Yale Food Addiction Scale

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The Yale Food Addiction Scale (YFAS) is a 25-point questionnaire, based on DSM-IV codes for substance dependence criteria, to assess food addiction in individuals. The scale was released in 2009 by Yale University's Rudd Center for Food Policy and Obesity. [1]

Contents

It was found that the brain mechanisms in people with food addiction were similar to those in people with substance dependence, such as drug addicts. [2] While there is currently no official diagnosis of "food addiction", the YFAS was created to identify persons who exhibited symptoms of dependency towards certain food. Foods most notably identified by YFAS to cause food addiction were those high in fat and high in sugar. A self-reported standardized tool was created by a Yale researcher, Ashley Gearhardt, to determine those individuals at high risk for food addiction, regardless of weight. [1]

Food addiction

The term food addiction remains a controversial topic. The concept of food addiction addresses a person's behavioral and neurophysiological changes with certain foods that closely resemble findings found in persons with substance dependence. The term became especially popular in the second half of the twentieth century, driven by the "obesity epidemic". [3] Earlier studies suggest that food addiction, similar to that of drug addiction, mainly exert their actions through the dopamine and opiate pathways. [4] Using functional magnetic resonance imaging (fMRI) subjects regardless of body mass index (BMI), with high food addiction score compared to those with lower scores, showed significant differences in brain activity. [1] Furthermore, a study conducted by the Scripps Research Institute found that rats fed a high-fat palatable diet for extended periods, overstimulated the brain's reward system, similar to brain activity in drug addiction. [5]

Development

To address the need for a standardized tool to identify persons with food addiction behaviors, psychologist Ashley Gearhardt, along with her colleagues William R. Corbin and Kelly D. Brownell, developed the Yale Food Addiction Scale while completing her graduate research at Yale University as a clinical psychology doctoral student. [2] Gearhardt and colleagues formatted their questionnaire to be based upon content of the Diagnostic and Statistical Manual of Mental Disorders IV "text revision" for substance dependence and was reviewed by experts in the fields of addiction, obesity, and eating pathology for revision. [4]

Content

YFAS contains 25 self-reported questions in dichotomous and Likert-type format. In the original scale, two items were included to determine the foods that triggered dependence. When filling out the questionnaire, subjects are asked to refer to the past 12 months of behaviors. [6] The questions fall under seven specific substance dependence criteria as defined by the DSM-IV, as well as clinically significant impairment. [4] The seven criteria per the instruction sheet for the YFAS are: [6]

  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 recreation 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.

Food addiction is recognized when an individual meets at least three of the above symptom criteria and scores for clinically significant impairment or distress. [4]

Foods emphasized

The YFAS survey identified certain foods that were likely to trigger dependence symptoms. These foods correlate with the high-fat, high-sugar foods selected in prior food addiction studies, however, the survey subject is instructed to think of any foods or food groups that cause positive symptoms identified in the questionnaire. The YFAS questionnaire lists the following foods:

Modified scales

A shortened YFAS (mYFAS) consisting of only nine items was proposed in 2014 which had similar prevalence rates as the 25-item YFAS. [2] To address the role food addiction plays in children, the original adult YFAS was adjusted. The Yale Food Addiction Scale for Children (YFAS-C) includes more age-appropriate activities, a lowered reading level, and a new scoring threshold. [8]

A 35-item revised version of the YFAS (the YFAS 2.0) was published in 2016, reflecting the changes in the diagnostic criteria for substance dependence in the DSM-5. [9] Although the YFAS and YFAS 2.0 substantially differ in terms of the number of items, response categories, item wordings, and scoring, it has been reported than prevalence rates and correlates of food addiction as measured with the YFAS 2.0 are largely similar to those with the YFAS. [10] Similar to the YFAS, there is also a short version of the YFAS 2.0 (mYFAS 2.0) and a version for children (YFAS-C 2.0). [11] [12]

Translated versions

The YFAS has been translated into several languages such as German, [13] French, [14] Italian, [15] Spanish, [16] Portuguese, [17] and Chinese. [18] Similarly, the YFAS 2.0 has been translated into several languages such as German, [19] French, [20] Italian, [21] Turkish, [22] Spanish, [23] Korean, [24] Arabic, [25] Japanese, [26] Malay, [27] Chinese, [28] Persian, [29] and Portuguese. [30]

Limitations

Incidence of scores positive for food addiction were higher in overweight and obese patients. However, the correlation between YFAS scores and BMI is small and there seems to be a non-linear relationship between the two when considering the entire body weight spectrum from underweight to severe obesity. [31] Previous studies have shown mixed results mainly due to limited sample size, concurrent eating disorders, and lack of clinical controls.

Five years after development of YFAS, Gearhardt and Adrian Meule summarized its utilization in research studies and its limitations. Gearhardt and Meule concluded:

"Although, the YFAS is not sufficient evidence that 'food addiction' exists, it does provide a standardized tool to identify individuals who are the most likely to be experiencing an addictive response to food." [2]

Related Research Articles

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<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

<span class="mw-page-title-main">Alcohol dependence</span> Medical condition

Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol.

Unspecified feeding or eating disorder (UFED) is a DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

A food addiction or eating addiction is any behavioral addiction that is primarily characterized by the compulsive consumption of palatable food items which markedly activate the reward system in humans and other animals despite adverse consequences.

A food craving is an intense desire to consume a specific food, and is different from normal hunger. It may or may not be related to specific hunger, the drive to consume particular nutrients that is well-studied in animals. In studies of food cravings, chocolate and chocolate confectioneries almost always top the list of foods people say they crave; this craving is referred to as chocoholism. The craving of non-food items as food is called pica.

The Barratt Impulsiveness Scale (BIS) is a widely used measure of impulsiveness. It includes 30 items that are scored to yield six first-order factors and three second-order factors.

<span class="mw-page-title-main">Eating Attitudes Test</span> Questionnaire of symptoms and concerns characteristic of eating disorders

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

<span class="mw-page-title-main">Polysubstance dependence</span> Medical condition

Polysubstance dependence refers to a type of substance use disorder in which an individual uses at least three different classes of substances indiscriminately and does not have a favorite substance that qualifies for dependence on its own. Although any combination of three substances can be used, studies have shown that alcohol is commonly used with another substance. This is supported by one study on polysubstance use that separated participants who used multiple substances into groups based on their preferred substance. The results of a longitudinal study on substance use led the researchers to observe that excessively using or relying on one substance increased the probability of excessively using or relying on another substance.

<span class="mw-page-title-main">CRAFFT Screening Test</span> Clinical assessment tool

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<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences as a result of their use. The National Institute of Mental Health (NIMH) states that “Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD”. Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants, tobacco

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

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References

  1. 1 2 3 "Welcome to Yale University Graduate School of Arts & Sciences". www.yale.edu. Archived from the original on September 26, 2011.
  2. 1 2 3 4 Meule, Adrian, and Ashley N. Gearhardt. "Five years of the Yale Food Addiction Scale: Taking stock and moving forward." Current Addiction Reports 1.3(2014): 193-205. Print.
  3. ↑ Corwin, R. L., and P. S. Grigson. "Symposium Overview—Food Addiction: Fact Or Fiction?." Journal of Nutrition 139(2009): 617–619. Print
  4. 1 2 3 4 Gearhardt, AN, Corbin, WR, and Brownell, KD. "Preliminary validation of the Yale Food Addiction Scale." Appetite 52(2009): 430–436. Print.
  5. ↑ Johnson, Paul M, and Kenny, Paul J. "Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats." Nature Neuroscience 13 (2010): 635–641. nature neuroscience. Web. 18 July 2014. http://www.nature.com/neuro/journal/v13/n5/full/nn.2519.html
  6. 1 2 "Home - UConn Rudd Center for Food Policy and Obesity" (PDF). Retrieved August 28, 2016.
  7. ↑ "Home - UConn Rudd Center for Food Policy and Obesity" (PDF). Retrieved August 28, 2016.
  8. ↑ Gearhardt, Ashley N, Roberto, Christina A., Seamans, Marissa J., Corbin, William R., Brownell, Kelly D.. "Preliminary validation of the Yale Food Addiction Scale for children." Eating Behaviors 14 (2013): 508–512. Print.
  9. ↑ Gearhardt, Ashley N.; Corbin, William R.; Brownell, Kelly D. (February 2016). "Development of the Yale Food Addiction Scale Version 2.0". Psychology of Addictive Behaviors. 30 (1): 113–121. doi:10.1037/adb0000136. ISSN   1939-1501. PMID   26866783.
  10. ↑ Meule, Adrian; Gearhardt, Ashley N. (September 1, 2019). "Ten Years of the Yale Food Addiction Scale: a Review of Version 2.0". Current Addiction Reports. 6 (3): 218–228. doi:10.1007/s40429-019-00261-3. ISSN   2196-2952. S2CID   195242182.
  11. ↑ Schulte, Erica M.; Gearhardt, Ashley N. (July 2017). "Development of the Modified Yale Food Addiction Scale Version 2.0: Development of the mYFAS 2.0". European Eating Disorders Review. 25 (4): 302–308. doi:10.1002/erv.2515. hdl: 2027.42/137291 . PMID   28370722. S2CID   32651196.
  12. ↑ Schiestl, Emma T.; Gearhardt, Ashley N. (November 2018). "Preliminary validation of the Yale Food Addiction Scale for Children 2.0: A dimensional approach to scoring". European Eating Disorders Review. 26 (6): 605–617. doi:10.1002/erv.2648. PMC   6231957 . PMID   30334311.
  13. ↑ Meule, Adrian; Vögele, Claus; Kübler, Andrea (July 2012). "Deutsche Übersetzung und Validierung der Yale Food Addiction Scale". Diagnostica. 58 (3): 115–126. doi:10.1026/0012-1924/a000047. ISSN   0012-1924.
  14. ↑ Brunault, Paul; Ballon, Nicolas; Gaillard, Philippe; Réveillère, Christian; Courtois, Robert (May 2014). "Validation of the French Version of the Yale Food Addiction Scale: An Examination of its Factor Structure, Reliability, and Construct Validity in a Nonclinical Sample". The Canadian Journal of Psychiatry. 59 (5): 276–284. doi:10.1177/070674371405900507. ISSN   0706-7437. PMC   4079141 . PMID   25007281.
  15. ↑ Innamorati, Marco; Imperatori, Claudio; Manzoni, Gian Mauro; Lamis, Dorian A.; Castelnuovo, Gianluca; Tamburello, Antonino; Tamburello, Stella; Fabbricatore, Mariantonietta (March 1, 2015). "Psychometric properties of the Italian Yale Food Addiction Scale in overweight and obese patients". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 20 (1): 119–127. doi:10.1007/s40519-014-0142-3. ISSN   1590-1262. PMID   25069837. S2CID   41402420.
  16. ↑ Granero, Roser; Hilker, Ines; Agüera, Zaida; Jiménez-Murcia, Susana; Sauchelli, Sarah; Islam, Mohammed A.; Fagundo, Ana B.; Sánchez, Isabel; Riesco, Nadine; Dieguez, Carlos; Soriano, José; Salcedo-Sánchez, Cristina; Casanueva, Felipe F.; De la Torre, Rafael; Menchón, José M. (November 2014). "Food Addiction in a Spanish Sample of Eating Disorders: DSM-5 Diagnostic Subtype Differentiation and Validation Data: Food Addiction and ED Subtypes". European Eating Disorders Review. 22 (6): 389–396. doi:10.1002/erv.2311. hdl: 2027.42/109343 . PMID   25139680.
  17. ↑ Torres, Sandra; Camacho, Marta; Costa, Patrício; Ribeiro, Gabriela; Santos, Osvaldo; Vieira, Filipa Mucha; Brandão, Isabel; Sampaio, Daniel; Oliveira-Maia, Albino J. (June 1, 2017). "Psychometric properties of the Portuguese version of the Yale Food Addiction Scale". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 22 (2): 259–267. doi:10.1007/s40519-016-0349-6. hdl: 1822/51677 . ISSN   1590-1262. PMID   28101831. S2CID   4404186.
  18. ↑ Chen, Gui; Tang, Zhaoli; Guo, Guiping; Liu, Xiaoqun; Xiao, Shuiyuan (August 1, 2015). "The Chinese version of the Yale Food Addiction Scale: An examination of its validation in a sample of female adolescents". Eating Behaviors. 18: 97–102. doi:10.1016/j.eatbeh.2015.05.002. ISSN   1471-0153. PMID   26026613.
  19. ↑ Meule, Adrian; Müller, Astrid; Gearhardt, Ashley N.; Blechert, Jens (August 1, 2017). "German version of the Yale Food Addiction Scale 2.0: Prevalence and correlates of 'food addiction' in students and obese individuals". Appetite. Current Developments in Food-Addiction Research. 115: 54–61. doi:10.1016/j.appet.2016.10.003. ISSN   0195-6663. PMID   27717658. S2CID   3655178.
  20. ↑ Brunault, Paul; Courtois, Robert; Gearhardt, Ashley N.; Gaillard, Philippe; Journiac, Kevin; Cathelain, Sarah; Réveillère, Christian; Ballon, Nicolas (March 2017). "Validation of the French Version of the DSM-5 Yale Food Addiction Scale in a Nonclinical Sample". The Canadian Journal of Psychiatry. 62 (3): 199–210. doi:10.1177/0706743716673320. ISSN   0706-7437. PMC   5317020 . PMID   28212499.
  21. ↑ Aloi, Matteo; Rania, Marianna; Rodríguez Muñoz, Rita Cristina; Jiménez Murcia, Susana; Fernández-Aranda, Fernando; De Fazio, Pasquale; Segura-Garcia, Cristina (September 1, 2017). "Validation of the Italian version of the Yale Food Addiction Scale 2.0 (I-YFAS 2.0) in a sample of undergraduate students". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 22 (3): 527–533. doi:10.1007/s40519-017-0421-x. ISSN   1590-1262. PMID   28780748. S2CID   23332325.
  22. ↑ Şengüzel, Esra; Öztora, Serdar; Dağdevi̇ren, Hamdi̇ Nezi̇h (2018). "Internal Reliability Analysis of the Turkish Version of the Yale Food Addiction Scale". Eurasian Journal of Family Medicine. 7 (1): 14–18. ISSN   2147-3161.
  23. ↑ Granero, Roser; Jiménez-Murcia, Susana; Gearhardt, Ashley N.; Agüera, Zaida; Aymamí, Neus; Gómez-Peña, Mónica; Lozano-Madrid, María; Mallorquí-Bagué, Núria; Mestre-Bach, Gemma; Neto-Antao, Maria I.; Riesco, Nadine; Sánchez, Isabel; Steward, Trevor; Soriano-Mas, Carles; Vintró-Alcaraz, Cristina (2018). "Validation of the Spanish Version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) and Clinical Correlates in a Sample of Eating Disorder, Gambling Disorder, and Healthy Control Participants". Frontiers in Psychiatry. 9: 208. doi: 10.3389/fpsyt.2018.00208 . ISSN   1664-0640. PMC   5980980 . PMID   29887808.
  24. ↑ 신성만; 조요한; 박명준; 윤지혜; 고은정 (March 2018). "A Development and Validation of the Korean Version of the Yale Food Addiction Scale 2.0". The Korean Journal of Woman Psychology. 23 (1): 25–49. doi: 10.18205/kpa.2018.23.1.002 . ISSN   1229-0726.
  25. ↑ Fawzi, Mounir; Fawzi, Mohab (August 1, 2018). "Validation of an Arabic version of the Yale Food Addiction Scale 2.0" (PDF). Eastern Mediterranean Health Journal. 24 (8): 745–752. doi:10.26719/2018.24.8.745. PMID   30328605. S2CID   53141386.
  26. ↑ Khine, May Thet; Ota, Atsuhiko; Gearhardt, Ashley N.; Fujisawa, Akiko; Morita, Mamiko; Minagawa, Atsuko; Li, Yuanying; Naito, Hisao; Yatsuya, Hiroshi (March 2019). "Validation of the Japanese Version of the Yale Food Addiction Scale 2.0 (J-YFAS 2.0)". Nutrients. 11 (3): 687. doi: 10.3390/nu11030687 . ISSN   2072-6643. PMC   6471687 . PMID   30909486.
  27. ↑ Swarna Nantha, Yogarabindranath; Kalasivan, Ahalya; Ponnusamy Pillai, Mahalakshmi; Suppiah, Poopathy; Md Sharif, Salmiah; Krishnan, Shamini Gayathri; Samy Pullay, Subasni; Osman, Noor Ashikin (February 2020). "The validation of the Malay Yale Food Addiction Scale 2.0: factor structure, item analysis and model fit". Public Health Nutrition. 23 (3): 402–409. doi:10.1017/S1368980019002684. ISSN   1368-9800. PMC   10200618 . PMID   31538554.
  28. ↑ Chen, I-Hua; Huang, Po-Ching; Lin, Yi-Ching; Gan, Wan Ying; Fan, Chia-Wei; Yang, Wen-Chi; Tung, Serene En Hui; Poon, Wai Chuen; Griffiths, Mark D.; Lin, Chung-Ying (2022). "The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity". Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.1014447 . ISSN   1664-0640. PMC   9732099 . PMID   36506452.
  29. ↑ Ghanbari, Nikzad; Nooripour, Roghieh; Firoozabadi, Abbas; Var, Tabassom Saeid Par; Wisniewski, Pamela; Hosseini, Seyed Ruhollah (November 10, 2022). "Psychometric assessment of Persian translation of Yale Food Addiction Scale Version 2.0 (YFAS 2.0) in Iranian college students". Journal of Eating Disorders. 10 (1): 158. doi: 10.1186/s40337-022-00689-5 . ISSN   2050-2974. PMC   9650813 . PMID   36357951.
  30. ↑ Gonçalves, Sónia; Moreira, Célia S.; Machado, Bárbara C.; Bastos, Beatriz; Vieira, Ana Isabel (March 1, 2022). "Psychometric properties and convergent and divergent validity of the Portuguese Yale Food Addiction Scale 2.0 (P-YFAS 2.0)". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 27 (2): 791–801. doi:10.1007/s40519-021-01218-0. ISSN   1590-1262. PMID   34053016. S2CID   235244672.
  31. ↑ Meule, Adrian (October 1, 2012). "Food addiction and body-mass-index: A non-linear relationship". Medical Hypotheses. 79 (4): 508–511. doi:10.1016/j.mehy.2012.07.005. ISSN   0306-9877. PMID   22854106.
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