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The Yale Food Addiction Scale

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What Is The Evidence That Food Addiction Exists?
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Relationships With Body Mass And Weight Change

As mentioned above, the prevalence of YFAS diagnoses is higher in obese samples than in non-obese samples. However, many studies did not find an association between body mass index and YFAS diagnoses or symptoms . This may be explained by the fact that study samples were restricted to either predominantly normal-weight individuals or obese individuals only and that there may be a nonlinear relationship between BMI and food addiction symptomatology . Specifically, the positive relationship between the YFAS and BMI in non-obese samples may be attenuated by individuals who receive a YFAS diagnosis, but engage in compensatory behaviors. Indeed, even a negative relationship between YFAS symptoms and BMI was found in individuals with BN . In individuals with morbid obesity, positive relationships between BMI and YFAS scores may be rendered impossible by ceiling effects . Following this line of thought, positive associations between BMI and YFAS scores may particularly be observed in samples with a wide range in BMI and, indeed, such studies clearly demonstrated a positive relationship . In children, the YFAS-C symptom count was also positively related to BMI .

Why Use This Test

1. Free. This Food Addiction Test is delivered to you free of charge and will allow you to obtain your scores related to the condition of food dependency.

2. Clinically oriented. The feedback delivered by this instrument is based on the work of M.D.s and Ph.D.s and is designed to deliver a clear clinical picture of the respondents current symptoms indicating food addiction as measured according to standardized items.

3. Statistical controls. Statistical analysis of the test is conducted to ensure maximum accuracy and validity of the test scores.

4. Made by professionals. The present test has been made with the input of people who work professionally with psychology and individual differences research.

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Prevalence Of Food Addiction And Association With Age Sex And Bmi

The percentage of participants with food addiction was 226 in the total sample, with a significantly higher percentage of food addiction found among participants with overweight and obesity compared to those who had a normal weight .

No difference in terms of food addiction was found between men and women and between those with a university level of education vs secondary or less , whereas a significantly higher mean age was found in those with food addiction compared to those without food addiction .

Psychometric Properties And Stability

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Across different studies, it could be shown that the YFAS has a one-factor structure and adequate internal consistency, which ranges between approximately =0.80 and 0.90. As yet, no study has investigated retest-reliability. While most studies that investigate retest-reliability of self-report instruments administer the same measure after some weeks, such an approach may be inappropriate for the YFAS, as items refer to the past 12 months in order to correspond to the diagnostic criteria for substance dependence in DSM-IV. Similarly, the timeframe may need to be modified from 12 months to, for example, 1 month , in order to determine whether the YFAS is sensitive to treatment changes. Preliminary evidence suggests that YFAS scores are decreased after treatment. In a recent study in participants who reported having a history of BN, but did not show signs of current bulimic symptomatology, YFAS diagnoses and symptoms were significantly lower than in participants with current bulimic symptoms . Moreover, prevalence of YFAS diagnoses in 26 obese individuals was 23 % after bariatric surgery , which is substantially lower than prevalence rates reported in obese individuals before bariatric surgery . Similarly, prevalence of YFAS diagnoses in 178 obese individuals was 5 % at the end of a behavioral weight-loss treatment , which is lower than prevalence rates reported in obese individuals seeking behavioral weight-loss treatment .

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Study : Myfas 20 Properties Among Patients With Obesity

Participants and Procedures

This cross-sectional study included 345 patients that were candidates for bariatric surgery in three wards specialized in severe obesity . The participants were told that the study would enable a better understanding of the difficulties encountered by bariatric surgery candidates, and there was no financial compensation. Although the study was proposed before the approval process for the surgery, they were also told that their results would not impact their treatment and the selection process. The assessment was conducted during the preoperative assessment. Table 2 presents the descriptive statistics of the study population sample. Table 4 additionally reports the prevalence, mean number of FA symptoms and type of FA criteria endorsed in this clinical sample. There was no significant difference in terms of FA prevalence between the three centers .

Table 4 Factor loadings of the modified Yale Food Addiction Scale 2.0 in the non-clinical sample and in patients with obesity .

Ethical Considerations

Measurements

We collected socio-demographic characteristics , current BMI, previous maximal BMI from medical records. In addition to the full YFAS 2.0, the mYFAS 2.0 and the Binge Eating Scale , the patients completed the 13-item Beck Depression Inventory . In this sample, Cronbachs alpha for the BES and BDI were respectively .83 and .86.

Statistical Analyses

Establishment Of Scoring Thresholds

Thresholds for the continuous questions in the adult YFAS were used as starting points to establish cut-offs for the YFAS-C. To evaluate whether the cut-offs accurately identified increased risk for eating pathology, scatter plots were created to explore the relation between YFAS-C questions and BMI. Of the 25 questions on the YFAS-C, three were altered from the scoring thresholds used in the adult YFAS. Additionally one question with a dichotomous scoring option from the adult version was changed to a continuously scored question to increase specificity. Seven dichotomous questions were retained on the YFAS-C. Like the adult YFAS, two scoring options were developed: a dichotomous diagnosis and a symptom count . Participants who reported three or more symptoms and clinically significant impairment or distress in the last 12 months were classified as meeting the criteria for food addiction. The symptom count score is a summary of the seven symptoms assessed by the measure . The median number of YFAS-C criteria endorsed was 2 and 7.2% of participants met the diagnostic threshold.

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Yale Food Addiction Scale For Children

A child version of the YFAS was recently developed by changing the item wording to be appropriate for children . Specifically, the adult YFAS was altered to refer to age-appropriate activities and the questions were edited to lower the reading level . Response categories were also rephrased to facilitate comprehension . Other minor changes included that one item with a dichotomous response format in the adult version was transformed to a continuously scored question, and new scoring thresholds were established . Similar to the adult version, the YFAS-C has a one-factor structure, and internal consistency was =0.78 in the validation study .

Study : Myfas 20 Properties Among Non

Food & Addiction: What it is, How it is Measured in Humans

Participants and Procedures

We recruited a non-clinical sample of 250 participants from the community that stems from a larger sample of 330 persons that has been described previously . Participants were told that the study investigated eating behavior, they engaged freely in the study, and there was no financial compensation. This larger sample was recruited at the University of Tours between May 2014 and May 2015 using a web-based questionnaire that was created using Sphinx software . Out of these 330 initial participants, we excluded individuals that screened positive for anorexia nervosa , bulimia nervosa , and binge eating disorder , as well as individuals who had either a body mass index < 18.5 kg/m2 or a BMI equal to or greater than 30 kg/m2 7 individuals had both a positive screening for an eating disorder and a BMI < 18.5 kg/m2 2 persons had both a positive screening for an eating disorder and a BMI > 30 kg/m2. For more details about the cutoffs used to screen for eating disorders, see . Table 2 presents the descriptive statistics of our final non-clinical sample . Table 3 additionally reports the prevalence, mean number of FA symptoms, and type of FA criteria endorsed in this non-clinical sample.

Table 2 Descriptive statistics of the non-clinical and clinical samples.

Table 3 Non-clinical population : Comparison of the results obtained with the mYFAS 2.0 and the YFAS 2.0 .

Ethical Considerations

Measurements

Binge Eating Scale

Statistical Analyses

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Factor Structure And Reliability

A confirmatory factor analysis for dichotomous data was conducted to confirm that the YFAS-C exhibited the same one-factor structure as the adult YFAS. The 22 questions related to the 7 diagnostic criteria were entered into a confirmatory factor analysis . The single factor model provided good fit to the data, CFI = 0.71, RMSEA = .078, and the single factor demonstrated adequate internal consistency reliability, KuderRichardson = .78. Next, the seven dichotomous symptoms were entered into a separate CFA model. This model also provided adequate fit to the data, CFI = 0.94, RMSEA = .080. Internal consistency was marginal, KuderRichardson = .67, likely reflecting the relatively smaller number of items.

Relationships With Other Constructs Not Or Indirectly Related To Eating

In addition to higher eating pathology, food addiction symptomatology is also associated with higher general psychopathology. For instance, individuals with a food addiction diagnosis show higher rates of depression and report higher scores on the Behavioral Inhibition System . In obese individuals, higher rates of attention-deficit hyperactivity disorder have been found in those with a YFAS diagnosis . In individuals with BN, food addiction symptoms were highly correlated with borderline personality disorder symptomatology . Similarly, food addiction symptoms correlated with lower self-esteem and more difficulties in emotion regulation in individuals with BED .

A cross-sectional study in which the mYFAS was used found a positive relationship between physical and sexual child abuse severity and the presence of adult food addiction in women . Food addiction symptoms are also correlated with issues related to weight and body image such as more pronounced anti-fat attitudes, higher weight bias internalization, and feelings of shame regarding ones own body .

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Modified Yale Food Addiction Scale

Most recently, a short form of the YFAS has been proposed . It consists of nine items only, with one item for assessing each of the seven symptoms of substance dependence in the DSM-IV and two items assessing the presence of a clinically significant impairment or distress . Internal consistency of the seven questions measuring food addiction symptoms ranged between =0.75 and 0.84. Importantly, the prevalence rates of food addiction diagnoses using the mYFAS, as well as its validity indices, were comparable to those found using the full version .

Relationship Of Yfas Outcomes With Other Variables

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Across the reviewed studies, YFAS diagnosis and symptom score were associated with a variety of anthropometric measures. Specifically, higher BMIâs were related to higher rates of FA diagnosis and number of symptoms endorsed . However, in one study of individuals with BN, FA diagnosis and higher symptom scores were associated with a significantly lower BMI . Symptom score was positively correlated with other measures of adiposity including waist-to-hip ratio, percent body fat and trunk fat . One study identified a relationship between YFAS symptom score and weight loss after a seven week behavioral weight loss intervention while a second study found no relationship between weight change after a six month intervention and baseline YFAS outcomes .

In support of the results of the pooled meta-analysis, prevalence of FA diagnosis and number of symptoms reported decreased with increasing age and females were found to have a higher prevalence of FA diagnosis and higher symptom scores . Two studies identified ethnicity differences with one reporting higher FA scores in African Americans and a second reporting prevalence of FA diagnosis to be higher in white females . However, other studies identified no differences in FA prevalence based on ethnicity . Diagnosis of FA was associated with health indicators including high cholesterol, smoking and decreased physical activity in one large scale epidemiological study .

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The Highly Processed Food Withdrawal Scale is a parent-report questionnaire that assesses 21 affective , cognitive , and physical withdrawal-type symptoms that may occur when parents restrict their childs access to highly processed foods. The ProWS-C was developed based on the adult version of the ProWS, with adaptations made for parent-report and developmental considerations for children. The ProWS-C was validated for parent-report of children aged 3-11 .

Development Scoring And Psychometric Properties

Food and Addiction: The Importance of The Environmental Change

In an attempt to overcome those heterogeneous definitions and measures of food addiction and its symptoms, the YFAS was developed in 2009 in order to provide a standardized assessment tool . This 25-item instrument is based on the seven substance dependence criteria in the DSM-IV and, accordingly, assesses seven food addiction symptoms as well as a clinically significant impairment or distress . Originally, two additional items were included for exploration of the specific kinds of food with which respondents have difficulties controlling consumption. However, these two items have not received much attention in subsequent studies and may be omitted when using the scale.Footnote 1

Table 1 Diagnostic criteria of substance use disorder according to the DSM-IV and DSM-5

The YFAS has a one-factor structure . KuderRichardsons alpha coefficient is usually reported as an indication of internal consistency because of the different response categories. That is, internal consistency is calculated using the dichotomized item scores . In the original validation study, internal consistency was =0.86 and ranged between =0.76 and 0.92 in subsequent studies .

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Based On Research From Yale University

Food addiction is a behavioral condition that fosters the compulsive overeating of foods that are high in fat or sugar. Brain imaging and other scientific studies have increasingly confirmed the notion that the brain mechanisms in people with food addiction are similar to those in people with other substance dependencies, such as drug or alcohol addiction.

Instructions: Below is a list of questions that relate to life experiences common among people who have exhibited food addiction. Please read each question carefully and indicate the extent to which it applies to you.

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