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

backgroundFood 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).

methodsThe 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.

resultsOf 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.

conclusionThis 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.