Executive functioning difficulties in relation to food addiction, disordered eating attitudes, and metabolic syndrome markers among adolescents seeking obesity treatment: a cross-sectional analysis.

Background: Executive functioning (EF) difficulties may play a significant role in the vicious cycle of overeating and metabolic disturbances. We aimed to investigate the correlates of EF difficulties in terms of food addiction symptoms, eating attitudes, and metabolic syndrome markers among adolescents seeking obesity treatment.

Methods: Thirty-five adolescents seeking obesity treatment were included. Executive functioning difficulties were assessed using both performance tasks (i.e. Stroop's task and Cancellation task) and parent reports on the Behavior Rating Inventory of Executive Function (BRIEF). Other measurements included adolescent self-reports of food addiction symptoms on the Yale Food Addiction Scale (YFAS) and eating attitudes on the Eating Attitudes Test-40 (EAT-40).

Results: The mean total symptom score was 4.66 (± 1.45) on the YFAS. The most commonly endorsed symptoms were 'Repeated unsuccessful attempts to stop or decrease food consumption' in 94.3% (N = 32), 'Tolerance to the same amount of certain foods and consuming increasing amounts' in 80.0% (N = 28), and 'Continuing to eat despite knowing the negative consequences' in 77.1% (N = 27) of the sample. 48.6% of the adolescents with obesity (N = 17) met the criteria for diagnostic evaluation threshold according to YFAS, which was related to worse performance in Stroop Task and parent-reported difficulties in Emotional Control (p < .05 for both). Food addiction symptoms had differences in correlations with EF difficulties. "Eating for longer durations and higher amounts than intended" was related to difficulties in Emotional Control and Working Memory (p < .05 for both). "Continuing to eat despite knowing the negative consequences" was associated with difficulties in Shift, Emotional Control, Initiate, Plan/Organize, and Organization of Materials (p < .05 for all). Dieting was the only disordered eating attitude significantly correlated with EF difficulties. Specifically, less endorsement of dieting was correlated with difficulties in Inhibit and Working Memory (p < .05). Moreover, executive functioning difficulties were related to increased body mass index and waist circumference, in addition to worse metabolic parameters including fasting blood glucose, insulin, HOMA-IR, triglycerides, and blood pressure measurements.

Conclusion: Our study points out that specific EF difficulties were related to food addiction symptoms, dieting, and metabolic syndrome markers among adolescents with obesity. Further studies are needed to with larger and more diverse samples.