The relationship between food addiction and patterns of disordered eating with exercise dependence: in amateur endurance athletes

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-019-00794-6 ORIGINAL ARTICLE The relationship between food addiction and patterns of disordered eating with exercise dependence: in amateur endurance athletes Carolin Hauck1 · Melanie Schipfer2,3 · Thomas Ellrott1 · Brian Cook4 Received: 4 April 2019 / Accepted: 3 October 2019 © The Author(s) 2019 Abstract Purpose Examine the prevalence and potential relationships among food addiction (FA)—as measured by Yale Food Addiction Scale 2.0 (YFAS 2.0), eating disorders (ED)—as measured by Eating Disorder Diagnostic Scale (EDDS)—and exercise dependence (EXD)—as measured by Questionnaire to Diagnose Exercise Dependence in Endurance Sports (FESA), for the first time worldwide, in amateur endurance athletes. Methods A total of 1022 German-speaking endurance athletes (44% male, Ø 36 years, Ø BMI 23 kg/m2) replied to an online questionnaire consisting of demographics, related parameters, and the German versions of YFAS 2.0, EDDS, and FESA. Results Prevalence of FA, ED, and EXD was 6.2, 6.5, and 30.5%. The probability for FA increases with BMI, thoughts about food and EXD score, and decreases with age and when an ED is present. People with FA and people with ED vs. people with both, FA&ED, differed significantly in this cohort. Strong significant relationships were found between FA and EXD (X2 (1) = 15.117, p < 0.001, n = 1022). Conclusions A considerable number of amateur endurance athletes may suffer from FA. The association between FA and EXD is stronger than between ED and EXD, indicating FA as a potentially more relevant subject—than ED—for prevention or therapy in people with EXD. Further studies are needed to investigate parameters and relationships between the possibly involved types of ED, FA, and EXD. Level of evidence Level III, well-designed cohort analytic study. Keywords Food addiction · Yale Food Addiction Scale 2.0 · Eating disorders · Eating Disorder Diagnostic Scale · Exercise dependence · Amateur endurance athletes Introduction The concept of food addiction The concept of ‘Food Addiction’ (FA) has gained much research and clinical attention. Specifically, similarities in This article is part of topical collection on Food and Addiction. * Carolin Hauck ‑goettingen.de 1 Institute for Nutrition and Psychology at the University of Goettingen, Humboldtallee 32, 37073 Göttingen, Germany 2 Martin-Luther-University Halle-Wittenberg, Universitaetsplatz 10, 06108 Halle (Saale), Germany 3 Profusa Inc., 345 Allerton Avenue, South San Francisco, CA 94080, USA 4 Alsana: An Eating Disorder Recovery Community, 2545 W Hillcrest Dr, Suite 205, Thousand Oaks, CA 91320, USA food intake and consumption of drugs of abuse have led to the theory that some naturally non-occurring, highly processed foods with added fats and/or refined carbohydrates may possess an addictive potential (e.g., biscuits, chocolate, pizza; [1–3]). The substance dependence diagnostic criteria from DSM-5 [4] were applied to food, and the phenomenon of addictive-like eating was named ‘FA’ [1]. However, little consensus exists regarding etiology, clinical presentations, biomarkers and physiological explanations, and effective treatment approaches [5]. Moreover, confusion exists concerning whether FA more closely represents an emerging form of behavioral addiction [6], food-type specific form of chemical dependence [7], or an emerging subtype of a clinical eating disorder (ED; the term ED refers to a clinical eating disorder) [8]. A significant amount of substance dependence diagnostic criteria, according to DSM-5 [4], seem to be similar to those criteria meeting for ED, like binge-eating disorder (BED; [9]. Therefore, a potential overlap of 50–95% between FA and ED has been hypothesized 13 Vol.:(0123456789) Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity [10–12]. However, the character of the potential overlap remains unclear [10–14]. Thus, distinguishing similarities and differences among FA from established criteria for the different types of ED is of both clinical and research importance. Eating disorders in athletes The prevalence of all EDs (e.g., Anorexia Nervosa, Bulimia Nervosa) is 3–5% in Germany [15]. Athletes represent a group that is at elevated risk for specific types of ED, such as Anorexia Nervosa [16]. The prevalence of ED in elite athletes varies from 6 to 45% in female and from 0 to 19% in male elite athletes [16]. Especially in leanness- and weightdependent sports, like endurance sports, elevated rates of ED can be found [17, 18]. For this reason, athletes represent a good group to find out potential associations between ED and FA. Exercise dependence in athletes In general, physical activity is seen as a positive behavior with favorable effects on health. Nevertheless, the positive benefits of exercise can have detrimental effects when taken to excess [19] and become a compulsive behavior with harmful consequences to the individual [20]. In addition to the higher prevalence of ED in athletes, some athletes, especially endurance athletes, comprise a group which is furthermore at higher risk for harmful excessive exercise, the so-called exercise dependence (EXD) [21]. Prevalence for EXD is 0.5–3.5% in the general population [22] and up to > 50% within triathletes [23]. Some research groups also describe pathological excessive exercise as ‘exercise addiction’ [24–32]. Prevalence for exercise addiction is 0.3–42% in various samples [25, 30]. Both terms, EXD and exercise addiction may in fact represent a similar, or even the same, phenomenon of pathological excessive exercise [33, 34]. To simplify it in this paper, only the term ‘EXD’ is used, which most likely describes both EXD and exercise addiction. Basically, athletes, especially endurance athletes, are obliged to perform excessive amounts of sport to improve their athletic performance. That may be why it is difficult to detect the line between healthy extreme exercise and pathological excessive exercise. Furthermore, especially in endurance sports, many athletes are similar to individuals with specific forms of ED, e.g., Anorexia Nervosa, in that they maintain a low body weight and low body fat mass, although they are generally otherwise healthy with healthy eating habits. Thus, a distinction between healthy exercise, as well as healthy eating habits, and unhealthy body size and athletic exercise that possibly indicated disordered eating is difficult to identify. For example, the simple carbohydrates required to fuel endurance-type athletic events may be similar to the 13 patterns of eating defined as FA and foods and quantities typically consumed during objective binge episodes. Therefore, there is the potential for the development of FA in this unique population that is also at-risk for EXD [19] and ED [16]. To date, the relationships among these risks have not been examined. For this reason, athl (...truncated)