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

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. 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). 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. 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. This study explored how thinking skills, known as executive functions, are connected to eating habits, food addiction symptoms, and health markers in teenagers receiving treatment for obesity. Executive functions help people control their behavior, plan ahead, switch between tasks, and manage emotions. We worked with 35 adolescents who were seeking help for obesity.We tested their executive functions using both performance tasks and questionnaires completed by their parents. The teenagers also answered questions about food addiction and eating attitudes, and we measured their body weight, waist size, and various health indicators like blood sugar, insulin, and blood pressure. Almost half of the participants met the criteria for food addiction. Common signs included repeatedly failing to cut down on certain foods, needing more of the same food to feel satisfied, and continuing to eat despite knowing it could cause harm. Those with food addiction had more difficulties with emotional control, working memory, and other thinking skills. Lower interest in dieting was linked to poorer self-control and working memory. Importantly, teenagers with greater executive function difficulties tended to have higher body weight, larger waistlines, and less healthy metabolic measures. These findings suggest that challenges with thinking and self-control skills may play an important role in both unhealthy eating behaviors and physical health problems in adolescents with obesity. Understanding and addressing these thinking skills could help improve treatment for young people struggling with obesity and related health issues.