Food Addiction

What Is Food Addiction?

Food addiction Photo courtesy of Yunique MedicalOpens in new window

Food addiction was first proposed in the mid-1950s as a loss of control over food intake with a persistent desire for food and unsuccessful attempts to curtail the amount of food eaten despite knowledge of adverse consequences.

Noting that obese and individuals who overeat, display characteristics reminiscent of addictionOpens in new window, an addiction model has been used to explain the abnormal eating patterns found in obese and overweight individuals, as well as in patients with Eating Disorders (EDs)Opens in new window.

H. Ziauddeen et al., reviewed food addiction as a phenotype description, one that is based on an overlap between certain eating behaviors and substance dependence.

More recently, Imperatori et al., argued that food addiction seems to be a transnosografic construct that exists in all EDs.

They argued that food addiction refers to specific food related behaviors characterized by excessive and dysregulated consumption of high colorie food (i.e., foods with high sugar and/or fat).

Most recently, food addiction is defined as a chronic and relapsing condition caused by the interaction of many complex variables that increase cravings for certain specific foods in order to achieve a state of high pleasure, energy or excitement, or to relieve negative emotional or physical states.

Food Addiction Versus Eating Disorders

It is crucial to distinguish the similarities and differences between food addiction and eating disordersOpens in new window, as well as between food addiction and other addiction models.

Several eating disorders have already been identified in DSM-V:

  1. Bulimia Nervosa (BN)
  2. Anorexia Nervosa (AN);
  3. overweight and obesity;
  4. Binge Eating Disorder (BED);
  5. ,li>Night Eating Syndrome (NES);
  6. Food Craving (FC)

Food addiction (FA) is an abnormal consumption pattern, seems to have significant psychopathological overlaps with these EDs, especially with BED and BN. Reduced control over eating, continued use despite negative consequences, and elevated levels of impulsivity and psychopathology are several overlaps between FA and both BED and BN.

However, there are also some crucial differences between FA and other EDs:

  1. Contrary to FA, BED is associated with elevated concerns with shape or weight. This crucial psychopathological core construct is not considered in patients with FA.
  2. Contrary to FA, BED and BN diagnoses specify that binge eating episodes must occur during a discrete period of time.
  3. FA has many typical symptoms of addiction, e.g., tolerance, withdrawal syndrome, devoting a certain amount of time to activities associated with eating and neglecting or abandoning other activities associated with eating and neglecting or abandoning other activities for food, which are not included in any ED.
  4. The function of eating in BED is to reduce mental tension (caused by for example: cognitive distortions related to food, embarrassment caused by shape and weight, eating restraint), however, in FA, food is used to induce hedonistic satisfaction (pleasant psychophysiological feelings).
  5. Contrary to BED, the body mass in FA is excessive or normal (e.g., when the dependence relates to one specific product).

How to Diagnose Food Addiction?

It is important to note that the most widely employed definition of FA derives from the overlay with DSM-IV-TR criteria for drug addiction. These criteria include:

  1. Substance taken in larger amount and for longer period than intended;
  2. persistent desire or repeated unsuccessful attempts to quit;
  3. a large amount of time/activity necessary to obtain, to use or to recover;
  4. important social, occupational, or recreational activities dismissed or reduced;
  5. continuative use despite knowledge of adverse consequences;
  6. tolerance;
  7. withdrawal symptoms.

For a person to be considered addicted to any given specific food, at least three of the seven criteria must be met at any time within a given year.

Seven questionnaires have also been developed to help diagnose FA. For example, in 2009, Merlo et al., developed the Eating Behaviors Questionnaire (EBQ) to investigate, in a pediatric sample, the three crucial components of FA, the so-called “3 Cs” of addiction:

  1. Compulsive use,
  2. attempts to Cut down (quitting attempts), and
  3. Continued use despite adverse consequences.

Despite its good psychometric properties, attempts to adapt this self-report to an adult population have not yet been pursued.

The Yale Food Addiction Scale (YFAS), developed by Gearhardt et al., is the most commonly used tool to assess FA in clinical and non-clinical samples. It is a specific self-report questionnaire for FA evaluation and diagnosis, most recently presented as the 35-item YFAS 2.0.

It investigates eating behaviors concerning hyper-palatable food consumed in the previous 12 months. A symptom count can be calculated, which can range between 0 and 11 symptoms.

Furthermore, a diagnostic score can be calculated (‘food addiction’ vs no ‘food addiction’), and diagnosis can be further specified as mild, moderate, or severe, depending on the number of symptoms present. Internal consistency has an α = 0.970. A shorter version of the YFAS and a version for children have recently been developed.

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