‚Food Addiction' – Addictive-Like Eating Behavior
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Copyright! Reproduction and dissemination – also partial – applicable to all media only with Special | Food addiction written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. Peer-reviewed | Manuscript received: January 31, 2017 | Revision accepted: April 13, 2017 © Antonio Balaguer soler/Hemera/Thinkstock ‚Food addiction‘ – addictive-like eating behavior The current state of research with the Yale Food Addiction Scale Carolin Hauck, Thomas Ellrott The construct of ,food addiction’ is increasingly a subject of focus both in public discussion and in scientifi c research. The concept of ,food addiction’ postulates a link between food intake and addiction. The aim of this article is to give nutrition experts a brief overview of the current scientifi c discussion, to provide an initial introduction to the complex topic of ,food addiction’, and to explain the possible clinical applications of the “Yale Food Addiction Scale” questionnaire (YFAS 2.0). 102 Ernaehrungs Umschau international | 6/2017 Copyright! Reproduction and dissemination – also partial – applicable to all media only with written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. addiction’ is not included in DSM-5, Abstract however within specialist circles, it is being discussed as a new aspect of There are three methodical research approaches that are used to inves- addiction/eating disorders. The pur- tigate the construct of a ,food addiction’: animal studies, neurocogni- pose of this article is to provide an tive human studies using imaging methods, and questionnaire-based overview of the discussion as it now human studies using the Yale Food Addiction Scale (YFAS). The focus of stands, and in particular, to provide this article will be the current state of research using the YFAS 2.0. Based an overview that is based on the use on the diagnostic criteria for substance addiction set forth in the Diagno- of the Yale Food Addiction Scale for stic and Statistical Manual of Mental Disorders (DSM-5), the YFAS asses- diagnostics (see “Approaches” sec- ses and evaluates the psychological aspects of human eating behavior tion). in a standardized manner to determine whether an individual may have The numerous ways in which an addiction. When ,food addiction’ is defined in this way, its prevalence the term ,food addiction’ has been in sample populations is 5–10%. Higher prevalence is observed in pa- translated into other languages and tients who are obese, have a binge eating disorder or bulimia nervosa, the various connotations of these or who are underweight. Currently, research is being conducted into different translations illustrate the links between ,food addiction’, pathological eating behavior, persona- fact that this phenomenon remains lity traits (e.g. cognitive control of eating behavior, impulsiveness), and poorly defined. It may be for this depression. However, the construct of ,food addiction’ that is under very reason that in German scien- consideration here is also the subject of criticism because there are still tific literature, the original English many research gaps that need to be filled in: for example with regard to term ,food addiction’ that was origi- distinctions and terminology, and with regard to neural and behavioral nally proposed by RANDOLPH in 1956 correlates, and their effects on stigmatization, prevention and therapy. is still being used frequently [6]. Five Keywords: food addiction, addictive-like eating behavior, YFAS, obesity, decades after the term was coined, eating disorder efforts began to discuss addic- tive-like eating behavior as a pos- sible explanation for the globally in- creasing prevalence of obesity. This caused the number of publications on ,food addiction’ to increase ra- pidly [7, 8]. A comprehensive mo- Introduction scientific literature [2, 3]. In every- nograph with the title “Food and day English, “ism” or “holic” suf- Addiction: A Comprehensive Hand- Terms like binge eating disorder, fixes are used synonymously with book” [9] was published in 2012. ,food addiction’ (e.g. “chocoholic” “addiction” in the sense of an “ex- [1]) and addictive-like eating behavior treme desire” or an “abnormal re- occur more frequently in German action” [2] in combination with an Approaches media. These terms link the abso- active “seeking” for the thing desi- lutely crucial food intake with an red [2]. Other examples of everyday In research, there are three different addiction, as is typical in the case terms using such suffixes include approaches to the construct of ,food of the consumption of drugs. How- shopaholic, workaholic, etc. The addiction’: neurocognitive human ever, the term “addiction” is often word “addicted” is also used in this studies, animal studies, and questi- used and understood differently sense, not necessarily meaning a real onnaire-based studies. in everyday language than it is in medical condition, e.g. “I’m addicted For the first of these approaches, to chocolate (chocoholic [1])”. imaging procedures are used, along However, the scientific definition of with measurement of the hormones addiction is much more specific. In and peptides that regulate hunger Citation: DSM-5 (Diagnostic and Statistical and satiety, and which are compo- Hauck C, Ellrott T (2017) ,Food Manual of Mental Disorders version nents of the central reward system Addiction‘: addictive-like eating 5) [5] “addiction” is classified under [10–13]. The main systems at work behavior. The current state of the overarching term “addiction and here are the mesolimbic dopamine research with the Yale Food related disorders” and comes under system and the cannabinoid and Addiction Scale. Ernahrungs the umbrella of substance use dis- opioid systems [14]. Umschau 64(6): 102–110 orders. The term “substance use The second approach is animal This article is av ailable online: disorders” includes both substance studies. In these studies, after in- DOI: 10.4455/eu.2017.023 abuse and substance dependence termittent deprivation of food and (according to DSM-IV [4]) [5]. ,Food sugar, reactions comparable to the Ernaehrungs Umschau international | 6/2017 103 Copyright! Reproduction and dissemination – also partial – applicable to all media only with Special | Food addiction written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. reactions after drug consumption were observed in the test animals [15-17]. In special experimental set- ups, energy-dense, highly proces- 40 sed foods also triggered reactions in 20 humans similar to those described in 0 association with drug abuse (especi- underweight representative morbid athletes ally loss of control) [12,14,16,18], al- frequency (%) persons (study 1, obesity (study 3, though significant differences (e.g. no (study 1, n = 20) n = 1,034) (study 2, n = 64) n = 1,034) endangerment of others/drug-related Fig. 1: Prevalence of ,food addiction’ assessed by YFAS 2.0 in three different crime, no withdrawal symptoms, no German samples [own data from (29, 31) and own unpublished data] sustained dose increases/tolerance de- YFAS = Yale Food Addiction Scale velopment) were reported. In addition, most people do not consume such foods to a pathological extent, and are that endangers oneself and others, Studies using the Yale therefore not “addicted” to them, des- and pharmacological aspects [5]. Food Addiction Scale pite regular consumption [19]. When two symptoms occur wit- The third scientific approach to ,food hin 12 months along with clinically In a systematic review of studies con- addiction’ in humans is questionnai- significant impairment, the crite- ducted up to July 2014 using the re-based studies designed to find ria for a substance use disorder are previous version of the YFAS (version overlaps in associated human beha- considered to be met. In addition, 1.0), an average ,food addiction’ pre- viors. In order to detect ,food addic- the severity is classified according valence of 19.9% was determined [29]. tion’ in a scientifically valid manner, to three severity grades: mild (2–3 Here, all English-language studies US researchers developed a questi- criteria met), moderate (4–5 criteria that measured a YFAS 1.0 diagnosis onnaire [20] in 2009, which analy- met) and severe (≥ 6 criteria met) or symptom score were included, re- zes addictive-like eating behavior on [5]. YFAS 2.0 attempts to trans- sulting in a sample of nearly 200,000 the basis of the DSM diagnostic cri- pose the classical criteria for addic- people who were predominantly fe- teria for substance dependency [4]. tion onto human eating behavior in male and 60% of whom were either This questionnaire-based method, order to detect potentially addicti- overweight or obese. Prevalence was known as the Yale Food Addiction ve-like eating behavior in a manner higher in women than in men, was Scale (YFAS), is already in its second analogous to the technique used for higher in people who were over- edition, which was published in substance use disorders. If this clini- weight/obese than in those of normal 2016, and is now known as the Yale cally significant impairment is pre- weight, and was higher in persons Food Addiction Scale 2.0 (YFAS 2.0) sent along with at least two symp- over 35 years of age than in younger [21]. The current version is based on toms, ,food addiction’ is “diagnosed” people [29]. Studies in students and the fifth edition of the DSM (DSM- according to YFAS 2.0 [20]. In the in population samples showed lower 5) [5]. The YFAS has been transla- current version of the YFAS (version prevalence rates of 5–10% [30]. Higher