Relevance of craving in eating behaviors
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1 Relevance of craving in eating behaviors Mélina FATSEAS Université Bordeaux CNRS, USR 3413 Pôle Addictologie CH Charles Perrens
2 Craving as a key clinical symptom of addictive disorders Core component of addiction Relevant to understand substance use motivation Related to loss of control Experience only in individuals with addiction Criteria included in the diagnosis of substance use disorder DSM-5 Tiffany and Wray, 2012
3 Craving in DSM-5 Central role in the pathophysiology of addiction Research in basic science Identification of triggers and temporal link with substance use Laboratory studies Ecological Momentary Assessment (EMA) approaches Clinical neurobiology of craving Neuroimaging studies
4 Clinical significance of craving Clinical utility of considering craving Diagnosis Pronostic utility Association with relapse vulnerability Direct clinical target Pronostic factor of treatment outcome Grant, Potenza et al, 2008 Monterosso, O Brien et al., 2001
5 Is craving relevant to eating behavior? High Palatable Food Addictive Substances Shared neurobiology - Reward systems - DA pathways Volkow and O Brien 2007; Volkow 2011, 2013; Ahmed 2012
6 Food craving An intense desire or urge to eat a specific type of food that is difficult to resist Assessment Visual Analogic Scale Multi-item questionnaire
7 Individuals with higher BMIs report higher frequencies of food craving Compared to controls, individuals with obesity reported More plans about eating More concerned about food More craving episodes generated by cues or negative emotional states More lost of control Abiles, 2010
8 Food Craving and binge eating N= 24 obese women Correlation positive between Sweet Food Craving and Binge Eating Dalton, 2014
9 Similarities between food craving/ craving for cigarettes or drugs Goldstein et al., 2010
10 Similarities between food craving/ craving for cigarettes or drugs Goldstein et al., 2010 Kober et al., 2010
11 Food addiction symptoms are associated with higher food craving in obese adults N=72 obese adults Yale Food Addiction Scale Food Craving Questionnaire Trait Davis et al., 2011
12 Food addiction symptoms are associated with higher food craving in obese adults N=72 obese adults Yale Food Addiction Scale Food Craving Questionnaire Trait Davis et al., 2011
13 What about Food Craving among patients with substance addiction? Aquitaine Addiction Cohort N=80 ( ) Measures Visual Analog Scale for Food Craving MINI (Mini International Neuropsychiatric Interview) Food addiction Scale (adapted from DSM-5)
14 Food Craving Craving for SWEET Frequency = 10 days (median) Average Intensity = 6.16 (SD=2.28) 68% 20% 5% 7% No Sweet Fat Sweet/ Fat Craving for FAT Frequency = 6 days (median) Average Intensity = 4.89 (SD=2.37) Craving for SWEET and FAT Frequency = 11 days for SWEET (median) Average Intensity = 5.93 (SD=2.70) Figure 1- Food craving frequency by type of food in the past 30 days. Frequency = 15 days for FAT (median) Average Intensity = 5.71 (SD=2.70)
15 Days Food addiction severity and food craving Frequency Median Subjects with severe diagnostic of FA presented the craving for sweet more frequent 7 FA Severity (DSM-5) Mild Moder ate Severe SWEET FAT
16 What about Food Craving among patients with substance addiction? One third of the sample reported Food Craving Craving for sweet was more prevalent Subjects with Food Addiction were more likely to report Food Craving More severe is FA, more frequent is the craving for sweet.
17 Implications for treatment? Development of interventions that target craving in the field of non-substance addictions Pharmacological treatments with anti-craving effects
18 Anti-craving medications in the field of substance addiction Anticraving medications to prevent relapse Addiction Traitement Opiates Nicotine Alcohol Methadone Buprenorphine Nicotine Replacement Therapy Varenicline Bupropion Naltrexone, Nalmefene Acamprosate Baclofene
19 Implications for treatment? Development of interventions that target craving in the field of non-substance addictions Pharmacological treatments with anti-craving effects Naltrexone and bupropion Greenway et al 2009, 2010; Apovian et al 2013; for review Billes et al, 2014
20 Combination of naltrexone/bupropion for obesity From Billes et al, 2014
21 Combination of naltrexone/bupropion for obesity From Billes et al, 2014
22 Implications for treatment? Development of interventions that target craving in the field of non-substance addictions Psychotherapy approaches Cognitive-behavioral therapy Triggers of craving Cognitive strategies Mindfulness-based approaches
23 Perspectives Food craving exists and is associated with compulsive food use and food addiction criteria Obesity Further studies should assess The support of food craving Specific categories of food or eating behavior? The temporal link with food intake Therapeutic implications
24
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