Re: Social, clinical, and policy implications of ultra-processed food addiction

Agreement: 
I Agree
Body: 

Dear Editor,

We have written a response to the comment “Misrepresention of food addiction and media impact.”

We thank the letter writer for taking time to read our article.

First, we will address concerns about the estimated prevalence of ultra-processed food (UPF) addiction. The letter writer did identify that the incorrect Praxedes citation (1) was used the second time we referenced the 14% prevalence of UPF addiction in adults. We will correct this. However, the appropriate Praxedes reference (2) is used the first time we reference the 14% prevalence (as acknowledged by the letter writer). The prevalence of 14% is clearly stated in the cited reference as the estimated non-clinical prevalence in that systematic review with meta-analysis of 272 studies. To quote that study, “Even when considering the prevalence of [food addiction] in non‐clinical samples (14%) found in our analysis, it is still similar to the prevalence of the use of these substances [referring to alcohol and nicotine] (1).” The overall weighted prevalence in that Praxedes meta-analysis based on both clinical and non-clinical samples was higher (20%), but we choose to go with the more conservative estimate of 14% that was based solely on non-clinical samples(1).

Second, the letter writer also raised issues with us using the term UPF addiction. In the article, we outline in detail the rationale for using the term UPF addiction to reflect the addictive phenotype captured by the Yale Food Addiction (YFAS), which we will not repeat here. To provide additional context, when the YFAS was created in 2008 by Dr. Gearhardt and colleagues, the research into the types of foods most implicated in addictive behavior was just beginning and the concept of ultra-processing had not yet been introduced. The YFAS instructions asks individuals to think specifically about their intake of processed foods high in refined carbohydrate and/or added fat foods in assessing addictive patterns of intake, all of which would now be classified as common UPFs. Given the limited science at the time of scale development, the YFAS instructions also allows participants to consider foods that may be personally problematic that are not listed in the instructions and the term food addiction was used to describe the phenotype. Since that time, it has become clear that not all foods are implicated in addictive intake and the science had demonstrated that common UPFs high in refined carbohydrate and/or added fats are the most strongly implicated in addictive patterns. Thus, as reviewed in the article, we feel the term UPF addiction is scientifically warranted.

1. Praxedes DR, Silva‐Júnior AE, Macena ML, Gearhardt AN, Bueno NB. Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta‐analysis. Obesity Reviews. 2023;24(2):e13529.
2. Praxedes DR, Silva‐Júnior AE, Macena ML, Oliveira AD, Cardoso KS, Nunes LO, et al. Prevalence of food addiction determined by the Yale Food Addiction Scale and associated factors: A systematic review with meta‐analysis. European Eating Disorders Review. 2022;30(2):85-95.

No competing Interests: 
Yes
The following competing Interests: 
Electronic Publication Date: 
Tuesday, November 14, 2023 – 16:01
Workflow State: 
Released
Full Title: 

Re: Social, clinical, and policy implications of ultra-processed food addiction

Check this box if you would like your letter to appear anonymously:: 
Last Name: 
Gearhardt
First name and middle initial: 
Ashley N.
Address: 
Ann Arbor, MI
Occupation: 
Professor of Psychology
Other Authors: 
Nassib B. Bueno, Alexandra G. DiFeliceantonio, Christina A. Roberto, Susana Jiménez- Murcia, and Fernando Fernandez-Aranda
Affiliation: 
University of Michigan
BMJ: Additional Article Info: 
Rapid response

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