Secondary analysis of YFAS 2.0 symptom counts, impairment/distress, and food addiction severity in adults with overweight/obesity

Purpose: Understanding the complexities of obesity is important for developing effective interventions. Evidence is growing that addictive-like tendencies toward foods may contribute to obesity in some individuals. The Yale Food Addiction Scale (YFAS, YFAS 2.0) was developed to identify individuals with addictive-like eating behaviors. Diagnosing food addiction (FA) requires meeting a symptom threshold plus clinically significant impairment/distress (self-perceived), but the utility of the impairment/distress criteria remains controversial. This secondary analysis compared individuals who did not meet the FA symptom criteria, met the symptom, but not the impairment/distress criteria, and met both criteria. Methods: This secondary analysis of data from a randomized controlled pilot study involving 83 adults with overweight/obesity used descriptive statistics and Univariate ANOVAS to compare YFAS 2.0 and Weight and Lifestyle Inventory responses among the groups. Results: Twenty-eight individuals did not meet the FA symptom criteria, 20 met the symptom, but not the impairment/distress criteria, and 35 met both criteria. Of the latter, 80.0% had severe, 8.6% had moderate, and 11.4% had mild FA. Age at onset of overweight was lower with severe than with mild FA (p = 0.023). Conclusions: The YFAS 2.0 identified a distinct group with severe FA and a group who met the FA symptom threshold, but not the impairment/distress criteria. Few participants perceived impairment/distress unless they endorsed ≥ 6 symptoms. Adding clinical interviews may aid in assessing impairment/distress and addictive-like eating behaviors, particularly in those meeting the FA symptom, but not the impairment/distress criteria. Better characterization of these groups may help targeting obesity interventions. Trial registration number: NCT03431831, 1/30/2018. Level of evidence: Level III, case-control analytic study.