Using Best-Worst Scaling to explore the perceived addictiveness of foods by processing level: a cross-sectional study among higher education students in Belgium.

backgroundHigher education students increasingly consume ultra-processed foods (UPFs) because they are affordable, convenient, and heavily marketed, and this pattern has been linked to adverse health outcomes. Beyond health risks, emerging evidence suggests UPFs may elicit addictive-like eating behaviors. To better understand which foods are perceived as most addictive, we applied a Best-Worst Scaling (BWS) approach-a stated-preference method-to quantify the relative perceived addictiveness of foods varying in level of processing.

methodsA cross-sectional online survey was conducted between May 10 and July 5, 2024, among 609 higher education students in the province of Liège, Belgium. Food addiction was measured using the modified Yale Food Addiction Scale version 2.0 (mYFAS 2.0). To identify which foods were perceived as most and least addictive, we used a BWS choice experiment. Participants evaluated 15 sets of 5 foods (randomly selected from 30) and, in each set, identified the food that would trigger the most and the least addictive-like problems as defined by the mYFAS 2.0 criteria. From these repeated choices, we calculated a Relative Importance Score (RIS) for each food, based on the standardized difference between its best and worst selections. The RIS provides a continuous measure of each food's perceived addictiveness relative to all others. Foods were categorized using the NOVA classification.

resultsThe prevalence of food addiction was 24.0% in the sample (5.4% mild, 6.4% moderate, and 12.2% severe). BWS results showed clear differences in perceived addictiveness across foods. Ultra-processed foods consistently ranked as the most problematic, with salted potato chips (RIS = 7.662; 95% CI 7.458-7.866), chocolate brownies (RIS = 7.579; 95% CI 7.357-7.802), sugary sweets (RIS = 7.462; 95% CI 7.234-7.689), and sugary soft drinks (RIS = 7.227; 95% CI 6.971-7.482). These foods did not differ significantly from one another but were distinctly more problematic than minimally processed or processed foods.

conclusionAddictive-like eating behaviors were highly prevalent among higher education students. The application of a BWS design provided a nuanced, quantitative ranking of foods based on perceived addictiveness, highlighting the predominance of ultra-processed items. These findings underscore the need for targeted public health interventions addressing the role of UPFs in problematic eating behaviors.