Association Between Consumption of Foods Classified by Chewiness Level and Overweight/Obesity Among Israeli Adolescents: Insights from a Cross-Sectional National Youth Survey

Background/Objectives: Food texture and oral processing characteristics may shape eating behavior, dietary intake, and body weight, yet the role of food chewiness in adolescent weight status remains underexplored. This study examined associations between intake across levels of food chewiness and weight status among adolescents in a national youth nutrition survey. Methods: This secondary cross-sectional analysis used data from the Israeli National Youth Health and Nutrition Survey (MABAT Youth Second Survey). Food Frequency Questionnaire (FFQ) items were classified by an expert panel into five chewiness levels, from 0 (lowest) to 4 (highest). Weight status was determined using body mass index (BMI) z-score categories. Multivariable survey logistic regression models examined associations between intake at each chewiness level (per 10-g/day higher reported intake) and overweight/obesity, adjusted for age, sex, population group, socioeconomic status, and total daily energy intake. Linear regression of the five fully adjusted log odds ratios on chewiness level assessed the trend, incorporating their full variance–covariance matrix estimated from 2000 school-level bootstrap resamples. Confidence intervals and two-sided p-values for the trend were calculated using approximate Wald t inference with 207 degrees of freedom. Results: The analysis included 3428 adolescents (mean age 15.2 ± 1.6 years; 47.7% male). Higher consumption of foods classified at greater chewiness levels was associated with higher odds of overweight/obesity, with the strongest associations observed for levels 3 and 4. After adjustment, each 10-g increase in intake at chewiness level 2 was associated with 0.2% higher odds of overweight/obesity, whereas each 10-g increase at levels 3 and 4 was associated with 0.7% and 0.6% higher odds, respectively. The estimated linear trend across chewiness levels was β = 0.00137 on the log odds ratio scale per one-level increase (95% CI: 0.00055–0.00220; two-sided Wald p = 0.0011). Conclusions: Higher reported intake of foods assigned to higher estimated chewiness levels was associated with greater odds of prevalent overweight/obesity after covariate adjustment. The cross-sectional design does not establish the temporal direction of these associations or a causal effect of food chewiness on weight status.