Food Addiction Risk Accelerates Fat Accumulation in Youth: Potential Protective Roles of Left Insula and Mindful Eating

OBJECTIVE: Food addiction (FA) is implicated in obesity, yet the potential moderating role of mindful eating and the underlying neural mechanisms in youth remain unclear. METHODS: This study integrated a multicenter cross-sectional survey, a longitudinal study with 6- and 12-month follow-ups, and an independent magnetic resonance imaging (MRI) sample. FA, eating motives, mindful eating, BMI z-score, fat content, and visceral fat level were assessed. Analyses utilized structural equation modeling, latent growth modeling, and voxel-based morphometry. RESULTS: Among 2071 screened, 1601 youth (55.5% boys; mean age = 12.69 ± 3.04 years) completed the baseline survey, with 880 and 564 completing the 6- and 12-month follow-ups, respectively. FA mediated the relationship between eating motives and weight status, and mindful eating moderated this pathway (p < 0.05). Longitudinally, baseline FA predicted accelerated accumulation of fat content and visceral fat level, but not BMI z-score (p > 0.05). The independent 75-MRI sample revealed that left insula gray-matter volume was negatively associated with FA but positively associated with mindful eating. CONCLUSIONS: FA may link eating motives to fat accumulation in youth, particularly abdominal fat; mindful eating may be protective, with left insula structure and left insula-striatum connectivity as possible neural correlates.