Journal of Behavioral Medicine

, Volume 42, Issue 2, pp 246–255 | Cite as

Effects of addictive-like eating behaviors on weight loss with behavioral obesity treatment

  • Ariana M. ChaoEmail author
  • Thomas A. Wadden
  • Jena Shaw Tronieri
  • Rebecca L. Pearl
  • Naji Alamuddin
  • Zayna M. Bakizada
  • Emilie Pinkasavage
  • Sharon M. Leonard
  • Nasreen Alfaris
  • Robert I. Berkowitz


To examine the relationship between food cravings and food addiction as defined by the Yale Food Addiction Scale (YFAS) and to assess the effects of these variables on weight loss during a 14-week group lifestyle modification program. Data were from 178 participants who were prescribed a 1000–1200 kcal/day portion-controlled diet and provided with weekly group lifestyle modification sessions. Participants completed the Food Craving Inventory and YFAS pre- and post-treatment. Weight was measured weekly. Participants with YFAS-defined food addiction (6.7%) reported more frequent overall food cravings relative to those without food addiction. More frequent food cravings at baseline were associated with less weight loss over the 14 weeks. Analyzed categorically, participants in the highest tertile of baseline food cravings lost 7.6 ± 0.5% of initial weight, which was significantly less compared to those in the lowest tertile who lost 9.1 ± 0.5%. Percent weight loss did not differ significantly between participants with YFAS-defined food addiction (6.5 ± 1.2%) and those who did not meet criteria (8.6 ± 0.3%). Addictive-like eating behaviors significantly declined from pre- to post-treatment. Participants with frequent food cravings lost less weight than their peers. Targeted interventions for food cravings could improve weight loss in these individuals. Few participants met YFAS-defined criteria for food addiction. Addictive-like eating behaviors tended to decline during behavioral weight loss, but neither baseline nor change in YFAS scores predicted weight loss.


Obesity Cravings Weight loss Food addiction Treatment 



AMC was supported by a Ruth L. Kirschstein National Research Service Award postdoctoral fellowship from the National Institute of Nursing Research/National Institutes of Health #T32NR007100. Support was also provided by an investigator-initiated grant from Eisai Pharmaceuticals and from HMR Weight Management Services Corp, Boston, MA (TAW). These funders had no role in the current study design or the collection, analysis, or interpretation of data, writing the manuscript or the decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

Thomas A. Wadden reports receiving personal fees for serving on advisory boards for Novo Nordisk, and Weight Watchers and has received grant support on behalf of the University of Pennsylvania from Eisai Pharmaceutical and Novo Nordisk. Thomas A. Wadden and Ariana M. Chao have received grant support on behalf of the University of Pennsylvania from Shire Pharmaceuticals. Jena Shaw Tronieri discloses serving as a consultant for Novo Nordisk. Rebecca L. Pearl discloses serving as a consultant for Weight Watchers. Naji Alamuddin, Zayna M. Bakizada, Emilie Pinkasavage, Sharon M. Leonard, Nasreen Alfaris, Robert I. Berkowitz declare no conflicts of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Agrawal, A., Heath, A. C., & Lynskey, M. T. (2011). DSM-IV to DSM-5: The impact of proposed revisions on diagnosis of alcohol use disorders. Addiction, 106, 1935–1943.CrossRefGoogle Scholar
  2. Albayrak, Ö., Wölfle, S. M., & Hebebrand, J. (2012). Does food addiction exist? A phenomenological discussion based on the psychiatric classification of substance-related disorders and addiction. Obesity Facts, 5, 165–179.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ® ). Washington: American Psychiatric Pub.CrossRefGoogle Scholar
  4. Avena, N. M., Bocarsly, M. E., Rada, P., Kim, A., & Hoebel, B. G. (2008a). After daily bingeing on a sucrose solution, food deprivation induces anxiety and accumbens dopamine/acetylcholine imbalance. Physiology & Behavior, 94, 309–315.CrossRefGoogle Scholar
  5. Avena, N. M., Rada, P., & Hoebel, B. G. (2008b). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 32, 20–39.CrossRefGoogle Scholar
  6. Avena, N. M., Rada, P., & Hoebel, B. G. (2009). Sugar and fat bingeing have notable differences in addictive-like behavior. The Journal of Nutrition, 139, 623–628.CrossRefGoogle Scholar
  7. Batra, P., Das, S. K., Salinardi, T., Robinson, L., Saltzman, E., Scott, T., et al. (2013). Relationship of cravings with weight loss and hunger. Results from a 6 month worksite weight loss intervention. Appetite, 69, 1–7.CrossRefGoogle Scholar
  8. Boswell, R. G., & Kober, H. (2016). Food cue reactivity and craving predict eating and weight gain: A meta-analytic review. Obesity Reviews, 17, 159–177.CrossRefGoogle Scholar
  9. Burmeister, J. M., Hinman, N., Koball, A., Hoffmann, D. A., & Carels, R. A. (2013). Food addiction in adults seeking weight loss treatment. Implications for psychosocial health and weight loss. Appetite, 60, 103–110.CrossRefGoogle Scholar
  10. Buscemi, J., Rybak, T. M., Berlin, K. S., Murphy, J. G., & Raynor, H. A. (2017). Impact of food craving and calorie intake on body mass index (BMI) changes during an 18-month behavioral weight loss trial. Journal of Behavioral Medicine, 40, 565–573.CrossRefGoogle Scholar
  11. Chao, A., Grilo, C. M., White, M. A., & Sinha, R. (2014). Food cravings, food intake, and weight status in a community-based sample. Eating Behaviors, 15, 478–482.CrossRefGoogle Scholar
  12. Chao, A., Grilo, C. M., White, M. A., & Sinha, R. (2015). Food cravings mediate the relationship between chronic stress and body mass index. Journal of Health Psychology, 20, 721–729.CrossRefGoogle Scholar
  13. Chao, A., Shaw, J. A., Pearl, R. L., Alamuddin, N., Hopkins, C. M., Bakizada, Z. M., et al. (2017). Prevalence and psychosocial correlates of food addiction in persons with obesity seeking weight reduction. Comprehensive Psychiatry, 73, 97–104.CrossRefGoogle Scholar
  14. Davis, C., Curtis, C., Levitan, R. D., Carter, J. C., Kaplan, A. S., & Kennedy, J. L. (2011). Evidence that ‘food addiction’ is a valid phenotype of obesity. Appetite, 57, 711–717.CrossRefGoogle Scholar
  15. Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Brandsma, L. L., & Lowe, M. R. (2007). A comparison of acceptance-and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372–2386.CrossRefGoogle Scholar
  16. Garber, A., & Lustig, R. (2011). Is fast food addictive? Current Drug Abuse Reviews, 4, 146–162.CrossRefGoogle Scholar
  17. Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009a). Food addiction: An examination of the diagnostic criteria for dependence. Journal of Addiction Medicine, 3, 1–7.CrossRefGoogle Scholar
  18. Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009b). Preliminary validation of the Yale Food Addiction Scale. Appetite, 52, 430–436.CrossRefGoogle Scholar
  19. Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2016). Development of the Yale Food Addiction Scale Version 2.0. Psychology of Addictive Behaviors, 30, 113–121.CrossRefGoogle Scholar
  20. Gilhooly, C., Das, S., Golden, J., McCrory, M., Dallal, G., Saltzman, E., et al. (2007). Food cravings and energy regulation: The characteristics of craved foods and their relationship with eating behaviors and weight change during 6 months of dietary energy restriction. International Journal of Obesity, 31, 1849–1858.CrossRefGoogle Scholar
  21. Hammarström, A., Wiklund, A. F., Lindahl, B., Larsson, C., & Ahlgren, C. (2014). Experiences of barriers and facilitators to weight-loss in a diet intervention-a qualitative study of women in Northern Sweden. BMC Women’s Health, 14, 59–69.CrossRefGoogle Scholar
  22. Harvey, J., Wing, R. R., & Mullen, M. (1993). Effects on food cravings of a very low calorie diet or a balanced, low calorie diet. Appetite, 21, 105–115.CrossRefGoogle Scholar
  23. Hebebrand, J., Albayrak, Ö., Adan, R., Antel, J., Dieguez, C., de Jong, J., et al. (2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neuroscience and Biobehavioral Reviews, 47, 295–306.CrossRefGoogle Scholar
  24. Heymsfield, S., Van Mierlo, C., Van der Knaap, H., Heo, M., & Frier, H. (2003). Weight management using a meal replacement strategy: Meta and pooling analysis from six studies. International Journal of Obesity, 27, 537–549.CrossRefGoogle Scholar
  25. Hill, A. J. (2007). The psychology of food craving. Proceedings of the Nutrition Society, 66, 277–285.CrossRefGoogle Scholar
  26. Joyner, M. A., Gearhardt, A. N., & White, M. A. (2015). Food craving as a mediator between addictive-like eating and problematic eating outcomes. Eating Behaviors, 19, 98–101.CrossRefGoogle Scholar
  27. Kahathuduwa, C., Binks, M., Martin, C., & Dawson, J. (2017). Extended calorie restriction suppresses overall and specific food cravings: A systematic review and a meta-analysis. Obesity Reviews, 18, 1122–1135.CrossRefGoogle Scholar
  28. Keogh, J., & Clifton, P. (2005). The role of meal replacements in obesity treatment. Obesity Reviews, 6, 229–234.CrossRefGoogle Scholar
  29. Krishnan, S., Tryon, R. R., Horn, W. F., Welch, L., & Keim, N. L. (2016). Estradiol, SHBG and leptin interplay with food craving and intake across the menstrual cycle. Physiology & Behavior, 165, 304–312.CrossRefGoogle Scholar
  30. Lent, M. R., Eichen, D. M., Goldbacher, E., Wadden, T. A., & Foster, G. D. (2014). Relationship of food addiction to weight loss and attrition during obesity treatment. Obesity, 22, 52–55.CrossRefGoogle Scholar
  31. Lichtman, S. W., Pisarska, K., Berman, E. R., Pestone, M., Dowling, H., Offenbacher, E., et al. (1992). Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine, 327, 1893–1898.CrossRefGoogle Scholar
  32. Long, C. G., Blundell, J. E., & Finlayson, G. (2015). A systematic review of the application and correlates of YFAS-diagnosed ‘food addiction’ in humans: Are eating-related ‘addictions’ a cause for concern or empty concepts? Obesity Facts, 8, 386–401.CrossRefGoogle Scholar
  33. Martin, C. K., O’Neil, P. M., & Pawlow, L. (2006). Changes in food cravings during low-calorie and very-low-calorie diets. Obesity, 14, 115–121.CrossRefGoogle Scholar
  34. Meule, A., & Kübler, A. (2012). Food cravings in food addiction: The distinct role of positive reinforcement. Eating Behaviors, 13, 252–255.CrossRefGoogle Scholar
  35. Moldovan, C. P., Weldon, A. J., Daher, N. S., Schneider, L. E., Bellinger, D. L., Berk, L. S., et al. (2016). Effects of a meal replacement system alone or in combination with phentermine on weight loss and food cravings. Obesity, 24, 2344–2350.CrossRefGoogle Scholar
  36. Niaura, R. (2000). Cognitive social learning and related perspectives on drug craving. Addiction, 95, 155–163.CrossRefGoogle Scholar
  37. Polivy, J., & Herman, C. P. (1985). Dieting and binging: A causal analysis. American Psychologist, 40, 193–201.CrossRefGoogle Scholar
  38. Pursey, K. M., Stanwell, P., Gearhardt, A. N., Collins, C. E., & Burrows, T. L. (2014). The prevalence of food addiction as assessed by the Yale Food Addiction Scale: A systematic review. Nutrients, 6, 4552–4590.CrossRefGoogle Scholar
  39. Rogers, P. J. (2017). Food and drug addictions: Similarities and differences. Pharmacology, Biochemistry and Behavior, 153, 182–190.CrossRefGoogle Scholar
  40. Ruddock, H. K., Christiansen, P., Halford, J. C., & Hardman, C. A. (2017). The development and validation of the Addiction-like Eating Behaviour Scale. International Journal of Obesity, 41, 1710–1717.CrossRefGoogle Scholar
  41. Ruddock, H. K., & Hardman, C. A. (2017). Food addiction beliefs amongst the lay public: What are the consequences for eating behaviour? Current Addiction Reports, 4, 110–115.CrossRefGoogle Scholar
  42. Ruderman, A. J. (1986). Dietary restraint: A theoretical and empirical review. Psychological Bulletin, 99, 247.CrossRefGoogle Scholar
  43. Sawamoto, R., Nozaki, T., Nishihara, T., Furukawa, T., Hata, T., Komaki, G., et al. (2017). Predictors of successful long-term weight loss maintenance: A two-year follow-up. Biopsychosocial Medicine, 11, 14–24.CrossRefGoogle Scholar
  44. Smithson, E., & Hill, A. (2016). It is not how much you crave but what you do with it that counts: Behavioural responses to food craving during weight management. European Journal of Clinical Nutrition, 71, 625–630.CrossRefGoogle Scholar
  45. Tiffany, S. T., & Wray, J. M. (2012). The clinical significance of drug craving. Annals of the New York Academy of Sciences, 1248, 1–17.CrossRefGoogle Scholar
  46. Tompkins, C. L., Laurent, J., & Brock, D. W. (2017). Food addiction: A barrier for effective weight management for obese adolescents. Childhood Obesity, 13, 462–469.CrossRefGoogle Scholar
  47. Tronieri, J. S., Alfaris, N., Chao, A. M., Pearl, R. L., Alamuddin, N., Bakizada, Z. M., et al. (2017). Lorcaserin plus lifestyle modification for weight loss maintenance: Rationale and design for a randomized controlled trial. Contemporary Clinical Trials, 59, 105–112.CrossRefGoogle Scholar
  48. Tronieri, J. S., Wadden, T. A., Berkowitz, R. I., Chao, A. M., Pearl, R. L., Alamuddin, N., et al. (2018). A randomized controlled trial of lorcaserin and lifestyle counseling for maintaining weight loss achieved with a low-calorie diet. Obesity, 26, 299–309.CrossRefGoogle Scholar
  49. Volkow, N. D., Wang, G. J., Fowler, J. S., Tomasi, D., & Baler, R. (2011). Food and drug reward: Overlapping circuits in human obesity and addiction. In C. S. Carter & J. W. Dalley (Eds.), Brain imaging in behavioral neuroscience (pp. 1–24). Berlin: Springer.Google Scholar
  50. Wadden, T. A., Faulconbridge, L. F., Jones-Corneille, L. R., Sarwer, D. B., Fabricatore, A. N., Thomas, J. G., et al. (2011). Binge eating disorder and the outcome of bariatric surgery at one year: A prospective, observational study. Obesity, 19, 1220–1228.CrossRefGoogle Scholar
  51. Wadden, T. A., Foster, G. D., Sarwer, D. B., Anderson, D. A., Gladis, M., Sanderson, R. S., et al. (2004). Dieting and the development of eating disorders in obese women: Results of a randomized controlled trial. The American Journal of Clinical Nutrition, 80, 560–568.CrossRefGoogle Scholar
  52. White, M. A., Whisenhunt, B. L., Williamson, D. A., Greenway, F. L., & Netemeyer, R. G. (2002). Development and validation of the Food-Craving Inventory. Obesity Research, 10, 107–114.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ariana M. Chao
    • 1
    • 2
    Email author
  • Thomas A. Wadden
    • 2
  • Jena Shaw Tronieri
    • 2
  • Rebecca L. Pearl
    • 2
  • Naji Alamuddin
    • 2
    • 3
  • Zayna M. Bakizada
    • 2
  • Emilie Pinkasavage
    • 2
  • Sharon M. Leonard
    • 2
  • Nasreen Alfaris
    • 2
    • 3
    • 4
  • Robert I. Berkowitz
    • 2
    • 5
  1. 1.Department of Biobehavioral Health SciencesUniversity of Pennsylvania School of NursingPhiladelphiaUSA
  2. 2.Department of PsychiatryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  3. 3.Department of MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  4. 4.Obesity, Metabolism, and Endocrine CenterKing Fahad Medical CityRiyadhSaudi Arabia
  5. 5.Department of PsychiatryThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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