Food addiction among children and adolescents

The concept of “food addiction”, an approach which suggests there may be parallels between substance (tobacco, alcohol, etc.) abuse and the excessive intake of certain foods, has been discussed in several previous posts and especially in The Obese Brain, Numerous experts point to substantial and even clear evidence that the imbalance of our brain’s reward circuit may be attributable to certain foods and eating habits, along the same lines as what happens with substances considered to be addictive and potentially compulsive behaviour such as gambling. Though these concepts have their own peculiarities and specificities, the features they commonly share may be an interesting and useful starting point for designing new therapies and treatments in the fight against obesity.

The truth is that debate within the scientific community on whether food addiction really exists or not has been ongoing for longer than desired. Furthermore, in my opinion, precious time is being lost to conduct real and practical research into what I consider to be a particularly promising perspective. Looking at the results being published, it would seem that scientists have become bogged down in their attempts to convince each other that the idea is, or is not, acceptable, instead of making a headlong effort to design and try out new trials and therapies.

And meanwhile, life goes on. Certain methodologies and tools developed around this new perspective and designed to help endorse its plausibility are slowly establishing themselves. One such methodology is the YFAS questionnaire (Yale Food Addiction Scale). First drawn up in 2009, this questionnaire is probably the most used tool in the subject of food addiction. The questionnaire consists of a series of sentences describing the symptoms and feelings associated with a lack of control and distress. Put forward by a group of scientists from the University of Yale, the YFAS is really an adaptation of a list of symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference book of psychiatry, used for many years to diagnose substance abuse. The idea is that if these ideas have proved useful over a long period of time in assessing addiction to tobacco and/or alcohol, they may also be useful in assessing potential addiction to “substances” other than commonly-used drugs: for example, certain foods.

The latest version for adults contains 25 items (18+7). A later version was adapted for children, with the same number of items but written in a more child-friendly way. Though each of the versions can be downloaded in its entirety using the links provided in the previous paragraph, I’m going to show you a third, more recent and simplified version of the questionnaire for adults for you to get a quick idea of how it works. This version consists of only 9 items and is designed for use in large-scale epidemiological studies.

This would be the list of symptoms or items:
  1. I find myself consuming certain foods even though I am no longer hungry.
  2. I worry about cutting down on certain foods.
  3. I feel sluggish or fatigued from overeating.
  4. I have spent time dealing with negative feelings from overeating certain foods, instead of spending time in important activities such as time with family, friends, work or recreation. 
  5. I have had physical withdrawal symptoms such as agitation and anxiety when I cut down on certain foods (do NOT include caffeinated drinks: coffee, tea, cola, energy drinks, etc.).
  6. I kept consuming the same types or amounts of food despite significant physical and/or emotional problems related to my eating.
  7. Eating the same amount of food does not reduce negative emotions or increase pleasurable feelings the way it used to. 
  8. My behaviour with respect to food and eating causes me significant distress.
  9. Issues related to food and eating decrease my ability to function effectively (daily routine, job/school, social or family activities, health difficulties).
Though assessment against the questionnaire as a whole is more complex, this simplified version generally makes diagnosis relatively simple: As is the case with substance abuse, diagnosis is considered as positive if two conditions have been maintained over the last 12 months: firstly, that at least one of the last two symptoms (items 8 & 9) has been identified at least twice a week, and secondly, that at least 3 of the 7 remaining symptoms (items 1 to 7) have also been identified with similar frequency. The higher the number of symptoms present, the more severe the “addiction” is considered to be.

Whatever, let’s get back to the title of this post and focus on children and adolescents.
The YFAS has been widely used in studies focused on adults. Though there is a specific version of the questionnaire designed for children, practically no research has been conducted on this specific subject area despite the fact that children are particularly affected by the obesity epidemic. However, one or two studies have been published recently so let’s take a look at them here.

The first study, "Food addiction in overweight and obese adolescents seeking weight-loss treatment", was conducted by German psychiatrists and led by Adrian Meule, an expert and inveterate writer on this issue. Using a range of specialised tools, his team focused their study on a group of 50 overweight and obese adolescents and on the following aspects: degree of addiction, food craving, the presence of eating disorders, impulsivity and depression. What they found was that over a third of the children under study (38%) were diagnosed, in YFAS terms, as suffering from food addiction. Furthermore, this same collective were not only more concerned with their weight and eating but also revealed a greater degree of impulsivity, reported more binge days and more frequent food cravings and more symptoms of depression.

The authors summed this up as follows:

" (...) findings have shown that addictive eating behaviour is present in adolescents and that an important subset of overweight adolescents seeking weight-loss treatment are diagnosed as positive on the YFAS. This subset can be distinguished from their “non-addict” equivalents by a pathology and psychopathology of high intake and stand-out results in certain aspects of impulsivity (...)”.

The second study on food addiction in children was published in 2014 under the title "A new insight into food addiction in childhood obesity". This study was conducted by a team of Turkish experts on a group of 100 overweight children and adolescents aged 10 to 18. The YFAS questionnaire was also used in the study and in this case, the percentage of food addicts was estimated at 71%.

Specifically, the authors concluded the following:

“This study shows that the rate of food addiction among obese children and adolescents is high. However, controlled, large-scale studies are needed before it can be definitively concluded that food addiction is one of the most important causes of obesity. We suggest that further studies of food addiction will illuminate the pathogenesis of obesity and offer new perspectives regarding its treatment."

There is, what’s more, another stand-out feature of particular interest in this study. The authors took advantage to ask the children what foods they craved the most. The top 5 were:
  1. Chocolate (70%)
  2. Ice-cream (58%),
  3. Sugary drinks (59%)
  4. Crisps (57%)
  5. White bread (55%)
... in other words, the “usual suspects” in this type of problem, as I’ve mentioned before in previous posts.

In short, though still a controversial issue, behaviour associated with addiction to certain foods would appear to be quite common not only among adults but also children and adolescents. On the basis that recent studies and reviews reveal the prevalence of food addiction among overweight adults to be at around 20% (for example, in "The Prevalence of Food Addiction as Assessed by the Yale Food Addiction Scale: A Systematic Review" and "Food-addiction scale measurement in 2 cohorts of middle-aged and older women" ), it’s probably fair to say that, unfortunately, the rate is higher amongst children.

Little research has been conducted to date on this issue so we’ll have to wait a while to see what becomes of all these ideas. However, as I mentioned before, there’s no time to lose: the outlook is not good and there’s enough data and evidence available now to start innovating and taking decisive action when designing future trials and studies. More interventions and proposed treatments are needed if we are to avoid our children’s health being jeopardised for the rest of their lives by the bane of obesity.

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