Dr Kirrilly Pursey

Introduction Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms. Objectives The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist. Design This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews. Participants This study included researchers, clinicians, consumers and health professionals. Primary outcome measure The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial. Results A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients. Conclusion Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.

(1) Background: Research suggests that certain foods may have addictive effects; however, no reviews have systematically appraised studies in this area. The aims of this review were to determine the nutrients, foods and dietary patterns associated with addictive eating. (2) Methods: Published studies up to November 2020 were identified through searches of 6 electronic databases. Eligible studies included those in in children and adults that reported dietary intakes of individuals with ¿food addiction¿. (3) Results: Fifteen studies (n = 12 in adults and n = 3 in children/adolescents with Yale Food Addiction Scale defined ¿food addiction¿) were included. Foods commonly associated with addictive eating were those high in a combination of fat and refined carbohydrates. Generally, intakes of energy, carbohydrates and fats were significantly higher in individuals with addictive eating compared to those without. (4) Conclusions: Due to the heterogeneity in study methodologies and outcomes across included studies, it is difficult to conclude if any specific foods, nutrients or dietary patterns facilitate an addictive process. Further research is needed to elucidate potential associations. However, present addictive eating treatment approaches could incorporate individualised dietary advice targeting foods high in fat and refined carbohydrates.

Aim: Understanding neural responses through functional magnetic resonance imaging (fMRI) to food and food cues in middle-older adults may lead to better treatment options to address the growing issue of malnutrition. This scoping review aimed to determine the extent, range and nature of research using fMRI, related to reward-based regions, in response to food cues in middle to older aged adults (50 years and over). Methods: The following databases were systematically searched in July 2019: CINAHL, CENTRAL, Embase, Dissertations and Theses, Ovid Medline, PsycINFO, PsycEXTRA, Scopus and Web of Science. Studies were eligible for inclusion if participants had a mean or median age =50 years, utilised and reported outcomes of either a food cue task-related fMRI methodology or resting-state fMRI. Data from included studies were charted, and synthesised narratively. Results: Twenty-two studies were included. Eighteen studies utilised a task-related design to measure neural activation, two studies measured resting state neural connectivity only and an additional two studies measured both. The fMRI scanning paradigms, food cue tools and procedure of presentation varied markedly. Four studies compared the neural responses to food between younger and older adults, providing no consensus on neural age-related changes to food cues; two studies utilised longitudinal scans. Conclusion: This review identified significant extent, range and nature in the approaches used to assess neuronal activity in response to food cues in adults aged 50 years and over. Future studies are needed to understand the age-related appetite changes whilst considering personal preferences for food cues.

Background: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of screening tools for the identification of disordered eating. Methods: A 24-item survey covering five content domains: clinic characteristics, identification of disordered eating, screening tool use, training and competence, and pathways for referral, was sent to Australasian clinics caring for =150 children and adolescents with T1D. Results: Of 13 eligible clinics, 10 participated. Two reported rates of disordered eating of >20%, while eight reported rates < 5%. All clinics used the routine clinical interview as the primary method of screening for disordered eating. Only one used screening tools; these were not diabetes-specific or routinely used. Barriers to use of screening tools included shortage of time and lack of staff confidence around use (n = 7, 70%). Enablers included staff training in disordered eating. Conclusions: Screening tools for disordered eating are not utilised by most Australasian paediatric T1D clinics. Overall, low reported rates of disordered eating suggest that it may be undetected, potentially missing an opportunity for early intervention.

Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of both conditions involves encouraging a wide variety of healthful foods in the context of usual cultural and family traditions. In recent times, low carbohydrate diets have seen a rise in popularity, both in T1D and in the general population. Low carbohydrate diets involve dietary restriction, although the extent depends on the level of carbohydrate prescription. Although dietary restriction is a known risk factor for eating disorders, there is limited literature on the impact of following a low carbohydrate diet on the development and maintenance of eating disorders in T1D. The aim of this review is to discuss the impact of dietary restriction on the development and treatment of eating disorders and propose considerations to enable optimum health outcomes in individuals with T1D, an at risk group. In order to achieve this, clarity regarding strategies that allow both flexibility in dietary intake and facilitate healthy eating behaviours, whilst achieving glycaemic targets, are required.

Introduction: The concept of ¿food addiction¿ (FA) has gained popularity in view of clinical and neurobiological overlaps between excessive food intake and addictive disorders. However, no studies have examined the link between FA and striatocortical circuits involved in addictive disorders, or the influence of homeostatic status, which regulates the drive to eat, on these systems. This study aims to investigate changes in striatal functional connectivity between fasted and fed conditions among adults ranging in body mass index (BMI) and FA symptoms. Methods: Thirty adults were recruited from the general community and completed self-reported surveys including demographics, FA symptoms using the Yale Food Addiction Scale, as well as height and weight measures, used to determine BMI. Participants completed two 3-T MRI scans, one in a fasted state and one in a fed state. We conducted seed-based analyses to examine between-session (¿fasted > fed¿) change in resting-state functional connectivity of the ventral and dorsal striatum, and its association with FA scores (controlling for BMI). Results: Higher symptoms of FA correlated with greater changes in ventral caudate-hippocampus connectivity between fasted and fed conditions. FA symptoms did not correlate with connectivity in the dorsal caudate circuit. Post-hoc analyses revealed that participants with higher symptoms of FA had ventral caudate-hippocampus hyperconnectivity in the fasted scan only, as well as a significant reduction of this connectivity between the fasted and fed scans. Conclusions: Heightened connectivity in the ventral striatum during a fasted state, which has been linked to reward prediction signals, underpins symptoms of FA. In contrast, connectivity in the dorsal striatum or ¿habit¿ system is unrelated to homeostatic status and FA symptoms, and is thus less relevant for subclinical manifestations of FA.

Background: The present study systematically reviewed the literature aiming to determine the relationships between food addiction, as measured by the Yale Food Addiction Scale (YFAS), and mental health symptoms. Methods: Nine databases were searched using keywords. Studies were included if they reported: (i) YFAS diagnosis or symptom score and (ii) a mental health outcome, as well as the association between (i) and (ii). In total, 51 studies were included. Results: Through meta-analysis, the mean prevalence of food addiction diagnosis was 16.2%, with an average of 3.3 (range 2.85¿3.92) food addiction symptoms being reported. Subanalyses revealed that the mean number of food addiction symptoms in populations seeking treatment for weight loss was 3.01 (range 2.65¿3.37) and this was higher in groups with disordered eating (mean 5.2 3.6¿6.7). Significant positive correlations were found between food addiction and binge eating [mean r¿=¿0.602 (0.557¿0.643), P¿<¿0.05], depression, anxiety and food addiction [mean r¿=¿0.459 (0.358¿0.550), r¿=¿0.483 (0.228¿0.676), P¿<¿0.05, respectively]. Conclusions: A significant, positive relationship exists between food addiction and mental health symptoms, although the results of the present study highlight the complexity of this relationship.

Background: The majority of literature examining the effect of dietary behaviour on academic achievement has focused on breakfast consumption only. Here, we aim to systematically review the literature investigating the broader effects of dietary intake and behaviours on school-aged children's academic achievement. Methods: A search was undertaken across seven databases using keywords. For studies to be included, they needed to be conducted in: school-aged children (5¿18 years); assess and report: (i) a measure of academic performance; (ii) a measure of dietary intake/behaviour; and (iii) the association between dietary intake/behaviours and academic performance. Forty studies were included in the review. Results: The majority of studies were cross-sectional in design (n = 33) and studied children aged >10 years, with very few reports in younger age groups. More than 30 different dietary assessment tools were used, with only 40% of those using a validated/standardised assessment method. Half the studies collected outcomes of academic achievement objectively from a recognised educational authority, whereas 10 studies used self-reported measures. The dietary outcomes most commonly reported to have positive associations with academic achievement were: breakfast consumption (n = 12) and global diet quality/meal patterns (n = 7), whereas negative associations reported with junk/fast food (n = 9). Conclusions: This review highlights that moderate associations exist for dietary intakes characterised by regular breakfast consumption, lower intakes of energy-dense, nutrient-poor foods and overall diet quality with respect to outcomes of academic achievement. Future studies should consider the use of validated dietary assessment methods and standardised reporting of academic achievement.

Purpose of Review: Behavioural and neurobiological similarities have been identified between the consumption of certain foods and addiction-related disorders. However, few studies have investigated what components of food may promote an addictive-like response in humans. This review evaluates recent research concerning the nutritional aspects of addictive-like eating. Recent Findings: Based on the current evidence base, highly processed, hyper-palatable foods with combinations of fat and sugar appear most likely to facilitate an addictive-like response. Total fat content and glycaemic index also appear to be important factors in the addictive potential of foods. Despite public interest and evidence from animal studies, few studies have reported an association between sugar and addictive-like eating. Summary: Due to the paucity of studies, it is difficult to conclusively identify a specific food or ingredient as capable of triggering an addictive-like response in humans. Future studies using validated dietary assessment tools are essential and may inform the development of novel strategies to treat maladaptive eating behaviours.

Objectives: There is increasing interest in the role of addictive-like eating in weight gain. No studies have investigated associations between addictive-like eating and specific patterns of fat deposition which are sensitive indicators of chronic disease risk. This exploratory study aimed to evaluate relationships between Yale Food Addiction Scale (YFAS) assessed "food addiction" and visceral adiposity. Methods: Australian adults aged 18-35 years were recruited to an online survey including demographics and the YFAS. The YFAS is a 25-item tool designed to assess addictive-like eating behaviors and uses two scoring outputs, "diagnosis" and "symptom scores". Participants had their anthropometric measurements taken [height, weight and body composition (visceral fat, fat mass, percentage body fat)] using a standardized protocol. Results: Ninety-three female participants (age 24.3 ± 4.0years, BMI 24.3 ± 6.0 kg/m2) completed all measurements. Twenty-one participants (22.3%) met the predefined criteria for YFAS "diagnosis". YFAS "symptom scores" were moderately correlated with visceral fat area (r = 0.36, p < 0.001), and "symptom scores" predicted increases in visceral fat area [r2 = 0.17, ß = 1.17, p = 0.001]. Effect sizes were moderate for all variables. Conclusion: This study showed that YFAS assessed FA was associated with visceral fat deposition, a sensitive indicator of increased cardiometabolic risk. Future research is required to investigate whether FA predicts future weight gain.

The Yale Food Addiction Scale (YFAS) is a widely used tool to assess the behavioural indicators of addictive-like eating. No studies, however, have used a longitudinal design to determine whether these addictive-like eating behaviours are a stable or transient phenomenon in a community-based population. This study aimed to evaluate whether food addiction Diagnosis and Symptom scores as assessed by the YFAS remain stable over 18-months in a non-clinical population. Young adults aged 18-35 years were recruited from the community to a web-based survey in 2013. The survey included demographics, anthropometrics and the YFAS. Participants who volunteered to be recontacted for future research were invited to complete the same survey 18-months later. The YFAS scoring outputs Diagnosis and Symptom scores were tested for agreement and reliability between the two time points. Of the 303 participants who completed the original survey and agreed to be recontacted, 69 participants (22.8% of those recontacted, 94% female, 67% normal weight at baseline) completed the 18-month follow-up survey. At baseline, thirteen participants met the YFAS predefined criteria for Diagnosis, while eleven participants met these criteria at the 18-month follow-up. YFAS Diagnosis was found to have moderate agreement [K = .50, 95% CI (.23, .77)] between the two time points while Symptom scores had good agreement [K = .70, 95% CI (.54, .83)]. Intraclass correlation coefficients were interpreted as moderate over the 18-month period for both the Diagnosis [ICC = .71, 95% CI (.45, .88)] and Symptom scores [ICC = .72, 95% CI (.58, .82)]. YFAS assessed food addiction Diagnosis and Symptom scores were found to be relatively stable over 18-months in a non-clinical population of predominantly female, young adults. Future research is required to determine the impact of behavioural weight loss interventions on YFAS assessed addictive-like eating.

BackgroundIt has been suggested that addictive behaviors related to consumption of specific foods could contribute to overeating and obesity. Although energy-dense, hyper-palatable foods are hypothesized to be associated with addictive-like eating behaviors, few studies have assessed this in humans. ObjectiveTo evaluate in young adults whether intakes of specific foods are associated with 'food addiction', as assessed by the Yale Food Addiction Scale (YFAS), and to describe the associated nutrient intake profiles. DesignAustralian adults aged 18-35. years were invited to complete an online cross-sectional survey including demographics, the YFAS and usual dietary intake. Participants were classified as food addicted (FAD) or non-addicted (NFA) according to the YFAS predefined scoring criteria. ResultsA total 462 participants (86% female, 73% normal weight) completed the survey, with 14.7% (n = 68) classified as FAD. The FAD group had a higher proportion of females (p =. 01) and higher body mass index (p< .001) compared to NFA. Higher YFAS symptom scores were associated with higher percentage energy intake (%E) from energy-dense, nutrient-poor foods including candy, take out and baked sweet products, as well as lower %E from nutrient-dense core foods including whole-grain products and breakfast cereals. These remained statistically significant when adjusted for age, sex and BMI category (p = .001). ConclusionsStatistically significant associations were identified between YFAS assessed food addiction and dietary intake, specifically intakes of energy-dense, nutrient-poor foods. However, the effect sizes were small limiting clinical applications. Further examination of the relationship between addictive-like eating and intake of specific foods in a nationally representative sample is warranted.

Obesity is a global issue and it has been suggested that an addiction to certain foods could be a factor contributing to overeating and subsequent obesity. Only one tool, the Yale Food Addiction Scale (YFAS) has been developed to specifically assess food addiction. This review aimed to determine the prevalence of food addiction diagnosis and symptom scores, as assessed by the YFAS. Published studies to July 2014 were included if they reported the YFAS diagnosis or symptom score and were published in the English language. Twenty-five studies were identified including a total of 196,211 predominantly female, overweight/obese participants (60%). Using meta-analysis, the weighted mean prevalence of YFAS food addiction diagnosis was 19.9%. Food addiction (FA) diagnosis was found to be higher in adults aged >35 years, females, and overweight/obese participants. Additionally, YFAS diagnosis and symptom score was higher in clinical samples compared to non-clinical counterparts. YFAS outcomes were related to a range of other eating behavior measures and anthropometrics. Further research is required to explore YFAS outcomes across a broader spectrum of ages, other types of eating disorders and in conjunction with weight loss interventions to confirm the efficacy of the tool to assess for the presence of FA.