**2. General Discussion and Conclusions**

The aim of this review was to enlighten the current concept of FA through four different angles and the spectrum of complementary disciplines: addiction medicine, nutrition in the context of obesity management, health psychology, and behavioral neurosciences. In our opinion, only a multidisciplinary perspective can render the complexity of FA and how it relates to environmental, social, and individual factors, while being inscribed in a continuum ranging from normal to disordered eating. This multifactorial comprehension of FA is needed to better organize prevention, diagnostic, and treatment, through the implementation of existing but also future strategies in the scope of personalized medicine. Even though the concept of personalized medicine sometimes appears hackneyed nowadays, it is particularly important and relevant in the context of FA and obesity treatment, considering the variety of individual profiles or situations, as well as the complex combination of environmental and individual factors at their origin.

Evaluation of FA is very unusual during first-line medical management and is not even systematic during obesity consultation. Practices are highly variable and dependent on the medical services and clinicians in charge of these consultations. As mentioned earlier, there is still no recognized psychological therapy validated for the management of FA in obese and/or ED patients, even though these patients represent high-risk profiles for FA. The role of FA in favoring body weight management problems and related comorbidities is still unclear, but early detection and treatment of FA might prevent the onset of further medical problems. The use of the YFAS questionnaire, when disordered eating is suspected, should become widespread in general medicine and specialized consultations, before referring the patient to a person with expertise in the management of ED and FA. This could be facilitated by the existence of a short version which is easier to fill. Because questionnaire studies are always subject to the biases and limitations of declarative methods, and denial could be present in some patients, there is a need for objective markers for which modern neuroimaging might represent an asset. Other biological markers might be explored—for example, at the metabolome and gut microbiota levels [134]—since the relationship between the gut microbiota and some neurocognitive processes has been extensively demonstrated.

Moreover, the FA construct has important treatment implications [21,51]. The standard approach to weight loss involves maintaining a healthy diet and physical exercise and is often associated with poor adherence and success rates. In the range of existing strategies are cognitive interventions [21], psychobehavioral interviews, and counseling via medical staff specialized in therapeutic education and nutrition, but also consultations with psychotherapists or psychiatrists. Addressing the psychological impact of internalized social stigma on patients remains pivotal, as several authors raised concerns that a diagnosis of food addiction could result in a double or additive stigma [50]. This emphasizes the need for empathic approaches and social support interventions in patients' management programs. For instance, the implementation of a self-help support group through a structured program could promote mutual support between persons with FA, break isolation, and create a space for sharing experiences [144]. Some authors also reviewed the beneficial input of online support options for food addiction, as well as other forms of self-help groups and sessions [145,146]. The restriction, or even the relative reduction, of some specific foods seen as addictive for a specific patient could be an option, contrary to the current view which aims at reducing dysfunctional dieting in favor of regular eating with flexible and moderate food consumption with no forbidden foods [51]. Such an approach is advocated by anonymous group meetings such as Overeaters Anonymous (OA), based directly on the 12-step program developed by Alcoholic Anonymous, which might help patients to break social isolation and the vicious circle at the origin of some forms of overeating [147], but we still lack perspective on the long-term success of such a strategy. Other initiatives can be applied in the context of FA, such as acceptance and commitment therapy (ACT) [148]. A wide range of motivational interviewing and cognitive behavioral therapies (CBT), which requires patients to critically evaluate the thoughts, feelings, and behaviors resulting in maladaptive responses and helps them to find their own solutions, adapted to their daily lives, can also be implemented in the context of FA and have already demonstrated their usefulness [149]. Such results must be replicated on larger cohorts and in the long term, and different types of CBT should be compared to provide recommendations about matching strategies to individual profiles, depending on their personality traits and susceptibilities, for example.

Several authors praised the use of innovative neuromodulation strategies to treat obesity, ED, but also FA [21,150], with the aim to modulate if not normalize some brain activities and neurocognitive processes involved in food intake control. If we put aside invasive strategies such as deep brain stimulation (DBS), there are still several candidates in the scope of minimally invasive strategies, such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and real-time fMRI neurofeedback. All these techniques can be used to stimulate or inhibit specific brain regions. The tDCS and TMS, via external electric or magnetic stimulation, are rather restricted to superficial (i.e., cortical) brain areas, such as the prefrontal cortex, which plays an important role in the cognitive control of eating. The rtfMRI can be applied to any brain area (including the deep striatal component of the reward circuit), since this method relies on the ability of the subject to voluntarily modify his/her brain activity on the basis of real-time feedback on this activity (e.g., via a visual gauge) combined with explicit or implicit tasks or mindfulness techniques. This approach has already been validated,

with promising outcomes in healthy, overweight, and obese women, with the aim to reduce hunger and cravings [151,152].

Prevention, diagnosis, and treatment should also benefit from new developments in the scope of information and communication digital technologies. Innovative smart devices, smartphone applications, and online counseling platforms might provide potent tools for phenotyping individual profiles, adjusting eating habits on a daily basis, and providing information to both patients and actors of medical care. Preliminary data suggested the effectiveness of a mobile health app based on FA to treat young obese people [153]. The faster disordered eating and FA are detected, the easier corrective measures can be applied in order to prevent the onset of a vicious circle and complete loss of control over food intake, further leading to obesity and numerous comorbidities.

**Author Contributions:** All authors contributed to the introduction, general discussion and conclusions. R.M. was responsible for the "addiction medicine" section, R.T. for the "nutrition" section, A.C. for the "psychology" section, and D.V.-L. for the "neurosciences" section. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
