Food Insecurity and Eating Disorders

What is Food Insecurity?

Food insecurity is defined as limited access or uncertain access to an adequate amount of food for all persons in a household to meet their nutritional needs.¹ In 2022, 44.2 million people in the United States, 7.3 million of whom were children, lived in households with food insecurity.² While food insecurity affects people of any age, gender, race, or ethnicity, it is most prevalent among individuals and families who have children or older family members (age 66 and over), racial and ethnic minorities and, among women, particularly single female households with one or more children.2 Food insecurity is also higher in urban and rural areas that lack adequate access to nutritious foods, called food deserts, and/or that only have access to inexpensive non-nutritious foods, called food swamps.³

Health Consequences of Food Insecurity

Food insecurity is linked to an increased risk of mortality and health conditions such as cardiovascular disease, hypertension, asthma, migraine, and worsening of type 2 diabetes.^4,5,6 Among children and adolescents, food insecurity has also been linked to impaired development and growth and cognitive deficits.hat it would be helpful to add a section on tips for people with EDs prior, during and after pregnancy.⁷ Food insecurity not only impacts a person’s physical health and nutrition, it can also affect a person’s mental health as well. Those who experience food insecurity have higher rates of anxiety disorders, depression, suicide ideation, sleep problems as well as eating disorders and disordered eating.^8,9,10

Link Between Food Insecurity and Eating Disorders

Studies show that people with food insecurity are more likely to exhibit disordered eating behaviors, including obsession with food, restriction, binge eating, and compensatory behaviors like purging, excessive exercise, and laxative use.^7,11 Individuals who experience food insecurity are also more likely to meet the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED). For example, a large population-based study in the United States found that food insecurity is associated with 1.67 higher odds of BED or subclinical BED and 1.31 higher odds of binge eating symptoms in early adolescence.¹² In addition, researchers have found that 17% of adults who experienced food insecurity during childhood met the diagnostic criteria for an eating disorder, a rate significantly higher than the general population.^7,13 Similarly, another study found that adults with food insecurity were 1.66 more likely to have binge eating than adults without food insecurity.¹⁴ Among midlife and older adults, experiencing food insecurity has been found to increase the risk of engaging in disordered eating behaviors like binge eating, skipping meals, purging, and laxative use with more severe food insecurity related to a greater risk of engaging in such disordered eating behaviors.¹⁵ In summary, studies have consistently found that food insecurity is strongly linked to disordered eating and eating disorders across the lifespan.  

While there is strong evidence that food insecurity and eating disorders are linked, it is still unclear exactly how they are related. Some researchers believe this link is due to the cyclical nature of food insecurity where individuals go through periods where food is more accessible (i.e., after they are paid) followed by periods when food is less accessible (i.e., at the end of the month when earnings are depleted).¹⁶ This cycle, they propose, functions in the same way that periods of dieting can lead to periods of binge eating. This can then result in more compensatory behaviors (i.e., dieting, purging, laxative use) in an effort to prevent any change in weight associated with the binging.¹⁴ Indeed, studies have found that whether restriction is involuntary (i.e., due to food insecurity) or voluntary (i.e., due to dieting), they can both result in disordered eating behaviors like binge eating.⁹

Other researchers have argued that the increased incidence of depression, anxiety disorders, and sleep problems among those with food insecurity may increase the risk of developing an eating disorder, thus accounting for the higher incidence of eating disorders among those with food insecurity.¹⁰  

Treatment Considerations

Given the serious physical and psychological health consequences that can result from eating disorders, it is essential to seek professional help as soon as possible. Unfortunately, many people with eating disorders cannot access the treatment they need and deserve due to a lack of financial resources. This is even more prevalent among those who are experiencing food insecurity as they typically live in low-income households, may be experiencing unemployment, and therefore may not have access to insurance or the finances to pay for eating disorder treatment.¹⁷ Indeed, studies have found that individuals experiencing food insecurity are more likely to postpone seeking necessary medical care and medications.¹⁸

Even when individuals with food insecurity are able to access specialized eating disorder treatment, they may not be able to follow recommended treatment plans. For example, a patient may not be able to follow the meal plan recommended by their provider if they cannot afford to purchase an adequate amount of food or they may not take prescribed medications if they have to choose between eating and paying for medication.⁹ Indeed, a study interviewing food-insecure patients receiving eating disorder treatment found they had difficulty following the recommended meal plan due to lack of access to food and reported feeling their treatment providers did not understand how food insecurity impacted their eating disorders.¹⁹

To combat these barriers to treatment, it is vitally important that healthcare providers are aware of the link between food insecurity and eating disorders and screen patients at greater risk of food insecurity for eating disorders in order to identify individuals who need specialized treatment.¹⁰ It is also important that screening for food insecurity becomes a regular part of the intake process for eating disorder treatment so that providers can modify their treatment plans to address the needs of patients who have limited or inconsistent access to food.⁹ 

Resources

If you or someone you know has an eating disorder and are facing financial barriers to accessing treatment you can learn more about free and low-cost support options, including accessing affordable care here.

For information on food assistance programs you can go here.