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Research depicting sex differences in obesity and food addiction have gained momentum to increase treatment efficacy 12. While it is believed that food addiction is distinct from other behavioral eating disorders, it does share the characteristics or withdrawal, tolerance, impulsivity, and emotional reactivity seen with substance-use disorders and other addictive behaviors 6, 7, 11. The Yale Food Addiction Scale (YFAS) is a validated and psychometrically sound measure that uses the DSM-IV diagnostic criteria for substance abuse to operationalize food addiction 9, 10. Food addiction describes an addictive response in some individuals, where unintended overeating, the increased intake of ultra-processed/hyperpalatable foods beyond homeostatic needs or eating primarily for pleasure occur despite negative consequences 6, 7, 8. Studies have shown associations between obesity and abnormal ingestive behaviors, primarily “food addiction”, in 40% of individuals seeking bariatric surgery 4, 5. population being obese, rising healthcare costs of over 700 billion dollars annually have been observed 1, 2, 3. Similar content being viewed by othersĪs the obesity epidemic progresses, with 42% of the adult U.S. These mechanistic pathways may have clinical implications for understanding the sex-dependent variability in response to diet interventions. Sex differences in functional connectivity suggest that females with food addiction engage more in emotional overeating and less cognitive control and homeostatic processing compared to males. Additionally, greater connectivity in the locus coeruleus could indicate that the maladaptive food behaviors displayed by individuals with food addiction serve as a coping mechanism in response to pathological anxiety and stress. Individuals with food addiction showed greater connectivity between regions of the reward network suggesting dysregulation of the dopaminergic pathway. (3) Increased connectivity between regions of the reward network was positively associated with scores on the General Food Cravings Questionnaire-Trait, indicative of greater food cravings in individuals with food addiction. (2) Females with food addiction had greater connectivity in the salience and emotional regulation networks and lowered connectivity between the default mode network and central executive network compared to males with food addiction. (1) Individuals with food addiction had greater connectivity between brainstem regions and the orbital frontal gyrus compared to individuals with no food addiction. Statistical significance was corrected for multiple comparisons at q < .05. Significant connectivities and clinical variables were correlated. Connectivity differences were analyzed using a general linear model in the CONN Toolbox and images were segmented using the Schaefer 400, Harvard–Oxford Subcortical, and Ascending Arousal Network atlases. Participants were administered the Yale Food Addiction Scale (YFAS), to determine diagnostic criteria for food addiction (YFAS Symptom Count ≥ 3 with clinically significant impairment or distress), and completed ingestive behavior questionnaires. 150 participants (females: N = 103, males: N = 47 food addiction: N = 40, no food addiction: N = 110) with high BMI ≥ 25 kg/m 2 underwent functional resting state MRIs. The aim of the study was to identify functional connectivity alterations associated with: (1) Food addiction, (2) Sex- differences in food addiction, (3) Ingestive behaviors. However, the neural mechanisms underlying sex differences in the prevalence of food addiction in obesity is unknown. Functional neuroimaging studies in obesity have identified alterations in the connectivity within the reward network leading to decreased homeostatic control of ingestive behavior.
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