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Cited by 63Eating Disorders and BehaviorsNutrition, Health and Food BehaviorChild Nutrition and Feeding Issues

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Open access
Wiss, David, Brewerton, Timothy·2020·Nutrients
DOI 10.3390/nu12102937PMC PMC7600542
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Abstract

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review argues that elevated Yale Food Addiction Scale scores can reflect true food addiction or can be inflated by dietary restraint and other psychiatric conditions, so clinicians should separate signal from noise. Using three fictional vignettes, it proposes a biopsychosocial, trauma-informed assessment to guide individualized inclusive versus exclusionary nutrition strategies.

Key findings

  • Food addiction prevalence is approximately 15% in a nationally representative US sample, higher in obesity, and a meta-analysis of 51 studies estimated a worldwide mean prevalence of 16.2%; estimates in obesity treatment samples range from 6.7–16.5% and are lower in adolescents.
  • Dietary restraint is a major source of false-positive FA scores; the YFAS does not detect restrained eating. In the three vignettes, all met YFAS 2.0 criteria for FA (Phenotype A severe, BMI 36.8; B moderate, BMI 17.0; C severe, BMI 26.4), but only A was interpreted as a clear FA signal without restraint, B as restraint-driven noise, and C as ambiguous with FA preceding restraint.
  • Psychiatric comorbidity can help contextualize FA: childhood physical and sexual abuse each increased FA risk by approximately 90%; a PTSD–FA association was reported in n = 49,408; depression correlated with FA at r = 0.459 and anxiety at r = 0.483; pooled lifetime comorbid SUD in eating disorders was 21.9%, and FA prevalence in an Italian SUD sample was 20.2%.
  • Treatment implications are individualized: no trials have tested strategies to reduce reward-based eating in eating disorder patients, and few successful FA interventions exist; the review recommends considering SUD, PTSD, depression, anxiety, and ADHD to decide between inclusive versus exclusionary nutrition approaches.

Methods

  • Narrative review using a biopsychosocial perspective, synthesizing literature on FA, eating disorders, SUDs, trauma/PTSD, depression, anxiety, and ADHD.
  • No primary data collection or systematic search is described; the paper presents three fictional clinical vignettes rooted in clinical experience, with assessment examples including the YFAS 2.0 and EDE-Q.
  • Main analysis is conceptual and case-based, proposing logical steps and a clinician guide (Table 1) to interpret elevated FA scores when validated instruments are not practical.

Limitations

  • Stated: no trials have been conducted using strategies designed to reduce reward-based eating in eating disorder patients; few successful FA interventions exist; no articles describe effective obesity interventions in individuals with ACEs; the vignettes are fictional; hybrid nutrition models have not been formally described or tested.
  • Stated: directionality remains unclear for several associations, including depression, anxiety, and ADHD with FA.
  • Evident: as a narrative review, it does not report a systematic search strategy, quality appraisal, or meta-analytic synthesis; the vignettes are illustrative and not generalizable, and treatment recommendations are based largely on clinical experience and indirect evidence.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/nu12102937

Cites

240 of 240 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 225 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Based on our clinical experience, we have observed that some (not all) of the most severe FA cases develop addictions to food with limited cross-addictions.

    “Based on our clinical experience, we have observed that some (not all) of the most severe FA cases develop addictions to food with limited cross-addictions.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Alma's clinical history indicates evidence of both caffeine and nicotine use disorders.

    “however, her clinical history indicates evidence of both caffeine and nicotine use disorders.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    When Jeffrey was taken off lisdexamfetamine after clinical concerns about under eating and body dysmorphic disorder, the loss-of-control eating began.

    “When Jeffrey was taken off lisdexamfetamine after clinical concerns about under eating and body dysmorphic disorder, the loss-of-control eating began.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    Binge eating was accompanied by compensatory exercise behaviors, indicating classic ED pathology.

    “Binge eating was accompanied by compensatory exercise behaviors, indicating classic ED pathology.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Over a 9-year period, the probability of going from obese to normal was 1 in 210 for men and 1 in 124 for women.

    “A study based on a large prospective cohort from the UK suggests that over a 9-year period, the probability of going from obese to normal was 1 in 210 for men, and 1 in 124 for women [33].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Fildes, 2015, Probability of an obese person attaining normal body weight: Cohort study using electronic health records, Am. J. Public Health source

      Not checked in the free run.

  • May combine two claims. 70
  • Classified as probably not a substantial claim. 91

  • May combine two claims.

    Findingnone given

    The ED developed after the FA and weight gain, eventually contributing to her relapse with heroin.

    “The ED developed after the FA and weight gain, eventually contributing to her relapse with heroin.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    She did not develop SUD early on despite regularly using 'party drugs' (methylenedioxyamphetamine or MDMA).

    “She did not develop SUD early on despite regularly using “party drugs” (methylenedioxyamphetamine or MDMA).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    While body dissatisfaction initially drove the ED behaviors, there was no history of dietary restraint before the SUD.

    “While body dissatisfaction initially drove the ED behaviors, there was no history of dietary restraint before the SUD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Evidence of cross-addiction can be found with caffeine and nicotine.

    “Evidence of cross-addiction can be found with caffeine and nicotine.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Whitney had no evidence of ELA, although did experience adversity in high school.

    “Whitney had no evidence of ELA, although did experience adversity in high school.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    All three cases meet criteria for FA (A and C are severe while B is moderate).

    “All three cases meet criteria for FA (A and C are severe while B is moderate).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The YFAS 2.0 is a valid and reliable measure of food addiction.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    With such small chances of sustaining weight loss, classic eating disorder treatment has favored targeting dietary restraint rather than weight loss, or the removal of specific foods.

    “Understandably, with such small chances of sustaining weight loss, classic ED treatment has favored targeting dietary restraint rather than weight loss, or the removal of specific foods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Food addiction does not always necessitate rigid nutrition interventions.

    “Importantly, FA does not always necessitate rigid nutrition interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Food addiction is more vulnerable to stigmatization than alcohol and may be perceived as a behavioral rather than substance addiction.

    “A survey study found that FA is more vulnerable to stigmatization than alcohol and may be perceived as a behavioral rather than substance addiction [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] DePierre, 2013, Public perceptions of food addiction: A comparison with alcohol and tobacco, J. Subst. Use source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Yale Food Addiction Scale (YFAS) was created in 2009 to match DSM-IV Substance Abuse criteria and has been validated as a tool for identifying eating patterns resembling alcohol and drug addictions.

    “The Yale Food Addiction Scale (YFAS) was created in 2009 to match criteria for Substance Abuse in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and has been validated as a tool for identifying eating patterns which resemble alcohol and drug addictions [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Gearhardt, 2009, Preliminary validation of the yale food addiction scale, Appetite source

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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Related psychopathology such as chronic dieting based on body dissatisfaction might indicate an opposite approach, such as inclusion of the foods persistently avoided.

    “Alternatively, related psychopathology (e.g., chronic dieting based on body dissatisfaction) might indicate an opposite approach (e.g., inclusion of the foods persistently avoided).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies show that the food addiction explanation reduces weight stigma.

    “other studies show that the FA explanation reduces weight stigma [26,27].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Puhl, 2020, The Effect of a Food Addiction Explanation Model for Weight Control and Obesity on Weight Stigma, Nutrients source

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    • cites [27] Latner, 2014, Food addiction as a causal model of obesity. Effects on stigma, blame, and perceived psychopathology, Appetite source

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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    An understanding of different food addiction phenotypes may help guide intervention strategies.

    “An understanding of different FA phenotypes may help guide intervention strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some research suggests that the food addiction label may increase stigmatizing attitudes.

    “While some research suggests that the FA label may increase stigmatizing attitudes [25]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Ruddock, H.K., Orwin, M., Boyland, E.J., Evans, E.H., and Hardman, C.A. (2019). Obesity stigma: Is the ‘food addiction’ label feeding the problem?. Nutrients, 11. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    Some authors posit that saying abstinence is ineffective because people binge when they finally eat sweets is like saying that abstinence from alcohol is ineffective because those with alcohol use disorder binge after taking the first drink.

    “some authors posit that saying abstinence is ineffective because people binge when they finally eat sweets is like saying that abstinence from alcohol is ineffective because those with AUD binge after taking the first drink [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Ifland, 2015, Clearing the confusion around processed food addiction, J. Am. Coll. Nutr. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This approach targets specific foods identified as addictive, such as chocolate, ice cream, French fries, pizza, cookies, chips, and cake.

    “This approach targets specific foods which have been identified as addictive, such as chocolate, ice cream, French fries, pizza, cookies, chips, and cake [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Schulte, E.M., Avena, N.M., and Gearhardt, A.N. (2015). Which foods may be addictive? The roles of processing, fat content, and glycemic load. PloS ONE, 10. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Food addiction may reduce externalized stigma but increase internalized stigma.

    “It has also been suggested that while FA reduces externalized stigma, it may increase internalized stigma [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Cassin, S.E., Buchman, D.Z., Leung, S.E., Kantarovich, K., Hawa, A., Carter, A., and Sockalingam, S. (2019). Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review. Nutrition, 11. source

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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Food addiction can be relevant as a clinical entity.

    “Here, the position that FA can be relevant as a clinical entity is presented”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The YFAS 2.0 reflects updated DSM-5 criteria.

    “The YFAS 2.0 (released 2016) reflects updated criteria in the DSM-5 [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Gearhardt, 2016, Development of the yale food addiction scale version 2.0, Psychol. Addict. Behav. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Believing that certain food products can be addictive is associated with support for policies intended to curb their use.

    “Furthermore, believing that certain food products can be addictive has been associated with support for policies intended to curb their use [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Moran, 2016, Believing that certain foods are addictive is associated with support for obesity-related public policies, Prev. Med. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some authors have proposed the terms refined food addiction or processed food addiction to better capture food addiction as a substance-related disorder.

    “some authors have proposed the terms “refined food addiction” or “processed food addiction” to better capture FA as a substance-related disorder [30,31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Ifland, 2009, Refined food addiction: A classic substance use disorder, Med Hypotheses source

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    • cites [31] Ifland, 2015, Clearing the confusion around processed food addiction, J. Am. Coll. Nutr. source

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  • Classified as probably not a substantial claim.

    Premisecitation

    Subtyping binge eating disorder based on psychiatric comorbidity may have important implications for treatment.

    “It has been suggested that subtyping BED based on psychiatric comorbidity may have important implications for treatment [59].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Becker, 2015, Comorbidity of mood and substance use disorders in patients with binge-eating disorder: Associations with personality disorder and eating disorder pathology, J. Psychosom. Res. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Different phenotypes in binge eating disorder are likely related to their dopaminergic response to highly palatable foods.

    “Different phenotypes in BED are likely related to their dopaminergic response to highly palatable foods.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In one study of binge eating disorder outpatients (n = 98), 65% reported an onset of dieting prior to their first binge and 35% reported that binge eating preceded their first diet.

    “In one study of BED outpatients (n = 98), 65% reported an onset of dieting prior to their first binge and 35% reported that binge eating preceded their first diet [36].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Grilo, 2000, Onset of dieting vs binge eating in outpatients with binge eating disorder, Int. J. Obes. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In some cases, restraint is related to a lower body weight, better weight regulation, and a better diet quality, while in others, restraint predicts poor diet, overeating, and obesity.

    “In some cases, restraint is related to a lower body weight, better weight regulation, and a better diet quality while in others, restraint predicts poor diet, overeating, and obesity [48].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Bryant, 2019, Obesity and Eating Disturbance: The Role of TFEQ Restraint and Disinhibition, Curr. Obes. Rep. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Short-term deprivation increases cravings for avoided foods, while long-term restriction results in reduction of food cravings that can facilitate extinction of conditioned responses.

    “While short-term deprivation increases cravings for avoided foods, long-term restriction results in reduction of food cravings that can facilitate extinction of conditioned responses [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Meule, 2020, The psychology of food cravings: The role of food deprivation, Curr. Nutr. Rep. source

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  • May combine two claims.

    Premisecitation

    The relationship between food addiction and BMI is non-linear: food addiction symptomatology can be higher in some underweight groups, in some cases related to compensatory behaviors that maintain lower BMIs.

    “The relationship between FA and BMI has been described as non-linear: FA symptomatology can be higher in some underweight groups, in some cases related to compensatory behaviors that maintain lower BMIs [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Meule, 2012, Food addiction and body-mass-index: A non-linear relationship, Med. Hypotheses source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Newly proposed models suggest that clinicians go beyond a no dieting approach for all eating disorder presentations and should incorporate addiction neuroscience.

    “Newly proposed models suggest that clinicians go beyond a “no dieting” approach for all ED presentations and should incorporate addiction neuroscience [46,47].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [46] Treasure, 2018, Are trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction, Eur. Eat. Disord. Rev. source

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    • cites [47] Wiss, 2016, Incorporating food addiction into disordered eating: The disordered eating food addiction nutrition guide (DEFANG), Eat. Weight. Disord. Stud. Anorexia, Bulim. Obes. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fairburn introduced a transdiagnostic theory of eating disorders proposing that diagnosis is not relevant to treatment.

    “In 2003, Fairburn introduced a transdiagnostic theory of EDs proposing that diagnosis is not relevant to the treatment [34]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Fairburn, 2003, Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment?, Behav. Res. Ther. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Neurobiological overlaps with bulimia nervosa and substance use disorders include dopamine D2 receptor-related vulnerabilities, structural and functional alterations in the frontal cortex, glutamatergic signaling, and the opioid system.

    “Several key reviews have summarized neurobiological overlaps with BN and SUDs, including dopamine (DA) D2 receptor-related vulnerabilities, structural and functional alterations in the frontal cortex, glutamatergic signaling, and the opioid system [53,54,55].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [53] Kaye, 2013, Does a shared neurobiology for foods and drugs of abuse contribute to extremes of food ingestion in anorexia and bulimia nervosa?, Biol. Psychiatry source

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    • cites [54] Frank, 2013, Altered brain reward circuits in eating disorders: Chicken or egg?, Curr. Psychiatry Rep. source

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    • cites [55] Hadad, 2014, Addicted to palatable foods: Comparing the neurobiology of bulimia nervosa to that of drug addiction, Psychopharmacology source

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  • May combine two claims.

    Premisecitation

    The current standard eating disorder treatment is associated with high rates of relapse and poor long-term outcomes.

    “The current standard ED treatment is associated with high rates of relapse and poor long-term outcomes [43,44,45].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [43] Kordy, 2002, Remission, recovery, relapse, and recurrence in eating disorders: Conceptualization and illustration of a validation strategy, J. Clin. Psychol. source

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    • cites [44] Clausen, 2009, Time to remission for eating disorder patients: A 2½-year follow-up study of outcome and predictors, Nord. J. Psychiatry source

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    • cites [45] Grilo, 2011, Stressful life events predict eating disorder relapse following remission: Six-year prospective outcomes, Int. J. Eat. Disord. source

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    Premisecitation

    Stigma leads to maladaptive eating behaviors, stress, and weight gain.

    “Stigma leads to maladaptive eating behaviors, stress, and weight gain [68].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Puhl, 2020, Weight stigma as a psychosocial contributor to obesity, Am. Psychol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some authors recommend that researchers and clinicians distinguish between flexible and rigid restraint.

    “Some authors recommend that researchers and clinicians distinguish between flexible and rigid restraint [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Linardon, 2018, The relationship between dietary restraint and binge eating: Examining eating-related self-efficacy as a moderator, Appetite source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Contemporary eating disorder models devote relatively little attention to biological factors driving binge eating, and changes in the food environment interacting with individual vulnerability are key predisposing risk factors.

    “It has been suggested that contemporary ED models devote relatively little attention to biological factors driving binge eating, and that changes in the food environment interacting with individual vulnerability are key predisposing risk factors [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Treasure, 2018, Are trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction, Eur. Eat. Disord. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is possible that poor binge eating disorder outcomes stem from the transdiagnostic assumption that binge eating disorder patients do not need to emphasize the quality of their food.

    “It is possible that poor BED outcomes stem from the transdiagnostic assumption that BED patients do not need to emphasize the quality of their food (“it’s not about the food”).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Those with heightened body image disturbance are more likely to engage in dietary restraint, which may contribute to bingeing as well as food addiction symptoms.

    “those with heightened body image disturbance are more likely to engage in dietary restraint [66] which may contribute to bingeing as well as FA symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] 2014, Body dissatisfaction and dietary restraint influence binge eating behavior, Nutr. Res. source

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  • May combine two claims.

    Premisecitation

    Among women with body image concerns (n = 1165), weight suppression correlated with future onset of eating disorders characterized by dietary restriction or compensatory weight control behaviors, but not with binge eating disorder.

    “among women with body image concerns (n = 1165), weight suppression correlated with future onset of EDs characterized by dietary restriction or compensatory weight control behaviors, but not with BED [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Stice, E., Rohde, P., Shaw, H., and Desjardins, C. (2020). Weight suppression increases odds for future onset of anorexia nervosa, bulimia nervosa, and purging disorder, but not binge eating disorder. Am. J. Clin. Nutr., nqaa146. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The wide-held notion that dieting inevitably leads to food cravings is strongly oversimplified as the relationship between food restriction and food craving is more complex.

    “Meule states that “the wide-held notion that dieting inevitably leads to food cravings is strongly oversimplified as the relationship between food restriction and food craving is more complex” [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Meule, 2020, The psychology of food cravings: The role of food deprivation, Curr. Nutr. Rep. source

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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Consideration of the temporal sequence of disorder onset can be useful in discerning the truly positive food addiction signal from the falsely positive noise, but no rule can be applied to all cases.

    “Here, it is suggested that consideration of the temporal sequence of disorder onset can be useful in discerning the truly positive FA “signal” from the falsely positive “noise,” but that no rule can be applied to all cases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Many authors have speculated that the bidirectional association between food and alcohol/drug dysfunction represents an addiction transfer, which has been supported by many studies of bariatric patients.

    “Many authors have speculated that the bidirectional association between food and alcohol/drug dysfunction represents an “addiction transfer” [85] which has been supported by many studies of bariatric patients [86].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [85] Brunault, 2015, Why do liver transplant patients so often become obese? The addiction transfer hypothesis, Med. Hypotheses source

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    • cites [86] Kanji, 2019, Exploring pre-surgery and post-surgery substance use disorder and alcohol use disorder in bariatric surgery: A qualitative scoping review, Int. J. Obes. source

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    There is a timely need to identify phenotypes of binge eating disorder that require different treatment strategies, specifically those that would aim to reduce addiction-like eating versus those that would aim to reduce dietary restraint.

    “Taken together, there appears a timely need to identify phenotypes of BED that require different treatment strategies, specifically those that would aim to reduce addiction-like eating versus those that would aim to reduce dietary restraint.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: There is a timely need to identify phenotypes of binge eating disorder that require different treatment strategies.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    To date, this information has not been integrated into mainstream eating disorder treatment programs, possibly because the translation of these findings contradicts the popular assumption that it's not about the food.

    “To date, this information has not been integrated into mainstream ED treatment programs, possibly because the translation of these findings contradicts the popular assumption that “it’s not about the food.””
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Regulatory Model of Addictive Vulnerability proposes that susceptibility to addictive disorders is linked to how well an individual's regulatory system responds to challenges, also referred to as allostasis.

    “The Regulatory Model of Addictive Vulnerability (RMAV) proposes that susceptibility to addictive disorders is linked to how well an individual’s regulatory system responds to challenges, also referred to as allostasis [96].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Ramsay, 2020, Individual differences in biological regulation: Predicting vulnerability to drug addiction, obesity, and other dysregulatory disorders, Exp. Clin. Psychopharmacol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    According to these authors, both obesity and drug addiction are examples of major disorders characterized by dysregulated control systems.

    “According to these authors, both obesity and drug addiction are examples of major disorders characterized by dysregulated control systems.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Ramsay, 2020, Individual differences in biological regulation: Predicting vulnerability to drug addiction, obesity, and other dysregulatory disorders, Exp. Clin. Psychopharmacol. source

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  • May combine two claims.

    Premisecitation

    Patients with co-occurring substance use disorder and eating disorder are more sensitive to reward, have more difficulty engaging in goal-directed activity, are more impulsive, and have less access to emotion regulation skills.

    “Patients with co-occurring SUD and ED are more sensitive to reward, have more difficulty engaging in goal-directed activity, are more impulsive, and have less access to emotion regulation skills [77].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [77] Claudat, 2020, Correlates of co-occurring eating disorders and substance use disorders: A case for dialectical behavior therapy, Eat. Disord. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other lines of research have implicated dopamine D2 receptors in food addiction and substance use disorder.

    “whereas other lines of research have implicated DA-D2 receptors [79,80,81,82,83].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [79] Blum, 1996, The D2 dopamine receptor gene as a determinant of reward deficiency syndrome, J. R. Soc. Med. source

      Not checked in the free run.

    • cites [80] Blum, 2000, The reward deficiency syndrome: A biogenetic model for the diagnosis and treatment of impulsive, addictive and compulsive behaviors, J. Psychoact. Drugs source

      Not checked in the free run.

    • cites [81] Blum, 2012, The addictive brain: All roads lead to dopamine, J. Psychoact. Drugs source

      Not checked in the free run.

    • cites [82] Blum, 2013, Dopamine genetics and function in food and substance abuse, J. Genet. Syndr. Gene Ther.

      Not checked in the free run.

    • cites [83] Blum, 2018, The food and drug addiction epidemic: Targeting dopamine homeostasis, Curr. Pharm. Des. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with obesity and binge eating disorder have widespread reduction in binding at mu-opioid receptors, in addition to deficiencies identified at striatal dopamine D2 receptors.

    “In addition to deficiencies identified at striatal DA-D2 receptors [89,90], individuals with obesity and BED have widespread reduction in binding at mu-opioid receptors (MOR) [91].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [89] Wang, 2001, Brain dopamine and obesity, Lancet source

      Not checked in the free run.

    • cites [90] Wang, 2004, Similarity between obesity and drug addiction as assessed by neurofunctional imaging, J. Addict. Dis. source

      Not checked in the free run.

    • cites [91] Joutsa, 2018, Binge eating disorder and morbid obesity are associated with lowered mu-opioid receptor availability in the brain, Psychiatry Res. Neuroimaging source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of women in substance use disorder treatment (n = 297), a third reported starting drug use in part to lose weight and nearly half were concerned that gaining weight could trigger relapse.

    “In a study of women in SUD treatment (n = 297), a third reported starting drug use (in part) to lose weight and nearly half were concerned that gaining weight could trigger relapse [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Warren, 2013, Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology, J. Subst. Abus. Treat. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a sample of Dutch adolescents (n = 2653), symptoms of food addiction were positively associated with alcohol use, cannabis use, smoking, and sugar intake.

    “in a sample of Dutch adolescents (n = 2653), symptoms of FA were positively associated with alcohol use, cannabis use, smoking, and sugar intake [8].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Mies, 2017, The prevalence of food addiction in a large sample of adolescents and its association with addictive substances, Appetite source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a large longitudinal study from Australia, illicit substance users had significant risk of developing recurrent binge eating in addition to, or in place of, their substance use; however, the reverse was not found.

    “In a large longitudinal study from Australia, illicit substance users had significant risk of developing recurrent binge eating in addition to, or in place of, their substance use; however, the reverse was not found [74].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Lu, H.K., Mannan, H., and Hay, P. (2017). Exploring relationships between recurrent binge eating and illicit substance use in a non-clinical sample of women over two years. Behav. Sci., 7. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a large twin study from the Netherlands, genetic factors explained 48% of the variation in high sugar consumption, with 52% explained by unique environmental factors, suggesting that neuronal circuits underlying the development of addiction and obesity are related, possibly due to dopamine receptor dysfunction that leads to difficulties resisting rewarding stimuli.

    “In a large twin study from the Netherlands, genetic factors explained 48% of the variation in high sugar consumption (52% explained by unique environmental factors), suggesting that neuronal circuits underlying the development of addiction and obesity are related, possibly due to DA receptor dysfunction that lead to difficulties resisting rewarding stimuli [87].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] Treur, 2016, Heritability of high sugar consumption through drinks and the genetic correlation with substance use, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study (n = 49,408), the PTSD-food addiction association did not differ substantially by trauma type, suggesting that all forms of early life adversity impact reward-related behaviors.

    “In this study (n = 49,408), the PTSD-FA association did not differ substantially by trauma type, suggesting that all forms of ELA impact reward-related behaviors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Mason, 2014, Posttraumatic stress disorder symptoms and food addiction in women by timing and type of trauma exposure, JAMA Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Higher numbers of PTSD symptoms predict increased prevalence of food addiction, and the strength of this association increased when symptom onset occurred at an earlier age.

    “Higher numbers of PTSD symptoms predict increased prevalence of FA and the strength of this association increased when symptom onset occurred at an earlier age [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Mason, 2014, Posttraumatic stress disorder symptoms and food addiction in women by timing and type of trauma exposure, JAMA Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meta-analysis has linked the 5HTTLPR allele strongest to anorexia nervosa, and to date no study has linked this polymorphism to food addiction.

    “However, meta-analysis has linked the 5HTTLPR allele strongest to AN [111] and to date no study has linked this polymorphism to FA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [111] Calati, 2011, The 5-HTTLPR polymorphism and eating disorders: A meta-analysis, Int. J. Eat. Disord. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Theory of Latent Vulnerability suggests that one's genotype interacts with an adverse environment to create a neurocognitive phenotype, characterized by changes in reward processing (dopamine), threat processing (amygdala), and memory processing (hippocampus).

    “The Theory of Latent Vulnerability suggests that one’s genotype interacts with an adverse environment to create a neurocognitive phenotype, characterized by changes in reward processing (DA), threat processing (amygdala), and memory processing (hippocampus) [116].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] McCrory, 2015, The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder, Dev. Psychopathol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACEs captured by the various forms of the questionnaire are referred to as a form of early life adversity; however, many other measures are used, such as the childhood trauma questionnaire.

    “ACEs captured by the various forms of the questionnaire are referred to as a form of ELA; however, it is important to acknowledge there are many other measures used, such as the childhood trauma questionnaire (CTQ) [114,115].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [114] Bernstein, 1997, Validity of the Childhood Trauma Questionnaire in an Adolescent Psychiatric Population, J. Am. Acad. Child Adolesc. Psychiatry source

      Not checked in the free run.

    • cites [115] Bernstein, 2003, Development and validation of a brief screening version of the Childhood Trauma Questionnaire, Child Abus. Negl. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both an increase in the number of traumatic events early in life and an increase in levels of perceived stress were associated with a higher ventral striatal dopamine response to amphetamine.

    “Both an increase in the number of traumatic events early in life and an increase in levels of perceived stress were associated with a higher ventral striatal DA response to amphetamine [123].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [123] Oswald, 2014, History of childhood adversity is positively associated with ventral striatal dopamine responses to amphetamine, Psychopharmacology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Meta-analysis has linked childhood trauma to cognitive deficits, with the greatest deficits among those with a PTSD diagnosis.

    “Meta-analysis has linked childhood trauma to cognitive deficits, with the greatest deficits among those with a PTSD diagnosis [118].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] Malarbi, 2017, Neuropsychological functioning of childhood trauma and post-traumatic stress disorder: A meta-analysis, Neurosci. Biobehav. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    One pathway which might in part explain the enduring biological impact of adversity is inflammation.

    “One pathway which might in part explain the enduring biological impact of adversity is inflammation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Several genetic studies have linked polymorphisms at 5HTTLPR to higher levels of impulsivity among individuals with bulimia nervosa, with associated aberrations of serotonergic functioning being exacerbated by early life adversity.

    “Several genetic studies have linked polymorphisms at 5HTTLPR (codes for serotonin transporters) to higher levels of impulsivity among individuals with BN [106,107], with associated aberrations of serotonergic functioning being exacerbated by early life adversity (ELA) [108,109,110].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [106] Steiger, 2004, The 5HTTLPR polymorphism, psychopathologic symptoms, and platelet [3H-] paroxetine binding in bulimic syndromes, Int. J. Eat. Disord. source

      Not checked in the free run.

    • cites [107] Bruce, 2005, Association of the promoter polymorphism −1438G/A of the 5-HT2A receptor gene with behavioral impulsiveness and serotonin function in women with bulimia nervosa, Am. J. Med. Genet. Part B Neuropsychiatr. Genet. source

      Not checked in the free run.

    • cites [108] Steiger, 2001, Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa, Arch. Gen. Psychiatry source

      Not checked in the free run.

    • cites [109] Steiger, 2007, The 5HTTLPR polymorphism, prior maltreatment and dramatic–erratic personality manifestations in women with bulimic syndromes, J. Psychiatry Neurosci.

      Not checked in the free run.

    • cites [110] Akkermann, 2012, The impact of adverse life events and the serotonin transporter gene promoter polymorphism on the development of eating disorder symptoms, J. Psychiatr. Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Childhood physical abuse and childhood sexual abuse both increase risk for food addiction by approximately 90%.

    “Not surprisingly, childhood physical abuse and childhood sexual abuse both increase risk for FA by approximately 90% [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Mason, 2013, Abuse victimization in childhood or adolescence and risk of food addiction in adult women, Obesity source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Events should be differentiated from their effects, which varies based on the experience of the individual.

    “Important for the understanding of trauma is that events be differentiated from their effects, which varies based on the experience of the individual [120].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [120] SAMHSA (2014). SAMHSA Concept of Trauma and Guidance for a Trauma-Informed Approach, Substance Abuse and Mental Health Services Administration. (HHS Publication No. (SMA) 14-4884).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a sample of healthy young adults (n = 200), greater lifetime stress exposure was related to increased impulsivity and food addiction, suggesting that food is a predictable go-to for self-medication.

    “in a sample of healthy young adults (n = 200), greater lifetime stress exposure was related to increased impulsivity and FA [126], suggesting that food is a predictable go-to for self-medication [127].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [126] McMullin, S.D., Shields, G.S., Slavich, G.M., and Buchanan, T.W. (2020). Cumulative lifetime stress exposure predicts greater impulsivity and addictive behaviors. J. Health Psychol. source

      Not checked in the free run.

    • cites [127] Brewerton, 2011, Posttraumatic stress disorder and disordered eating: Food addiction as self-medication, J. Women’s Health source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among male military veterans (n = 106), impulsivity moderated the relationship between PTSD symptoms and alcohol consumption.

    “Among male military veterans (n = 106), impulsivity moderated the relationship between PTSD symptoms and alcohol consumption [104]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Mahoney, 2020, The Role of impulsivity in the association between posttraumatic stress disorder symptom severity and substance use in male military veterans, J. Trauma. Stress source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    As traumatic stress affects a variety of brain structures and functions, ACEs impact a variety of functions and behaviors and therefore have been determined nonspecific.

    “As traumatic stress affects a variety of brain structures and functions, ACEs impact a variety of functions and behaviors therefore have been determined nonspecific [113].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Anda, 2005, The enduring effects of abuse and related adverse experiences in childhood, Eur. Arch. Psychiatry Clin. Neurosci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with food addiction are more likely to report a family history of addiction, which may be consistent with genetic underpinnings.

    “In addition to higher levels of impulsivity, individuals with FA are more likely to report a family history of addiction [105] which may be consistent with genetic underpinnings.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [105] Wenzel, K.R., Weinstock, J., and McGrath, A.B. (2020). The clinical significance of food addiction. J. Addict. Med., 1. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Adverse Childhood Experiences study from 1998 highlighted a 5- to 10-fold increase in the risk of alcohol use disorder and substance use disorder following exposure to four or more ACEs in the first 18 years of life.

    “The Adverse Childhood Experiences (ACE) study from 1998 highlighted 5- to 10-fold increase in the risk of AUD and SUD following exposure to four or more ACEs in the first 18 years of life [112].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [112] Felitti, 1998, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study, Am. J. Prev. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Exposures by themselves do not define PTSD.

    “Exposures by themselves do not define PTSD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Assessment of impulsivity in conjunction with assessment of substance use disorder may prove beneficial in separating the food addiction signal from the noise, but more research is needed before the impulsivity construct can be used in predicting the clinical utility of food addiction.

    “Taken together, assessment of impulsivity in conjunction with assessment of SUD may prove beneficial in separating the FA signal (true positives) from the noise (false positives), but more research is needed before the impulsivity construct can be used in predicting the clinical utility of FA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    If any abuse is identified in children or adolescents, it is likely they have also previously experienced, are currently experiencing, or are at risk for experiencing additional forms of abuse.

    “If any abuse is identified in children or adolescents, it is likely they have also previously experienced, are currently experiencing, or are at risk for experiencing additional forms of abuse [119]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [119] Ziobrowski, 2020, Using latent class analysis to empirically classify maltreatment according to the developmental timing, duration, and co-occurrence of abuse types, Child Abus. Negl. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Mediterranean diet may also be helpful in reducing the odds of anxiety.

    “In addition to reducing depressive symptoms, the Mediterranean diet may also be helpful in reducing the odds of anxiety [161].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] Sadeghi, O., Keshteli, A.H., Afshar, H., Esmaillzadeh, A., and Adibi, P. (2019). Adherence to mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress. Nutr. Neurosci., 1–12. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent review article suggests that the prevalence of comorbid PTSD and eating disorders ranges from 9% to 24%, although estimates are consistently higher when looking specifically at binge-type eating disorders.

    “A recent review article suggests that the prevalence of comorbid PTSD and EDs ranges from 9% to 24% [136], although estimates are consistently higher when looking specifically at binge-type EDs [137,138,139,140,141].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [136] Rijkers, 2019, Eating disorders and posttraumatic stress disorder, Curr. Opin. Psychiatry source

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    • cites [137] Dansky, 1997, The national women’s study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa, Int. J. Eat. Disord. source

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    • cites [138] Hudson, 2007, the prevalence and correlates of eating disorders in the national comorbidity survey replication, Biol. Psychiatry source

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    • cites [139] Romans, 2001, Child sexual abuse and later disordered eating: A New Zealand epidemiological study, Int. J. Eat. Disord. source

      Not checked in the free run.

    • cites [140] Sanci, 2008, Childhood sexual abuse and eating disorders in females, Arch. Pediatr. Adolesc. Med. source

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    • cites [141] Johnson, 2002, Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood, J. Consult. Clin. Psych. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other estimates suggest traumatic events occur in over a third of adolescents in eating disorder outpatients (n = 182), and the prevalence is highest among those with bulimia nervosa.

    “Other estimates suggest traumatic events occur in over a third of adolescents in ED outpatients (n = 182), and the prevalence is highest among those with BN [135].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [135] White, 2018, The relationship between trauma and weight status among adolescents in eating disorder treatment, Appetite source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Omega-3 fatty acids have been investigated for their role in anxiety disorders, but results are inconsistent, and data are too sparse to draw conclusions.

    “Omega-3 fatty acids have been investigated for their role in anxiety disorders, but results are inconsistent, and data are too sparse to draw conclusions [164,165].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [164] Bozzatello, P., Rocca, P., Mantelli, E., and Bellino, S. (2019). Polyunsaturated fatty acids: What is their role in treatment of psychiatric disorders?. Int. J. Mol. Sci., 20. source

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    • cites [165] Bozzatello, P., Brignolo, E., De Grandi, E., and Bellino, S. (2016). Supplementation with omega-3 fatty acids in psychiatric disorders: A review of literature data. J. Clin. Med., 5. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All forms of childhood maltreatment are associated with all forms of eating disorders, although some more than others.

    “All forms of childhood maltreatment are associated with all forms of EDs, although some more than others [131].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Molendijk, 2017, Childhood maltreatment and eating disorder pathology: A systematic review and dose-response meta-analysis, Psychol. Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Exposure to trauma significantly increases risk for food addiction and therefore should be considered during comprehensive psychiatric/psychological and nutrition assessments.

    “Taken together, exposure to trauma significantly increases risk for FA and therefore should be considered during comprehensive psychiatric/psychological and nutrition assessments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Evidence consistently shows that eating disorder symptoms such as anxiety and depression are more severe among those with a PTSD diagnosis, and those with the dissociative subtype are even worse off.

    “Evidence consistently shows that ED symptoms such as anxiety and depression are more severe among those with a PTSD diagnosis [145], and those with the dissociative subtype are even worse off [146].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [145] Scharff, A., Ortiz, S.N., Ma, L.N.F., and Smith, A.R. (2019). Comparing the clinical presentation of eating disorder patients with and without trauma history and/or comorbid PTSD. Eat. Disord., 1–15. source

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    • cites [146] Gidzgier, 2019, The dissociative subtype of PTSD in women with substance use disorders: Exploring symptom and exposure profiles, J. Subst. Abus. Treat. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Anxiety disorders show a dose-response association with worsening diet quality; directionality remains unclear.

    “Meanwhile, anxiety disorders show a dose–response association with worsening diet quality [163]; however, directionality remains unclear.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [163] Bot, 2018, Diet quality in persons with and without depressive and anxiety disorders, J. Psychiatr. Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent meta-analysis of RCTs concluded that no effect of dietary interventions is observed for anxiety.

    “However, a recent meta-analysis of RCTs concluded that no effect of dietary interventions is observed for anxiety [162].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [162] Firth, 2019, The effects of dietary improvement on symptoms of depression and anxiety, Psychosom. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared to women with no addictions, women with food addiction and with substance use disorder endorsed more depression and PTSD symptoms and had more difficulties with goal-directed behaviors, acceptance of emotions, and impulse control.

    “Compared to women with no addictions, women with FA and with SUD endorsed more depression and PTSD symptoms and had more difficulties with goal-directed behaviors, acceptance of emotions, and impulse control [130].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [130] Hardy, 2017, Food addiction and substance addiction in women: Common clinical characteristics, Appetite source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is likely that depressed individuals may turn to highly palatable foods to alleviate negative affect.

    “While it is likely that depressed individuals may turn to highly palatable foods to alleviate negative affect”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    If a patient receiving ED treatment with the 'all foods fit' philosophy is consistently eating low-fiber foods ('intuitively') and has non-resolving depressive symptoms, it may indicate that a more targeted nutrition strategy is warranted.

    “Further, if a patient receiving ED treatment with the “all foods fit” philosophy is consistently eating low-fiber foods (“intuitively”) and has non-resolving depressive symptoms, it may indicate that a more targeted nutrition strategy is warranted.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In one sample of adult patients with eating disorders from Sweden (n = 853), a quarter had a lifetime diagnosis of PTSD.

    “In one sample of adult patients with EDs from Sweden (n = 853), a quarter had a lifetime diagnosis of PTSD [134].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [134] Isomaa, 2015, Posttraumatic stress disorder in eating disorder patients: The roles of psychological distress and timing of trauma, Psychiatry Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The odds of binge eating disorder following maltreatment is consistently higher than anorexia nervosa, yet meta-analysis confirms that, when pooled, the risk for bulimia nervosa is the highest.

    “The odds of BED following maltreatment is consistently higher than AN [132], yet meta-analysis confirms that, when pooled, the risk for BN is the highest [133].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [132] Afifi, 2017, Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample, Int. J. Eat. Disord. source

      Not checked in the free run.

    • cites [133] Caslini, 2016, Disentangling the association between child abuse and eating disorders, Psychosom. Med. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Alma did not develop alcohol or drug problems due to important social factors during her upbringing where she witnessed the devastating impact they had on her father.

    “Alma did not develop alcohol or drug problems due to important social factors during her upbringing where she witnessed the devastating impact they had on her father.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It may prove important to consider ADHD when conceptualizing FA phenotypes in the context of nutrition strategies.

    “It may prove important to consider ADHD when conceptualizing FA phenotypes in the context of nutrition strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One study suggested that irrational beliefs may be the source of the anxiety associated with FA.

    “One study suggested that irrational beliefs may be the source of the anxiety associated with FA [176].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [176] Nolan, L.J., and Jenkins, S.M. (2019). Food Addiction Is Associated with Irrational Beliefs via Trait Anxiety and Emotional Eating. Nutrition, 11. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In one study of undergraduate students (n = 705), nearly 12% reported using prescription stimulants to lose weight.

    “In one study of undergraduate students (n = 705), nearly 12% reported using prescription stimulants to lose weight [189] however these students were not diagnosed with ADHD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [189] Jeffers, 2013, Misuse of prescription stimulants for weight loss, psychosocial variables, and eating disordered behaviors, Appetite source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Alma was a 'foodie' prior to the rape incident, suggesting that her tendency to seek highly palatable food may have a genetic basis as well as linked to her early psychosocial environment (and cultural background).

    “Furthermore, Alma was a “foodie” prior to the rape incident, suggesting that her tendency to seek highly palatable food may have a genetic basis as well as linked to her early psychosocial environment (and cultural background).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a recent study of 136 patients with EDs, a positive screen for ADHD related to worse eating symptoms and the presence of high ED levels contributed to treatment dropout.

    “In a recent study of 136 patients with EDs, a positive screen for ADHD related to worse eating symptoms and the presence of high ED levels contributed to treatment dropout [187].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [187] Testa, G., Baenas, I., Vintró-Alcaraz, C., Granero, R., Agüera, Z., Sánchez, I., Riesco, N., Jiménez-Murcia, S., and Fernández-Aranda, F. (2020). Does ADHD symptomatology influence treatment outcome and dropout risk in eating disorders? A longitudinal study. J. Clin. Med., 9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A rodent model suggests that consumption of a Western diet may lead to long-lasting damage to fear neurocircuitry, particularly during adolescence.

    “A rodent model suggests that consumption of a Western diet may lead to long-lasting damage to fear neurocircuitry, particularly during adolescence [173].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [173] Haddad, 2018, Exposure to an obesogenic diet during adolescence leads to abnormal maturation of neural and behavioral substrates underpinning fear and anxiety, Brain Behav. Immun. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Lisdexamfetamine, which is FDA approved for ADHD as well as BED, works by enhancing dorsofrontal cortex function.

    “Lisdexamfetamine, which is FDA approved for ADHD as well as BED, works by enhancing dorsofrontal cortex function [190,191].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [190] Hudson, 2017, Efficacy of lisdexamfetamine in adults with moderate to severe binge-eating disorder: A randomized clinical trial, JAMA Psychiatry source

      Not checked in the free run.

    • cites [191] McElroy, 2015, Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are recent data to support the possibility that choice impulsivity in ADHD results from substance misuse.

    “There are recent data to support the possibility that choice impulsivity in ADHD results from substance misuse [181].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [181] Paraskevopoulou, 2020, Effects of substance misuse and family history of substance use disorder on delay discounting in adolescents and young adults with attention-deficit/hyperactivity disorder, Eur. Addict. Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent systematic review suggested that anxiety may mediate the association between PTSD and SUD.

    “A recent systematic review suggested that anxiety may mediate the association between PTSD and SUD [171]; therefore, it is biologically plausible that anxiety is on the pathway from ELA to FA, though this has not yet been shown.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [171] Vujanovic, 2018, Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review, Clin. Psychol. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The role of gastrointestinal microbiota has received attention as a potential mediator linking diet quality to anxiety symptoms.

    “The role of gastrointestinal microbiota has also received attention as a potential mediator linking diet quality to anxiety symptoms [166,167,168,169].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [166] Cryan, 2019, The microbiota-gut-brain axis, Physiol. Rev. source

      Not checked in the free run.

    • cites [167] Cryan, 2012, Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour, Nat. Rev. Neurosci. source

      Not checked in the free run.

    • cites [168] Noonan, S., Zaveri, M., MacAninch, E., and Martyn, K. (2020). Food & mood: A review of supplementary prebiotic and probiotic interventions in the treatment of anxiety and depression in adults. BMJ Nutr. Prev. Health. source

      Not checked in the free run.

    • cites [169] Foster, 2013, Gut–brain axis: How the microbiome influences anxiety and depression, Trends Neurosci. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Among those with EDs, impulsivity is also linked to serotonergic genes (i.e., 5HTTLPR).

    “However, the evidence reviewed above suggests that among those with EDs, impulsivity is also linked to serotonergic genes (i.e., 5HTTLPR).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Alma's father has AUD, which can be useful in evaluating biological susceptibility to addictive disorders.

    “Alma’s father has AUD, which can be useful in evaluating biological susceptibility to addictive disorders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    It is biologically plausible that anxiety is on the pathway from ELA to FA, though this has not yet been shown.

    “therefore, it is biologically plausible that anxiety is on the pathway from ELA to FA, though this has not yet been shown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A large genome-wide association study suggests that higher BMI increases risk of developing ADHD but not the other way around; therefore, directionality remains unclear.

    “Meanwhile, a large genome-wide association study suggests that higher BMI increases risk of developing ADHD but not the other way around [188]; therefore, directionality remains unclear.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [188] Vaz, 2019, Assessing causality in the association between attention-deficit/hyperactivity disorder and obesity: A Mendelian randomization study, Int. J. Obes. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Regular inclusion of highly palatable foods appears to be the safest course in order to prevent further progression of restriction and/or purging.

    “Regular inclusion of highly palatable foods appears to be the safest course in order to prevent further progression of restriction and/or purging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The ADHD diagnosis indicates the potential for higher levels of impulsivity and the stimulant medications may have appetite dysregulating effects.

    “However, the ADHD diagnosis indicates the potential for higher levels of impulsivity and the stimulant medications may have appetite dysregulating effects [182,189,197].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [182] Ptacek, 2016, Attention deficit hyperactivity disorder and disordered eating behaviors: Links, risks, and challenges faced, Neuropsychiatr. Dis. Treat. source

      Not checked in the free run.

    • cites [189] Jeffers, 2013, Misuse of prescription stimulants for weight loss, psychosocial variables, and eating disordered behaviors, Appetite source

      Not checked in the free run.

    • cites [197] Grant, 2018, Nonmedical use of stimulants is associated with riskier sexual practices and other forms of impulsivity, J. Addict. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    However, it is possible that this approach can increase risk for SUD relapse if Whitney continues to gain weight and is unable to accept her body at a higher BMI.

    “However, it is possible that this approach can increase risk for SUD relapse if Whitney continues to gain weight and is unable to accept her body at a higher BMI [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Warren, 2013, Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology, J. Subst. Abus. Treat. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In this case, FA preceded the dietary restraint, meaning that the signal existed before the noise.

    “In this case, FA preceded the dietary restraint, meaning that the signal existed before the noise.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a study of 60 women, 12-Step self-help groups for compulsive eating have been shown to reduce anxiety and depression, but not FA.

    “In a study of 60 women, 12-Step self-help groups for compulsive eating have been shown to reduce anxiety and depression, but not FA [221].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [221] Weinstein, 2015, The effects of a 12-step self-help group for compulsive eating on measures of food addiction, anxiety, depression, and self-efficacy, J. Groups Addict. Recover. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The fact that Jeffrey never struggled with AUD/SUD is also informative.

    “The fact that Jeffrey never struggled with AUD/SUD is also informative.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    This case study exemplifies how an underweight individual can have elevated YFAS scores; however, the diagnosis of moderate FA is not informative for treatment.

    “This case study exemplifies how an underweight individual can have elevated YFAS scores; however, the diagnosis of moderate FA is not informative for treatment.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The YFAS 2.0 is a valid and reliable measure of food addiction.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    However, she was resilient to this exposure.

    “However, she was resilient to this exposure.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Phenotype C is an example of a case that could be interpreted as an FA signal (true positive), or as a more classic ED presentation (false positive), depending on the training (and bias) of the practitioner.

    “Phenotype C is an example of a case that could be interpreted as an FA signal (true positive), or as a more classic ED presentation (false positive), depending on the training (and bias) of the practitioner.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The YFAS 2.0 is a valid and reliable measure of food addiction.
    • Rests on an assumption: The EDE-Q is a valid and reliable measure of dietary restraint.
    • Rests on an assumption: The three clinical vignettes are representative of the phenotypes they illustrate.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The present review suggests that it would be effective to identify FA phenotypes based on the presence of other psychiatric disorders such as ED, AUD/SUD, PTSD, depression, anxiety, and ADHD as part of a comprehensive biopsychosocial assessment, and to assign nutrition treatment based on the relative strength of the FA signal amidst the noise (true versus false positive).

    “The present review suggests that it would be effective to identify FA phenotypes based on the presence of other psychiatric disorders such as ED, AUD/SUD, PTSD, depression, anxiety, and ADHD as part of a comprehensive biopsychosocial assessment, and to assign nutrition treatment based on the relative strength of the FA signal amidst the noise (true versus false positive).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The three clinical vignettes bring attention to heterogeneity that is possible given an FA diagnosis using the YFAS 2.0.

    “The three clinical vignettes bring attention to heterogeneity that is possible given an FA diagnosis using the YFAS 2.0.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The YFAS 2.0 is a valid and reliable measure of food addiction.
    • Rests on an assumption: The three clinical vignettes are representative of the phenotypes they illustrate.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Jeffrey's modeling career appears influenced by his mother's history of modeling and related social network.

    “Jeffrey’s modeling career appears influenced by his mother’s history of modeling and related social network.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    While no trials have been reported using targeted nutrition interventions for FA, several studies have shown that non-diet approaches such as intuitive eating can be effective in reducing dietary restraint.

    “While no trials have been reported using targeted nutrition interventions for FA, several studies have shown that non-diet approaches such as intuitive eating can be effective in reducing dietary restraint [199,200,201].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [199] Tylka, 2006, Are intuitive eating and eating disorder symptomatology opposite poles of the same construct?, J. Couns. Psychol. source

      Not checked in the free run.

    • cites [200] Linardon, 2017, Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns, Eat. Behav. source

      Not checked in the free run.

    • cites [201] Katzer, 2008, Evaluation of a “Nondieting” stress reduction program for overweight women: A randomized trial, Am. J. Health Promot. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent studies have identified different phenotypic characterizations of the FA construct.

    “Recent studies have identified different phenotypic characterizations of the FA construct [60,61,202,203].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [60] Ivezaj, 2016, Examining binge-eating disorder and food addiction in adults with overweight and obesity, Obesity source

      Not checked in the free run.

    • cites [61] Romero, 2019, Is food addiction a predictor of treatment outcome among patients with eating disorder?, Eur. Eat. Disord. Rev. source

      Not checked in the free run.

    • cites [202] Jiménez-Murcia, S., Agüera, Z., Paslakis, G., Munguía, L., Granero, R., Sánchez-González, J., Sánchez, I., Riesco, N., Gearhardt, A.N., and Diéguez, C. (2019). Food addiction in eating disorders and obesity: Analysis of clusters and implications for treatment. Nutrition, 11. source

      Not checked in the free run.

    • cites [203] Fauconnier, 2020, Food addiction among female patients seeking treatment for an eating disorder: Prevalence and associated factors, Nutrition

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    There is no AUD/SUD in the immediate family, which can be helpful information when assessing potential FA (reward dysfunction).

    “There is no AUD/SUD in the immediate family, which can be helpful information when assessing potential FA (reward dysfunction).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It is likely that practitioners who do not endorse the clinical utility of FA will observe the PTSD-ED connection and ignore the contribution of addiction-like eating into Whitney's assessment and treatment plan.

    “It is likely that practitioners who do not endorse the clinical utility of FA will observe the PTSD–ED connection and ignore the contribution of addiction-like eating into Whitney’s assessment and treatment plan.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Following her serious injury and PTSD warranting opioid medications, she developed an opioid use disorder, implicating trauma as an important risk factor.

    “However, following her serious injury and PTSD warranting opioid medications, she developed an opioid use disorder, implicating trauma as an important risk factor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    He was previously successful in restraining himself with food but eventually lost his ability to do so, which is not uncommon over longer periods of time.

    “He was previously successful in restraining himself with food but eventually lost his ability to do so, which is not uncommon over longer periods of time [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Fairburn, 2003, Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment?, Behav. Res. Ther. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Jeffrey is a classic example of how thin ideals can be perpetuated by the family system, become internalized, and eventually become pathological.

    “Jeffrey is a classic example of how thin ideals can be perpetuated by the family system, become internalized, and eventually become pathological.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Rather, FA is a product of restrained eating stemming from body dissatisfaction.

    “Rather, FA is a product of restrained eating stemming from body dissatisfaction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    As this phenotype exemplifies FA, it suggests that FA-informed nutritional strategies may be warranted as well as safe (low risk of developing an ED).

    “As this phenotype exemplifies FA, it suggests that FA-informed nutritional strategies may be warranted as well as safe (low risk of developing an ED).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Once becoming sober and being prescribed several medications, her PTSD symptoms and reward-seeking behavior led to FA and associated distress.

    “Once becoming sober and being prescribed several medications, her PTSD symptoms and reward-seeking behavior led to FA and associated distress.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    However, a comprehensive biopsychosocial assessment identified divergent phenotypes that may warrant different nutrition interventions.

    “However, a comprehensive biopsychosocial assessment identified divergent phenotypes that may warrant different nutrition interventions.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The YFAS 2.0 is a valid and reliable measure of food addiction.
    • Rests on an assumption: The EDE-Q is a valid and reliable measure of dietary restraint.
    • Rests on an assumption: The three clinical vignettes are representative of the phenotypes they illustrate.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    It is being suggested to view EDs with co-occurring FA on a continuum rather than as discrete conditions, using the eight-step process as a guide, rather than simply to dichotomize inclusive vs. exclusive nutrition strategies.

    “Thus, it is being suggested to view EDs with co-occurring FA on a continuum rather than as discrete conditions, using the eight-step process as a guide, rather than simply to dichotomize inclusive vs. exclusive nutrition strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    It has been suggested that the more interactive, engaging and person centered a mobile health treatment is, the more appealing it will be to those suffering from compulsive overeating.

    “It has been suggested that the more interactive, engaging and person centered a mobile health treatment is, the more appealing it will be to those suffering from compulsive overeating [231].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [231] Moghimi, 2020, eHealth treatments for compulsive overeating: A narrative review, Curr. Addict. Rep. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recently, there have been recommendations for interventions among adolescents that promote executive functioning in the context of salience and reward processing.

    “Recently, there have been recommendations for interventions among adolescents that promote executive functioning in the context of salience and reward processing [196].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [196] Borowitz, 2020, Weight-Related differences in salience, default mode, and executive function network connectivity in adolescents, Obesity source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It seems that until researchers and clinicians determine who is a good candidate for an FA-based nutrition intervention, FA science will continue to stimulate disagreement.

    “It seems that until researchers and clinicians determine who is a good candidate for an FA-based nutrition intervention, FA science will continue to stimulate disagreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Patients with food addiction may have very different behavioral characteristics, such as those who binge versus those who do not.

    “Similar to how SUD patients exhibit different patterns of abuse, patients with FA may have very different behavioral characteristics such as those that binge versus those that do not.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some authors recommend that if an ED is present in addition to FA, clinicians should first provide evidence-based treatments for those conditions.

    “Some authors recommend that if an ED is present in addition to FA, clinicians should first provide evidence-based treatments for those conditions [225].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [225] Cassin, 2020, Psychosocial interventions for food addiction: A systematic review, Curr. Addict. Rep. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Many people with more classic ED training may view these apps as a causal factor to ED pathology, either in the short term or over the life course.

    “Meanwhile, many people with more classic ED training may view these apps as a causal factor to ED pathology, either in the short term or over the life course.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    This highlights the difference between dietary restraint that can be helpful for some versus pathological for others.

    “This highlights the difference between dietary restraint that can be helpful for some versus pathological for others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Much of the controversy regarding food addiction pertains to treatment, which lacks data, rather than to the existence of the problem, which has robust data.

    “While there is disagreement regarding FA, it appears that much of the controversy pertains to the treatment (lacking data) rather than the existence of the problem (robust data).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    It is well established that earlier intervention is beneficial for addressing ED pathology.

    “It is well established that earlier intervention is beneficial for addressing ED pathology [226].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Romano, 2020, Changes in disordered eating behaviors over 10 or more years: A meta-analysis, Int. J. Eat. Disord. source

      Not checked in the free run.

132 of 132

  • The paper relies on this without support.

    The Yale Food Addiction Scale does not detect restrained eating.

    “A common criticism of the YFAS in clinical applications is that the measure itself does not detect restrained eating (tendency to restrict food intake for weight control).”

  • The paper relies on this without support.

    Different food addiction phenotypes have not been adequately described.

    “This paper explores the nuances of different FA phenotypes, which have not been adequately described.”

  • The paper relies on this without support.

    No trials have been conducted using strategies designed to reduce reward-based eating in patients with eating disorders.

    “No trials have been conducted using strategies designed to reduce reward-based eating in patients with EDs;”

  • The paper relies on this without support.

    Much of the food addiction research in eating disorder populations has failed to account for dietary restraint.

    “Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives.”

  • The paper relies on this without support.

    There is a timely need to identify phenotypes of binge eating disorder that require different treatment strategies.

    “Taken together, there appears a timely need to identify phenotypes of BED that require different treatment strategies”

  • The paper relies on this without support.

    The YFAS 2.0 is a valid and reliable measure of food addiction.

    “Several assessment tools were administered, including the eating disorder examination questionnaire (EDE-Q) which indicated an absence of dietary restraint and the YFAS 2.0 where she met criteria for severe food addiction (BMI = 36.8).”

  • The paper relies on this without support.

    The EDE-Q is a valid and reliable measure of dietary restraint.

    “Several assessment tools were administered, including the EDE-Q, which indicated high levels of dietary restraint, and the YFAS 2.0, where he met criteria for moderate food addiction (BMI = 17.0).”

  • The paper relies on this without support.

    The three clinical vignettes are representative of the phenotypes they illustrate.

    “The three clinical vignettes bring attention to heterogeneity that is possible given an FA diagnosis using the YFAS 2.0.”

  • The paper relies on this without support.

    Anxiety is a well-established risk factor for EDs, SUDs, and PTSD.

    “Anxiety is a well-established risk factor for EDs, SUDs, and PTSD.”

  • The paper relies on this without support.

    Stimulant medications often used in the treatment of ADHD can have an impact on appetite, with suppressing effects while using and rebound appetite when not.

    “It is worth noting that stimulant medications (i.e., amphetamines) often used in the treatment of ADHD can have an impact on appetite, with suppressing effects while using and rebound appetite when not.”

  • The paper relies on this without support.

    Most eating disorders are currently treated with an inclusive nutrition strategy aimed to reduce fears around food and desensitize individuals to highly palatable foods through regular consumption.

    “Currently, most EDs are treated with an inclusive nutrition strategy aimed to reduce fears around food and desensitize individuals to highly palatable foods through regular consumption.”

  • The paper relies on this without support.

    Failure to recognize or treat trauma/PTSD is a major contributor to poor outcomes.

    “Our clinical experience suggests that failure to recognize/treat trauma/PTSD is a major contributor to poor outcomes.”

  • The paper relies on this without support.

    Tailor-made hybrid models between inclusive and exclusive approaches have been useful in clinical experience.

    “Tailor-made hybrid models between inclusive and exclusive approaches have been useful in our clinical experience but have yet to be formally described or tested.”

  • The paper relies on this without support.

    Exclusive nutritional strategies may exacerbate restrict–binge patterns.

    “These strategies may run the risk of exacerbating restrict–binge patterns, therefore should be supervised by clinicians experienced in EDs as well as in detecting reward dysfunction (through examination of cross-addictions) and impulsivity (with respect to food and other behaviors).”

  • The paper relies on this without support.

    When food alters dopamine circuitry, efforts to moderate become more difficult and intuitive eating can feel impossible.

    “When food alters DA circuitry, efforts to moderate become more difficult and “intuitive eating” can feel impossible.”

  • The paper relies on this without support.

    The impact of contemporary Westernized foods may be contributing to poor eating disorder treatment outcomes.

    “The impact of contemporary Westernized foods may be contributing to poor ED treatment outcomes.”

  • The paper relies on this without support.

    It is very challenging to implement divergent nutritional strategies in residential treatment settings where there is comparison on the unit and heightened interest in each other’s food plans.

    “However, it will be very challenging to implement divergent nutritional strategies in residential treatment settings where there is comparison on the unit and heightened interest in each other’s food plans.”
17 of 17

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The role of dietary restraint has been included as an important psychological factor that should be accounted for when conceptualizing FA and obesity.

    “Finally, the role of dietary restraint has been included as an important psychological factor that should be accounted for when conceptualizing FA and obesity, particularly given the strong relationship between ELA and EDs, as recently reviewed elsewhere [46].”

    From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [46]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Citation [107] concerns a different serotonin gene variant

    Minor

    The text cites reference [107] as evidence about 5HTTLPR, but that reference's title identifies a −1438G/A variant of the 5-HT2A receptor gene instead.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Frank, K.W., and Berner, L.A. (2020). Food Addiction, Binge Eating, and the Role of Dietary Restraint: Converging Evidence From Animal and Human Studies, Springer Nature.
  2. Spielberger, C.D. (2010). The Corsini Encyclopedia of Psychology, John Wiley & Sons.

Cited by

Sorted by citations

Related

Authors
Wiss, D., & Brewerton, T.
Affiliations
  • University of California, Los Angeles (US)
  • Medical University of South Carolina (US)
Corresponding author
Wiss, David
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2020-09-25
Volume
12
Issue
10
Pages
2937
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu12102937
PMC
PMC7600542
OpenAlex
W3088566631
Semantic Scholar
9691bd81f62b18d86df210f2752a7da8b7f6c66f
Cited by
63
References
240
Citations by year
2026: 6 · 2025: 8 · 2024: 14 · 2023: 6 · 2022: 7 · 2021: 20 · 2020: 2
FWCI
0.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
food addiction, dietary restraint, binge eating, eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, psychiatric comorbidity, weight stigma, false positives, clinical evaluation, nutrition interventions, case formulation
MeSH terms
Food Addiction, Anorexia Nervosa, Anxiety, Feeding and Eating Disorders, Bulimia, Diet, Feeding Behavior, Humans, Obesity, Bulimia Nervosa, Binge-Eating Disorder

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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