الفهرس 
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Abstract
“Food addiction” (FA) is a phrase increasingly used by the public but continues to garner debate in the scientific literature. FA refers to a behavioral phenotype of food consumption that mirrors the clinical criteria for substance dependence. It has been suggested that an addiction to certain types of food, particularly highly processed, hyper-palatable foods, could be a factor contributing to pandemic of overeating and obesity worldwide in parallel with dramatic changes in the food environment. The aim of the present work was to study the prevalence rate of food addiction among Egyptian adult sample with overweight and obesity seeking weight-loss treatment using the Arabic version of YFAS and to study the relationship between some socio-demographic data include (age, gender, family history regarding obesity and substance abuse,etc..) and food addiction. Finally to assess the correlation between the BMI (kg/m2) and different food addiction markers.A cross-sectional study design was conducted in Alexandria, targeting adults with BMI ≥ 25 seeking weight loss treatment. The sample size was determined to be 320 based on a prevalence estimate of 28.5%; using 5% desired degree of precision and 95 % confidence limits. Adults were recruited from nutrition clinics at Alexandria smouha university hospital, and a private nutrition center. The adults with overweight and obesity fulfilling the above mentioned inclusion criteria were invited to participate in the study during their visit to the selected clinics after taking verbal consent.Participants were subjected to:1.Structured interview using a predesigned questionnaire to collect following data:Age, Gender, Personal habits(smoking, substance abuse),Medical history(metabolic, cardiovascular or endocrine diseases causing overweight and obesity), Psycho-social history: (including history of depressive symptoms and stress during the last year),Drug history(including tricyclic antidepressants, selective serotonin reuptake inhibitor (SSRI), Antihistamines, antipsychotics, beta blockers, and corticosteroids),and Family history(including overweight, obesity, any psychiatric illness and substance abuse)2. Weight was measured in kilograms and height in centimeter, then Body Mass Index (BMI) was calculated as the weight in kilograms divided by the square of the height in meters (kg/m2).3.Psychological test using “The Arabic version of Yale Food Addiction Scale (YFAS)” which was developed by the researcher, and it was reviewed by official translator center and then the reliability was established, as pilot study was done.The study revealed the following important results:The prevalence rate of food addiction among Egyptian adult sample with overweight and obesity was 38.44 %. Obese class III participants had the highest rate (55.0%) of addictive behavior to the food, while Overweight participants had the lowest rate (27.59%).Regarding food addiction markers, We found that (87.81%) of the study participants reported “persistent desire or repeated unsuccessful attempts to quit” followed by (50.94%) reported “Tolerance” then “Use continues despite knowledge of adverse consequences”(46.56%),“Substance taken in larger amount and for longer period than intended.”(39.06%), “Withdrawal symptoms” (38.75%), “Much time/activity to obtain, use, and recover” (37.19%) and lastly “Important social, occupational or recreational activities given up or reduced” (25.0%).
• A round one third (39.69 %) of the study participants met “use cause clinical significant impairment or distress” for food addiction. There was statistically significant difference among the four studied groups. Obese Class III participants had the highest percentage (57.50%) while Overweight participants had the lowest percentage (29.31%).About 27.19% of the study participants experienced stress in the last 12 months. The highest rate is among the obese class ΙΙ, ΙΙΙ (roughly 32%The percentage of stress among participants addict to food was 34.96%.while the percentage among the non-addict was 22.34%.There was statistical significant association between stress and food addiction.
• Around a half (48.78%) of participants diagnosed as food addict had positive family history of obesity while only (32.49%) of non-addict participants had positive family history of obesity. There was a statistically significant association between food addiction and family history of obesityRegarding “Substance taken in larger amount and for longer period than intended” and “Persistent desire or repeated unsuccessful attempts to quit” there were no a significant association among the four studied groups (Overweight, Obese Class I, Obese Class II and Obese Class III Regarding “Much time/activity to obtain, use, recover” there was a statistically significant differences among the four studied groups, which is more associated with obese class III group (BMI ≥40) (65.0%) and less associated with overweight group (BMI 25-29.9) (26.72%).Regarding “Important social, occupational or recreational activities given up or reduced” there was a statistically significant difference among the four studied groups, which is more associated with obese class III group (BMI ≥40) (42.50%) and less associated with Obese Class I, II groups(21.51%), (21.13%).Concerning “Use continues despite knowledge of adverse consequences” there was a statistically significant difference among the four studied groups, which is more associated with obese class III, II (60.0%, 57.75%) and less associated with Obese Class I, Overweight groups(40.86%, 39.66% Regarding “Tolerance” there was a statistically significant difference among the four studied groups, which is more associated with obese class III (65.0%) and less associated with Overweight group (40.52%).Regarding “Withdrawal symptoms” there was a statistically significant difference among the four studied groups, which is more associated with obese class III (57.50%) and less associated with Overweight group (29.31% Results of the scoring of continuous version of the YFAS showed 41.88% of the participants had high risk level of food addiction, 35.30 % had moderate risk level while 22.82 % had low risk level of food addiction.
• There was a positive correlation between the BMI (kg/m2) and the number of food addiction markers as increasing the number of the markers associated with increase of the BMI Accordingly the following recommendations are suggested:Screening of addictive behaviors to food is recommended take place as a routine in assessment programs of obesity The Arabic version of Yale food addiction scale is recommended as a valid and reliable screening tool for addictive behaviors to food in our culture as it is easily implemented, scored and interpreted Assessment of overweight/obese population should be multi-dimensional. Necessitating multi-disciplinary services involving specialists in mental health, medicine and surge Raising community awareness about obesity and it is negative impact on the human’s physical and psychological health is mandatory Developing educational manuals about obesity and the concept of food addiction to encourage positive healthy eating behaviors and better understanding of psychological needs of overweight/obese population and how to overcome stress. These manuals are recommended to be available in the waiting areas in any nutritional centers There are many weight reduction programs and activities but sustaining long term weight loss remains a challenge as the addictive behaviors to food had a major role in that. So one potential approach is to develop programs provide cognitive and behavioral therapy, which may elevate individual’s confidence and motivation in weight loss Future research should examine “food addiction” in different samples of obese and non-obese persons with and without coexisting BED. To date, most studies in which the YFAS was used were based on self-report questionnaires only. Thus, there is an urgent need to go beyond cross-sectional, questionnaire-based studies and investigate food addiction in longitudinal or experimental studies More investigations needed to show that individuals with or without YFAS diagnosis (or with a high or low symptom count) can be differentiated by behavioral and brain responses to food cues and a dopaminergic genetic profile, in addition to differences in self-report measures Sophisticated experimental or field studies are necessary to further support validity of the YFAS. For example, although a substantial proportion of individuals meet the criteria of ‘tolerance’ and ‘withdrawal symptoms’ as assessed with the YFAS, other evidence for those symptoms is restricted to animal studies. Elaborated longitudinal studies in which food intake is objectively measured are needed to further support the existence of these symptoms in humans More studies are needed in order to reveal if individuals with a YFAS diagnosis actually spend more ‘time in activities necessary to obtain food, eat, and recover from overeating’ than do individuals not receiving a YFAS diagnosis.
• In 2013, a newly revised version of the DSM, the DSM-5(270), was published that included substantial changes to the substance dependence criteria. Future investigations need to determine if and how these new criteria can be translated to eating behavior and whether their application will lead to different prevalence rates and correlates of food addiction.