Elsevier

Comprehensive Psychiatry

Volume 73, February 2017, Pages 97-104
Comprehensive Psychiatry

Prevalence and psychosocial correlates of food addiction in persons with obesity seeking weight reduction

https://doi.org/10.1016/j.comppsych.2016.11.009Get rights and content

Abstract

Introduction

Food addiction is a controversial concept. The potential influence of food addiction on patients' psychosocial functioning and well-being has not been well established. The purpose of this study was to examine the relationships between psychosocial functioning (depressive symptoms and health-related quality of life [HRQOL]) and food addiction as measured by the Yale Food Addiction Scale (YFAS). We also explored whether food addiction contributed additional variance in explaining psychosocial functioning, beyond demographic and clinical factors (e.g., binge eating).

Methods

The sample included 178 participants (mean age = 44.2 ± 11.2 years; BMI = 40.9 ± 5.9 kg/m2; 88.2% female; 70.8% Black) with obesity seeking treatment for weight loss. Participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey, Impact of Weight on Quality of Life-Lite, Patient Health Questionnaire, YFAS, and Questionnaire on Eating and Weight Patterns-5.

Results

Twelve (6.7%) participants met criteria for food addiction, with 4 (33.3%) of these participants having co-occurring binge eating disorder. After adjusting for covariates, the number of food addiction symptoms accounted for 6.5% to 16.3% of additional variance in general HRQOL, 5.0% to 21.5% in weight-related HRQOL, and 19.1% in symptoms of depression.

Conclusions

In this treatment-seeking sample of participants, we found a low prevalence of food addiction, suggesting that addictive-like eating is unlikely to be a causal mechanism for most people with obesity. However, individuals who met criteria for food addiction had reduced psychosocial functioning compared to those who did not meet criteria. Individuals with addictive-like eating may require additional psychosocial support.

Introduction

Food addiction is a popular yet highly controversial construct that was first introduced in the scientific literature as term to describe abnormal eating behaviors. However, it is now often used to explain the etiology and maintenance of some forms of obesity [1]. Food addiction is most commonly measured and operationalized using the Yale Food Addiction Scale (YFAS) [2]. As originally developed, this measure applies the seven criteria for substance dependence, taken from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), to food and eating behaviors [2]. Criteria include wanting to cut down or stop using the substance but not managing to; taking the substance in larger amounts or over a longer period; giving up important social, occupational, or recreational activities because of substance use; and continued use of the substance despite knowledge of having a persistent or recurrent physical or psychological problem. Using the YFAS, estimates of the prevalence of food addiction in the general population range from 0 to 10% [3], [4]. Results from a meta-analysis suggest that the prevalence of food addiction is 11.1% among individuals who are normal weight, compared with 24.9% among those who are overweight/obese [5]. The prevalence has been reported to be as high as 56.8% in individuals with both obesity and binge eating disorder [6]. A growing number of studies have sought to demonstrate the validity and clinical utility of the construct of food addiction.

Food addiction is associated with several clinical conditions, one of which is binge eating disorder (BED). BED is characterized by the consumption of an objectively large amount of food in a discrete period of time (i.e., 2 h), with an accompanying sense of loss of control over eating [7]. Among participants with clinically diagnosed BED, the co-occurrence of food addiction ranges from 41.5% [8] to 72.2% [9]. Like persons with BED, those with a diagnosis of food addiction tend to have a higher body mass index (BMI) [10], [11] than unaffected individuals, as well as more symptoms of depression [12], [13], [14] and eating disorder psychopathology (i.e., shape and weight concerns [6], [15]). However, among individuals who are obese, some studies have demonstrated no difference in BMI between those with and without food addiction or BED [16].

The present study had two primary goals, the first of which was to examine the relation of food addiction to health-related quality of life (HRQOL). Reduced HRQOL is common in individuals with substance use disorders [17], [18], as it is in persons with BED [19]. However, the impact of food addiction on HRQOL has not been established. We hypothesized that among persons with obesity, those with food addiction, compared to individuals without this latter diagnosis, would report poorer general and weight-related HRQOL. The study's second goal was to examine whether the diagnosis of food addiction accounted for unique variance in psychosocial functioning (i.e., HRQOL and symptoms of depression) above and beyond that associated with BED. The discovery of additional variance would suggest the potential usefulness of the diagnosis of food addiction in capturing the behavioral and psychosocial characteristics of a subset of individuals with obesity.

Section snippets

Study design and participants

This was a cross-sectional study of baseline data from 178 participants enrolled in a randomized controlled trial for weight reduction. Inclusion criteria were: BMI  33 kg/m2 and ≤55 kg/m2 (or ≥30 kg/m2 with an obesity-related comorbidity); age  21 and ≤65 years; and having a primary care provider who was responsible for providing routine medical care. Exclusion criteria were: clinically significant medical or psychiatric conditions that would contraindicate weight loss; diabetes; pregnant or

Participant characteristics

Participants had a mean age of 44.2 ± 11.2 years and BMI of 40.9 ± 5.9 kg/m2. The majority of the sample was female (88.2%); 70.8% of participants self-identified as Black, 21.9% as White, and 7.3% as Other race/ethnicity. Participants had an average of 1.9 ± 1.7 comorbidities, most commonly hypertension (35.4%), dyslipidemia (21.9%) and arthritis (19.7%). The average score on the PHQ-9 was 4.9 ± 4.8, with 15.7% of participants endorsing moderate or greater depressive symptoms.

Prevalence of food addiction and BED

Twelve of 178 (6.7%)

Discussion

As hypothesized, participants who met criteria for food addiction reported poorer general and weight-related HRQOL than individuals who did not meet criteria. A norm-based, group mean score of less than 47 on the SF-36 indicates a value below average for the general population [25]. The group means for individuals who did not meet food addiction criteria were all above 47. However, all of the SF-36 group mean scores for participants who met criteria for food addiction were below 47, indicating

Author disclosures

Funding: AMC was supported by a Ruth L. Kirschstein National Research Service Award postdoctoral fellowship from the National Institute of Nursing Research/National Institutes of Health #T32NR007100. Support was also provided by an investigator-initiated grant from Eisai Pharmaceuticals and from HMR Weight Management Services Corp, Boston, MA (TAW). These funders had no role in the current study design or the collection, analysis, or interpretation of data, writing the manuscript or the

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