Efficacy of a Cognitive - Affective - Addictive Based Intervention to Decrease Food Craving in Obese Patients.

Body mass index (BMI) is a measure of body fat based on height and weight, expressed in kg/m2

Body mass index (BMI) is a measure of body fat based on height and weight, expressed in kg/m2

Waist circumference measured following the WHO STEPwise approach to surveillance (STEPS) and their corresponding guidelines for physical measurement

Waist circumference measured following the WHO STEPwise approach to surveillance (STEPS) and their corresponding guidelines for physical measurement

Bio Impedance Analysis (BIA) is a more specific measure of body composition and adiposity. The variables of interest will be the percentages of body fat and fat-free mass.

Bio Impedance Analysis (BIA) is a more specific measure of body composition and adiposity. The variables of interest will be the percentages of body fat and fat-free mass.

Emotional Appetite Questionnaire (EMAQ) contains 22 items assessing variations of food intake in response to emotional states and situations. 9 items evaluate negative emotions, 5 evaluate positive emotions, 5 refer to negative situations and 3 to positive situations.A score is calculated for positive emotions (EMAQ-PE), negative emotions (EMAQ-NE), positive situations (EMAQ-PS) and negative situations (EMAQ-NS). For each subscale, the ratings for the relevant items are added together and the sum divided by the total number of items forming the subscales. A positive total score (EMAQ-P) is obtained by averaging the EMAQ-PE and EMAQ-PS scores. A negative total score (EMAQ-N) is obtained by averaging the EMAQ-NE and EMAQ.

Emotional Appetite Questionnaire (EMAQ) contains 22 items assessing variations of food intake in response to emotional states and situations. 9 items evaluate negative emotions, 5 evaluate positive emotions, 5 refer to negative situations and 3 to positive situations.A score is calculated for positive emotions (EMAQ-PE), negative emotions (EMAQ-NE), positive situations (EMAQ-PS) and negative situations (EMAQ-NS). For each subscale, the ratings for the relevant items are added together and the sum divided by the total number of items forming the subscales. A positive total score (EMAQ-P) is obtained by averaging the EMAQ-PE and EMAQ-PS scores. A negative total score (EMAQ-N) is obtained by averaging the EMAQ-NE and EMAQ.

Eating Disorder Examination-Questionnaire (EDE-Q) includes 36-item assessing the frequency of disordered eating behaviors over the past 28 days. The EDE-Q provides subscale scores reflecting the severity of aspects of the psychopathology of eating disorders. The subscales are Restraint, Eating Concern, Shape Concern and Weight Concern. To obtain a particular subscale score, the ratings for the relevant items are added together and the sum divided by the total number of items forming the subscales. If ratings are only available on some items, a score may nevertheless be obtained by dividing the resulting total by the number of rated items as long as more than half the items have been rated. To obtain total score, the four subscales scores are summed and the resulting total divided by the number of subscales (i.e. four). The variables of interest will be the EDE-Q total score and subscales' scores.

Eating Disorder Examination-Questionnaire (EDE-Q) includes 36-item assessing the frequency of disordered eating behaviors over the past 28 days. The EDE-Q provides subscale scores reflecting the severity of aspects of the psychopathology of eating disorders. The subscales are Restraint, Eating Concern, Shape Concern and Weight Concern. To obtain a particular subscale score, the ratings for the relevant items are added together and the sum divided by the total number of items forming the subscales. If ratings are only available on some items, a score may nevertheless be obtained by dividing the resulting total by the number of rated items as long as more than half the items have been rated. To obtain total score, the four subscales scores are summed and the resulting total divided by the number of subscales (i.e. four). The variables of interest will be the EDE-Q total score and subscales' scores.

Dutch Eating Behaviour Questionnaire (DEBQ) consists of 33 items and assesses on a 5-point Likert scale, ranging from "never" to "very often" external, restraint and emotional eating. For the study, only the 10 items of the external eating subscale will be used. The variable of interest will be the corresponding External eating subscale score.

Dutch Eating Behaviour Questionnaire (DEBQ) consists of 33 items and assesses on a 5-point Likert scale, ranging from "never" to "very often" external, restraint and emotional eating. For the study, only the 10 items of the external eating subscale will be used. The variable of interest will be the corresponding External eating subscale score.

modified Yale Food Addiction Scale (mYFAS) 2.0 : is a 35-item self-report scale assessing Food Addiction (FA) symptoms based on the 11 diagnostic criteria for substance related and addictive disorders proposed in the DSM-5. FA is mild if there are 2 or 3 symptoms and clinically significant impairment/distress, moderate if there are 4 or 5 symptoms and significant impairment/distress, and severe if there are 6 or more symptoms and significant impairment/distress. The variables of interest will be the number of symptoms and the presence (vs absence) of a FA diagnosis.

modified Yale Food Addiction Scale (mYFAS) 2.0 : is a 35-item self-report scale assessing Food Addiction (FA) symptoms based on the 11 diagnostic criteria for substance related and addictive disorders proposed in the DSM-5. FA is mild if there are 2 or 3 symptoms and clinically significant impairment/distress, moderate if there are 4 or 5 symptoms and significant impairment/distress, and severe if there are 6 or more symptoms and significant impairment/distress. The variables of interest will be the number of symptoms and the presence (vs absence) of a FA diagnosis.

Mini International Neuropsychiatric Interview (MINI) is a structured diagnostic interview providing standardized assessment of psychiatric disorders defined according to Axis I DSM-5 : eating disorders, addictive disorders, mood disorders, anxiety disorders, and attention deficit hyperactivity disorder The variables of interest will be the proportion of patients with each of types of disorders. The number of comorbid psychiatric conditions will also be assessed using four categories : no comorbid disorder, one comorbid disorder, two comorbid disorders, three or more comorbid disorders

Addiction Severity Index (ASI) : is a semi-structured interview to assess impairments that commonly occur due to substance-related disorders . It explores seven areas that may be affected by addiction: medical status, employment/support status, substance and behavioral addiction, family and social relationships, legal status, and psychological status. For each area explored, an Interviewer Severity Rating (ISR) is established, from 0 to 9, reflecting the severity in the considered area. A score equal or above 4 reflects a need for additional treatment. ASI ISRs will be dichotomized to less than 4 or 4 and more (important need for additional treatment). The variables of interest will be the proportion of patients with need for additional treatment in each of the seven areas

Trail Making Test (TMT) : is used to measure cognitive and motor speed and mental flexibility. The variables of interest will the difference in completion time between TMT B and TMT A (TMT B - TMT A) and the number of perseverative errors on the TMT B.

Wisconsin Card Sorting Test 64 (WCST) : measures categorisation, inference, testing of hypotheses, cognitive flexibility, cognitive inhibition and response to feedback. The variable of interest will be the number and percentage of perseverative errors

Zoo test : Is a subtest of the Behavioural Assessment of the Dysexecutive Syndrome (BADS). It provides information about subjects' ability to plan a route to visit six of a possible 12 locations in a zoo, firstly in a demanding, open-ended situation where little external structure is provided, and secondly in a situation that involves simply following a concrete, externally imposed strategy. The map and rules have been constructed so that there are only four variations on a route through the zoo that can be followed in order that none of the rules of the test are infringed. There are two trials. A profile score is computed based on planning time, execution time and the number of errors for both trials. The maximum profile score is of 4. The variable of interest will be the total profile score

The UPPS Impulsive Behavior Scale evaluates in 20 items five different impulsivity facets (4 items each) : Negative Urgency, Positive Urgency, Lack of Premeditation, Lack of Perseverance and Sensation Seeking. Each item are rated on Likert scale ranging from 1 ("I agree strongly") to 4 (" I disagree strongly"). For each subscale, a mean score of the available items is calculated. The variables of interest will be the five different impulsivity facets scores

Monetary Choice Questionnaire (MCQ) includes a fixed set of 27 items with immediate rewards ranging from $11-$78 and delayed rewards ranging from $25-$85 with a delay of 7-186 days. Delayed rewards are grouped into three categories based on size, with nine items per category. Participants' hyperbolic discount parameter (k value) is determined by fitting data a discount function equation. The variables of interest will be the k value and the proportion of participants by k rank

Total number of correct words serves as the primary performance score

Difficulties in Emotion Regulation Scale (DERS) is a 36-item measure that assesses individuals' typical levels of difficulties in emotion regulation with six subscale: (a) nonacceptance of emotional responses, (b) difficulty engaging in goal-directed behavior when distressed, (c) impulse control difficulties when distressed, (d) lack of awareness of emotions, (e) limited access to strategies for regulation, and (f) lack of emotional clarity. For each subscale, a score is calculated by summing responses from relevant items. A total score is obtained by adding each subscale score. The variable of interest will be the DERS total score

Difficulties in Emotion Regulation Scale (DERS) is a 36-item measure that assesses individuals' typical levels of difficulties in emotion regulation with six subscale: (a) nonacceptance of emotional responses, (b) difficulty engaging in goal-directed behavior when distressed, (c) impulse control difficulties when distressed, (d) lack of awareness of emotions, (e) limited access to strategies for regulation, and (f) lack of emotional clarity. For each subscale, a score is calculated by summing responses from relevant items. A total score is obtained by adding each subscale score. The variable of interest will be the DERS total score

Depression Anxiety Stress Scales (DASS-21) : is a 21-item measure of negative emotional symptoms that evaluates three dimensions: depression, anxiety and stress (7 items per subscale). A 4-point severity scale from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time), measures the extent to which each emotional state has been experienced over the past week. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items. Scores obtained will need to be multiplied by 2 to calculate the final score of each dimension. The variables of interest will be the three dimensions' scores.

Depression Anxiety Stress Scales (DASS-21) : is a 21-item measure of negative emotional symptoms that evaluates three dimensions: depression, anxiety and stress (7 items per subscale). A 4-point severity scale from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time), measures the extent to which each emotional state has been experienced over the past week. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items. Scores obtained will need to be multiplied by 2 to calculate the final score of each dimension. The variables of interest will be the three dimensions' scores.

Quality Of Life, Obesity and Dietetics rating scale (QOLOD) includes 36 items designed to assess quality of life in 5 domains: physical impact, psycho-social impact, impact on sex life , comfort with food, and diet experience The variables of interest will be the 5 subscales scores

Quality Of Life, Obesity and Dietetics rating scale (QOLOD) includes 36 items designed to assess quality of life in 5 domains: physical impact, psycho-social impact, impact on sex life , comfort with food, and diet experience The variables of interest will be the 5 subscales scores

Compliance at group session will correspond to the number of sessions completed out of the 10 proposed group sessions.

Patient Satisfaction Questionnaire (PSQ) includes 6 domains of satisfaction that are rated on a 10-points Likert scale as well as 2 open questions on what was helpful and what could be improved. For both groups (i.e experimental intervention and control intervention), the variable of interest will be the a mean total score of satisfaction in each of the 6 domains. In addition, for the group receiving the experimental intervention, scores of satisfaction in each of the 6 domains will be described separately for the CRT, EST and CBT modules of the intervention

Patient Satisfaction Questionnaire (PSQ) includes 6 domains of satisfaction that are rated on a 10-points Likert scale as well as 2 open questions on what was helpful and what could be improved. For both groups (i.e experimental intervention and control intervention), the variable of interest will be the a mean total score of satisfaction in each of the 6 domains. In addition, for the group receiving the experimental intervention, scores of satisfaction in each of the 6 domains will be described separately for the CRT, EST and CBT modules of the intervention

Patient Satisfaction Questionnaire (PSQ) includes 6 domains of satisfaction that are rated on a 10-points Likert scale as well as 2 open questions on what was helpful and what could be improved. For both groups (i.e experimental intervention and control intervention), the variable of interest will be the a mean total score of satisfaction in each of the 6 domains. In addition, for the group receiving the experimental intervention, scores of satisfaction in each of the 6 domains will be described separately for the CRT, EST and CBT modules of the intervention

Motivation to change will be assessed explore beliefs about the importance to change and perceived ability to change. Rating scores are based on a Likert 0-10 scale. Higher scores indicate more positive beliefs about one's importance/ability to change. These two scores will be used as variables of interest

Revised Helping Alliance Questionnaire (HAQ-11) is a 11-item questionnaire that measures the strength of the patient-therapist therapeutic alliance. A total score is obtained by summing the item scores. The variable of interest will be the HAQ-11total score

will be acquired by 5 signal-based assessments per day. One random assessment Ecological Momentary Assessment data collection will occur during each of the following time periods: 9:00 am to 11:00 am; 11:00 am to 2:00 pm; 2:00 pm to 5:00 pm; 5:00 pm to 8:00 pm; and 8:00 pm to 10:00 pm during 7 days. The questions administered after random prompt will include items relative to eating behaviors, craving and food intake, exposure to food cues, positive and negative affectivity, the experience of stress (type of stress and level of perceived stress), other personal states, cognitive functioning, craving and emotional regulation strategies.

will be acquired by 5 signal-based assessments per day. One random assessment Ecological Momentary Assessment data collection will occur during each of the following time periods: 9:00 am to 11:00 am; 11:00 am to 2:00 pm; 2:00 pm to 5:00 pm; 5:00 pm to 8:00 pm; and 8:00 pm to 10:00 pm during 7 days. The questions administered after random prompt will include items relative to eating behaviors, craving and food intake, exposure to food cues, positive and negative affectivity, the experience of stress (type of stress and level of perceived stress), other personal states, cognitive functioning, craving and emotional regulation strategies.