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There are many known risk factors for eating disorders, such as a history of dieting, anxiety disorders, perfectionism, body image dissatisfaction, and weight-based bullying. However, a less commonly discussed risk factor is food insecurity, or not having access to sufficient food, which can increase the risk of developing an eating disorder.
Food insecurity is a “household-level economic and social condition of limited or uncertain access to adequate food.” (1)
Food insecurity can be temporary, or it can be chronic, lasting for many years or even throughout a lifetime.
One of the defining qualities of food insecurity is the disruption of normal eating patterns, including reduced food intake, due to a lack of financial resources necessary to buy food. (1)
A national survey on food insecurity found that for households with very low food security: (1)
Food insecurity is a systemic issue affecting over 38 million people in the US as of 2020. (2) There are many different causes of food insecurity across the country, such as:
Many people live in areas in which there is limited or no access to a variety of affordable and accessible foods. This might mean that the community doesn’t have a grocery store or that the food in their area is too expensive to reasonably afford. Lack of access to food can also result from limited access to transportation, making it difficult to travel elsewhere to get adequate affordable food.
Binge eating disorder (BED) is characterized by a pattern of binge eating episodes involving at least once a week for a three-month period. (3)
Binge eating episodes occur when a person consumes an abnormally large amount of food in a short period of time. People engaging in binge eating may experience little or no control over what and how much they’re eating. (3)
Binge eating disorder affects people of all sizes, weights, genders, and races. (3)
Many people don’t meet the full criteria for binge eating disorder but do engage in binge eating episodes. (3)
When an individual doesn’t have access to consistent meals, it can cause significant cognitive, behavioral, and emotional changes, including an obsession or preoccupation with food. Someone who is hungry and doesn’t have enough food may spend a significant amount of time dreaming or fantasizing about their next meal. (4)
This preoccupation with food can increase the likelihood of binge eating episodes once food becomes available. People with food insecurity may engage in overeating once they have access to food again after receiving SNAP benefits or a paycheck. (4)
This is known as a feast-or-famine cycle and can lead to significant fluctuations in food consumption and a pattern of binge eating episodes. Without treatment or intervention, binge eating episodes can escalate and turn into binge eating disorder.
Research indicates that people with food insecurity are more likely to report binge eating episodes than those with food security among emerging adults and their parents. Over 25% of emerging adults and 11.3% of parents experiencing food insecurity reported binge eating compared to 18.4% of emerging adults and 6.4% of parents with food security. (4)
Further, food-insecure adults experience more severe binge eating episodes than those with food security. (4)
People experiencing food insecurity may also develop other types of eating disorders and disordered eating behaviors besides BED. Some evidence indicates that food insecurity also increases the risk of developing bulimia nervosa (BN) and related disorders. (4)
Until recent years, research about food insecurity and eating disorders has been limited, likely due to misconceptions about those struggling with eating disorders. Historically, people have falsely believed that eating disorders only affect thin, white, affluent girls and women. However, food insecurity disproportionately affects people of color and low-income individuals and families. Additionally, researchers have also historically overlooked individuals with eating disorders of any kind who are in higher weight bodies.
The truth is, eating disorders affect people of all weights, ages, genders, races, ethnicities, and socioeconomic backgrounds. And yet, to this day, the myth of eating disorders being a young, thin, white woman’s condition is often still perpetuated.
Unfortunately, this myth has influenced research, assessment, diagnosis, prevention, and treatment. This even shows up in diagnostic criteria for eating disorders like anorexia nervosa (AN), such as:
These behaviors can also be the result of food insecurity, with people restricting calories not as an attempt to lose weight or obtain a smaller body, but to make food last longer in their household. Caloric restriction, for whatever reason, can have negative mental and physical health consequences and is a risk factor for eating disorder development.
Despite the overlap in behaviors, this parallel has been ignored in eating disorder research because of the myth about who eating disorders typically impact. It’s time professionals in the field begin expanding their research to include people of diverse backgrounds and experiences.
Reducing food insecurity and providing more accessible and inclusive types of eating disorder treatment are also crucial for addressing the issues covered in this article. Lack of access to consistent, affordable, and adequate food can make it difficult or impossible for an individual to recover from an eating disorder. Individuals who are able to attend eating disorder treatment face a significant impediment to maintaining recovery if they do not have access to food security after leaving treatment.
Children and adults in low-income households may not be able to access eating disorder treatment at all due to not having health insurance, not being able to afford treatment due to prohibitively high costs, or being unable to take time away from work or childcare to attend treatment. Many forms of treatment are not culturally responsive or culturally competent regarding the needs and experiences of individuals with eating disorders who are BIPOC and/or who experience past or ongoing food insecurity. Peer support, alternative types of care, scholarships for treatment, and provider education around these intersecting issues are all crucial factors for providing help to people with eating disorders who are experiencing food insecurity.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
