Food Insecurity and Eating Problems

Written by Rachel Kraff.

For many people, the reflexive response to feeling hungry is to open the fridge or check out what’s in the pantry. If something tasty doesn’t present itself, there might be groans something to the effect of, “Ugh, there is nothing to eat here!” But for others, the experience of having “nothing to eat” is not about a lack of easily reheated leftovers; rather, it’s a reflection a lack of availability of food. 

According to the U.S. Department of Agriculture, as of 2020, 10.5 percent of households were at some point food insecure and nearly 15% of households with children in the U.S. were affected by food insecurity. Food insecurity is defined as the limited or uncertain ability to obtain or access nutritional and safe food. Of food insecure households in 2020, 3.9 percent or 5.1 million households were categorized to be at ‘very low food security.’ When people have very low food security, this means that they are very like to skip meals due to limited resources.  

Food insecurity has a known impact on health-related outcomes. It has been associated with:

• mental health issues such as depression, anxiety, and emotional distress
• diabetes, and
• other medical problems associated with high weight. 

Of particular interest to us at the Columbia Center for Eating Disorders, research has shown that there may be a link between food insecurity and eating problems, including clinically significant disordered eating (For more on the difference between eating disorders and disordered eating, see this related post). Intuition might lead us to think that food insecurity results primarily in restrictive eating behaviors, that a scarcity mindset leads some individuals who are uncertain when more food will be available to them to cut back or ration. However, it appears that food insecurity is also associated with binge eating. Binge eating is defined as experiencing a loss of control while eating a large amount of food. Although there are limited data in individuals with food insecurity who also endorse disordered eating, one study on young adults showed that 25.3% of people with food insecurity reported binge eating whereas only 18.4% of food secure individuals reported the same behavior. 

Why might food insecurity be associated with loss of control eating?

Extreme restriction is a well-known precipitant to disordered eating behaviors. Whether intentional or involuntary, if our bodies are deprived of food, we may be more inclined to ‘feast’ when food is available again. When this pattern repeats, it can become an entrenched cycle. The routine of restrictive eating and loss of control eating is a feature of several defined eating disorders, including bulimia nervosa, anorexia nervosa binge-purge subtype, and binge-eating disorder, and improving the regularity of one’s eating pattern – eating 3 meals and snacks daily – is a cornerstone of their treatment.  

For years, research has shown that “feast-or-famine” availability of food is associated with problematic eating behaviors. In addition, a recent qualitative study found that people with past food insecurity in current treatment for an eating disorder with binge eating as a core symptom felt that the experience of food insecurity had an impact on the development of their eating problem. 

The mechanism for this relationship remains unclear. For example, the restriction-binge cycle may be influenced by the federal programs in place to assist low-income individuals. The distribution of the Supplemental Nutrition Assistance Program, previously known as food stamps, and other government assistance programs, typically occurs at the beginning of a calendar month; an individual’s resources may therefore be scarcer at the end of the month. This may promote a cycle of loss of control eating at the beginning of the month, then involuntary restriction at the end of the month. Alternatively, ongoing overall stress and general financial anxiety may result in eating “for comfort” in response to emotion.

Why we need to know more.

By studying food insecurity and eating behaviors and attitudes, we can gain a better knowledge of how food insecurity affects eating behavior. We can also learn what groups of people with food insecurity are at greatest risk for eating problems. Much of what we know about this topic comes from studies of adults. However, here at Columbia (and with collaborators at Fordham) we recently undertook a study to learn more about the connection between food insecurity and eating disorder symptoms in teens.  In 58 adolescents from the New York City metropolitan area, food insecurity was associated with binge eating frequency, concern about body shape, and higher weight/body mass index, suggesting similar relationships to those seen in adults . With better understanding of the mechanism(s) underlying the relationship between food insecurity and problematic eating-related behaviors, opportunities for prevention – such as modifications to public policy related to nutrition assistance programs and identification of individuals in need of eating disorders treatment – are likely to improve.

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