BY: Melissa Munn-Chernoff, PhD

DATE: 16 August, 2017

A recent article by Becker and colleagues¹ in the International Journal of Eating Disorders examined the prevalence of eating disorder symptoms among individuals experiencing food insecurity. Food insecurity, which affected nearly 16 million households in the United States in 2015,² is defined as “having inadequate access to sufficient food, both in terms of quantity and quality, secondary to lack of financial or other resources.”¹ It is often associated with significant food restriction, stress associated with living in poverty,¹ and obesity.³ Further, individuals who are overweight or obese may experience weight stigma from the media and medical providers, leading to dietary restriction. Thus, eating disorder symptoms may be elevated in individuals experiencing food insecurity compared with the general population based on previous research showing that consistent dietary restriction and stress can lead to binge eating and overeating. Therefore, Becker and colleagues evaluated whether eating disorder symptoms, dietary restraint for any reason, weight stigma, and anxiety were increased among individuals experiencing food insecurity.

Nearly 500 individuals who were clients of area food pantries were included in the study. Eating disorder symptoms were examined in 4 groups of individuals: not food insecure (n=41; i.e., individuals who received assistance from food pantries but did not meet criteria for food insecurity as assessed in this study); household food insecure (n=45; i.e., “participants report anxiety about food, eating the same thing repeatedly because of lack of resources, and food running out”); individual food insecure (n=190, i.e., “participants report being hungry at times because they lack food”); and child hunger insecure (n=227; i.e., “participants report inability to feed their children secondary to lack of resources”). The child hunger group arguably has the most food insecurity since it is assumed that the parents are allocating any food they have to their children; thus, both children and parents are not receiving adequate food.

Results suggested that individuals in the child hunger insecure group had the highest levels of eating disorder symptoms. Seventeen percent of individuals in this group had a clinically significant eating disorder, compared with 9.4% in the food insecure group, 2.6% in the household food insecure group, and 2.9% in the not food insecure group. Binge eating, overeating, night eating (waking up to eat a large amount of food with distress at night), vomiting, laxative/water pill use, skipping at least two meals in a row, exercising harder than usual because of eating too much food, and weight/shape concerns were all more common in the child hunger food insecure group than the other three groups. There were no differences between groups for the eating disorder symptoms based on sex, race, or ethnicity. Similarly, internalized weight stigma and worry was greatest in the child hunger group.

There are several implications for this study. First, these data reiterate that eating disorders do not discriminate on the basis of socioeconomic status. Individuals who are food insecure need to be considered in future research in order to fully understand risks that are specific to this population (e.g., food restriction for any reason). Second, prevention, intervention, and treatment programs need to be designed so they can reach individuals who do not have the money to access these programs. For example, current treatments for eating disorders are primarily delivered face-to-face with a trained clinician, which is difficult to disseminate to a wide range of individuals. Finally, although not directly assessed, anti-obesity programs may negatively affect individuals who are food insecure and overweight or obese, given that internalized weight stigmatization was high in a proportion of these individuals. Additional research in this population will be critical to better understand risk factors for eating disorder symptoms in this understudied population.

References

¹Becker CB, Middlemass K, Taylor B, Johnson C, and Gomez F (in press). Food insecurity and eating disorder pathology. International Journal of Eating Disorders. doi:10.1002/eat.22735.

²Coleman-Jensen A, Rabbitt M, Gregory C, and Singh A (2015). Household Food Security in the United States, ERR-215 (Washington, DC: US Department of Agriculture, Economic Research Service), September, 2016.

³Franklin B, Jones A, Love D, Puckett S, Macklin J, and White-Means S (2012). Exploring mediators of food insecurity and obesity: A review of recent literature. Journal of Community Health, 37, 253-264.