Yale Food Addiction Scale
The Yale Food Addiction Scale (YFAS; Gearhardt, Corbin, & Brownell, 2009) is the first measure designed specifically to assess signs of addictive-like eating behavior. The YFAS allows for a more systematic examination of the hypothesis that highly processed foods (e.g., French fries, milkshakes) might trigger an addictive process for certain people. The YFAS includes 25 items and translates the diagnostic criteria for substance dependence as stated in the DSM-IV (American Psychiatric Association, 2000) to relate to the consumption of calorie-dense foods (e.g., high in refined carbohydrates and fat). The scale includes items that assess specific criteria, such as diminished control over consumption, a persistent desire or repeated unsuccessful attempts to quit, withdrawal, and clinically significant impairment. The YFAS includes two scoring options: 1) a “symptom count” ranging from 0 to 7 that reflects the number of addiction-like criteria endorsed and 2) a dichotomous “diagnosis” that indicates whether a threshold of three or more “symptoms” plus clinically significant impairment or distress has been met. The YFAS has received psychometric support in a non-clinical populations (Gearhardt et al., 2009; Pedram et al., 2013), binge eating populations (Gearhardt, White et al., 2013; Gearhardt et al., 2012), obese bariatric surgery patients (Clark & Saules, 2013; Meule, Heckel, & Kübler, 2012) and a diverse clinical sample (Davis et al., 2011). Foreign language translations, including German, French, Turkish, Italian, Chinese, and Spanish versions, have also been developed by other research teams.
The Yale Food Addiction Scale Version 2.0 (YFAS 2.0; Gearhardt, Corbin, & Brownell, 2016) was published in the Psychology of Addictive Behaviors. Recently, the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) was released, which included significant changes to the substance-related and addictive disorders (SRAD) section. The YFAS 2.0 was developed to maintain consistency with the current diagnostic understanding of addiction and to improve the psychometric properties of the original YFAS. Both versions of the YFAS are similarly associated with elevated body mass index, binge eating, and weight cycling. However, exceeding the food addiction threshold was more strongly associated with obesity for the YFAS 2.0 than the original YFAS. Thus, the YFAS 2.0 appears to by a psychometrically sound measure that reflects the current diagnostic understanding of addiction to further investigate the potential role of an addictive process in problematic eating behavior.
Other versions of the YFAS are available. The modified version of the YFAS (mYFAS) was developed for use in large epidemiologic cohorts by adapting the validated YFAS to a core of 9 questionnaire items with 1 question from each of the symptom groups that compose the 7 diagnostic criteria plus 2 individual items that assess the presence of clinically significant impairment and distress (Flint et al., 2014). The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is an abbreviated, 13-item version of the Yale Food Addiction Scale 2.0 (YFAS 2.0). The mYFAS 2.0 has one question to assess each of the 11 DSM-5 diagnostic criteria for substance-use disorders, plus 2 questions to assess clinically significant distress and impairment (Schulte & Gearhardt, 2017). The modified versions of the YFAS perform similarly on psychometric indicators as the full versions of the scale and are useful brief assessment tool for food addiction.
The Yale Food Addiction Scale for Children (YFAS-C) was developed for use in younger age groups by altering the original YFAS to be at a 2nd grade reading level and to refer to age-appropriate activities (Gearhardt et al., 2013). The Dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0; Schiestl & Gearhardt, 2018) was developed to reflect the updated DSM-5 criteria for substance use disorder and has a 3rd grade reading level. Unlike other versions of the YFAS, the dYFAS-C 2.0 uses a dimensional scoring approach which is more sensitive to detecting subclinical variability in food addiction symptoms. The dYFAS-C 2.0 may be particularly useful in non-clinical, community samples, where clinical levels of food addiction may be low.
Highly Processed Food Withdrawal Scale (ProWS)
The Highly Processed Food Withdrawal Scale (ProWS) is a self-report questionnaire that assesses 29 physical (e.g., headaches) and psychological (e.g., irritability) withdrawal-type symptoms that may occur when individuals cut down on or abstain from highly processed foods. The ProWS was developed based on prior self-report measures of withdrawal syndromes when cutting down on cannabis and tobacco.