New research shows that 5% of all adolescents in Denmark exhibit an addiction-like attraction to unhealthy foods versus 11% of the adolescents with a mental disorder. A researcher behind the study says that there should be much greater focus on the associations between mental disorder and obesity and how these conditions interact and share common risk factors.
It is well-established that individuals with a mental disorder have an elevated risk of developing an addiction disorder. New research shows that this tendency also applies to food addiction, referring to a strong craving for foods with a high content of fat, sugar, salt and artificial flavours.
The study specifically shows that, in Denmark, more than twice as many adolescents with a mental disorder have food addiction compared to adolescents without a mental disorder. According to a researcher behind the study, greater focus is needed on food addiction among adolescents with a mental disorder.
“Food addiction is a condition so disabling that it adversely affects everyday life. Our study shows that relatively many adolescents have both a mental disorder and food addiction, and we should probably pay more attention to how food addiction, obesity and mental disorders interact and how this affects the overall symptomatology,” explains co-author Christina Horsager, physician, PhD, Postdoctoral Fellow from the Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Denmark.
The research has been published in European Eating Disorders Review.
Validating the Yale Food Addiction Scale for Children 2.0
Food is required to survive, but some individuals develop an addiction-like attraction towards highly processed foods called food addiction, a condition having several behavioral and psychological similarities with the abuse of conventional substances of abuse like tobacco, alcohol and drugs.
Besides estimating the prevalence of food addiction among adolescents with and without a mental disorder, the study also aimed to validate the full Yale Food Addiction Scale for Children 2.0 (YFAS-C 2.0) – a rating scale based on the diagnostic criteria for substance use disorder, which in this modified version specifically measures food addiction symptomatology in children and adolescents.
The results show that the Yale Food Addiction Scale for Children 2.0 is applicable and valid for use in adolescents.
“Having validated measurement tools (rating scales) are extremely important in research, and this finding is therefore important for future research in this field,” says Christina Horsager.
Tested the Scale among 13- to 17-year-olds in Denmark
A total of 559 adolescents from the general population in Denmark and 413 adolescents with a mental disorder responded to the web-based questionnaire, which included the Yale Food Addiction Scale for Children 2.0. The group of adolescents with a mental disorder included psychotic disorders, affective disorders, anxiety disorders, eating disorders, autism spectrum disorders and attention deficit disorders.
The questions in the Yale Food Addiction Scale for Children 2.0 are based on the same criteria that are used to diagnose substance use disorders related to, for example, alcohol and drugs.
“People with food addiction therefore experience similar symptoms as experienced in other addiction disorders. This could be loss of control, eating more than planned and being unable to stop eating, despite the awareness of negative mental and physical consequences. In addition, they often spend so much time thinking about, acquiring and eating food that it overshadows everyday activities such as school and friends. Symptoms also include craving and tolerance, meaning one has to eat more and more to be satiated or satisfied or to eliminate both physical and mental discomfort. Research also indicate that people who meet the criteria for food addiction have neurobiological changes that are similar to changes seen in other addiction disorders such as addiction to cocaine,” explains Christina Horsager.
She points out that food addiction is not, yet, accepted as a diagnosis in the diagnostic systems, however, that there is a growing body of evidence supporting that food addiction is indeed a valid syndrome.
Twice as many adolescents with a mental disorder have food addiction
The results show that 5% of all adolescents in Denmark meet the criteria for food addiction versus 11% among adolescents with a mental disorder. Also, that food addiction was more prevalent in females and in adolescents with obesity.
Christina Horsager says that the pattern is similar to that found in adults in Denmark, but the percentages for adults are about twice as high: about 10% of adults in the general population meet the criteria for food addiction versus 24% of adults with a mental disorder.
“Monitoring adolescents seems to be especially important since their brains are still immature, and therefore more susceptible for developing addiction disorders. Similarly, weight status, especially overweight, tends to track into adulthood. The lower percentage of food addiction found among adolescents compared with adults suggests that we have a window of opportunity with adolescents to prevent some cases from developing. This appears to be especially important among adolescents with a mental disorder, who have an especially high prevalence of food addiction,” says Christina Horsager.
She elaborates that obesity is becoming increasingly prevalent and that obesity and mental disorders are clearly associated. More recent research indicates that obesity itself in some cases may lead to depression – therefore it seems highly relevant also to take obesity into account when treating individuals with a mental disorder.
“Food addiction appears to represent a possible risk factor between mental disorder and obesity and is therefore an important field for future research,” explains Christina Horsager.
Overeating might lead to mental disorder
Christina Horsager thinks that there needs to be much greater focus on the interaction between mental disorders and obesity, including the role of food addiction.
Several studies have shown that co-existing food addiction seems to intensify the symptoms of a mental disorder e.g., worsen depressive symptomatology or eating disorder severity.
The mechanisms behind this link remain unknown. Some are probably associated with overweight and are physiological, such as chronic low-grade inflammation in fat tissue, and others are mental or psychological, involving, for example, low self-esteem and stigma.
Further, Christina Horsager envisions that the symptoms of food addiction might place such a great burden and stress on the individual, that the condition itself can worsen symptoms of an existing mental disorder.
“You cannot divide obesity and mental disorders into two separate boxes. Treating individuals with a mental disorder should probably include treating co-existing obesity and the underlying causes. Conversely, treating individuals with obesity is probably difficult if co-existing mental health problems are not considered,” she says.
According to Christina Horsager, there seems to be a need for rethinking existing treatment strategies. There should probably be much greater focus on underlying causes of obesity to better adapt and individualize treatment – and prevention.
In food addiction, due to the conceptual and phenotypic similarities with other addiction disorders, it has been suggested to base treatment strategies on principles from the field of addiction disorders. At an individual level this could include reducing symptoms of craving and withdrawal via treatment involving cognitive behavioral therapy, pharmacotherapy, and psychoeducation. From a public health perspective, we should probably be more aware of our surrounding food environment.
Christina Horsager and her colleagues are working on a new project, the Food Addiction, Obesity and Type 2 Diabetes in Denmark (FAT2DK) cohort study, specifically aimed at improving understanding of the connections between food addiction, mental disorders, obesity and metabolic consequences, such as type 2 diabetes. ”Few studies have assessed the longitudinal course and correlates of food addiction, and with this study, we will aim to bridge this gap,” she says.
“Perhaps, for some people, food addiction can be a specific therapeutic target when treating or preventing mental disorders, obesity and comorbidities such as type 2 diabetes,” concludes Christina Horsager.