The association between family environment and food addiction in children and adolescents: A prospective cohort study

BACKGROUND AND AIMS: Food addiction is a dysfunctional chronic psychological disease. Family environment, a modifiable factor, has demonstrated considerable contribution to food addiction. Our objective was to analyze the relationship between family environment and food addiction. DESIGN, SETTING AND PARTICIPANTS: The study included 5554 participants aged 9-19 years enrolled in the School-based Evaluation Advancing Response for Child Health (SEARCH) in China. Our study used the first three waves of data. MEASUREMENTS: The exposure was family environment, assessed by Family Environment Scale-Chinese Version (FES-CV) at baseline. The FES-CV includes seven subscales: cohesion, active-recreational orientation, achievement orientation, control, intellectual-cultural orientation, conflict and organization. The outcome was food addiction status, measured using the Chinese version of the modified Yale Food Addiction Scale 2.0 at one year follow-up. A binary logistic regression analysis was used to examine the prospective associations between exposure and outcome. Latent Class Analysis was used to identify distinct characteristics of family environment. Mediation analyses assessed the mediating effects of psychological distress. FINDINGS: We observed that six subscales of family environment were statistically significantly associated with food addiction in adjusted model. Control [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.22] and conflict (OR = 1.19, 95% CI = 1.11-1.28) subscales were positively associated, whereas cohesion (OR = 0.82, 95% CI = 0.77-0.88), active-recreational orientation (OR = 0.91, 95% CI = 0.85-0.97), intellectual-cultural orientation (OR = 0.91, 95% CI = 0.84-0.98) and organization (OR = 0.87, 95% CI = 0.81-0.94) subscales were inversely associated. The clustering of family environments demonstrated that compared with children and adolescents in playful families, those in conflict-ridden families had a 1.92-fold greater risk (OR = 2.92, 95% CI = 1.86-4.58) of food addiction. Further, we observed that depression and stress partially mediated this association, with the mediated proportions ranging from 18.0%-21.0%. CONCLUSIONS: There appears to be a positive association between a conflict-ridden family environment and food addiction among children and young adults in China. Considering family environment is a modifiable factor, improvement of family environment may be an effective strategy to reduce food addiction by enhancing the psychological well-being of children and adolescents.