Food Insecurity and Disordered Eating

How Poverty Impacts the Expression of Eating Disorders

What is Food Insecurity and Who Does It Impact?

As we live in one of the wealthiest nations in the world, it is difficult to imagine that many individuals still frequently struggle with hunger. While the country readily discards billions of pounds of viable food every year, 42 million people in the United States experience hunger on a regular basis due to food insecurity. According to the United States Department of Agriculture, food insecurity is formally defined as “a household-level economic and social condition of limited or uncertain access to adequate food”1. Food insecurity refers to insufficient physical, social, and economic access to sufficient, safe, and nutritious food to meet dietary needs and food preferences for an active and healthy life2. It is important to note that the issue of food insecurity extends past a lack of access to fresh, healthy, and affordable food; food insecurity also stems from “systemic inequities that prevent or prohibit equitable distribution and/or access to basic needs”3. Thus, food insecurity is a problem that involves both individual access to food and systematic, structural barriers to entire communities of people.

Many American families facing the obstacle of food insecurity experience these challenges obtaining nutritious food as a result of poverty, inadequate resources, and lack of available places to purchase diversified, nourishing meals4. These conditions pose both immediate and gradual struggles that force food insecure individuals to make difficult decisions about when, where, and how to nourish their bodies. Individuals living in food-insecure households report not being able to afford a well-balanced meal, worrying that food will run out, not eating when hungry, cutting meal sizes or skipping meals, or going a whole day without eating1. Such circumstances can lead to a tumultuous relationship with food in which uncertainty and anxiety exert a dominant influence over thoughts about diet and body image.

The issue of food insecurity disproportionately impacts marginalized, low-income, under-resourced communities that grapple with underemployment, stagnant salaries, and rising cost of living. Specifically, food insecurity most strongly affects people of color, rural people, the elderly, and children. 72% of African-American and Latino children are particularly at risk, with at least 25% of these children facing a constant struggle to nourish their growing bodies with nutritious food3. This lack of consistent access to nutritious food sources not only impedes regular eating patterns, but also may establish physical and mental indicators of food insecurity that persist throughout one’s lifetime. Compared with those living in food secure environments, individuals struggling with food insecurity tend to have higher body mass indices (BMIs) and waist-to-height ratios. Additionally, individuals living in food insecure households report higher rates of depressive symptoms and stress than those with no history of food insecurity5. However, few research endeavors have examined the direct association between eating disorder symptoms and degree of food insecurity.

The Link Between Food Insecurity and Disordered Eating

While only a handful studies have investigated the link between high levels of food insecurity and eating disorder pathology, recent research has discovered that adults who experience significant food deprivation on a regular basis are more likely to engage in several disordered eating behaviors. Compared with individuals who have regular access to food, food insecure individuals engaged in more objective binge eating and overeating, night-time eating, purging and other compensatory behaviors (such as exercising harder than usual and using laxatives/water pills), food restriction (such as skipping two or more meals in a row), and dietary restraint. Additionally, high food insecurity corresponded with an increase in weight/body shape concerns due to weight stigma: societally-held judgement, biases, and prejudice predetermined by weight and body shape. These effects seemed to be most prevalent in households consisting of food insecure adults who reported an inability to feed their children; this “child hunger” group is considered the highest level of food insecurity as “the presumption is that hungry children indicate even hungrier adults given the propensity of most caregivers to prioritize feeding children”. Researchers found that 17% of individuals in the child hunger food insecurity group exhibited a clinically significant eating disorder, compared with less than 3% of participants in the non-food insecure group5. These results suggest that higher levels of food insecurity are linked with increased eating disorder pathology for adults who have inconsistent and uncertain access to nutritious food. Early experiences with food insecurity may have specific consequences for young children, particularly those who are obese; overweight children raised in food insecure households tend to exhibit disordered eating habits such as excessive night-time eating, episodes of binge eating, and food hiding/secretive eating7.

The implications of this research demonstrate that prolonged periods of food insecurity may establish problematic eating patterns in both adults and children. For some of these food insecure individuals, disordered eating habits can progress into a fully developed eating disorder that decisively impacts one’s daily thoughts and actions. Considering the lack of resources available to those suffering from food insecurity, it is unlikely that many of these individuals will have the opportunity to seek regular treatment for their eating disorder.

Future Directions and Food Justice Awareness

Keeping in mind the prevalence and extensive impact of food insecurity in the United States as well as the rest of the world, future research examining the distinct mechanisms by which food insecurity influences the development of disordered eating is urgently required to better understand how to prevent and treat eating disorder pathology in a vulnerable population.  Additionally, consideration of how food insecurity affects neurocognitive development may have specific implications for food insecure children attending school. However, in addition to further research, there are several more immediate ways that one can get involved in promoting food security for all. 

Rooted in systemic inequality and structural barriers preventing access to and distribution of basic needs, food insecurity is a problem that must be addressed on a societal level through careful organization and political reform. An easy way that anyone can bring awareness to the social issue of food insecurity is learning about food justice and becoming involved in the food justice movement. This perspective asserts that nutritious food is a basic human right regardless of economic restraints or social inequality; all individuals should have the ability to freely grow, sell, and eat healthy food. The food justice movement “seeks to truly advance self-reliance and social justice by placing communities in leadership of their own solutions and providing them with the tools to address the disparities within our food systems and within society at large”8. By advocating for equal access to and control over nutritious food, you can raise awareness about the endemic problem of food insecurity and educate others about the risk of disordered eating patterns that may develop as a result of prolonged hunger and malnutrition. 

By Rachel Uri

References

1United States Department of Agriculture (2017, June 28). Food Security in the United States. Retrieved from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us

2United Nations Food and Agricultural Organization (2009). The State of Food and Agriculture. Retrieved from http://www.fao.org/docrep/012/i0680e/i0680e.pdf

3North Carolina State University Extension (2017). Food Justice. Retrieved from https://localfood.ces.ncsu.edu/local-food-justice/

4Feeding America (2017). Understanding Hunger and Food Insecurity. Retrieved from http://www.feedingamerica.org/hunger-in-america/what-is-hunger-and-food-insecurity.html

5Darling, K.E., Fahrenkamp, A.J., Wilson, S.M., D’Auria, A.L., Sato, A.F. (2017). Physical and mental health outcomes associated with prior food insecurity among young adults. Journal of Health Psychology, 22(5), 572-581. doi: 10.1177/1359105315609087

6Becker, C.B., Middlemass, K., Taylor, B., Johnson, C., Gomez, F. (2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 1-10. doi: 10.1002/eat.22735

7Tester, J.M., Lang, T.C., Laraia, B.A. (2016). Disordered eating behaviors and food insecurity: a qualitative study about children with obesity in low-income households. Obesity Research and Clinical Practice, 10, 544-552. doi: http://dx.doi.org/10.1016/j.orcp.2015.11.007

8Ahmadi, Brahm (2011). Racism and food justice: The case of Oakland. Food Movements Unite!, ed. Eric Holt-Giménez, 149–62. Oakland, CA: Food First Books.