When it comes to the causes of eating disorders, we often point to the more straightforward ones: body image concerns, a history of dieting, a genetic predisposition, perfectionism. But the reality is, a huge range of diverse factors can contribute to a problematic relationship with food, many of which we never think of. One of those factors? The availability of food itself.

For Equip Lead Peer Mentor Makailah (Mak) Dowell, uncertainty around what and when she would be able to eat directly impacted the development of her eating disorder. “I was homeless and food insecure for six years of my life,” Dowell says. “And even when we made it out of this spot, my grandmother and I were limited to what food stamps could provide.”

Once she did gain more reliable access to food, Dowell says she began to binge eat. “That led me into the binge-purge cycle, and I developed bulimia nervosa,” she remembers. Looking back now, she sees clearly that her food insecurity led to these harmful behaviors, but at the time she could neither identify nor stop them.

Read on to learn the nuances of food insecurity, how it can directly impact eating disorders, and how to get support.

What is food insecurity?

The United States Department of Agriculture defines food insecurity as “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” According to Feeding America, a nationwide network of food banks, food pantries, and local meal programs, 47 million people (including 14 million children) experience food insecurity annually in the United States.

“Food insecurity is a state where individuals and communities have a lack of consistent access to adequate amounts of safe, nutritious foods to support growth and development,” says Equip Therapist Lead Ana Gardner, LCSW. She explains that food insecurity can be broken down into four pillars:

• Availability: how much food is being procured
• Accessibility: how easily the food is accessed
• Utilization: how people use food
• Stability: how stable the food system is over time

Gardner also notes that food insecurity can be experienced at different levels of severity. According to the Food and Agriculture organization of the United Nations (FAO) there are three levels of food insecurity: 

1. Food security/mild food insecurity: People who are food secure have reliable access to enough food, both in terms of amount and nutritional value. Mild insecurity includes facing uncertainty about continued ability to obtain adequate food.
2. Moderate food insecurity: People experiencing moderate food insecurity are forced to limit the quality, quantity, or both of the food they eat.
3. Severe food insecurity: People experiencing severe food insecurity have typically run out of food and, at worst, gone a day (or days) without eating.

While millions of people struggle with food insecurity, the issue affects some groups more than others. “Food insecurity has a higher prevalence in low income households, and with racial and ethnic minorities,” Gardner says. “It’s linked to a decreased variety of food and a lower consumption of micronutrients. Food insecurity additionally affects pregnant women negatively and is associated with pregnancy complications.”

The COVID-19 pandemic also negatively impacted the overall health (which includes mental health) of many, specifically those who are low income and/or experience food insecurity. “The pandemic increased food insecurity globally, and correspondingly eating disorders have also increased,” Gardner says.

Food insecurity and eating disorders

The link between eating disorders and food insecurity is well-documented. Research shows that food insecurity is associated with higher rates of binge eating disorder, bulimia nervosa, and overall eating disorder pathology. Food insecurity during adolescence has been shown to be a risk factor for developing disordered eating in adulthood.

“Food insecurity directly affects eating habits,” Gardner says. “Those experiencing food insecurity may stretch their food supplies to make them last longer, skip meals to prioritize feeding other family members, or prioritize other expenses, like medical bills, over meals. Food insecurity is also a psychological stressor that can lead to increases in stress, depression, and anxiety.”

People experiencing food insecurity are more likely to live in areas that are low income and have limited access to affordable and nutritious food, also known as food deserts. “The combination of food insecurity, financial barriers, and food deserts leave many undernourished and with disordered eating practices,” Gardner says.

As Dowell sees it, eating disorders and food insecurity can, in some cases, go hand in hand. “Eating disorders can be heavily influenced by the lack of food options, which can create both higher urges to binge, but also an ability to skip meals while having a valid excuse for why you’re skipping it.” Dowell says that her own eating disorder enabled her to justify skipped meals and the restriction cycle. “I felt guilty asking my grandmother to buy more food that we couldn't afford," she says. “I would lean into isolation, guilt, and invalidation, which my eating disorder thrived on. Food insecurity started my eating disorder by driving high hunger cues and kicking off a binge cycle when access to food was provided.”

Dowell is far from alone in this scenario, as food restriction has been linked to a heightened preoccupation with food and binge eating (in fact, restriction is often at the root of any eating disorder). “The binge-restrict cycle is a well documented pattern of restricting food intake, followed by a craving to eat, and an eventual binge,” Gardner says. “In food-insecure environments, restricting food intake can be a survival mechanism that may lead to a binge when food becomes available, and over time this can engrain disordered eating practices.”

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Barriers to treatment for food-insecure folk

While there are effective treatment strategies for eating disorders, those experiencing food insecurity may have a particularly challenging time accessing care. “People struggling with food insecurity face various barriers to eating disorder treatment, and general medical and mental health care,” Gardner says. “Some barriers include stigma and financial issues. Specifically, ethnic minorities face higher stigma surrounding mental health issues. Financial barriers can also be one of the biggest impediments for people in seeking eating disorder treatment.”

Dowell agrees that the financial aspect of seeking help for food insecurity and eating disorders can pose a major obstacle. “If people are leveraging public assistance for food and healthcare, they have limited options and education on what they can do for their eating disorder,” she says. “Not to mention the shame of not knowing if you can get support, which can drive many folks away from recovery.”

What to do if you’re affected by food insecurity and an eating disorder

While both eating disorders and food insecurity can cause feelings of shame and isolation, it’s important to know that these issues are far more common than they may seem—and that everyone is deserving of help. “If someone is struggling with food insecurity and an eating disorder, it can feel overwhelming and destabilizing,” Gardner says. “Please know you are not alone and there are resources available.”

Gardner says that seeking out mental health resources, professional support, and a support system can all have lasting benefits for those experiencing food insecurity and an eating disorder. “Working towards meeting basic needs lays the foundation for eating disorder recovery,” she says. “Focus on the progress or the ‘wins’ you have each day, do not focus on being perfect.”

In addition to reaching out to local food banks, food pantries, and resources like Feeding America, Gardner recommends that anyone experiencing food insecurity research assistance programs and nonprofit organizations. “Some people may qualify for government assistance like the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC) to receive financial support for purchasing food,” she says. “Eating disorder support resources include Project Heal, National Eating Disorders Association (NEDA), and the Alliance for Eating Disorders. These resources can be a lifeline.”

Dowell advises those facing food insecurity to visit their local state office for public resource assistance. “This can be a great spot to connect with a case manager on what your options are and what is most accessible,” she says. “I would also look to the free resources available, like virtual support groups, meal support groups, educational blogs, and so much more. Resource and information gathering will empower you to take the steps you deserve to heal.”

Gardner hopes more people become aware of the fact that neither food insecurity nor eating are always “visible,” and they don’t discriminate. “Both eating disorders and food insecurity can deeply impact people of all backgrounds, cultures, body sizes, etc., and also deeply affects mental health,” she says. “If you’re struggling with either of these, or both, please know that there is hope. Healing is a process, and it happens one step at a time. Recovery is never linear, and asking for help can be the bravest thing someone can do. No matter how difficult things may seem, there is a path forward, one step at a time.”

Based on her own experience, Dowell agrees. “Do not give up,” she says. “The road can be long, but it’s worth it.”

FAQs

What is food insecurity?

Food insecurity refers to people not having enough to eat and possibly not knowing where their next meals are coming from. About 47 million people, including 14 million children, experience food insecurity annually in the United States.

How does food insecurity lead to eating disorders?

Food insecurity directly affects eating habits because the uncertainty of when and where a meal will come from can cause people to restrict, skip meals, prioritize the feeding of their family members over themselves, and/or prioritize medical expenses over food expenses. Food insecurity is also a psychological stressor that can lead to stress, depression, and anxiety, which are all common among individuals with eating disorders. Additionally, food insecurity can contribute to the binge-restrict cycle, a pattern of restricting food intake, followed by a craving to eat, and an eventual binge. For those in food-insecure environments, food restriction may start as a survival tactic that may lead to a binge when food becomes available.

What eating disorders are most associated with food insecurity?

Food insecurity has been associated with higher rates of binge eating disorder (BED), bulimia nervosa, and overall eating disorder pathology, but anyone can experience any type of eating disorder whether or not they are struggling with food insecurity.

How can you address both food insecurity and an eating disorder?

Seeking out mental health resources, professional support, and a support system can all be beneficial in addressing food insecurity, eating disorders, or both. For those struggling with financial barriers, there are government assistance programs and nonprofits dedicated to helping those in need.