The MotivATE randomized controlled trial: treating food addiction with adapted motivational interviewing and cognitive behavioural therapy versus a waitlist control condition.

BACKGROUND

Food addiction is the concept that individuals can feel "addicted" to highly processed foods. Few interventions exist to treat it; however, recent studies targeting food addiction have drawn upon evidence-based treatments for addictions and eating disorders, including adapted motivational interviewing (AMI) and cognitive behavioural therapy (CBT).

METHODS

The current study investigated the efficacy of a novel 4-session intervention for food addiction that combines AMI + CBT (MotivATE) compared to a waitlist control (WLC). Of 131 screened individuals from the general community, 92 participants (mean age = 34.9 years, SD = 12.0; 77% women; 51% People of Colour; 29% sexual minorities) were randomized into AMI + CBT (MotivATE) therapy (n = 55) or WLC (n = 37). Participants needed to meet criteria for at least "mild" food addiction on the modified Yale Food Addiction Scale (YFAS) 2.0 to be eligible. Baseline average YFAS 2.0 scores were 8.7-8.9 symptoms ("severe" food addiction) out of a possible 11 for both groups. Therapists were clinical psychology doctoral students supervised by a registered clinical psychologist. Participants were assessed at Baseline, Month 1 (postintervention), Month 2, and Month 4. Follow-up periods were similar to previous MI interventions for binge eating. Sample size was determined by power analyses using effect sizes from such interventions.

RESULTS

Of 60 participants who started therapy, 40% met diagnostic criteria for Binge Eating Disorder, 25% for Bulimia Nervosa, 7% for Other Specified Feeding or Eating Disorder (OSFED), and 28% did not meet criteria for a current eating disorder. The therapy group reported significantly greater reductions in food addiction, addiction-like eating, binge eating symptoms, and loss-of-control eating compared to the WLC group at all follow-up timepoints. However, the therapy group did not report greater reductions in self-reported binge eating episodes or food cravings compared to WLC.

CONCLUSION

This trial provides initial evidence for the feasibility and efficacy of a brief AMI + CBT intervention for food addiction among a diverse community sample. Future trials of this intervention may benefit from greater dosages of treatment and longer follow-up periods. Trial registration ClinicalTrials.gov identifier NCT04666831; registered December 14, 2020.