Previous research on ‘food addiction’ as measured with the Yale Food Addiction Scale (YFAS) showed a large overlap between addiction-like eating and bulimia nervosa. Most recently, a revised version of the YFAS has been developed according to the changes made in the diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. The current study examined prevalence and correlates of the YFAS2.0 in individuals with bulimia (n = 115) and controls (n = 341). Ninety-six per cent of participants with bulimia and 14% of controls received a YFAS2.0 diagnosis. A higher number of YFAS2.0 symptoms was associated with lower interoceptive awareness, higher depressiveness, and higher impulsivity in both groups. However, a higher number of YFAS2.0 symptoms was associated with higher body mass and weight suppression in controls only and not in participants with bulimia. The current study is the first to show a large overlap between bulimia and ‘food addiction’ as measured with the YFAS2.0, replicating and extending findings from studies, which used the previous version of the YFAS. Compensatory weight control behaviours in individuals with bulimia likely alleviate the association between addiction-like eating and higher body mass. Thus, the large overlap between bulimia and ‘food addiction’ should be taken into consideration when examining the role of addiction-like eating in weight gain and obesity.
‘Food addiction’ refers to the idea that certain foods (e.g. highly processed and high-calorie foods) may have an addictive potential and that some forms of overeating may represent an addicted behaviour (Meule, 2015). Although this concept is controversially discussed in the scientific community (Benton, 2010; Rogers & Smit, 2000; Wilson, 2010; Ziauddeen & Fletcher, 2013), it has received increasing interest in recent years (Meule, 2015). This popularity of the food addiction concept can be, in part, attributed to the development of the Yale Food Addiction Scale (YFAS), which was the first standardized self-report measure for the assessment of addiction-like eating (Gearhardt, Corbin, & Brownell, 2009). The YFAS consists of 25 items and asks participants about their eating behaviour during the past year. Importantly, items are based on the diagnostic criteria for substance dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) fourth edition (American Psychiatric Association, 1994), which were translated to refer to food and eating. Likewise, scoring of the scale allows for calculating a symptom count, that is, the number of endorsed ‘food addiction’ symptoms, which can range between zero and seven symptoms.
The scale also asks for a clinically significant impairment or distress resulting from individuals’ eating behaviour. When at least three symptoms are met and a clinically significant impairment or distress is present, individuals receive a ‘food addiction’ diagnosis.
In 2013, the fifth edition of the DSM (DSM-5) was released, which includes revised diagnostic criteria for substance use disorder (American Psychiatric Association, 2013). Specifically, four new criteria were added, and diagnostic thresholds were lowered such that the presence of two symptoms (and a clinically significant impairment or distress) suffices to receive a diagnosis of substance use disorder (for a discussion of the four new criteria in relation to food and eating, see Meule & Gearhardt, 2014b). Given these substantial changes in the diagnostic criteria for substance use disorder, the YFAS has been revised recently (Gearhardt, Corbin, & Brownell, 2016). The YFAS2.0 consists of 35 items for measuring 11 ‘food addiction’ symptoms. Besides having more items, the YFAS2.0 differs from the original YFAS in some other aspects as well (e.g. changes in item wordings and response options).
Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0
De Vries, S.-K., & Meule, A.
The study was approved by the institutional review board at the University of Salzburg. Participants were recruited via online forums targeted at individuals with eating disorders (e.g. Facebook groups for individuals with bulimia) and via student mailing lists at several German universities. The study was advertised as a study on ‘attitudes and eating behaviour’, and it was explicated that both individuals with and without eating disorders were invited to participate. Three ×50€ were raffled among participants who
completed the entire set of questions. The study’s website at www.soscisurvey.de was visited 1590 times. One-thousand and thirty-eight individuals started the survey and, of these, 663 finished the survey. Applying the website’s data quality check, which is based on the time spent on each page, led to exclusion
of two participants. Of the remaining 661 participants, 100 received an eating disorder diagnosis other than bulimia based on the Eating Disorder Diagnostic Scale (EDDS) — DSM-5 version. As there were only few participants in each diagnostic group, however, these participants were excluded from further analyses.
Of the remaining 561 participants, 118 received a diagnosis of bulimia nervosa and 443 participants did not receive an eating disorder diagnosis based on the EDDS. As individuals with bulimia all had a BMI >18.5 kg/m2 (as this is one criterion for receiving a diagnosis of bulimia according to the EDDS), control participants with a BMI <18.5 kg/m2 were excluded. Finally, as there were only three men with a diagnosis of bulimia, men were excluded from further analyses, resulting in a final sample of n = 115 women with bulimia and n = 341 female controls without eating disorders (Table 1).
3 men with a diagnosis of bulimia, men were excluded from further analyses, resulting in a final sample of n = 115 women with bulimia and n = 341 female controls without eating disorders (Table 1).
In the current study, almost all participants with bulimia (96%) received a YFAS2.0 diagnosis. This result is in line with studies, in which the previous version of the YFAS was used, which similarly found that prevalence rates of ‘food addiction’ range between 80% and 100% in individuals with bulimia (Gearhardt et al.,
2014; Granero et al., 2014; Meule et al., 2014). Thus, it appears that the changes made in the YFAS2.0 do not affect the association between bulimia and addiction-like eating. In the controls without eating disorders, 14% received a YFAS2.0 diagnosis, which is similar to the prevalence rates found with the English version
of the YFAS2.0 (approximately 15%; Gearhardt et al., 2016). Thus, although there is a high overlap between eating disorders (particularly bulimia) and ‘food addiction’, there is also a substantial subset of individuals without eating disorders who receive a YFAS2.0 diagnosis.
There has been considerable interest in the role of ‘food addiction’ for weight gain and development of obesity (Meule, 2012). While the present study showed that psychological correlates of ‘food addiction’ symptomatology (interoceptive awareness, depression, and impulsivity), which have been found previously
(Granero et al., 2014; Meule & Gearhardt, 2014a), were similarly found in the individuals with bulimia and the controls, associations with BMI and weight suppression were moderated by group. Specifically, higher BMI and weight suppression were associated with YFAS2.0 symptoms in the controls but not in the participants with bulimia. As has been suggested previously (Meule, 2012), it seems plausible that the positive association between BMI and YFAS2.0 scores is alleviated within the population of individuals with bulimia because of their compensatory weight control behaviours. Specifically, higher ‘food addiction’ symptomatology is likely related to more frequent purging in individuals with bulimia, which counteracts weight gain.1 This, and the fact that those with bulimia already display very high levels of weight suppression, may similarly explain the absent association between higher weight suppression and more YFAS2.0 symptoms in the participants with bulimia, although weight suppression was associated with YFAS2.0 symptoms in controls.
food addiction; Yale Food Addiction Scale; bulimia nervosa; Eating Disorder Diagnostic Scale; impulsivity
De Vries, S.-K., & Meule, A. (2016). Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0. European Eating Disorders Review, 24(6), 518–522. doi:10.1002/erv.2470