Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0

Previous research on ‘food addiction’ as measured with the Yale Food Addiction Scale (YFAS) showed a large overlap between addiction‐like eating and bulimia nervosa. Most recently, a revised version of the YFAS has been developed according to the changes made in the diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. The current study examined prevalence and correlates of the YFAS2.0 in individuals with bulimia (n = 115) and controls (n = 341). Ninety‐six per cent of participants with bulimia and 14% of controls received a YFAS2.0 diagnosis. A higher number of YFAS2.0 symptoms was associated with lower interoceptive awareness, higher depressiveness, and higher impulsivity in both groups. However, a higher number of YFAS2.0 symptoms was associated with higher body mass and weight suppression in controls only and not in participants with bulimia. The current study is the first to show a large overlap between bulimia and ‘food addiction’ as measured with the YFAS2.0, replicating and extending findings from studies, which used the previous version of the YFAS. Compensatory weight control behaviours in individuals with bulimia likely alleviate the association between addiction‐like eating and higher body mass. Thus, the large overlap between bulimia and ‘food addiction’ should be taken into consideration when examining the role of addiction‐like eating in weight gain and obesity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Development of the Modified Yale Food Addiction Scale Version 2.0

The Yale Food Addiction Scale (YFAS) operationalizes indicators of addictive‐like eating, originally based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM‐IV‐TR) criteria for substance‐use disorders. The YFAS has multiple adaptations, including a briefer scale (mYFAS). Recently, the YFAS 2.0 was developed to reflect changes to diagnostic criteria in the DSM‐5. The current study developed a briefer version of the YFAS 2.0 (mYFAS 2.0) using the participant sample from the YFAS 2.0 validation paper (n = 536). Then, in an independent sample recruited from Mechanical Turk, 213 participants completed the mYFAS 2.0, YFAS 2.0, and measures of eating‐related constructs in order to evaluate the psychometric properties of the mYFAS 2.0, relative to the YFAS 2.0. The mYFAS 2.0 and YFAS 2.0 performed similarly on indexes of reliability, convergent validity with related constructs (e.g. weight cycling), discriminant validity with distinct measures (e.g. dietary restraint) and incremental validity evidenced by associations with frequency of binge eating beyond a measure of disinhibited eating. The mYFAS 2.0 may be an appropriate choice for studies prioritizing specificity when assessing for addictive‐like eating or when a briefer measurement of food addiction is needed. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction and Bulimia Nervosa

In individuals with obesity and binge eating disorder (BED), eating patterns can show addictive qualities, with similarities to substance use disorders on behavioural and neurobiological levels. Bulimia nervosa (BN) has received less attention in this regard, despite their regular binge eating symptoms. The Yale Food Addiction Scale (YFAS) was developed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for substance use disorders, and food addiction can be diagnosed when at least three addiction symptoms are endorsed and a clinically significant impairment or distress is present. Although the prevalence of food addiction diagnoses is increased in individuals with obesity and BED, recent studies which used the YFAS showed that there are also individuals with normal weight who can be classified as being ‘food addicted’. Based on self‐reported eating disorder symptoms, women with current (n = 26) or remitted (n = 20) BN, and a control group of women matched for age and body mass index (n = 63) completed the YFAS and other measures. Results revealed that all patients with current BN received a food addiction diagnosis according to the YFAS while only six (30%) women with remitted BN did. None of the women in the control group received a food addiction diagnosis. Results provide support for the notion that BN can be described as addiction‐like eating behaviour and suggest that food addiction most likely improves when BN symptoms remit. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Factor Structure and Item Analysis of the Yale Food Addiction Scale in Obese Candidates for Bariatric Surgery

Converging research suggests phenomenological and neurobiological similarities between excessive food consumption and addictive behaviour in substance dependence. Recently, the Yale Food Addiction Scale (YFAS) has been proposed for the assessment of addictive eating behaviour. The German version of the YFAS was administered to obese individuals seeking bariatric surgery (N = 96). Factor structure, internal consistency, and item statistics were analysed. Forty participants (41.70%) received a food addiction diagnosis. The one‐factorial structure of the YFAS, which has been found in non‐clinical samples, could be confirmed. All but three items had factor loadings >.50. Internal consistency was α = .82. Item analysis revealed that items related to unsuccessful attempts to cut down and consumption despite physical and emotional problems were endorsed by the majority of participants. Findings support the use of the YFAS in clinical populations, while applicability of some items differs between clinical and non‐clinical samples. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction in a Spanish Sample of Eating Disorders: DSM‐5 Diagnostic Subtype Differentiation and Validation Data

Although the concept of ‘food addiction’ (FA) has raised growing interest because of evidence for similarities between substance dependence and excessive food intake, there is a lack of studies that explore this construct among the wide spectrum of eating disorders (EDs). Besides providing validation scores of a Spanish version of the Yale FA Scale (YFAS‐S), this study examined the prevalence of ‘FA’ among ED subtypes compared with healthy‐eating controls (HCs) and the association between ‘FA’ scores, eating symptomatology and general psychopathology. A sample of 125 adult women with ED, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders 5 criteria, and 82 healthy‐eating women participated in the study. All participants were assessed with the YFAS‐S, the ED Inventory‐2 and the Symptom Checklist‐Revised. Results showed that the internal structure of the one‐dimensional solution for the YFAS‐S was very good (α = 0.95). The YFAS‐S has a good discriminative capacity to differentiate between ED and controls (specificity = 97.6% and sensitivity (Se) = 72.8%; area under receiver operating characteristic curve = 0.90) and a good Se to screen for specific ED subtypes. YFAS‐S scores were associated with higher levels of negative affect and depression, higher general psychopathology, more severe eating pathology and greater body mass index. When comparing the prevalence of ‘FA’ between ED subtypes, the lowest prevalence of ‘FA’, measured with the YFAS‐S, was for the anorexia nervosa (AN) restrictive subtype with 50%, and the highest was for the AN binge–purging subtype (85.7%), followed by bulimia nervosa (81.5%) and binge eating disorder (76.9%). In conclusion, higher YFAS‐S scores are associated with bingeing ED‐subtype patients and with more eating severity and psychopathology. Although the ‘FA’ construct is able to differentiate between ED and HC, it needs to be further explored. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology,Depressive Symptoms,and Self‐Esteem among Treatment‐Seeking Adolescents with Bulimia Nervosa

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment‐seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self‐esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self‐esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self‐esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Associations of Food Addiction in a Sample Recruited to Be Nationally Representative of the United States

The current study investigated the prevalence of food addiction and its associations with obesity and demographic factors in a sample recruited to be more nationally representative of the United States than previous research. Individuals (n = 1050) were recruited through Qualtrics' qBus, which sets demographic quotas developed using the United States census reference population. Participants (n = 986) self‐reported food addiction, measured by the modified Yale Food Addiction Scale 2.0, height, weight, age, gender, race and income. Food addiction was observed in 15% of participants, with greater prevalence in individuals who were younger, Hispanic and/or reported higher annual income. Food addiction prevalence was higher in persons who were underweight or obese, relative to normal weight or overweight. Food addiction was associated with higher body mass index in women and persons who were older, White and/or reported lower income. Identifying the scope of food addiction and individual risk groups may inform public policy initiatives and early intervention efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Facets of Impulsivity and Compulsivity in Women with Anorexia Nervosa

This study sought to investigate independent associations of impulsivity and compulsivity with eating disorder (ED) symptoms. Women (N = 81) with full or subthreshold Diagnostic and Statistical Manual of Mental Disorders IV anorexia nervosa (AN) completed a semi‐structured interview and self‐report questionnaires. Multiple regression analyses were conducted using ED symptoms as dependent variables and facets of impulsivity and compulsivity as predictor variables (controlling for body mass index and AN diagnostic subtype). For impulsivity facets, lack of perseverance was uniquely associated with eating concern, shape concern and restraint, whereas negative urgency was uniquely associated with eating concern and frequency of loss of control eating; neither sensation seeking nor lack of premeditation was uniquely associated with any ED variables. Compulsivity was uniquely associated with restraint, eating concern and weight concern. Results support independent associations of impulsivity and compulsivity with ED symptoms in adults with AN, suggesting potential utility in addressing both impulsive and compulsive processes in treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge Eating and Temperament in Morbidly Obese Prebariatric Surgery Patients

The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Subtyping Children and Adolescents Who Are Overweight Based on Eating Pathology and Psychopathology

Children and adolescents who are overweight can differ on dimensions measuring dietary restraint and psychopathology. Classifying clinical obese children and adolescents based on these psychological characteristics is shown to be useful in making differential prognoses. The present study aimed to research the validity of subtyping children and adolescents with overweight (N = 138) in a non‐clinical sample. Using cluster analysis, results revealed three subtypes: a dietary restraint/internalizing group (DR + IN; n = 41), a pure internalizing group (IN; n = 20) and a non‐symptomatic group (NS; n = 77). The DR + IN group outscored both other groups on measures of eating pathology, whereas the IN group outscored both other groups on measures of negative offect. Interestingly, the three groups did not differ on degree of overweight. The results seem to suggest that different psychological mechanisms can be observed in subgroups of young overweight adolescents. Further research should explore how individual psychological characteristics can be helpful when stipulating weight loss treatment programmes. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Improving Inhibitory Control Abilities (ImpulsE)—A Promising Approach to Treat Impulsive Eating?

Although there is preliminary evidence that inhibitory control training improves impulsive eating, less is known about the effects on eating behaviour and weight loss in clinical samples. Sixty‐nine treatment‐seeking adults with obesity (binge‐eating disorder 33.3%; other specific feeding and eating disorders 40.6%) were randomly blockwise allocated to ImpulsE, an intervention to improve inhibitory control and emotion regulation abilities or a guideline‐appropriate cognitive behavioural therapy (CBT)‐based treatment as usual. Self‐reported and performance‐based impulsivity, eating disorder pathology and BMI were compared at baseline (T1), post‐treatment (T2) and 1‐ or 3‐month follow‐up. ImpulsE led to better food‐specific inhibition performance (p = .004), but groups did not differ regarding improvements in global Eating Disorder Examination Questionnaire (EDE‐Q) score at T2. At 3‐month follow‐up, binge eaters benefited most from ImpulsE (p = .028) and completers of ImpulsE demonstrated a significantly greater weight reduction (p = .030). The current findings propose ImpulsE as a promising approach to treat obesity, illustrating acceptability and additional benefits for course of weight. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Relationship between dietary restraint, binge eating, and leptin in obese women

OBJECTIVE: To describe some biological, behavioural and psychological correlates of the Three-Factor Eating Questionnaire, and to determine the relationship between dietary restraint, binge eating, and leptin among obese women seeking treatment. DESIGN: Consecutive series of obese women enrolled in a clinical program for weight reduction treatment. SUBJECTS: Forty-two obese women. Eight participants met the criteria for 'severe binge eating' as measured by the Binge Eating Scale. MEASUREMENTS: Energy intake, resting energy expenditure, body composition, leptin, restraint, disinhibition, hunger and binge eating were assessed before starting the treatment. RESULTS: In this sample both higher disinhibition and hunger scores were associated with greater binge eating severity. Obese women with severe binge eating had lower restraint, higher disinhibition and hunger scores, as well as higher daily fat intake, when compared with obese non-binge-eaters. Interestingly, restraint scores were negatively associated with leptin levels among subjects with severe binge eating. CONCLUSION: In obese women with severe binge eating, the negative relationship between dietary restraint and serum leptin concentrations seems mediated by a greater fat intake. These findings need to be verified in further human studies.     

Temperament Dispositions,Problematic Eating Behaviours and Overweight in Adolescents

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours and excess weight. Several self‐report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programmes, as they suggest that reducing restrained eating by working on temperament may help to control weight. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Impact of Self‐Reported Impulsivity on the Course of Weight Is Mediated by Disinhibited Eating

This study investigates the impact of impulsivity and the mediating role of disinhibited eating behaviour (DEB) on weight and weight trajectories in a large data set including obese non‐treatment seeking individuals (obese control, n = 138) and obese individuals who were either receiving a conventional treatment program (n = 227) or bariatric surgery (n = 123). Data was assessed one, 4 and 9 years after baseline including self‐reports for impulsivity and DEB. Results suggest a significant association between impulsivity and body mass index, which is partially mediated by DEB. Longitudinally, the influence of impulsivity on the course of weight after 9 years was fully mediated by DEB in obese control but not in the treatment groups. The results indicate an interplay between impulsivity and DEB with respect to obesity. Further research is needed to clarify how the mediation works and when it exerts its effect, in order to identify those that might profit from a specific (impulsivity‐reducing) training. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Processing of Food Stimuli in Abnormal Eating: A Systematic Review of Electrophysiology

To update the knowledge about attentional processing of food stimuli, a systematic review of electrophysiological studies was conducted using PubMed, PsychInfo and Web of Knowledge (2000–2014). Twenty‐one studies were included into a qualitative synthesis. Presentation of food and control pictures was used to analyze event‐related potentials related to sensory processing and motivated attention. Results show consistent attentional bias towards food pictures compared with neutral pictures for patient and control groups. Group comparisons between individuals with abnormal‐eating and healthy‐eating participants were more inconsistent. Results suggest that temporal differences in the millisecond range are essential for the understanding of visual food processing. In obesity, early attention engagement to food is followed by relatice disengagement. Loss of control eating, as well as external and emotional eating, are associated with a sustained maintenance of attention towards high‐caloric food. There is a lack of studies in anorexia nervosa, bulimia nervosa and binge eating disorder. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Gastric stimulation in obese subjects activates the hippocampus and other regions involved in brain reward circuitry

The neurobiological mechanisms underlying overeating in obesity are not understood. Here, we assessed the neurobiological responses to an Implantable Gastric Stimulator (IGS), which induces stomach expansion via electrical stimulation of the vagus nerve to identify the brain circuits responsible for its effects in decreasing food intake. Brain metabolism was measured with positron emission tomography and 2-deoxy-2[18F]fluoro-D-glucose in seven obese subjects who had the IGS implanted for 1-2 years. Brain metabolism was evaluated twice during activation (on) and during deactivation (off) of the IGS. The Three-Factor Eating Questionnaire was obtained to measure the behavioral components of eating (cognitive restraint, uncontrolled eating, and emotional eating). The largest difference was in the right hippocampus, where metabolism was 18% higher (P < 0.01) during the "on" than "off" condition, and these changes were associated with scores on "emotional eating," which was lower during the on than off condition and with "uncontrolled eating," which did not differ between conditions. Metabolism also was significantly higher in right anterior cerebellum, orbitofrontal cortex, and striatum during the on condition. These findings corroborate the role of the vagus nerve in regulating hippocampal activity and the importance of the hippocampus in modulating eating behaviors linked to emotional eating and lack of control. IGS-induced activation of regions previously shown to be involved in drug craving in addicted subjects (orbitofrontal cortex, hippocampus, cerebellum, and striatum) suggests that similar brain circuits underlie the enhanced motivational drive for food and drugs seen in obese and drug-addicted subjects, respectively.     

Food‐related impulsivity in obesity and Binge Eating Disorder – a systematic review

Impulsivity towards food has been recognized as a potential factor leading to increased food intake in obesity. Patients suffering from binge eating disorder (BED) form a specific subgroup of obese people that might be characterized by increased impulsivity. These assumptions, although, have yet to be verified. Therefore, this review evaluates evidence for food‐related impulsivity in obese people with and without BED and examines possible differences between both populations. More precisely, evidence for the two components of impulsivity is analyzed separately: evidence for reward sensitivity, specifically, the urge for appetitive stimuli and evidence for rash‐spontaneous behaviour such as acting disinhibited with no regard for the consequences. Our search resulted in 51 articles demonstrating generally increased food‐related impulsivity. We found particular emphasis on increased reward sensitivity in obese people, which appeared to be more pronounced in people with BED. There was little and conflicting evidence, however, concerning increased rash‐spontaneous behaviour in obese people without BED, but consistent evidence of an increase in obese people with BED. All in all, the evidence supports the view that BED represents a specific phenotype of obesity with increased food‐related impulsivity. Taking these specific deficits into account can enhance the effectiveness of weight reduction programmes and psychotherapy.     

Prevalence and sociodemographic correlates of eating disorder endorsements among adolescents and young adults from China

This research assessed the prevalence and sociodemographic correlates of eating disorder symptoms among young people from China. A sample of 1320 females and 783 males between 12 and 22 years of age was recruited from academic settings in various regions of China and completed a back‐translated Chinese version of the Eating Disorder Diagnostic Scale, as well as measures of body dissatisfaction and demographics. As expected, reported eating disorder symptoms and body dissatisfaction were significantly higher for females than males. Eating disorder symptoms and body dissatisfaction were also more pronounced for participants from higher income households. Finally, age differences in symptoms and body dissatisfaction were inconsistent. In sum, findings extend past prevalence research and highlight specific sociodemographic correlates of eating pathology and body dissatisfaction among Chinese adolescents and young adults. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Exploring the Relationship between Coping Strategies and Binge Eating in Nonclinical Adolescents

The aims of the study were to determine the rate of binge eating and examine the relationship between binge eating and coping in nonclinical adolescents. A total of 1913 adolescents completed the Bulimic Investigatory Test, Edinburgh, the Adolescent Coping Scale (ACS), the Youth Self‐Report and additional questions regarding the binge‐eating episodes. Of the total sample, 6.94% reported bingeing in the last 6 months. The adolescents who binge eat reported a more frequent use of Intropunitive avoidance and Introversion and a less frequent use of Positive‐effortful coping compared with those who do not binge eat. However, when the effects of age and depression were controlled in the analysis, the groups only differed in the Positive and Intropunitive avoidance dimensions of coping. Training adolescents on how to cope with stress in a more constructive manner may be a possible strategy for the prevention of maladaptive eating patterns in adolescents. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory‐2 (EDI‐2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m². Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI‐2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI‐2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non‐responders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.