Food Insecurity and Eating Disorders: a Review of Emerging Evidence:

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This week’s post examines a recent review of emerging evidence examining the potential relationship between food insecurity and eating disorder pathology by Hazzard and colleagues, 2020.

Food insecurity refers to limited ability to access nutritious food, including feelings of not knowing when a next meal may be or inability to afford balanced and regular meals. More recently, food insecurity has been examined as a risk factor for disordered eating due to the feast-or-famine mindset and feelings of restriction it can cause.  While programs aimed at mitigating this issue may be well-intentioned, programs like the U.S. Supplemental Nutrition Assistance Program (SNAP) may have the opposite effect by only delivering benefits once per month. Due to the limited nature of SNAP benefits, users often struggle to budget their benefits for the entire month, creating stress and feelings of food insecurity. Authors examined this risk factor as they describe a study in which participants underwent a semi-starvation phase, they developed an obsession with limiting food intake as well as binge-eating behaviors when food became more available (Hazzard et al., 2020).

Authors also examined research showing that adults experiencing food insecurity were statistically more likely to report binge eating and report a greater severity of binge-eating behaviors compared to food-secure adults. They further highlighted research on the association between food insecurity and compensatory behaviors such as fasting, vomiting, diuretic use, and other behaviors aimed at counteracting the effects of eating. Finally, the review highlights research showing that food insecurity is associated with specific eating disorder diagnoses, including binge-eating disorder, and bulimia nervosa. Taken together, this evidence strongly supports the relationship between food insecurity and eating disorders, with the majority of evidence looking at this relationship in adults. Due to a lack of research, this relationship is less clear in adolescents (Hazzard et al., 2020).

The authors highlight several methodological limitations of the current research that must be considered, including the fact that the majority of samples, although large, were collected using nonprobability sampling techniques, which means that the participant is chosen on a non-random criteria, and not every participant of a certain population has a chance of being included in the study. Another consideration is the fact that different studies use different measurement tools, making it difficult to compare across studies. They also note that the majority of studies are cross-sectional and thus a causal relationship cannot be determined (Hazzard et al., 2020).

The results of this study align with emerging research identifying that eating disorders affect many different marginalized groups, including people of color and those experiencing poverty. Furthermore, the authors discuss implications of this research for clinicians and public health experts. First, it is important to challenge stereotypes surrounding eating disorders. Second, screening for food insecurity should be included as part of the treatment process for eating disorders, and that food insecurity status and the stressors that come with this environment should be considered throughout the treatment plan (Hazzard et al., 2020).

While there is emerging evidence that strongly supports the association between eating disorders and food insecurity, more research is needed to better understand this relationship and more effectively target strategies to mitigate this public health crisis.

Reference:

Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food Insecurity and Eating Disorders: A Review of Emerging Evidence. Eating Disorders, 22(74). https://doi.org/10.1007/s11920-020-01200-0.

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