Ecological momentary assessment of symptom trajectories during sugar reduction: application of substance use disorder criteria

Excessive sugar consumption and the difficulty faced in reducing intake have fuelled debate over whether sugar is addictive. This study aimed to identify the most prominent substance use disorder (SUD) symptoms experienced during sugar reduction and to determine whether distinct symptom burden trajectories emerged over time. Adults from New Zealand willing to quit free sugars (n = 203) participated in an ecological momentary assessment (EMA) study. A pre-EMA survey assessed food addiction symptoms, dietary intake, BMI, craving, self-efficacy, and psychological distress. Participants received five EMAs a day for two weeks to assess sugar consumption and DSM-5 SUD criteria reflecting impaired control, tolerance, withdrawal, social impairment and risky use. Nearly one-third of participants (31.0%) remained sugar-free throughout follow-up. Sugar consumption was reported in 9% of EMAs and peaked in the evening EMA (11.5%), primarily as snacks and desserts or baked goods. The most frequent symptoms were cravings, preoccupation and difficulty remaining abstinent. Common withdrawal symptoms were low energy, body aches and pains, and low mood. Group-based trajectory modelling identified a low (47%) and high (53%) symptom burden group. Pre-EMA assessment associated with high burden group membership included presence of food addiction as per Yale Food Addiction Scale, higher sugar consumption, BMI, craving, anxiety, and stress, as well as lower self-efficacy. The findings indicate that SUD-like symptoms occur during attempts to reduce or stop sugar intake. To determine whether these symptoms persist and are associated with significant impairment or distress future research should extend the EMA protocol to include a pre-quit assessment and longer-term monitoring.