), and the Socio-demographic Questionnaire. The AEBS-p showed good reliability, based on a significant internal consistency value (Cronbach's alpha = 0.91), and good correlation in the test-retest evaluation. A committee of judges considered the content validity appropriate. Convergent validation was positive with the mYFAS 2.0 and BES (p < 0.001). The AEBS-p showed a significant correlation with body mass index (BMI) (p < 0.001) and significantly predicted variance in BMI that was accounted for by both the mYFAS 2.0 and BES (p = 0.022). The AEBS-p demonstrated good reliability and validity for evaluating addictive eating behaviors in the Brazilian population.

Food addiction, eating addiction and eating disorders.

The concept of food addiction is currently a highly debated subject within both the general public and the scientific communities. The term food addiction suggests that individuals may experience addictive-like responses to food, similar to those seen with classic substances of abuse. An increasing number of studies have established the prevalence and correlates of food addiction. Moreover, food addiction may be associated with obesity and disordered eating. Thus, intervening on food addiction may be helpful in the prevention and therapy of obesity and eating disorders. However, controversy exists about if this phenomenon is best defined through paradigms reflective of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) substance-related disorders (e.g. food addiction) or non-substance-related disorders (e.g. eating addiction) criteria. This review paper will give a brief summarisation of the current state of research on food addiction, a more precise definition of its classification, its differentiation from eating addiction and an overview on potential overlaps with eating disorders. Based on this review, there is evidence that food addiction may represent a distinct phenomenon from established eating disorders such as bulimia nervosa or binge-eating disorder. Future studies are needed to further examine and establish orthogonal diagnostic criteria specific to food addiction. Such criteria must differentiate the patterns of eating and symptoms that may be similar to those of eating disorders to further characterise food addiction and develop therapy options. To date, it is too premature to draw conclusions about the clinical significance of the concept of food addiction.

Gambling disorder and comorbid behavioral addictions: Demographic, clinical, and personality correlates.

Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs.

Does Eating Addiction Favor a More Varied Diet or Contribute to Obesity?-The Case of Polish Adults.

Rapidly increasing prevalence of overweight and obesity indicates a need to search for their main causes. Addictive-like eating and associated eating patterns might result in overconsumption, leading to weight gain. The aim of the study was to identify main determinants of food intake variety (FIV) within eating addiction (EA), other lifestyle components, and sociodemographic characteristics. The data for the study were collected from a sample of 898 Polish adults through a cross-sectional survey in 2019. The questionnaire used in a study included Food Intake Variety Questionnaire (FIVeQ), Eating Preoccupation Scale (EPS) and questions regarding lifestyle and socio-demographic factors. High eating addiction was found in more than half of people with obesity (54.2%). In the study sample physical activity at leisure time explained FIV in the greatest manner, then subsequently EPS factor: Eating to provide pleasure and mood improvement. In the group of people with obesity, the score of this EPS factor was the best predictor of FIV, in a way that its higher score was conducive to a greater variety of food intake. Socio-demographic characteristics differentiated FIV only within group with normal body weight (age) and with overweight (education). As conclusion, food intake variety (FIV) was associated with physical activity at leisure time, and then with EPS factor "Eating to provide pleasure and mood improvement", whereas socio-demographic characteristics were predictors of FIV only within groups identified by Body Mass Index (BMI). Nevertheless, our observations regarding Eating to provide pleasure and mood improvement factor and its associations with food intake variety indicate a need for further research in this area. Future studies should also use other tools to explicitly explain this correlation.

The Modified Yale Food Addiction Scale 2.0: Validation Among Non-Clinical and Clinical French-Speaking Samples and Comparison With the Full Yale Food Addiction Scale 2.0.

OBJECTIVES: The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) was designed to assess food addiction using a shorter version than the YFAS 2.0. We lack data about the psychometric properties of the mYFAS 2.0 in patients with obesity, as well as studies comparing the psychometric properties of the mYFAS 2.0 versus the full YFAS 2.0. This study aimed to validate the French-language mYFAS 2.0 in a non-clinical population (study 1, n = 250), to determine the yet unknown psychometric properties of this scale in patients with obesity (study 2, n = 345), and to compare the full YFAS 2.0 and the mYFAS 2.0 in terms of food addiction (FA) prevalence and symptoms detection in both populations. METHOD: Study 1 included 250 non-clinical individuals (non-underweight and non-obese persons screened negative for eating disorders). Study 2 included 345 bariatric surgery candidates recruited in three centers (Québec, Canada; Reims and Tours, France). The mYFAS 2.0 structure was investigated using confirmatory factorial analyses with tetrachoric correlations. Convergent validity was tested using the full YFAS 2.0, the Binge Eating Scale (both studies), the revised 18-item Three Factor Eating Questionnaire (study 1), the Beck Depression Inventory (study 2), and the body mass index (BMI; both studies). RESULTS: The mYFAS 2.0 was unidimensional, and had adequate (study 1: KR-20 = .78) and acceptable (study 2: KR-20 = .73) internal consistency. In study 1, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, BMI, binge eating, cognitive restraint, uncontrolled eating and emotional eating; in study 2, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, binge eating, depression, but not BMI. Participants endorsed fewer symptoms with the mYFAS 2.0 than with the YFAS 2.0; FA prevalences were similar between questionnaires in the non-clinical, but not in the clinical sample. A FA 'diagnosis' and risk of binge eating disorder were associated but did not completely overlap. CONCLUSIONS: The mYFAS 2.0 has close psychometric properties to the YFAS 2.0 in non-clinical and clinical samples. However, the use of the mYFAS 2.0 in bariatric surgery candidates might lead to a significant underestimation of FA prevalence and number of FA symptoms.

Food Addiction among Female Patients Seeking Treatment for an Eating Disorder: Prevalence and Associated Factors.

The concept of "food addiction" (FA) has aroused much focus because of evidence for similarities between overeating and substance use disorders (SUDs). However, few studies have explored this concept among the broad spectrum of eating disorders (ED), especially in anorexia nervosa (AN). This study aimed to assess FA prevalence in ED female patients and to determine its associated factors. We recruited a total of 195 adult women with EDs from an ED treatment center. The prevalence of FA diagnosis (Yale Food Addiction Scale) in the whole ED sample was 83.6%; AN restrictive type (AN-R), 61.5%; AN binge-eating/purging type (AN-BP), 87.9%; bulimia nervosa (BN), 97.6%; and binge-eating disorder (BED), 93.3%. The most frequently met criteria of FA were "clinically significant impairment or distress in relation to food", "craving" and "persistent desire or repeated unsuccessful attempts to cut down". An FA diagnosis was independently associated with three variables: presence of recurrent episodes of binge eating, ED severity, and lower interoceptive awareness. In showing an overlap between ED and FA, this study allows for considering EDs, and AN-R in particular, from an "addictive point of view", and thus for designing therapeutic management that draws from those proposed for addictive disorders.

An addiction-based mobile health weight loss intervention: protocol of a randomized controlled trial.

BACKGROUND: The notion of obesity as an addictive process is controversial. However, studies show that between 5.9 and 30.7% of adolescents with obesity report food or eating addiction. Few weight management interventions have tested techniques based on addiction medicine principles. METHODS: This multi-center randomized control trial (RCT) is designed to test the effectiveness of a mobile health (mHealth) weight-loss intervention based on addiction principles, such as withdrawal and tolerance, in a sample of 180 adolescents (ages 14-18) recruited from four pediatric weight management clinics in Southern California. Akin to a Multiphase Optimization Strategy (MOST) design evaluating multicomponent behavioral interventions, we will compare the combination of an app + phone coaching (App+Coach) to app alone (App) and in-clinic multi-disciplinary (Clinic) intervention arms. The primary outcome is mean change in zBMI and %BMIp95 over 18 months. We hypothesize that youth who receive App+Coach will have a greater reduction in body weight over the 18-month study period at a lower cost than standard of care models. Secondary outcomes include adherence to treatment regimen, intervention satisfaction, effect of the intervention on metabolic factors and activity level. We will also explore potential moderators of intervention effectiveness such as addictive eating habits, self-regulation and executive functioning. CONCLUSIONS: New and creative approaches are needed to address pediatric obesity. If successful, this RCT may provide an innovative and cost-effective mHealth approach, based on addiction methods, for weight loss among adolescents with overweight and obesity.

An addiction model-based mobile health weight loss intervention in adolescents with obesity.

BACKGROUND: Clinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents. METHODS: Adolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined. RESULTS: Eighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs. $1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001), which was comparable to the age-matched EMPOWER program completers (p = 0.31 and p = 0.06). CONCLUSIONS: An addiction medicine-based mHealth intervention targeted for adolescents was feasible to implement, resulted in high retention and adherence rates, and reduced zBMI and %BMIp95 in a more cost-effective manner than an in-clinic intervention.

Food Addiction and Binge Eating: Lessons Learned from Animal Models.

The feeding process is required for basic life, influenced by environment cues and tightly regulated according to demands of the internal milieu by regulatory brain circuits. Although eating behaviour cannot be considered "addictive" under normal circumstances, people can become "addicted" to this behaviour, similarly to how some people are addicted to drugs. The symptoms, cravings and causes of "eating addiction" are remarkably similar to those experienced by drug addicts, and both drug-seeking behaviour as eating addiction share the same neural pathways. However, while the drug addiction process has been highly characterised, eating addiction is a nascent field. In fact, there is still a great controversy over the concept of "food addiction". This review aims to summarize the most relevant animal models of "eating addictive behaviour", emphasising binge eating disorder, that could help us to understand the neurobiological mechanisms hidden under this behaviour, and to improve the psychotherapy and pharmacological treatment in patients suffering from these pathologies.