Systematic Review of Food Addiction as Measured with the Yale Food Addiction Scale: Implications for the Food Addiction Construct.

Send Orders for Reprints to 526 Current Neuropharmacology, 2019, 17, 526-538 SYSTEMATIC REVIEW ARTICLE Systematic Review of Food Addiction as Measured with the Yale Food Addiction Scale: Implications for the Food Addiction Construct Louise Penzenstadlera,*, Carina Soaresa, Laurent Karilab and Yasser Khazaala,c,d a Geneva University Hospitals, Geneva, Switzerland; bUniversity Hospital Paul Brousse, Université Paris Sud, France; Geneva University, Faculty of Medicine, Geneva, Switzerland; dResearch Center, Montreal University Institute of Mental Health, Montreal, Canada c Abstract: Background: The concept of food addiction attracts much interest in the scientific community. Research is mainly based on the Yale Food Addiction Scale (YFAS), a tool developed to assess food addiction. Substance use disorder criteria have been used to develop this scale. Objective: The aim of this paper was to review the clinical significance of food addiction diagnoses made with the YFAS and to discuss the results in light of the current debate on behavioral addictions. A R T I C L E H I S T O R Y   Received: January 10, 2018 Revised: May 03, 2018 Accepted: October 30, 2018 DOI: 10.2174/1570159X16666181108093520   Methods: We performed a systematic review of the studies that assessed food addiction with the YFAS published between January 2014 and July 2017 by searching the electronic databases PsycINFO, MEDLINE, and PsycARTICLES. Results: Sixty publications were included in the analysis. Thirty-three studies examined nonclinical samples and 27 examined clinical samples. All studies used YFAS scoring results to define food addiction. The prevalence of food addiction according to the YFAS varied largely by the studied samples. In general, a higher body mass index and the presence of eating disorders (EDs), especially binge eating disorder (BED), were associated with higher YFAS scores. Conclusion: The concept of food addiction has not been established to this day although it can be grouped with other EDs such as BED. More research is needed to understand this behavior and the differences between food addiction and other EDs. The criteria for food addiction should be revisited in light of the concepts currently used to examine behavioral addictions. Keywords: Addictive disorders, behavioral addiction, binge eating disorder, eating disorders, food addiction, obesity, yale food addiction scale, YFAS. 1. INTRODUCTION Obesity and eating disorders (EDs) such as binge eating disorder (BED) are an important health concern in our society. Possible similarities between overeating and substance use disorder (SUD) have been discussed for decades, with the first mention of the term “food addiction” given by Theron Randolph in 1956 [1]. In the last 3 years, in the midst of important debates related to behavioral addictions, numerous articles have been published on this topic [2]. The concept of food addiction (FA) was introduced to describe patterns of specific eating behaviors and excessive consumption based on the hypothesis of similarities between such patterns and addictive behaviors [3]. *Address correspondence to this author at the Geneva University Hospitals, Rue de Grand-Pré, 70 C, 1202 Geneva, Switzerland; Tel: +41 22 372 57 50; Fax: +41 22 372 55 70; E-mail: 1570-159X/19 $58.00+.00 The definition for FA proposed by Gearhardt et al. [3] emerged by mapping the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria for substance dependence to eating behaviors [4]. These include tolerance, withdrawal symptoms, larger amounts consumed than intended, persistent desire or unsuccessful attempts to cut down, much time spent using or recovering from a substance, continual use despite knowledge of consequences, and activities given up due to use of a substance. As in the case of substance use disorder, the presence of 3 of 7 symptoms has been suggested as necessary to define FA, as well as to show clinically significant impairment or distress (Table 1). To date, FA is not a clinically recognized disorder, but it has been suggested that addictive-like consumption of processed, hyper-palatable, and energydense foods could influence weight gain and obesity [5]. The most commonly used and well-known tool to measure so-called FA is the Yale Food Addiction Scale (YFAS). ©2019 Bentham Science Publishers Systematic Review of Food Addiction as Measured with the Yale Food Addiction Scale Table 1. Current Neuropharmacology, 2019, Vol. 17, No. 6 527 DSM-IV-TR substance dependence criteria. 1. Substance taken in larger amount and for longer period than intended 2. Persistent desire or repeated unsuccessful attempt to quit 3. Much time/activity to obtain, use, recover 4. Important social, occupational, or recreational activities given up or reduced 5. Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous) 6. Tolerance (marked increase in amount, marked decrease in effect) 7. Characteristic withdrawal symptoms; substance taken to relieve withdrawal Presence of clinical impairment or significant distress The first scale was developed in 2009 [3], consisting of a self-report questionnaire that examines eating behaviors during the past 12 months. The YFAS has good clinical validity [6] and has been translated into different languages. It also has good internal consistency, as well as convergent, discriminant, and incremental validity [3, 7]. Elevated scores on this scale have been linked to obesity, EDs, and binge eating [8]. Criteria for substance dependence according to the text revision of the DSM-IV (DSM-IV-TR [9] (Table 1) were used to develop the items for the questionnaire in the YFAS (Table 2) and adapted to consumption of high fat and sugar foods [3]. This means that the questions were formulated to specifically fit these criteria. However, following diagnostic changes in the fifth edition of the DSM (DSM-5) [10] that introduced measures for a continuum of severity and craving, a new version of the YFAS, the YFAS 2.0, was developed in 2016 that added these new criteria for SUD (Tables 2 and 3). The YFAS has 25 questions that measure 7 SUD criteria and the YFAS 2.0 has 35 questions that measure 11 SUD criteria. A short form of each scale was also developed: the modified YFAS (mYFAS) in 2014 [11] and the mYFAS 2.0 in 2017 [12]. If clinical impairment or distress is not present, the “diagnosis” of FA is not retained in all scales even if other symptoms are present. Scoring is computed according to the explanations reported in Table 4. Several reviews have been published on FA. Prevalence varied between 16.2% [13] and 19.9% [14] and was higher in overweight patients [14] and patients seeking weight loss [13]. Burrows [13] found a relationship between the presence of FA and binge eating, as well as between FA and depression and anxiety. Another review examined FA in patient (...truncated)