The current study investigated the prevalence of food addiction and its associations with obesity and demographic factors in a sample recruited to be more nationally representative of the United States than previous research. Food addiction was observed in 15% of participants, with greater prevalence in individuals who were younger, Hispanic and/or reported higher annual income. Food addiction prevalence was higher in persons who were underweight or obese, relative to normal weight or overweight. Food addiction was associated with higher body mass index in women and persons who were older, White and/or reported lower income. Identifying the scope of food addiction and individual risk groups may inform public policy initiatives and early intervention efforts.
Abstract
Summary
Food addiction reflects the theory that some individuals may experience an addictive-like response to foods high in fat and/or refined carbohydrates like sugar, akin to a substance-use disorder (Ahmed, Avena, Berridge, Gearhardt, & Guillem, 2013; Davis et al., 2011; Gearhardt, Davis, Kuschner, & Brownell, 2011). In
support, studies in animals and humans have demonstrated biobehavioural indicators of addiction in response to foods high in fat and/or refined carbohydrates (Avena, Rada, & Hoebel, 2008; Gearhardt, Yokum, et al., 2011; Johnson & Kenny, 2010; Oswald, Murdaugh, King, & Boggiano, 2011; M. J. Robinson
et al., 2015). However, the theory remains controversial, particularly because research aiming to identify the addictive agent in food (e.g., added sugar) is in its nascent stages (Ziauddeen & Fletcher, 2013), and the unique clinical utility of the construct is debated (Davis, 2013; D. G. Smith & Robbins, 2013). There also exist alternative perspectives suggesting that food addiction is better conceptualized and measured as a behavioural addiction to the act of eating (Hebebrand et al., 2014; Ruddock, Christiansen, Halford, & Hardman, 2017). While there is no agreed upon definition of food addiction, the phenotype is most frequently measured in humans by the Yale Food Addiction Scale (YFAS). Importantly, as food addiction is
not a clinical diagnosis recognized by the Diagnostic and Statistical Manual (DSM) (American Psychiatric Association, 2013), the term ‘food addiction’ in the current manuscript will henceforth reflect the classification made by the YFAS. The YFAS is a self-report measure that adapts the DSM criteria for
substance-use disorders to evaluate addictive-like consumption of foods high in fat and/or refined carbohydrates (Gearhardt, Corbin, & Brownell, 2009, 2016). The YFAS has been associated with clinically relevant features, such as frequency of binge eating episodes, weight cycling, obesity, and short-term abstinence from binging-purging in persons with bulimia nervosa following intervention (Davis et al., 2011; Gearhardt, Boswell, & White, 2014; Granero et al., 2014; Hilker et al., 2016; Schulte & Gearhardt, 2017). However, many previous studies of food addiction have consisted of small samples or samples with limited
generalizability to the national population (e.g., clinical samples, undergraduates, overrepresentation of females and White individuals). These limitations present a challenge in estimating the scope of food addiction and its relation to individual characteristics (e.g., gender and race) (Pursey, Stanwell, Gearhardt, Collins, & Burrows, 2014).
Associations of Food Addiction in a Sample Recruited to Be Nationally Representative of the United States
Schulte, E. M., & Gearhardt, A. N.
1050 Individuals were recruited through Qualtrics’ which sets demographic quotas developed using the United States census reference population. Analyses were conducted with 986 individuals, after excluding 48 respondents who had nonsensical data (e.g., reporting age as ‘1234’) and 16 for reporting BMI < 10 or >75. A wider range of BMI was permitted in the present study to allow for representation across weight classes, and the present sample paralleled the frequency of ‘extreme obesity’ (BMI > 40) in other nationally representative samples [current sample frequency: 6.4%; frequency in National Health and Nutrition Examination Survey dataset: 6.3% (Fryar, Carroll, & Ogden, 2012)]. Gender, race and income were similar to the 2010 United States census reference population (www.census.gov) (see Table 1).
Methodology
Sample Size
986 Participants self-reported food addiction, measured by the modified Yale Food Addiction Scale 2.0, height, weight, age, gender, race and income.
Participants were 51.2% female, with an average age of 44.91 (SD = 16.27). Self-reported racial identification was 68.4% White, 12.7% African American, 12.6% Hispanic, 3.2% Asian and 3.1% Other. Average self-reported BMI was 27.53 (SD = 7.38), with the following weight class categorizations: 4.7% underweight (BMI < 18.5), 37.5% normal weight (BMI = 18.5–24.9), 30.4% overweight (BMI = 25.0–29.9) and 27.4% obese (BMI > 30). Participants’ median income was $50 000–$74 999.
Conclusion
The average number of food addiction symptoms endorsed on the mYFAS 2.0 was 1.81 (SD = 3.18) and ranged from 0 to 11. Further, 15.0% of participants met the diagnostic threshold score for mYFAS 2.0 food addiction (1.0% mild, 2.4% moderate and 11.6% severe). Table 2 details the average mYFAS 2.0 symptoms
and prevalence for all demographic characteristics.
URL
food addiction; substance-use disorders; obesity
Key Words
Schulte, E. M., & Gearhardt, A. N. (2017). Associations of Food Addiction in a Sample Recruited to Be Nationally Representative of the United States. European Eating Disorders Review, 26(2), 112–119. doi:10.1002/erv.2575