Validation of the French Version of the Yale Food Addiction Scale: An Examination of Its Factor Structure, Reliability and Construct Validity in a Nonclinical Sample

International audienceObjective: Food addiction is a concept that has recently been proposed by applying the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for substance dependence to eating behaviour. Food addiction has received increased attention given that it may play a role in binge eating, eating disorders, and the recent increase in obesity prevalence. Currently, there is no psychometrically sound tool for assessing food addiction in French. Our study aimed to test the psychometric properties of a French version of the Yale Food Addiction Scale (YFAS) by establishing its factor structure, internal consistency, and construct validity in a nonclinical population.Method: A total of 553 participants were assessed for food addiction (French version of the YFAS) and binge eating behaviour (Bulimic Investigatory Test, Edinburgh and Binge Eating Scale). We tested the scale’s factor structure (factor analysis for dichotomous data based on tetrachoric correlation coefficients), internal consistency, and construct validity with measures of binge eating.Results: Our results supported a 1-factor structure, which accounted for 54.1% of the variance. We demonstrated that this tool had adequate reliability and highly construct validity with measures of binge eating in this population, both in its diagnosis and symptom count version. A 2-factor structure explained an additional 9.1% of the variance, and could help to differentiate between patients with high, compared with low, levels of insight regarding addiction symptoms.Conclusions: In our study, we validated a psychometrically sound French version of the YFAS, both in its symptom count and diagnosis version. Future studies should validate this tool in clinical samples

Depression is associated with some patient-perceived cosmetic changes, but not with radiotherapy-induced late toxicity, in long-term breast cancer survivors.: Depression-associated factors in long-term breast cancer survivors

International audienceOBJECTIVE: Although depression is prevalent in long-term breast cancer survivors (LTBCS; ≥5 years since diagnosis), it is underdiagnosed and undertreated. A better understanding of factors associated with depression could improve depression screening, treatment, and prevention in this population. Our study aimed to assess the link between patient and doctor ratings of breast cosmetic outcomes, late radiotherapy toxicity, and depression in LTBCS. METHODS: In all, 214 patients recruited from the ARCOSEIN study were assessed for late radiotherapy toxicity (by using the LENT-SOMA scale) and patient and doctor ratings of breast cosmetic outcomes (mean = 6.7 years since the end of treatment). We reassessed 120 of these patients for depression (HAD) during a second wave of long-term assessment (mean = 8.1 years since the end of treatment). We used univariate analyses and polytomous logistic regression analyses to predict the HAD depression, which was defined as follows: normal, 0-7 points; and significant depression, ≥8 points (8-10 points, possible depression; ≥11 points, probable depression). RESULTS: The mean HAD depression score was 4.5 ± 3.6. 19. 2% of our population had significant depression, 6.7% with probable depression, and 12.5% with possible depression. Significant depression was not associated with late radiotherapy toxicity or initial cancer-related variables. Patients with probable depression reported worse cosmetic outcomes than nondepressed patients in terms of perceived breast largeness (p = 0.04), breast deformation (p = 0.02), and changes in skin pigmentation (p = 0.03). CONCLUSIONS: In LTBCS, depression seems to be more strongly associated with changes in some patients' perceived breast cosmetic outcome than late treatment toxicity or initial cancer-related variables. Copyright © 2012 John Wiley & Sons, Ltd

Observations regarding 'quality of life' and 'comfort with food' after bariatric surgery: comparison between laparoscopic adjustable gastric banding and sleeve gastrectomy.

International audienceBACKGROUND: Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are coexisting first-choice restrictive procedures for bariatric surgery candidates, it is possible, given their different modes of action, that these procedures have different effects on quality of life (QOL). We hypothesized that improvement of QOL and comfort with food could be better with LSG compared to LAGB. METHODS: This cohort study included 131 obese patients who had either LAGB (n = 102) or LSG (n = 29). Patients were assessed during preoperative and at 6- and 12-month postoperative visits. Five QOL dimensions were assessed using the 'Quality of Life, Obesity and Dietetics' rating scale: physical impact, psycho-social impact, impact on sex life, comfort with food and diet experience. We compared QOL evolution between LAGB and LSG using linear mixed models adjusted for gender and body mass index at each visit. RESULTS: Excess weight loss was 28.4 ± 14.7% and 34.8 ± 18.4% for LAGB and 35.7 ± 14.3% and 43.8 ± 17.8% for LSG at 6 and 12 months postoperatively, respectively. Both LAGB and LSG provided significant improvement in the physical, psycho-social, sexual and diet experience dimensions of QOL. LSG was associated with better improvement than LAGB in short-term (6-month) comfort with food. CONCLUSIONS: Our results add further evidence to the benefit of LSG and LAGB in obesity management. Within the first year of follow-up, there is no lasting difference in the comfort with food dimension between LSG and LABG

High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study.: Psychiatric factors and weight loss in obesity surgery

International audienceOBJECTIVE: Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD: This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 2006 and February 2010 in a French tertiary referral center. We assessed preoperative depression (using the Beck depression inventory and the SCL-90-R depression subscale), anxiety (using the Hamilton anxiety rating scale and the SCL-90-R anxiety subscales), and binge eating (using the bulimic investigatory test, Edinburgh). The primary outcome was the percentage of excess weight loss at 12 months (PEWL). RESULTS: The preoperative mean body mass index (BMI) was 55.3 kg/m2 ± 10.2 kg/m2 and 41.7 kg/m2 ± 8.7 kg/m2 at the 12-month follow-up visit. The mean PEWL was 46.8% ± 15.8%. After adjusting for the preoperative BMI, the PEWL was negatively associated with preoperative scores for depression (β= -0.357; P < 0.05), phobic anxiety (β = -0.340; P < 0.05), interpersonal sensitivity (β = -0.328; P < 0.05), and binge eating (β = -0.315; P = 0.05). Other forms of anxiety were not correlated with the PEWL. CONCLUSIONS: Higher preoperative depression, phobic anxiety, interpersonal sensitivity, and binge eating scores are associated with low postoperative weight loss in patients undergoing sleeve gastrectomy. Future studies should assess the preoperative prevalence of syndromal or subsyndromal atypical depression and its relationship to postoperative weight loss in bariatric surgery candidates

Why do liver transplant patients so often become obese? The addiction transfer hypothesis

International audienceIn patients who receive transplantation for alcohol liver disease, obesity and metabolic syndrome are highly prevalent after transplantation and both contribute to a significant proportion of cardiovascular complications, late morbidity and mortality in this population. Although immunosuppressive medications have been hypothesised to explain some of these post-liver-transplantation (LT) metabolic complications, they cannot be considered the sole cause of obesity and metabolic syndrome, and the high prevalence of these illnesses remains unexplained. Given the significant overlap between the neurobiological, psychiatric and psychological factors that underlie alcohol addiction and reward-related behavioural dyscontrol disorders such as food addiction (FA), we hypothesised that the high prevalence of obesity and metabolic syndrome reported in patients who receive transplantation for alcohol liver disease could be explained at least partially by a switch in some individuals from a previous alcohol addiction to post-transplantation FA (i.e., addiction transfer = addiction switch). In our integrative model, we also speculate that an increased prevalence of FA or alcohol addiction may occur in patients with both specific psychobiological profiles and shared risk factors. We further hypothesise that in the subpopulation of patients who develop either alcohol addiction or FA after LT, those with high insight with regard to the consequences of alcohol use could be at higher risk for FA, whereas those with low insight could be at higher risk for alcohol addiction. We discuss here evidence for and against this hypothesis and discuss which patients could be more vulnerable to these two addictions after LT. Because it will not be either possible or ethical to test some of our hypotheses in humans, future studies should test these hypotheses using a translational strategy, using both clinical and preclinical approaches. If our hypotheses could account for the significant increase in obesity and metabolic syndrome after LT, this would lead to new avenues for research and preventive as well as therapeutic interventions for alcohol-related LT patients. All patients with previous or current alcohol addiction should be systematically screened for FA and followed up for subsequent risk of obesity and metabolic syndrome. Such strategies might be effective in improving survival, outcomes and quality of life after LT and also in the overall population of patients with alcohol addiction. By determining common risk factors for both alcohol addiction and FA using a translational approach, our model could help to find novel psychopharmacological and psychological strategies that might be effective in both FA and alcohol addiction

OBEDIS Core Variables Project : European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.Peer reviewe

Study of the psychopathological factors associed with depression, quality of life and food addiction in patients with chronic diseases using Wilson and Cleary's theoretical model

L’objectif de cette thèse d’articles était de préciser la place respective des mesures objectives (ex., durée et sévérité de la maladie, traitements reçus) et subjectives (ex., troubles psychiatriques, personnalité) en tant que déterminants potentiels de dépression, de qualité de vie (QV) et d’addiction à l’alimentation chez des patient(e)s souffrant de cancer du sein ou d’obésité sévère. En nous basant sur des modèles biopsychosociaux issus du modèle de Wilson et Cleary, nous avons démontré que : 1) La dépression était plus fortement associée aux caractéristiques psychopathologiques de l’individu (personnalité, dépression avant traitement) qu’à la sévérité de la maladie ou aux types de traitements reçus ; 2) Les facteurs associés à la QV dépendent de la dimension de QV considérée (association entre mesures objectives et QV physique ; association entre mesures subjectives et toutes les dimensions de QV) ; 3) Les patients obèses souffrant d’addiction à l’alimentation ont une vulnérabilité psychopathologique spécifique. Nos travaux suggèrent qu’en cas de maladie chronique, les mesures subjectives sont des déterminants potentiels importants de la santéThis article thesis aimed to assess risk factors for three different health outcome measures (depression, health-related quality of life and food addiction) in two populations (breast cancer patients and morbidly obese patients), by assessing the relative impact of biological and physiological variables (i.e., disease duration and severity, types of treatment used), and individual and psychological variables (i.e., psychiatric disorders, personality). By proposing and putting to the test several integrative biopsychosocial models based on Wilson and Cleary’s theoretical model, we demonstrated that : 1) Depression after breast cancer treatment is more strongly associated with variables related to the premorbid individual and psychological characteristics (i.e., personality and depression before treatment) than to biological and physiological variables (i.e., disease severity, types of treatment used) ; 2) Risk factors for lower quality of life are different depending on the quality of life dimension considered (e.g., physical, psychological or sexual) : biological and physiological variables are associated with physical quality of life ; individual and psychological factors are associated with all quality of life dimensions ; 3) Obese patients with food addiction exhibit some specific psychopathological risk factors. Our work suggest to systematically assess individual and psychological variables in patients with chronic diseases because these variables are important potential predictors for different health outcome

Inter-Individual Differences in Food Addiction and Other Forms of Addictive-Like Eating Behavior

International audienceThe “addictive-like eating behavior” phenotype encompasses different terms or concepts, including “food addiction” (FA), “eating addiction” or “compulsive eating behavior”. Although these terms may theoretically refer to different conceptualizations of addictive-like eating, all agree on the similarities this phenotype may share with other addictive disorders in terms of diagnostic criteria (with some core symptoms being food craving, loss of control over eating, and maintenance of the behavior despite negative consequences), epidemiology, risk factors, and treatment [1–3]. The main hypothesis underlying the “addictive-like eating behavior” phenotype is that it may help identify, among persons with obesity, eating disorders or persons with other eating symptoms, a specific and distinct subpopulation of vulnerable individuals for whom specific therapeutic management strategies may be proposed [4]. Although the FA model has the potential to open new avenues of conceptualization and management in obesity and eating disorders by providing new options to the existing treatments [3,5], some authors questions the validity and the specificity of the FA/addictive-like eating behavior phenotype [6,7]. To explain the possible inconsistencies in this evidence, and to gain insight into the possible validity and clinical utility of the addictive-like eating behavior phenotype, we argue here that we have to take into account the heterogeneous nature of FA. Beyond the identification of this phenotype, we hypothesize here that one key issue may be, as already demonstrated for other addictive disorders, that different psychobiological factors or different pathways may account for this increased vulnerability, with the identification of different clusters of vulnerable patients [8–11]. By examining the inter-individual differences that could account for this phenotype, and by disentangling the contribution of these different factors for a given individual, we may then propose tailor-based interventions based on the specific psychobiological factors involved. Before directly testing this hypothesis in interventional studies, one preliminary step is to identify what are the psychobiological factors associated with this “addictive-like eating behavior” phenotype in different clinical and non-clinical populations, and to determine how these factors may cluster together to help identify these different clusters of patients

Addiction à l'alimentation

International audienceThe food addiction/eating addiction concepts postulate it is possible to become addicted to certain foods or to our eating behavior, with symptoms similar to those observed in well-recognized addictive disorders: craving and loss of control, existence of harms due to this behavior, and maintenance of this behavior despite these harms. In this manuscript, we discuss how an addiction-based conceptualization of our eating behavior might improve our understanding and treatment of certain forms of disordered eating. Based on a short case report, we discussed here the possibility to address the following points: (1) the assessment of the food-related harms as well as the patient’s readiness to change; (2) the assessment of the co-occurring psychiatric disorders and the associated psychopathological factors, especially ADHD, post-traumatic stress disorder, negative affectivity, and impulsivity; (3) the determination of a shared therapeutic objective based on the patient’s advice; (4) compulsive eating and its associated neurobiological mechanisms ; (5) the need to adress both the specificity and the complexity of eating behavior. By applying to eating behavior some theoretical models that have demonstrated extensive validity in the field of addictive disorders, we may develop effective and tailored-based therapeutic interventions.Le concept d’addiction à l’alimentation (AA) fait l’hypothèse qu’il est possible de développer une addiction vis-à-vis de notre alimentation, avec des symptômes similaires aux autres troubles addictifs : craving et perte de contrôle, existence de dommages et poursuite du comportement malgré les dommages (l’AA pouvant être conceptualisée comme un trouble de l’usage de substance ou comme une addiction comportementale). Dans cet article, nous présentons dans quelle mesure une conceptualisation selon une perspective addictologique pourrait contribuer à une meilleure compréhension et une meilleure prise en charge des désordres de la prise alimentaire dits « de l’excès ». A partir d’un cas clinique, nous avons discuté de l’intérêt d’évaluer les dommages et d’évaluer la motivation au changement, de repérer et de prendre en charge les troubles psychiatriques/psychopathologiques co-occurrents (notamment le TDAH, le trouble de stress post-traumatique, l’affectivité négative et l’impulsivité), de choisir l’objectif thérapeutique avec le patient, de prendre en compte la dimension compulsive et les facteurs neurobiologiques impliqués, sans oublier d’intégrer la spécificité et la complexité de l’objet « alimentation ». En appliquant à la prise alimentaire des modèles théoriques déjà éprouvés dans le champ des troubles addictifs, nous pouvons espérer développer des interventions thérapeutiques efficaces et personnalisées, adaptées à la singularité de chaque individu

Caractéristiques psychiatriques et psychopathologiques associées à la propension au changement (une étude transversale auprès de 87 patients douloureux chroniques)

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