Exploring clinical phenotypes of food addiction and its distress correlates: A cross-sectional evaluation in treatment-seeking individuals with obesity

Introduction: Food addiction (FA) shares neurobiological and behavioral mechanisms with substance use disorders, including craving and compulsive consumption despite harm and significant impairment. This study examines the prevalence of FA among treatment-seeking individuals with obesity, focusing on the contribution of emotional dysregulation, eating behaviors, and distress tolerance, to draw parallels with substance use frameworks. Methods: This cross-sectional study included 125 individuals with obesity (BMI > 30 kg/m2) and FA diagnosis was performed using the Yale Food Addiction Scale 2.0 (YFAS-2.0). We employed the Difficulties in Emotional Regulation Scale (DERS), Distress Tolerance Scale (DTS), Interpersonal Reactivity Index (IRI) to evaluate emotional, empathy and distress measures, and performed an Exploratory Factory Analysis to evaluate the adequacy of DTS and IRI. We used LASSO regression to identify FA predictors, mediation analysis to explore indirect effects among significant variables and FA. Results: FA was present in 37.6 % of participants, with higher prevalence among individuals with binge eating (68.4%) and grazing (54.8 %). DERS was higher in individuals with FA (MD = 25.79; 95 % C.I. [18.45, 33.13], p < .01), while distress tolerance was lower (MD = −7.15, 95 % C.I. [−10.5, −3.84], p < .01). LASSO regression identified pathological eating behaviors as the strongest predictors of FA, alongside emotional dysregulation. Mediation analysis revealed that emotional dysregulation mediated the relationship between distress tolerance and FA. Discussion: FA represents a frequent phenomenon in obesity, often driven by low distress tolerance and poor emotional regulation, mirroring other addictions. Pathological eating behaviors may represent different phenotypic expressions of FA. Considering the relevant psychological underpinning, integrating tailored psychological interventions into obesity management may promote sustained weight management and improved outcomes.