A three-year Mediterranean diet programme worked for weight loss. People with signs of food addiction lost as much at first, then gained much of it back

Some people describe their eating the way others describe an addiction: strong cravings, losing control around certain foods, carrying on despite wanting to stop. Researchers measure this with the Yale Food Addiction Scale, and a team in Spain wanted to know two things: can a long, intensive lifestyle programme ease those symptoms, and do people who score for food addiction do as well on the programme as everyone else? Their answer was published in BMC Medicine on 6 October 2026.

The study used 448 people from the cognition arm of PREDIMED-Plus, a large Spanish trial. They were 65 on average, carried extra weight and had metabolic syndrome. Half were randomly placed in an intensive programme: a Mediterranean diet with fewer calories, more physical activity and regular behavioural support. The other half, the control group, were advised to follow a Mediterranean diet with no calorie limit. Food addiction symptoms, weight, waist size, diet quality, activity and quality of life were measured at the start, after one year and after three years.

Food addiction scores fell in both groups, but the fall lasted only in the intensive group, which scored lower than the control group at three years. Among people without food addiction at the start, the intensive programme roughly tripled the odds of losing at least 8% of body weight and of trimming the waist by at least 5%, and it helped them stick to the diet far better. In that group, average weight in the intensive arm went from 86.3 kg to 80.2 kg after a year and was still 80.7 kg at three years. People in the intensive arm who did meet the food addiction criteria lost about as much in the first year (87.3 kg down to 81.6 kg), but were back up to 83.3 kg by year three, and their three-year loss was no longer statistically clear. Their waist and diet-quality gains were also smaller.

The authors' modelling suggests why: for people without food addiction, sticking closely to the diet carried through into lasting improvements in weight, waist and quality of life, but that link did not show up in people with food addiction. They argue that food addiction should be screened for and treated as a distinct profile in obesity care, with extra support aimed at cravings and loss of control. The analysis was a secondary look at one part of a larger trial, food addiction was self-reported on a questionnaire, and everyone was an older Spanish adult with metabolic syndrome, so the results may not carry over to younger or healthier people. At the time of writing the journal had posted the abstract and supplementary tables, with the full text to follow.