FA has been a debated concept, with some people questioning its validity. However, the development and refinement of the Yale Food Addiction Scale (YFAS) have supported the clinical relevance of defining FA. Although FA has not been recognized or defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), the YFAS follows criteria of substance use disorders proposed by the DSM to make provisional FA diagnoses.
Prevalence of FA as determined using the YFAS-C has been reported in 18 publications. The meta-analysis estimated an overall FA prevalence at 15% (95% CI: 11–19%) among children and adolescents, with an I squared of 95.64%. Moreover, the prevalence in the community samples was 12% (95% CI: 8–17%) and 19% (95% CI: 14–26%) in the overweight/obese samples.
The prevalence estimatesreported here represent recent/current findings. Additionally, FA prevalence tended to be higher and YFAS-C scores were higher inchildren and adolescents with overweight/obesity (prevalence of 19% and score of 2.63) as compared with their community-based counter-parts (prevalence of 12% and score of 1.54). Further meta-regression analysis revealed that the difference of FA prevalence approached statistical significance (p= 0.056) and that of the YFAS-C score reached statistical significance (p= 0.002).The relatively high FA prevalence found in children and adolescents is comparable with that in adults. Therefore, FA appears relevant to both pediatric and adult populations. Moreover, similar to adults, a trend of higher FA prevalence was found among children with over-weight/obesity when compared with those without overweight/obesity in the community. Specifically, higher FA prevalence was found in adults with obesity than those without obesity in a meta-analysis and two narrative reviews. Our meta-analysis on children and adolescents resonates with these findings and extends them to a younger age group. In addition to FA prevalence, higher YFAS-C score found in our meta-analysis supports the importance to considering FA in youth. Therefore, healthcare providers, policymakers, parents, and other stakeholders should attend to FA in youth.
Our meta-regression results showed non-significant effects of age and gender on both FA prevalence and YFAS-C scores. Thus, when considering FA among pediatric populations, healthcare providers and other stakeholders should notice that boys and girls may share comparable risks for developing FA.
All analyzed studies used the same instrument, the YFAS-C, to assess FA. The YFAS-C is a “gold standard”in assessing FA amongchildren and adolescents. Specifically, it has been developed with rigorous methodologies, including the adoption of addiction criteria pro-posed in the DSM-5 and the descriptions modified for use among youth. Moreover, the strong psychometric properties of the YFAS-C have been reported in many studies using multiple testing methods,including classical and modern test theories. Moreover,using the same instrument to assess FA across the synthesized studies included in the present meta-analysis helps to ensure measurement quality. Therefore, together with the nonsignificant publication bias suggested by the Egger and Begg tests, we have confidence that the estimated FA prevalence and YFAS-C score are very reliable.
In conclusion, FA is an important topic among youth. With the relatively high prevalence of FA among children and adolescents found in the present systematic review and meta-analysis, healthcare providers, policymakers, and other stakeholders should design appropriate interventions to address FA in this age group. Moreover, higher estimates of FA were observed among children and adolescents with overweight/obesity as compared with lean/normal-weight individuals. Thus, targeted interventions may be particularly relevant to children and adolescents with overweight/obesity.