Obesity is a global health concern, and one potential contributing factor is addictive-like eating behavior. Despite growing interest, the prevalence of food addiction (FA) in large community samples in Iran, and the potential sex-specific correlates of FA, remain unexplored. This study aimed to assess the prevalence of FA in a non-clinical Iranian population and to compare its sociodemographic correlates between males and females. This cross-sectional study, conducted from 2021 to 2022, included valid data from 9,345 adults (82.1% female, 17.9% male). Participants completed the Persian version of the modified Yale Food Addiction Scale 2.0 (mPYFAS 2.0) and demographic surveys. Univariable and multivariable logistic regression analyses were performed to identify FA correlates. Overall, 15.6% of participants met the diagnostic threshold for FA (8.7% males, 17.2% females). Regarding FA severity, 4.0% exhibited mild FA (males: 2.9%; females: 4.3%), 4.1% displayed moderate FA (males: 2.0%; females: 4.6%), and 7.5% demonstrated severe FA (males: 3.8%; females: 8.3%). Multivariable analyses revealed that younger age, female sex, overweight/obesity, and lower education were associated with higher FA prevalence in the overall sample. Sex-specific analyses showed that age and weight status were significant correlates for females, while weight status and education level were significant for males. Notably, underweight status was positively correlated with FA for males but was negatively associated with FA for females. Regarding FA symptoms, females reported higher endorsement of most symptoms except for situation and problems and activities where no sex differences were found. This study highlights the significant prevalence of FA in Iran, emphasizing sex differences in prevalence, symptomatology, and associated sociodemographic factors. These findings provide valuable insights for designing tailored, sex-specific interventions to mitigate FA severity.
Obesity, as a critical public health concern, is one important risk factor and comorbidity of a wide range of health conditions, such as major depressive disorders, anxiety disorders, sleep disorders, cardiovascular diseases, kidney diseases, diabetes, neoplasms, cancers, all leading to an increased mortality risk compared to the overall population. As estimated by the latest data, the global prevalence of obesity has increased from 8.8% (4.8%) in 1990 to 18.5% (14%) in 2022 in women and men. With the increasing number of people with obesity, it is imperative to identity the potential risk factors to inform effective interventions. Food addiction (FA), as a promising risk factor, has attracted much attention during recent years both in the academia and by clinicians.
As a phenotype which proposes that some people may develop addictive-like symptoms towards specific foods high in sugar and/or fat (especially ultra-processed foods, such as chocolate and ice cream), FA may increase the food intake and contribute too overweight or obesity ultimately. This is supported by the significant association found between FA and obesity in both children, adolescents and adults in recent meta-analyses. Moreover, FA is closely related to the obesity-related constructs (such as impulsivity, reward sensitivity, loss of control, craving, cognitive dysfunction, mental distress, psychiatric comorbidities, social and occupational impairment), which further supports its vital role in the development of obesity. According to the latest meta-analysis, the pooled prevalence of FA is 15% among children and adolescents, 14% for non-clinical adults and 40% in clinical samples, which is especially high in patients with eating disorders (bulimia nervosa (84%), binge eating disorder (63%) and anorexia nervosa (53%)). Thus, the identification of associated factors of FA might hold great practical implications for the development of interventions to manage and decrease FA symptoms. Sex is a critical, though frequently neglected, candidate for the prevalence and the number of symptoms and the type of symptoms endorsed of FA.
Sex is a vital dimension, which calls for much more research attention in the field of addictive disorders, and FA is no exception. The sex differences of FA might be reflected on the prevalence, number of symptoms, specific symptoms endorsed and comorbidity and correlates.
As for the prevalence of FA, sex differences were repeatedly reported, with higher prevalence in female than male was found in meta-analysis of studies using the (Yale Food Addiction Scale (YFAS), while the latest meta-analysis of research employing YFAS 2.0 revealed that the prevalence of male (27%) is higher than that of female (24%). Meanwhile, no sex difference was also mentioned in several investigations.
For the symptoms of FA, by using YFAS, no sex difference was revealed on the symptom score while sex differences were revealed for specific symptoms endorsed. Female students scored higher than male counterpart on "use despite knowledge of adverse consequences", "persistent desire or repeated unsuccessful attempts to cut down", "tolerance", "withdrawal" and "clinically significant impairment" symptom whereas no sex difference was reported on "loss of control", "much time spent to obtain, use, recover", and "important activities given up" symptom. Since four more symptoms were added into YFAS 2.0 when compared to YFAS, thus, it remains unknown whether there are any sex differences on these four symptoms.
For the comorbidity of FA, sex differences were frequently reported as well. The co-occurring FA and post-traumatic stress disorder (PTSD) was found to be higher for male (RR = 8.54) compared to female (RR = 4.32) after controlling for potential covariates in the community sample, whereas this sex difference was absent in veterans.
Relatively little attention was paid to the sex difference on the correlates of FA. The sex differences identified in this line of research demonstrated that sex-specific considerations were warranted when developing the interventions to alleviate the severity of FA. Chronotype (natural preferences of the body for wakefulness and sleep) was found to be a correlate of FA for males but not for females. Specifically, being evening type might increase the risk of having a FA diagnosis only for men but not for women. Plasma dopamine levels was revealed to be negatively associated with food addiction in males, and positively in females. For the adolescents seeking treatment for obesity, the sex differences about the attitudinal correlates of FA symptoms were revealed as well. More specifically, functional impairment due to FA symptoms was associated with anxiety about gaining weight for the boys and social pressure about eating among the girls. Dieting was positively linked to avoidance from important social, functional and interpersonal activities due to eating among the boys, whereas it was correlated with continuing to eat despite knowing negative consequences among the girls. The association between social pressure about eating and eating for longer duration and higher amount than intended was only found for the girls but not for boys. Moreover, some sex-specific correlates of FA was also identified in previous research, such as polycystic ovarian syndrome for women.
The prevalence of FA in Iran ranged from 6.3% to 31% depending on the samples investigated. The sex difference was only revealed in children and adolescent sample, with boys tending to be more likely to meet FA diagnosis than girls. However, this sex difference was absent in Iranian adult samples. Whether there are any potential sex differences on the comorbidity and correlates of FA, especially in Iran, remain largely unknown.
The previous studies conducted in Iran were limited by the small sample sizes (222 ~ 473 participants) and the specific research groups with health conditions (e.g., adults with obesity), visitors of family physician clinics and individuals undergone laparoscopic sleeve gastrectomy), which hinders from getting the prevalence of FA from the community level. In addition, the inclusion of single sex (such as only women were investigated in) also unable to analyze the potential sex differences.
Thus, the current investigation aimed to determine the prevalence of in community level with large adult sample size in Iran and to explore whether there maybe potential sex-specific factors related to FA to help to develop more sex-appreciate interventions for FA in the future.