Ecological momentary assessment of symptom trajectories during sugar reduction: application of substance use disorder criteria.
Level 3 - non-randomized controlled study
Prospective observational cohort follow-up study without a control group
PubMed 41905576 · doi:10.1016/j.appet.2026.108549
What was done
Adults in New Zealand willing to quit free sugars (n = 203) completed a pre-study survey assessing food addiction symptoms, dietary intake, BMI, craving, self-efficacy, and psychological distress. Participants then underwent an ecological momentary assessment (EMA) protocol with five prompts per day for two weeks to track sugar intake and DSM-5 substance use disorder symptoms (impaired control, tolerance, withdrawal, social impairment, and risky use). Group-based trajectory modelling was used to identify symptom burden trajectories.
What was found
Overall, 31.0% of participants remained sugar-free across the follow-up period. Sugar consumption was recorded in 9% of all EMAs, peaking at 11.5% in the evening primarily via snacks, desserts, or baked goods. Most frequent symptoms were cravings, preoccupation, and difficulty remaining abstinent; common withdrawal symptoms were low energy, body aches and pains, and low mood. Trajectory modelling identified a low (47%) and high (53%) symptom burden group. Baseline factors associated with the high-burden group included food addiction on the Yale Food Addiction Scale, higher sugar consumption, higher BMI, elevated craving, anxiety, and stress, and lower self-efficacy.
Why it matters
This study provides real-time observational evidence that individuals attempting to reduce sugar experience withdrawal and craving patterns similar to substance use disorders, with burden varying according to baseline psychological and dietary traits.
Limits
The study lacked a pre-quit EMA baseline period and follow-up was limited to two weeks, preventing assessment of symptom persistence or long-term distress. Outcomes relied entirely on self-report in a self-selected sample of adults motivated to quit sugar, with no control comparison group.
Cited by
- context Withdrawal symptoms and intense cravings following sugar cessation typically last for approximately two weeks.