The aim of this study was to determine the impact of ACEs and other childhood influences on the development of food addiction in college-attending young adults. There was an overall 21.9% prevalence of food addiction in this sample, which is higher than some other studies examining food addiction in this population [5, 28]. Jahrami et al found a 20.3% prevalence in females and 17.4% prevalence in males , and Sengor and Gezer found a 21.1% prevalence of high YFAS scores , which are more similar to the findings of the present study. There was a 24.2% prevalence of high ACEs in this study, which is again higher than other studies on the college-attending young adult population [39–42]. In previous investigations of psychosocial factors at the university used in this study, rates of mental health disorders and ACEs have been higher than other college populations [43–45]. This population resides in Appalachia, an area plagued by health disparities , which could provide an explanation for this trend.
Quantitative analysis showed that although ACEs were significantly correlated with food addiction. However, when controlling for other potential influences, ACEs did not significantly predict food addiction. The impact of ACEs on the development of food addiction in clinical populations has been found to be significant [10, 11, 15, 17]. ACEs have also been found to be a significant predictor of the development of eating disorders in the clinical population [21, 47] and emotional eating in the general population . Comorbidities of depression or other mental health disorders are common in the food addiction population  and eating disorder population . Depression caused a 233% increased risk of developing food addiction, adding evidence of mental health’s significant influence on eating behaviors. Depression, but not ACEs, being a significant predictor of the development of food addiction in this population was partially explained by qualitative results.
When participants were asked about their eating environment growing up, a variety of themes emerged. Many participants described a pressure to be healthy, which was characterized by an emphasis on diet culture, being conscious of weight, and maintaining a certain physique. There were many descriptions of restrictive eating environments, where parents or caregivers would limit the types of food allowed in the home, with some even putting locks on pantries so that participants could not access them. Some participants reflected that they believe this contributed to their current symptoms, where they now overindulged in certain foods due to being deprived of them in childhood. Participants who discussed diet culture and restrictive eating environments commonly brought up their mothers’ eating habits. Research has shown that maternal eating habits are a significant influence on child eating habits, especially on their daughters . Additionally, Birch and Fisher found that when parents strictly control children’s food intake, this can cause the child to have strong preferences for high-fat, energy-dense foods . A qualitative study on food addiction by Paterson et al found similar participant descriptions of restrictive eating environments during childhood . The effects of this environment were further elucidated in the present study when asked about their emergence of symptoms, where participants described entering college was when their symptoms appeared or worsened. This was credited to the newfound freedom of making their own food choices, especially by those who had been restricted growing up. Participants also cited the stress of the transition to college as being a contributing factor to their symptoms. The college environment has a widespread availability of hyper-palatable food  and the life-stage of emerging adulthood in this population has been shown to worsen mental health symptoms, especially since COVID-19 [44, 52]. This, combined with a restrictive eating environment in childhood, is one way that food addiction was shown to develop in this study.
Participants also described positive eating environments growing up, with an importance of family mealtime, and associated positive memories tied to food and eating. The possibility that individuals with food addiction turn to food due to its association with positive memories needs further exploration. Other eating environments described by participants were characterized by unhealthy and processed foods, and these findings were consistent with the findings from Paterson et al . Research has shown that early childhood eating habits can extend into adulthood . This study shows that when combined with other factors, these unhealthy eating practices can develop into food addiction. Participants also described negative associations with family dinner, and the possibility of food becoming a source of anxiety for these participants needs further exploration. The worsening of mental health was another reason for the emergence of symptoms, which aligns with depression being a significant predictor in the quantitative results. Depression and anxiety are shown to be correlated with poorer diet quality [43, 54] as well as overweight and obesity . These findings contribute to research on these topics, but also show that depression can cause the more severe outcome of food addiction, when combined with other influences.
There were several other themes developed from the emergence of symptoms. Participants described noticing their behaviors once they felt pressure from school and relationships, largely due to body image pressures. Studies have found that body image pressures and consistent comments about weight and shape a significant contributing factor to the development of eating disorders [56, 57]. Participants also discussed their symptoms emerging after triggering events, including parental divorce, moving homes, relationships ending, or other familial distress. The ACE questionnaire captures the experience of childhood trauma, containing items such as sexual or physical abuse, neglect, and household substance use disorders. These findings show that certain events, that are not captured by the ACE questionnaire, can contribute to the development of food addiction. Participants cited that food provided them stability or something to cope with during these stressful times, contributing to the understanding of why food addiction can develop after these life events. It is possible that the evidence for ACEs leading to substance use disorder is consistently seen because ACEs contain more severe instances of trauma. The lack of evidence on ACEs being a significant predictor of food addiction in this study points to the potential that less severe childhood events can cause food addiction, because food is readily available and needed to survive. In other words, it is a more accessible coping mechanism that may require less adverse life events to become dependent on. The other influences captured by qualitative analysis also point to this. However, this needs further exploration.