Food insecurity is a growing issue in America: 12.8% of U.S. households, approximately 17 million people, had some form of experience with it in 2022. Food insecurity includes having unstable or inadequate access to food due to factors such as socio-economic status, geographical limitations, or climate-related displacement. With food prices rising, and food deserts limiting access to quality food, more people are facing the physical and mental health consequences of food insecurity. One of those issues is an increased risk for eating disorders.
One study found that up to 17% of those who experience child hunger go on to report eating disorder symptoms in adulthood. In addition, 47% of adolescents who experience food insecurity report unsafe weight control behaviors.
Other studies have found a distinct connection between food insecurity and an increased risk for bulimia and binge eating disorder. Both of these illnesses are perpetuated by the binge-restrict cycle: exhaustion and hunger leads to a period of bingeing due to your biological need to get out of a starvation state. A lack of sufficient food access in food insecurity can mimic the restriction that is present in dieting—and can ultimately also lead to binge eating (and in the case of bulimia, purging).
To get a dietitian’s perspective on the link between food insecurity and eating disorders, we interviewed Amye O'Neal, RDN, LDN, Clinical Dietitian at Equip. Here’s what she advises providers to know about this topic.
What’s the relationship between food insecurity and the development of eating disorders?
There is no single root cause to an eating disorder; it’s the culmination of a perfect storm of factors. Regular and safe access to food is one key factor for many patients. Put in simple terms, when someone lacks adequate food for a period of time, their body doesn’t understand why there’s no food and responds to the lack of food as if there is a famine. Their metabolism slows down to conserve energy. Their body shifts into survival mode. When the person then has access to food again, their brain can signal them to eat as much as possible (which often constitutes binge eating) in anticipation of another famine.
While food insecurity can play a significant role, it’s important that a patient’s care team also address other key contributing factors, such as ongoing medical/health concerns, weight stigmatization, and racial discrimination.
How would you work with a patient who’s experiencing food insecurity and also suffering from an eating disorder?
Often the most important thing for patients experiencing food insecurity is to help them eat enough calories. Using an “all foods fit” philosophy can help to first ensure a patient is meeting their caloric needs. Nutrition deficiencies are also common, and include iron, iodine, Vitamin A and Vitamin D. Generally under-eating and unintended restriction of food groups is the typical cause for these nutrition deficiencies.
Of course, having access to the food to correct nutritional deficiencies or get enough calories isn’t a guarantee for individuals with food insecurity. That’s where the advocacy of a provider, especially a dietitian, can step in. They can help provide nutrition education, unpack common food myths, assist in cheap meal planning, and support efforts in finding free food programs, grocery store reward programs, coupons, and other strategies to reduce food costs or increase quantity.
What are the ties between food insecurity and mental health?
The socio-economic factors that contribute to food insecurity are complex and multifaceted. Financial hardships can make it difficult for individuals to meet their basic needs, including clothing, shelter, and food. Health insurance is another cost barrier that can prevent individuals from accessing the care they need to recover from eating disorders.
These financial hardships can also lead to high levels of stress, which can negatively impact the body and make it difficult for individuals to focus on their recovery. In times of stress, it’s normal for humans to seek comfort, which can increase the risk of a relapse, or of maladaptive coping strategies such as substance use.
Anything else you’d like providers to know about diagnosing or treating eating disorder patients who experience food insecurity?
Typically food insecurity doesn’t happen in isolation. There are usually other socio-economic factors at play that can also affect a patient’s recovery journey, such as challenges related to substance use, transportation, health care, or housing. They may have difficulty storing and preparing food due to lack of resources or facilities.
Providers need to understand these complex factors that affect eating behaviors, and avoid blaming or judging a patient for their situation. Instead, a spirit of collaboration with patients can lead to realistic and flexible solutions that suit their needs and preferences.
Eating disorder treatment has the power to help people transform their relationship to food, and that can include gaining support and tools for combating food insecurity. Equip supports families facing food by taking extra steps to assess their needs and connecting them with resources in their community such as SNAP benefit enrollment or local food banks. We can’t expect people to recover from their eating disorders if they don’t have the tools they need to live full, happy lives.
1. Becker, Carolyn Black, Keesha Middlemass, et al. “Food Insecurity and Eating Disorder Pathology.” International Journal of Eating Disorders 50, no. 9 (2017): 1031–40. https://doi.org/10.1002/eat.22735.
2. Hazzard, Vivienne M., Laura Hooper, et al. “Associations between Severe Food Insecurity and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study.” Preventive Medicine 154 (2022): 106895. https://doi.org/10.1016/j.ypmed.2021.106895.