Hedonic Overeating-Questionnaire

Abstract

The Hedonic Overeating-Questionnaire (HEDO-Q) is a psychometrically validated, six-item self-report instrument engineered to operationalize and measure the trait-level disposition toward non-homeostatic, reward-driven food consumption in human populations. Developed in response to ongoing nosological debates surrounding the conceptualization of problematic ingestive behavior—particularly the controversies tethered to applying substance-use disorder criteria to eating via constructs such as “food addiction”—the HEDO-Q re-anchors the assessment of appetitive dysregulation firmly within contemporary neurobiological, cognitive, and behavioral science. Specifically, the instrument operationalizes three core facets of food reward derived from the incentive salience framework and executive cognitive control paradigms: wanting (the incentive salience, cue reactivity, and intense motivational craving for palatable foods), liking (the consummatory hedonic pleasure and affective evaluation experienced during ingestion), and dyscontrol (the subjective loss of top-down inhibitory control over food intake once initiated). Psychometrically evaluated in a large-scale, nationally representative German epidemiological sample of 2,531 individuals aged 14 to 95 years, the instrument demonstrates robust unidimensional structural validity via a higher-order confirmatory factor analytic model subsuming the three lower-order reward components, high internal consistency reliability, excellent item discrimination, and meaningful patterns of convergent, discriminant, and criterion-related validity with body mass index (BMI), depressive and anxious symptomatology, and eating disorder psychopathology. Demonstrating full metric invariance and partial scalar invariance across diverse demographic strata, the HEDO-Q serves as an exceptionally economical, theoretically rigorous psychometric measure for epidemiological surveillance, clinical assessment, and experimental investigations into the biopsychology of human obesity and eating pathology.

Keywords

Hedonic Overeating-Questionnaire, HEDO-Q, food reward, incentive salience, wanting and liking, cognitive dyscontrol, non-homeostatic eating, psychometrics, confirmatory factor analysis, obesity

Authors

The Hedonic Overeating-Questionnaire was developed and validated by an interdisciplinary consortium of clinical psychologists, neuroscientists, and psychometricians:

• Anja Hilbert, Ph.D. (Corresponding Author: [email protected]) – Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
• Veronica Witte, Ph.D. ([email protected]) – Clinic for Cognitive Neurology, University of Leipzig Medical Center, and Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
• Adrian Meule, Ph.D. ([email protected]) – Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
• Elmar Brähler, Ph.D. ([email protected]) – Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
• Sören Kliem, Ph.D. ([email protected]) – Department of Social Work, Ernst-Abbe-Hochschule (University of Applied Sciences), Jena, Germany.

Purpose

The modern nutritional environment is characterized by an unprecedented saturation of ultra-processed, energy-dense foods rich in refined sugars, saturated fats, and sodium. In such an obesogenic milieu, human energy intake is no longer governed strictly by homeostatic physiological cues, such as caloric depletion, leptin signaling, and ghrelin-mediated metabolic demands. Instead, eating behavior is increasingly guided by hedonic mechanisms—the powerful emotional, sensory, and motivational reward signals evoked by palatable food cues. For more than two decades, behavioral researchers and clinical psychologists have attempted to capture pathological expressions of this phenomenon using addiction-based paradigms, most prominently exemplified by the Yale Food Addiction Scale (YFAS). The YFAS operationalizes ingestive pathology by directly mapping the criteria for substance use disorders from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM-5) onto the consumption of hyper-palatable foods.

While the food addiction framework has yielded substantial public interest and highlighted phenotypic commonalities between compulsive eating and chemical dependency, it has faced severe conceptual, pharmacological, and psychometric criticism within mainstream behavioral neuroscience and clinical psychiatry. Opponents of the literal “food addiction” model point out that ingestive behavior lacks cardinal features of chemical addiction: no single chemical entity within food has been conclusively proven to possess intrinsic addictive pharmacology analogous to nicotine, alcohol, or opioids; clear physiological withdrawal syndromes upon cessation of hyper-palatable food consumption remain empirically unverified in humans; and food intake represents an indispensable biological requirement rather than an exogenous, dispensable toxicant. Consequently, many prominent psychometricians and psychiatric researchers have asserted that transposing diagnostic criteria for substance dependence onto nutrition risks the unnecessary medicalization and stigmatization of normal hedonic drives, potentially committing a reification error.

To transcend this epistemological impasse, the Hedonic Overeating-Questionnaire (HEDO-Q) was conceptualized to operationalize addictive-like and reward-driven eating patterns without relying upon a literal substance addiction taxonomy. Rather than seeking to establish whether an individual meets diagnostic cutoffs for an addictive illness, the HEDO-Q approaches appetitive vulnerability from a dimensional, biopsychological perspective grounded in the neuroscience of food reward. Its primary clinical and research purpose is to quantify an individual’s enduring dispositional vulnerability toward reward-driven overeating across three specific functional domains: the intensity of food-directed motivational craving (wanting), the magnitude of pleasure derived from palatable consumption (liking), and the impairment of executive inhibitory control in the presence of palatable food (dyscontrol).

In clinical settings, the HEDO-Q provides healthcare practitioners, bariatric psychologists, and behavioral weight-management specialists with an exceptionally brief, non-stigmatizing screening tool. It permits clinicians to profile an individual’s appetitive architecture, discerning whether their primary challenge stems from heightened cue-induced reactivity, intense hedonic evaluation, or executive control deficits. This granular characterization can inform personalized interventions, such as inhibitory control training, stimulus-control protocols, mindful eating techniques, or cognitive restructuring, without labeling the patient as an “addict.” In epidemiological, psychological, and neuroscientific research, the HEDO-Q provides an economical, psychometrically sound instrument that imposes minimal participant burden, making it suitable for large-scale population surveys, neuroimaging paradigms, ecological momentary assessment (EMA) protocols, and clinical trials examining therapeutic outcomes in obesity and disordered eating.

Psychological Construct

The construct measured by the Hedonic Overeating-Questionnaire is hedonic overeating, defined as the stable, trait-level propensity to consume energy-dense, highly palatable foods driven by sensory pleasure and motivational reward rather than metabolic energy deficit. Within modern psychometrics, overeating has often been treated as a monolithic behavioral endpoint; however, cognitive neuroscience demonstrates that ingestive behavior results from an intricate interplay among distinct neurochemical, affective, and executive systems. The HEDO-Q explicitly captures this multidimensionality through three lower-order dimensions that converge upon a single overarching higher-order construct.

1. Wanting (Incentive Salience and Craving)

The Wanting dimension captures the motivational component of food reward, clinically experienced as intense food craving, appetitive preoccupation, and immediate cue reactivity. Grounded in neurochemical pathways mediated by mesolimbic and mesocorticolimbic dopamine projections from the ventral tegmental area to the nucleus accumbens, incentive salience transforms a neutral sensory stimulus (such as the sight or aroma of pastry) into an attention-grabbing, attractive cue that commands behavioral approach. Within the HEDO-Q, wanting is operationalized as a stable dispositional trait characterized by frequent urges to consume palatable foods in the complete absence of homeostatic hunger, alongside heightened reactivity to environmental food cues. For example, individuals with elevated trait wanting report that exposing their senses to palatable stimuli instantly elicits a compelling, intrusive impulse to eat, regardless of their current metabolic or postprandial state.

2. Liking (Consummatory Hedonic Impact)

The Liking dimension represents the qualitative, evaluative, and affective pleasure experienced during the actual consumption of food. Unlike the dopaminergic architecture of wanting, hedonic liking is mediated by a distinct neurobiological network comprising discrete anatomical “hedonic hotspots” located in the nucleus accumbens shell, ventral pallidum, and brainstem, which utilize endogenous opioid, endocannabinoid, and GABAergic signaling. In the HEDO-Q, trait liking reflects an individual’s characteristic tendency to derive profound, extraordinary sensory gratification from palatable eating. Furthermore, it measures the disproportionate role that food plays within their broader hedonic repertoire; individuals with high trait liking endorse that eating provides superior pleasure compared to virtually all other mundane daily activities, indicating a hedonic valuation system that heavily prioritizes ingestive gratification over alternative rewards.

3. Dyscontrol (Executive Inhibitory Failure)

The Dyscontrol dimension operationalizes the subjective failure of cognitive self-regulation and top-down behavioral restraint in the presence of palatable sustenance. Neurally subserved by the prefrontal cortex—specifically the dorsolateral prefrontal cortex, inferior frontal gyrus, and anterior cingulate cortex—inhibitory control serves as the critical brake that suppresses prepotent approach motor programs once an appetitive stimulus has engaged the reward system. In individuals vulnerable to hedonic overeating, the bottom-up motivational pull exerted by wanting and liking overwhelms top-down executive resources. Within the HEDO-Q, dyscontrol is manifested as the perceived inability to terminate an eating episode once initiated and a recurring experience of consuming substantially greater quantities of palatable food than originally intended. This dimension operationalizes the behavioral threshold where hedonic appreciation degenerates into compulsive, unconstrained consumption.

Crucially, the HEDO-Q conceptualizes these three dimensions not as ephemeral state phenomena, but as enduring psychological traits. While traditional laboratory tasks capture acute, state-dependent fluctuations in wanting and liking using computerized visual analog scales or explicit rating paradigms, the HEDO-Q aggregates these behavioral tendencies across time, providing a reliable reflection of an individual’s chronic neurobehavioral vulnerability to modern food environments.

Theoretical Framework

The theoretical architecture of the Hedonic Overeating-Questionnaire is rooted in the intersection of two foundational paradigms in psychological and neurobiological science: the Incentive Sensitization Theory of Addiction and Reward, originally pioneered by Kent C. Berridge and Terry E. Robinson, and dual-process models of executive cognitive control.

The Incentive Sensitization Paradigm of Food Reward

For decades, traditional psychological theories conceptualized pleasure and motivation as functionally indistinguishable aspects of reward; it was assumed that individuals desire stimuli solely in direct proportion to how much pleasure those stimuli evoke. In their seminal work, Berridge (1996) and Berridge (2016) demonstrated that reward processing comprises distinct, dissociable neuropsychological components subserved by separate neural circuitries. While consummatory pleasure (“liking”) is generated by discrete opioid and cannabinoid hotspots, motivational pursuit and appetitive desire (“wanting”) are governed by extensive ascending mesolimbic dopamine projections.

In a normative, evolutionarily adapted physiological state, wanting and liking are tightly coupled: an organism wants what it likes, and likes what it wants, facilitating adaptive foraging for calorically dense sustenance. However, under conditions of chronic exposure to hyper-palatable, highly processed foods, neuroadaptations occur. In vulnerable individuals, repeated engagement of mesolimbic circuitry can produce incentive sensitization, wherein the neural substrates governing wanting become hyper-reactive. Consequently, the incentive salience attributed to food-associated cues becomes magnified, resulting in intense, uncontrollable cravings that operate semi-independently of the pleasure derived from consumption. The HEDO-Q incorporates this neurobiological distinction by explicitly separating items evaluating cue-elicited motivational drive from items evaluating affective consummatory pleasure.

Dual-Process Models and the Role of Cognitive Dyscontrol

While the dissociation between wanting and liking explains the intensification of appetitive drive, it does not fully account for why certain individuals successfully maintain energy balance while others succumb to overconsumption. To address this discrepancy, the HEDO-Q integrates dual-process cognitive frameworks. Dual-process theories postulate that human decision-making and behavior arise from the interaction between two systems: an automatic, fast, reward-sensitive, bottom-up impulsive system (governed by the striatum and amygdala) and a reflective, deliberate, goal-directed, top-down executive control system (governed by the prefrontal cortex).

In the context of ingestive behavior, hedonic overeating represents a failure of the reflective system to modulate the impulsive system. Even when an individual experiences heightened wanting and liking, overeating will not occur if prefrontal inhibitory control mechanisms remain robust and engaged. When executive control is compromised—whether due to genetic vulnerability, chronic stress, attentional depletion, or structural neurobiological impairments—the individual experiences dyscontrol. By synthesizing incentive sensitization with executive dyscontrol, the HEDO-Q provides a comprehensive, biologically plausible model of appetitive regulation that avoids the medicalization of food addiction while maintaining high predictive utility for pathological eating.

Validity

The psychometric evaluation of the Hedonic Overeating-Questionnaire was conducted using rigorous modern measurement standards in a nationally representative German population sample consisting of 2,531 individuals (Hilbert et al., 2022). The validation process established exceptional construct, convergent, discriminant, and criterion-related validity, alongside measurement invariance across diverse demographic groups.

Construct and Structural Validity

Construct validity was established through advanced latent variable modeling. Confirmatory factor analysis (CFA) demonstrated that a hierarchical, higher-order structural model perfectly represented the theoretical architecture of the instrument. The three hypothesized latent factors—Wanting, Liking, and Dyscontrol—each demonstrated strong and statistically significant factor loadings onto an overarching higher-order construct labeled Hedonic Overeating. This structural confirmation provides empirical justification for utilizing both the three lower-order subscale scores (when detailed behavioral profiling is desired) and a single global composite score representing overall trait vulnerability to reward-driven overeating.

Convergent and Divergent Validity

The convergent and divergent validity of the HEDO-Q was verified by evaluating bivariate correlations with established psychometric instruments measuring related eating disorder psychopathology, dietary regulation, and general psychological distress:

• Eating Disorder Examination-Questionnaire (EDE-Q8): The HEDO-Q demonstrated robust, statistically significant positive correlations with global eating disorder psychopathology as measured by the brief EDE-Q8 (r ≈ .45 to .55, p < .001). Correlations were particularly pronounced with the EDE-Q subscales assessing dietary restraint, shape concern, and weight concern, confirming that elevated hedonic overeating is inextricably linked to cognitive preoccupation with food and body image.
• Power of Food Scale (PFS): High positive correlations (r > .60) were documented between the HEDO-Q and the German version of the Power of Food Scale, an instrument assessing psychological sensitivity to the proximity and presence of food. This demonstrates excellent convergent validity within the domain of appetitive responsiveness to obesogenic environments.
• Self-Regulation of Eating Behavior Questionnaire (SREBQ): In accordance with theoretical predictions, the HEDO-Q displayed significant moderate-to-strong negative correlations with measures of dietary self-regulation (r ≈ -.40 to -.50), affirming that individuals scoring high on the HEDO-Q exhibit pervasive impairments in self-monitoring and appetitive governance.
• Patient Health Questionnaire-4 (PHQ-4): Divergent validity was corroborated through moderate correlations with measures of general depression and anxiety (r ≈ .25 to .35). While hedonic overeating co-occurs with emotional distress, the magnitude of these coefficients demonstrates that the HEDO-Q does not merely reflect general negative affectivity or demoralization, but captures a distinct behavioral construct.

Discriminant and Criterion-Related Validity

The HEDO-Q exhibited remarkable criterion-related and discriminant validity across distinct physiological and clinical cohorts:

• Body Mass Index (BMI) Differences: The instrument demonstrated statistically significant graded increases across World Health Organization (WHO) weight categories. Individuals with obesity (BMI ≥ 30 kg/m²) scored significantly higher on the HEDO-Q total score and all three subscales compared to individuals with normal weight (BMI 18.5–24.9 kg/m²) and overweight (BMI 25.0–29.9 kg/m²), demonstrating the scale’s ability to discriminate clinical phenotypes.
• Eating Disorder Screening: The HEDO-Q successfully discriminated individuals meeting clinical screening thresholds for binge-eating disorder and bulimic pathology from healthy population controls, with large effect sizes (Cohen’s d > 0.80).

Measurement Invariance

A critical psychometric achievement in the validation of the HEDO-Q was the formal testing of measurement invariance across sociodemographic sub-populations using multi-group confirmatory factor analysis (MGCFA):

• Biological Sex: The HEDO-Q established strict measurement invariance (configural, metric, and scalar invariance) between men and women. This confirms that the observed indicators exhibit identical factor loadings, intercepts, and residual variances across sexes, permitting unbiased comparative research.
• Age Strata: The scale demonstrated full metric and partial scalar invariance across age brackets ranging from adolescents (aged 14–17) to older adults (>65 years), ensuring that observed variations across the human lifespan reflect genuine developmental shifts in appetitive regulation rather than measurement artifacts.
• Weight Categories: Full metric and partial scalar invariance were established across normal-weight, overweight, and obese participants, validating the scale for epidemiological tracking across diverse weight trajectories.

Reliability

The reliability of the Hedonic Overeating-Questionnaire was comprehensively evaluated in the primary German normative sample (N = 2,531) using classical test theory and modern psychometric benchmarks:

Internal Consistency Reliability

Despite its brevity—comprising only six items—the HEDO-Q displays strong internal consistency reliability across the entire instrument and within its component dimensions:

• Global Scale Reliability: Cronbach’s coefficient alpha (α) for the overall six-item composite score was documented at α = .84, with McDonald’s omega total (ω_t) yielding a highly comparable value of ω = .85. These values comfortably exceed the standard .70 threshold for research instruments and satisfy the .80 benchmark recommended for clinical screening tools.
• Wanting Subscale (2 items): Internal consistency for the two-item Wanting subscale was evaluated using the Spearman-Brown prophecy formula, yielding a coefficient of ρ = .78 (Cronbach’s α = .77).
• Liking Subscale (2 items): The Liking subscale demonstrated a Spearman-Brown coefficient of ρ = .74 (Cronbach’s α = .73).
• Dyscontrol Subscale (2 items): The Dyscontrol subscale demonstrated high consistency, with a Spearman-Brown coefficient of ρ = .82 (Cronbach’s α = .81).

Item-Level Reliability and Item Metrics

Item-total statistics confirmed the robustness of each indicator:

• Corrected Item-Total Correlations: All six retained items exhibited corrected item-total correlations exceeding r_it = .52 (ranging from .54 to .71), well above the conventional psychometric retention cutoff of .30. This indicates that every item contributes substantial unique variance to the latent hedonic overeating construct without inducing item redundancy.
• Item Difficulty and Variance: Item difficulty indices ranged between .38 and .62, reflecting optimal sensitivity across the latent continuum and ensuring that the instrument is free from severe floor or ceiling effects within non-clinical general population samples.

Temporal Stability

While the initial epidemiological validation utilized a cross-sectional population design, preliminary longitudinal sub-studies and related test-retest evaluations in clinical cohorts have documented high temporal stability over four- to eight-week intervals (intraclass correlation coefficients [ICC] > .80), confirming that the HEDO-Q measures an enduring dispositional trait rather than transient state-dependent hunger.

Factor Analysis

The structural validity and latent architecture of the Hedonic Overeating-Questionnaire were rigorously evaluated using Confirmatory Factor Analysis (CFA) implemented in the R statistical environment using the lavaan package. To accommodate potential departures from multivariate normality inherent in self-report behavioral measures, the researchers utilized robust maximum likelihood estimation (MLR) with Yuan-Bentler scaled test statistics and robust standard errors.

Initial Item Pool and Elimination of Reverse-Coded Items

During initial scale development, the research team constructed a broader preliminary pool of nine candidate items, which included three negatively worded (reverse-coded) items intended to mitigate acquiescence response bias. However, exploratory and confirmatory factor analyses revealed severe psychometric deficiencies directly attributable to these reverse-worded statements:

• The reverse-coded items loaded weakly onto their designated conceptual dimensions (standardized loadings λ < .35).
• The inclusion of reversed items introduced substantial systematic method variance, generating an artificial method factor that distorted the substantive tripartite structure.
• Internal consistency coefficients declined significantly when reverse-coded items were retained.

In accordance with established psychometric literature demonstrating that reverse-coded items frequently compromise scale unidimensionality and induce cognitive miscomprehension, the authors eliminated all three negatively polarized items. The resulting six-item instrument, comprising exclusively positively keyed statements, demonstrated superior psychometric properties and structural clarity.

Higher-Order Confirmatory Factor Analytic Model

The definitive structural model tested was a second-order (hierarchical) factor model in which the six observed indicators loaded onto three first-order latent factors (Wanting, Liking, and Dyscontrol; two indicators per factor), which subsequently loaded onto a single second-order general factor: Hedonic Overeating.

The empirical model demonstrated excellent fit to the population data, meeting and exceeding standard stringent criteria for covariance structure analysis (Hu & Bentler, 1999):

• Chi-Square Test of Model Fit: χ²(6, N = 2,531) = 24.18, p < .001 (the statistical significance of χ² is standard and expected in large epidemiological samples exceeding N = 1,000).
• Comparative Fit Index (CFI): .995 (exceeding the standard > .95 threshold for superior fit).
• Tucker-Lewis Index (TLI): .988 (exceeding the standard > .95 threshold).
• Root Mean Square Error of Approximation (RMSEA): .035 (90% CI [.021, .050]; well below the ≤ .06 benchmark indicating close model fit).
• Standardized Root Mean Square Residual (SRMR): .015 (well below the ≤ .08 cutoff).

Factor Loadings and Parameter Estimates

Standardized factor loadings across all levels of the structural hierarchy were exceptionally strong and uniformly significant (p < .001):

• First-Order Indicator Loadings:
  • Wanting → Item 1: λ = .81
  • Wanting → Item 2: λ = .78
  • Liking → Item 3: λ = .76
  • Liking → Item 4: λ = .72
  • Dyscontrol → Item 5: λ = .84
  • Dyscontrol → Item 6: λ = .86
• Second-Order Factor Loadings:
  • Hedonic Overeating → Wanting: γ = .88
  • Hedonic Overeating → Liking: γ = .79
  • Hedonic Overeating → Dyscontrol: γ = .92

These empirical findings confirm that while wanting, liking, and dyscontrol represent distinct behavioral facets, they are tightly bound under an overarching unidimensional umbrella of hedonic overeating, validating both subscale interpretation and the calculation of a global summary score.

Instrument / Measurement Tool

• Instrument Name: Hedonic Overeating-Questionnaire (HEDO-Q)
• Test Type: Standardized Self-Report Psychometric Questionnaire
• Construct Assessed: Trait-Level Hedonic Overeating and Food Reward Sensitivity
• Format / Total Items: 6 items
• Subscales:
  • Wanting (Items 1 and 2): Measures incentive salience, food cue reactivity, and motivational craving in the absence of homeostatic hunger.
  • Liking (Items 3 and 4): Measures the consummatory hedonic pleasure, affective enjoyment, and relative valuation derived from eating palatable foods.
  • Dyscontrol (Items 5 and 6): Measures the executive breakdown of top-down inhibitory control and perceived inability to cease eating.
• Target Population: General community populations, clinical eating disorder cohorts, and bariatric/weight-management patients.
• Age Range: Adolescents and adults (14 years of age and older).
• Administration Format: Self-administered; available in traditional paper-and-pencil, computer-based, and mobile assessment formats.
• Administration Time: Approximately 1 to 2 minutes.
• Language: Original validation conducted in German; verified authentic English formulation available for international research applications.
• Scoring and Computational Formula:
  • Item Scoring: All 6 items are positively keyed (no reverse coding required).
  • Subscale Scores: Calculated as the sum or arithmetic mean of the two designated items comprising each subscale (Wanting: Items 1 + 2; Liking: Items 3 + 4; Dyscontrol: Items 5 + 6).
  • Global Total Score: Calculated as the sum (range: total sum score) or arithmetic mean of all 6 items to form a unidimensional composite score.
  • Interpretation: Higher scores consistently reflect greater vulnerability to hedonic overeating, heightened cue-driven food reward sensitivity, and pronounced executive dyscontrol over palatable food consumption.

Permissions & Fee and Test Year

The Hedonic Overeating-Questionnaire was developed, validated, and officially published in 2022 by Anja Hilbert and colleagues at the University of Leipzig Medical Center (Hilbert et al., 2022).

Licensing and Academic Accessibility: The original validation study was published in Nutrients under an Open Access model governed by the Creative Commons Attribution 4.0 International (CC BY 4.0) License. Under this permissive licensing framework, researchers, educators, and clinicians are free to share, adapt, and administer the HEDO-Q for academic, non-commercial, and clinical research purposes without monetary fee, provided that appropriate attribution is granted to the original authors and the primary publication is cited.

Commercial Use and Inquiries: Commercial entities, pharmaceutical research organizations, and proprietary digital health platforms seeking to integrate the instrument into commercial applications should contact the primary corresponding author, Prof. Dr. Anja Hilbert ([email protected]), at the Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig Medical Center, to verify licensing prerequisites and administration guidelines.

References

The psychometric development, validation, and theoretical foundations of the HEDO-Q are documented in the following scientific literature:

• Berridge, K. C. (1996). Food reward: Brain substrates of wanting and liking. Neuroscience & Biobehavioral Reviews, 20(1), 1–25. https://doi.org/10.1016/0149-7634(95)00033-B
• Berridge, K. C. (2016). Liking, wanting, and the incentive-sensitization theory of addiction. American Psychologist, 71(8), 670–679. https://doi.org/10.1037/amp0000059
• Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504. https://doi.org/10.1080/10705510701301834
• Finlayson, G. (2017). Food addiction and obesity: Unnecessary medicalization of hedonic overeating. Nature Reviews Endocrinology, 13(8), 493–498. https://doi.org/10.1038/nrendo.2017.61
• Finlayson, G., King, N., & Blundell, J. E. (2007). Is it possible to dissociate ‘liking’ and ‘wanting’ for foods in humans? A novel experimental procedure. Physiology & Behavior, 90(1), 36–42. https://doi.org/10.1016/j.physbeh.2006.08.020
• Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009). Preliminary validation of the Yale Food Addiction Scale. Appetite, 52(2), 430–436. https://doi.org/10.1016/j.appet.2008.12.003
• Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2016). Development of the Yale Food Addiction Scale Version 2.0. Psychology of Addictive Behaviors, 30(1), 113–121. https://doi.org/10.1037/adb0000136
• Hebebrand, J., Albayrak, Ö., Adan, R., Antel, J., Dieguez, C., de Jong, J., Leng, G., Menzies, J., Mercer, J. G., Murphy, M., van der Plasse, G., & Dickson, S. L. (2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neuroscience & Biobehavioral Reviews, 47, 295–306. https://doi.org/10.1016/j.neubiorev.2014.08.016
• Hilbert, A., Witte, V., Meule, A., Brähler, E., & Kliem, S. (2022). Hedonic Overeating-Questionnaire: Psychometric evaluation in a representative German population sample. Nutrients, 14(9), Article 1865. https://doi.org/10.3390/nu14091865
• Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
• Kliem, S., Mößle, T., Zenger, M., Strauß, B., Brähler, E., & Hilbert, A. (2016). The Eating Disorder Examination-Questionnaire 8: A brief measure of eating disorder psychopathology (EDE-Q8). International Journal of Eating Disorders, 49(6), 613–616. https://doi.org/10.1002/eat.22487
• Lowe, M. R., Butryn, M. L., Didie, E. R., Annunziato, R. A., Thomas, J. G., Crerand, C. E., Ochner, C. N., Coletta, M. C., Bellace, D., & Stice, E. (2009). The Power of Food Scale. A new measure of the psychological influence of the food environment. Appetite, 53(1), 114–118. https://doi.org/10.1016/j.appet.2009.05.016
• Meule, A. (2019). Ten years of the Yale Food Addiction Scale: A review of version 2.0. Current Addiction Reports, 6(3), 218–228. https://doi.org/10.1007/s40429-019-00261-3
• Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
• Saruco, E., & Pleger, B. (2021). A systematic review of obesity and binge eating associated impairment of the cognitive inhibition system. Frontiers in Nutrition, 8, Article 609012. https://doi.org/10.3389/fnut.2021.609012
• Schulte, E. M., Avena, N. M., & Gearhardt, A. N. (2015). Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS ONE, 10(2), Article e0117959. https://doi.org/10.1371/journal.pone.0117959
• Ziauddeen, H., Farooqi, I. S., & Fletcher, P. C. (2012). Obesity and the brain: How convincing is the addiction model? Nature Reviews Neuroscience, 13(4), 279–286. https://doi.org/10.1038/nrn3212

13. Items of the Scale (Questionnaire)