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Q&A Session On Binge Eating Disorder, Addictions-The Yale University Conference

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Title: Q&A Session On Binge Eating Disorder, Addictions-The Yale University Conference


1
Session On Binge Eating Disorder, Addictions- The
Yale University Conference
QA
Ashley Gearhardt, PhD
2
Can you describe organization rationale and
outcomes of the historic yale conference?
  • The Yale Conference on Food Addiction was the
    first gathering of experts across the fields of
    addiction, obesity, and feeding behavior to focus
    on the question of whether certain foods can be
    addictive. The presentations and conferences that
    took place over the course of that meeting
    influenced much of the foundational thought about
    how addictive processes may be contributing to
    overeating and supported the emergence of this
    new area of study.

3
How do you describe food addiction in 10 words or
less? How is it different than sugar addiction?
  • Compulsive overeating triggered by repeated
    exposure to highly rewarding food. While I see
    (added) sugars as one of the most relevant
    ingredients to addictive-like eating, other
    ingredients also appear to be implicated. For
    example, potato chips and French fries are
    commonly eaten in an addictive-like way, but they
    have a low sugar content. They do have a higher
    starch content (which is converted to sugar in
    the body) and fat content. The food addiction
    term broadens the scope of focus beyond sugar.

4
Can you describe the genesis, evolution and
validation of yale food addiction scale (YFAS)?
Are some foods most addicting, more addicting and
non-addicting?
  • At the time that we first started doing this
    work, there was no scale to measure food
    addiction. Researchers were using obesity as a
    proxy, which we had some concerns about. Obesity
    can be caused by so many factors (e.g.,
    medication side effects, genetic conditions,
    physical inactivity), using it as a marker of an
    addiction to food is not super precise. We also
    saw that some people who had body weights in the
    normal range were reporting addictive-like
    eating, but this was not reflected in their
    weight because of dieting practices, physical
    activity or a fast metabolism.

5
Continue
  • Other approaches out there were the use of
    self-identification (ex. are you a chocoholic?),
    but it was hard to know what this might be
    capturing. So, we decided to use the diagnostic
    criteria for substance dependence (and now
    substance use disorders based on the DSM 5) and
    translate it to apply to the consumption of
    highly rewarding foods (e.g., chocolate, salty
    snacks). This allowed us to use the same criteria
    that we would use to diagnose any other substance
    use disorder to measure addictive-like eating.

6
Continue
  • It was also important for us to specify the types
    of foods that were most likely implicated in food
    addiction. We all have to eat, but the type of
    eating behavior associated with food addiction is
    driven not by a need for sustenance, but to
    experience pleasure or to fulfill a craving. Our
    future work has further borne out that this is
    not an addiction to the act of eating, but more
    specifically to the intake of foods that have
    artificially high levels of rewarding ingredients
    (like refined carbohydrates and fat). As time
    goes on and more research comes out, I think one
    of the next steps will be revising the term of
    food addiction to more accurately reflect the
    types of food that are capable of triggering an
    addictive process. Perhaps, highly processed food
    addiction?

7
Should all psychiatrists evaluating disordered
eating include the yfas and add yfas to anorexia
nervosa, bulimia nervosa and binge eating
disorders? Which clinicians should use the yfas?
  • For clinicians evaluating disordered eating, it
    would be useful to assess for food addiction by
    including some version of the YFAS. We have
    developed and validated brief versions of the
    scale (see the modified Yale Food Addiction Scale
    2.0) that can be used to quickly screen for an
    addictive-like phenotype. Food addiction and
    eating disorders appear to be overlapping, but
    distinct constructs with about half of
    individuals with an eating disorder meeting for
    food addiction. Individuals with both eating
    disorders and food addiction appear to have a
    more severe variant of the disorder.

8
Continue
  • For example, in binge eating disorder, those with
    food addiction exhibit more frequent binge eating
    episodes, more emotion dysregulation, and greater
    impulsivity. In bulimia nervosa, higher levels of
    food addiction symptoms at baseline predict worse
    treatment outcomes in response to a brief
    psychosocial treatment. Thus, knowing if an
    eating disorder patient has also high YFAS scores
    may inform clinical care. It is also important to
    note that about half of people with food
    addiction do not meet the requirements for an
    existing eating disorder. So, the use of the YFAS
    may also help understand the eating problems of
    people who do not clearly fit into traditional
    eating disorder categories. We also see that
    rates of food addiction are elevated for
    individuals with depression and post traumatic
    stress disorder, so it may also be important to
    assess in more general mental health clinics.

9
What are the shared characteristics between binge
eating disorder and food addiction, and what are
the unique?
  • The overlap between binge eating disorder and
    food addiction really is not that surprising when
    we step back and look at these conditions from a
    mechanistic level. Both binge eating disorder and
    addiction perspectives theorize that dysfunction
    in reward processes, craving, emotion
    dysregulation, and inhibitory control
    difficulties contribute to overconsumption of
    food and addictive substances, respectively.
    There are some unique aspects to both
    perspectives to consider as well.

10
What are the shared characteristics between binge
eating disorder and food addiction, and what are
the unique?
  • From a traditional eating disorder perspective,
    the role of shape and weight concern and attempts
    at dietary restriction are thought to be causal.
    From an addiction perspective, these aspects
    could still be considered important, but would
    not be as central. In contrast, the nature of the
    food itself would be extremely important from an
    addiction perspective. From a traditional eating
    disorder perspective, the role of the food itself
    is minimized. However, from an addiction
    perspective, certain foods (likely highly
    processed foods) may be so rewarding that they
    are capable of triggering addictive changes in
    reward and motivational circuitry.

11
What are the relationships between overeating ,
obesity, parental food addiction and feeding
practices? Please explain. What are common
comorbidities you have found for YFAS?
  • Research on how food addiction runs in families
    is only starting to emerge. In a recent study, we
    found that parents with higher food addiction
    scores also have children with higher food
    addiction scores. There are a number of factors
    that could contribute to this, including
    genetics, parenting practices, and the home food
    environment.

12
What are the relationships between overeating ,
obesity, parental food addiction and feeding
practices? Please explain. What are common
comorbidities you have found for YFAS?
  • We definitely need more research on this topic!
    And we need to provide parents with tools on how
    to optimally feed a child who has an
    addictive-like drive for highly processed foods.
    Right now there is very little guidance out there
    for parents, but definitely lots of blame. As
    researchers and clinicians, we need to do a
    better job equipping parents with empirically
    supported practices that is sensitive to the
    individual needs of their child. It is highly
    unlikely that a one-size fits all approach to
    feeding is going to be successful for all
    children, especially those at risk for food
    addiction.

13
What are the relationships between overeating ,
obesity, parental food addiction and feeding
practices? Please explain. What are common
comorbidities you have found for YFAS?
  • We do see that the YFAS is associated with a
    number of important co-morbidities, including
    obesity, diet-related disease and eating
    disorders. It is also associated with depression,
    PTSD, and gambling. My instinct is that
    transdiagnostic treatment approaches that focus
    on shared mechanisms across disorders (e.g.,
    emotion regulation, inhibitory control) are going
    to be important for addressing these
    comorbidities.

14
Craving, Liking, and Wanting research is critical
to our understanding of addiction but what about
in food addiction?
  • Craving is also essential in the context of food
    addiction. I think one of the misconceptions
    about addiction is that people who struggle are
    individuals who just like the drug more, but
    research hasnt really born that out. Instead, it
    seems to be that people who experience greater
    wanting and motivational drive for the substance
    (regardless of how much pleasure they get when
    they actually consume it) are at the greatest
    risk.

15
Craving, Liking, and Wanting research is critical
to our understanding of addiction but what about
in food addiction?
  • This enhanced motivational drive can express
    itself in the form of conscious cravings or
    sometimes automatic approach tendencies that can
    occur outside of the persons awareness. I think
    that equipping patients with a greater
    understanding of what triggers this enhanced
    motivational drive for them (e.g., cues in the
    environment, emotional states) is essential in
    giving them back control of their eating behavior.

16
Can you describe the FAST Lab, what you have done
in this lab and what you hope to do going forward?
  • At Yale, one of my mentors was Dr. William Corbin
    and he has a simulated bar lab. I got to see
    firsthand how important it was to investigate
    addictive behaviors in naturalistic, cue-rich
    environments. The experience of drinking a beer
    in a sterile, clinical room is so different than
    the typical experience of consuming alcohol. If
    we do research only in sterile, hyper-controlled
    environments, we dont see the craving,
    expectancies and behavior that are really key to
    problem drinking. Using Wills work as an
    inspiration,

17
Can you describe the FAST Lab, what you have done
in this lab and what you hope to do going forward?
  • I created the Food Addiction Science and
    Treatment lab to create a naturalistic, cue-rich
    food environment that resembles a fast food
    restaurant. It has furniture and menu boards to
    resemble a fast food restaurant, all our research
    assistants wear a uniform that resembles a fast
    food worker and it smells like French fries when
    the participants walk in. We have been using this
    lab to identify what are the mechanisms through
    which people are prone to overeat (craving being
    a big one!) and now we are investigating how
    neural responses to food advertisements might
    predict eating behavior in our fast food
    restaurant lab.

18
What types of studies are being conducted to
evaluate the relationship between weight loss
surgery and addiction?
  • There is interesting work suggesting that
    individuals who have weight loss surgery are at
    greater risk for the development of substance use
    disorders. Although there are many factors that
    likely contribute to this (e.g., different rates
    of absorption of drugs, increased access to pain
    killers after surgery), one hypothesis is that
    there is an addiction transfer from highly
    processed foods to drugs of abuse post-surgery.
    Dr. Gold was one of the first researchers to
    publish work on how individuals who are
    attempting to quit drugs of abuse are at greater
    risk for weight gain and overeating. The research
    on weight loss surgery suggests this increased
    risk might also go the other direction too.

19
What are the 3-5 future directions?
  • It is an exciting time to be doing research in
    this field and there are definitely more
    questions than answers. Some big future
    directions that come to mind for me are 1)
    identifying why certain foods are more capable of
    triggering an addictive process than others, 2)
    the development of new treatments that take into
    account the potentially addictive nature of
    highly processed foods, 3) investigating how
    addictive-like eating may emerge in children and
    teenagers, and 4) conducting more detailed
    research on the withdrawal syndrome that may
    result from cutting back on potentially addictive
    foods.

20
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21
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    -eating-disorders.html
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