In bariatric surgery candidates, the food addiction (FA) phenotype is observed in 1 out of 4 patients and is associated with a higher prevalence of mood and anxiety disorders, according to the results of a study published in Psychiatry Research.
Farid Benzerouk, MD, of the Adult Psychiatry Center and the Department of Endocrinology, Diabetes, and Nutrition at the University Hospital of Reims Reims, France, and colleagues conducted a cross-sectional study to investigate the prevalence of the FA phenotype and its association with psychiatric disorders in bariatric surgery candidates and the eating behavior characteristics associated with FA.
The investigators included 128 bariatric surgery candidates in the study and assessed FA using the Yale Food Addiction Scale 2.0 (YFAS 2.0), as well as mood and anxiety disorders; suicidality; eating disorders, including bulimia nervosa and anorexia nervosa; and alcohol and tobacco use disorders.
The YFAS 2.0 evaluates 11 diagnostic criteria for substance-related and addictive disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The presence of at least 2 of the 11 symptoms over the previous 12 months plus clinically significant impairment or distress is considered diagnostic for FA. The authors used the mini-international neuropsychiatric interview (MINI), version 5.0.0 to assess symptoms of mood disorders and anxiety, and they measured depression severity using the Beck Depression Inventory (BDI). To assess alcohol and smoking use disorders, the authors used the alcohol use disorders identification test (AUDIT) and the Fagerstrom Test for Nicotine Dependence (FTND). They used the Dutch eating behavior questionnaire (DEBQ) to assess emotional eating, restrained eating, and external eating.
Mean body mass index (BMI) was 46.1, and 71.1% of the cohort were women. Twenty-five percent of the patients were of the FA phenotype. Most of these patients had severe FA, with a mean number of 7.2 FA symptoms. Patients with FA had a higher prevalence of current anxiety disorders and for both current and lifetime major depressive disorder. Furthermore, they were more likely to report suicidality in the past month; however, they did not differ from patients with obesity without FA for prevalence of alcohol use disorder or for anorexia nervosa or bulimia nervosa.
In terms of food consumption, patients with a diagnosis of FA were more likely to have a loss of control over consumption of particular foods, such as those high in salt; in carbohydrates and fat, such as French fries and pizza; in sugar, such as chocolate, cake, and doughnuts; and sugary drinks; however, there was no difference between patients with FA and patients without FA for loss of control over the consumption of fruits, vegetables, or grain products. Patients with FA also had a higher prevalence of emotional eating.
The study is limited by its cross-sectional design, and the authors noted that future studies using a longitudinal design are needed to determine the association between the FA phenotype and outcomes after bariatric surgery. The authors also noted that these findings highlight the complexity of obesity as a disease that shares a common etiology with some psychiatric and addictive disorders.
Benzerouk F, Gierski F, Ducluzeau P-H, et al. Food addiction, in obese patients seeking bariatric surgery, is associated with higher prevalence of current mood and anxiety disorders and past mood disorders. Psychiatry Res. 2018;267:473-479.