Dynamic interplay between food addiction, psychological and behavioral factors, and weight-related measures: A longitudinal network analysis in developing youth

Background and aims: Food addiction (FA) likely contributes to obesity within a complex system of psychological, behavioral, and physiological factors. However, interactions among these factors remain incompletely understood. This study used a network approach to identify interrelationships among FA, eating motives, lifestyle habits, and weight indicators in a developmental youth cohort. Methods: A longitudinal panel study was conducted in Eastern China. Youth aged >8 years (mean ages 13-14 years) completed survey and anthropometric measurements. The Chinese version of the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), Kids Palatable Food Eating Motive Scale (K-PEMS) and Mindful Eating Scale for Children (MEQ-C) were used to measure addictive eating motives and behaviors. Semi-quantitative food intake, physical activity and sleep duration were assessed, and height and weight were measured by trained researchers to calculate a Body Mass Index Z score (BMIZ). Body composition measurement utilized bioelectrical impedance for detecting subcutaneous fat content (FC) and a visceral fat level (VFL). Network analysis, including cross-sectional network estimation at each time point, longitudinal network comparison, and cross-lagged panel network (CLPN) modeling, was used to examine the centrality, connectivity, and temporal relationships among FA and key variables. Results: Among the 2680 participants enrolled, 2054 completed both waves of surveys (retention rate: 76.7%; 49.5% girls). In the baseline (T1) cross-sectional network, FA showed the highest closeness and betweenness and was linked to the weight-related subnetwork (BMIZ, FC, and VFL) primarily through VFL. The follow-up (T2) cross-sectional network showed a broadly similar overall pattern. Longitudinal comparison suggested generally stable centrality patterns across time, with lifestyle-related factors showing relatively greater prominence at T2. In the CLPN, the strongest directional paths primarily extended from FA to later eating motives, whereas direct longitudinal paths from FA to weight indicators were not observed. FA and mindful eating exhibited bidirectional relationships, and mindful eating was also negatively associated with subsequent reward-based eating motives. Conclusion: FA may represent an important intervention target within the broader obesity-related psychobehavioral system in youth, particularly in relation to eating motives and reward-driven eating processes. Interventions that address FA together with mindful eating and modifiable lifestyle factors may offer a more comprehensive approach to youth weight-related health.