Food Addiction Symptoms and Clinical Outcomes in Binge‐Type Eating Disorders: A Randomized Clinical Trial of Cognitive Behavioral Therapy‐Guided Self‐Help in China

OBJECTIVE: Food addiction (FA) is clinically relevant in binge-type eating disorders (EDs), yet its treatment relevance remains unclear in mainland China. This study examined (1) FA's associations with ED psychopathology and psychosocial functioning; (2) FA symptom changes following cognitive behavioral therapy-guided self-help (CBT-gsh); and (3) whether FA improvement was independently associated with changes in psychosocial functioning. METHOD: In this assessor-blind randomized controlled trial, 87 adults with binge-type EDs were allocated to a 10-week asynchronous web-based CBT-gsh program or a waitlist control group. Assessments occurred at baseline, post-treatment, and 1-month follow-up. FA severity was the primary outcome; secondary outcomes included ED psychopathology, binge-eating frequency, psychosocial impairment, depression/anxiety, and body mass index (BMI). Linear mixed models and hierarchical regression were used to analyze the data. RESULTS: At baseline, FA severity was positively associated with ED psychopathology and psychosocial impairment. All outcomes except BMI improved significantly in the intervention group (all ps < 0.001), with no changes in controls. At post-treatment, 20% of intervention participants achieved binge-eating abstinence versus 2.5% of controls, and fewer met moderate-to-severe FA criteria (Δn = -16) in the intervention group. FA reduction was independently associated with lower post-treatment psychosocial impairment (β = 0.49, p < 0.001), beyond baseline impairment and ED psychopathology changes. DISCUSSION: This study provides the first evidence from mainland China that CBT-gsh was associated with FA reductions in binge-type EDs. These reductions were independently associated with better psychosocial functioning, underscoring FA as a complementary and clinically meaningful treatment target.