The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study was the first to investigate the factor structure, psychometric properties, and clinical significance of the YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. Data were analysed from 220 community-based participants who met criteria for “probable BED” based on self-report symptom frequency. Classification of food addiction (FA) was met by 42.3% of the sample. The YFAS 2.0 exhibited a unidimensional structure, adequate internal consistency, and convergent and incremental validity. YFAS 2.0 scores contributed the largest percentage of unique variance in psychological distress and impairment over other BED features (overvaluation of weight and shape, binge eating, BMI), highlighting the clinical significance of the FA construct in BED. Support for the validity and reliability of the YFAS 2.0 in individuals with BED-like symptoms was found. Findings also suggest that the presence of FA may represent a more disturbed group of BED characterised by greater general and eating disorder-specific psychopathology. Our findings overall highlight the potential need to screen and assess addictive-like eating behaviours during interventions for BED.
Food addiction (FA) refers to the idea that certain foods (e.g., highly processed, calorie dense) may trigger an addictive-like response in some individuals (Davis et al., 2011). A growing body of evidence has identified numerous similarities linking excess food consumption and addiction. For example, early work in animal models has demonstrated that rats exhibited biological and behavioural attributes of addiction (e.g., decreased sensitivity of dopamine, desire to obtain food in spite of adverse consequences, withdrawal etc.) with highly processed foods (Avena et al., 2008). Moreover, neuroimaging studies have also shown that ingesting either highly processed foods or drugs activated similar neural systems, and that the dopamine-related neural activation was comparable between obese and drug-addicted patients (Stice et al., 2009, Volkow et al., 2008). Finally, several behavioural indicators of addiction have also shown to be present in disturbed eating behaviours in humans, such as a loss of control, an inability to stop problematic use, and continued use in spite of adverse consequences (Davis et al., 2011).
Although this concept of food addiction (FA) remains controversial, it has received an enormous amount of scientific attention in recent years (e.g., Davis, 2013, Gearhardt et al., 2011a). Part of the popularity of the FA concept comes from the development of the initial 25-item Yale Food Addiction Scale (YFAS; Gearhardt et al., 2009), which was the first self-report measure to operationalise FA and assess addiction-like eating based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for substance dependence (American Psychiatric Association, 1995).
An updated version of the YFAS (YFAS 2.0; Gearhardt et al., 2016) was recently developed to coincide with the revised criteria for substance use disorder (SUD) presented in the latest DSM (DSM-5; American Psychiatric Association, 2013). In the DSM-5, SUDs are no longer classified as substance abuse or substance dependence, but now reflect a single disorder with severity specifiers (mild, moderate, severe) based on the number of symptoms exhibited. A DSM-5 diagnosis of SUD is based on 11 criteria, which include the previous features of substance dependence (e.g., tolerance, withdrawal) from the DSM-IV and one new criterion related to craving. The threshold for a DSM-5 SUD diagnosis requires that at least two of the 11 criteria are met over a 12-month period. The YFAS 2.0 reflects these changes by containing 35-item items assessing the same 11 criteria for SUDs (but modified in a way to reflect an addictive-like response to palatable food) as well as impairment and distress. Evidence upholds the psychometric properties of the YFAS 2.0 in non-clinical normal weight and overweight samples, including a well-replicated one-factor structure, adequate internal consistency, and convergent and incremental validity (Aloi et al., 2017, Brunault et al., 2017, Gearhardt et al., 2016, Granero et al., 2018, Meule et al., 2017).
Assessment of food addiction using the Yale Food Addiction Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance
Linardon, Jake, and Mariel Messer
This study thus had two aims. First, we aimed to examine the psychometric properties of the YFAS 2.0 in individuals with BED-like symptoms, by testing its factor structure, internal consistency, convergent validity (i.e., correlations with measures of body weight and disordered eating), and incremental validity (i.e., whether it predicts unique variance in binge eating after controlling for relevant confounds). Second, we aimed to investigate the clinical significance of the FA construct, by testing whether FA predicts unique variance in psychological distress and impairment above and beyond participant demographics (i.e., age, sex, and ethnicity) and other clinically significant BED features (i.e., overvaluation of weight and shape, binge eating frequency, BMI) in individuals with BED symptomatology.
Participants in the present study were recruited as part of an ongoing larger survey study on body image and disordered eating. Only participants meeting criteria for “probable BED” (referred hereafter) were included in this study, based on the following Eating Disorder Examination Questionnaire criteria: (a) endorsement of objective binge eating on at least four days in the past month, and (b) the absence of regular (i.e., ≥ twice in past month) extreme weight-control behaviours (i.e.,
To conclude, the present study examined the FA construct as measured by the YFAS 2.0 in individuals with BED-like symptomatology. Our findings provided strong support for the YFAS 2.0′s psychometric properties, including a unidimensional structure, good internal consistency, and evidence of convergent and incremental validity. FA also contributed the largest percentage of unique variance in psychological
distress and impairment over other established BED features (i.e., overvaluation, binge eating, BMI), which highlights the potential importance of ensuring that addictive-like eating behaviour is screened and assessed during BED treatment.
Binge-eating disorder; Food addiction; Psychometric properties
Linardon, Jake, and Mariel Messer. “Assessment of Food Addiction Using the Yale Food Addiction Scale 2.0 in Individuals with Binge-Eating Disorder Symptomatology: Factor Structure, Psychometric Properties, and Clinical Significance.” Psychiatry Research, vol. 279, Sept. 2019, pp. 216–21. DOI.org (Crossref), https://doi.org/10.1016/j.psychres.2019.03.003.