Relative food abundance predicts greater binge-eating symptoms in subsequent hours among young adults experiencing food insecurity: Support for the "feast-or-famine" cycle hypothesis from an ecological momentary assessment study

Food Insecurity Predicts Excessive Exercise, Dietary Restriction, Cognitive Restraint, and Purging, but Not Binge Eating, in College Students Across 3 Months

OBJECTIVES

College students are at elevated risk for both food insecurity and eating disorder (ED) symptoms. Prior literature supports cross-sectional associations between food insecurity and ED symptoms, including binge eating, purging (e.g., diuretic and laxative misuse, self-induced vomiting), and dietary restriction. However, less is known about the temporal relation, particularly among college students.

METHODS

We tested associations between food insecurity and cognitive restraint, binge eating, dietary restriction, purging, and excessive exercise across one college semester (three months). College students [N = 259; mean (SD) age = 19.22 (1.23)] were recruited to complete the Eating Pathology Symptoms Inventory (EPSI) and the 30-day version of the United States Department of Agriculture Adult Food Security Survey Module in August (baseline) and November (follow-up). We conducted five multiple regression models to examine baseline food insecurity as a predictor of each EPSI subscale score of interest, adjusting for baseline EPSI score, sociodemographic characteristics, and body mass index.

RESULTS

Baseline food insecurity significantly predicted greater cognitive restraint (β = 0.12, p < 0.05), dietary restriction (β = 0.18, p < 0.001), excessive exercise (β = 0.15, p < 0.01), and purging (β = 0.14, p < 0.05) at follow-up, adjusting for baseline levels, sociodemographic characteristics, and body mass index. Baseline food insecurity did not predict binge eating at follow-up when the baseline level, body mass index, and sociodemographic characteristics were considered.

DISCUSSION

Experiencing food insecurity may contribute to the development or exacerbation of excessive exercise, dietary restriction, cognitive restraint, and purging among college students. Findings highlight the potential need for food insecurity interventions to include support for disordered eating.

Functions of Dietary Restriction and Unique Associations With Mood States Among Young Adults With Food Insecurity: Findings From an Ecological Momentary Assessment Study

OBJECTIVE

Limited research has examined the function or consequences of dietary restriction among individuals for whom it may serve differential purposes, such as those with food insecurity. Indeed, food insecurity may uniquely relate to differential functions for engaging in dietary restriction, which may relate to subsequent changes in mood; this study sought to assess these associations.

METHOD

A subsample of 77 young adults from the Minnesota-based EAT (Eating and Activity over Time) cohort with food insecurity (Mage = 25.2 ± 1.8 years; Women = 72.7%; Black = 18.2%; Latinx = 19.5%; Asian = 18.2%; White = 27.3%) reported on state-level functions for dietary restriction (financial only, weight-control only, or both) versus no restriction, and state-level mood, via ecological momentary assessment (EMA). Demographics-adjusted linear mixed models were conducted to examine the function of dietary restriction since the last EMA signal and current mood.

RESULTS

Across a 14-day EMA period, 29.9% of observations involved dietary restriction due to financial functions only, 6.2% involved dietary restriction due to both financial and weight-control functions, and 3.0% involved restriction for weight-control functions only. Compared to instances of no dietary restriction, overall negative mood was higher after engaging in dietary restriction for both functions (B = 0.43; p = 0.002), but not for financial (B = 0.12; p = 0.14) or weight-control (B = 0.30; p = 0.06) functions only.

DISCUSSION

These findings suggest dual-purpose dietary restriction (i.e., for both financial and weight-control) is common in young adults with food insecurity and may influence mood; thus, it may be an important intervention target.

Anxiety moderates the association between severity of food insecurity and sleep duration among young adults in food-insecure households

This study examined associations between food insecurity (FI) severity, anxiety symptoms, and sleep duration among young adults in food-insecure households. We hypothesized that more severe FI and higher anxiety would independently predict shorter sleep duration, and that anxiety would amplify the FI-sleep duration relationship. Analysis was conducted on a subsample (n = 96) of the EAT 2010-2018 young adult cohort. Participants completed the U.S. Household Food Security Survey Module, Generalized Anxiety Disorder-7, and sleep assessment items. Linear regression models, controlling for demographics, showed that increased anxiety symptoms were associated with decreased sleep duration (p < .001), while FI severity was not significantly associated. A synergistic interaction between FI severity and anxiety (p = .04) revealed that individuals with severe FI and high anxiety had the shortest sleep duration. Results suggest that people struggling with both FI and anxiety may be at high risk of short sleep. Future interventions for individuals with FI should consider anxiety's role in influencing sleep disturbance.

Characterizing the within-person variability of food insecurity in everyday life

Food insecurity (FI), the lack of access to adequate food, is linked with negative health and psychological outcomes. FI is typically measured retrospectively over the last year; although this measurement is useful to understand FI prevalence to inform broad policy, it leaves the experience of FI in everyday life poorly understood. Understanding how FI varies across shorter periods of time (days or weeks) can help inform FI prevention and/or intervention. This study characterizes within-person (day-to-day) variance in FI in everyday life. Low-income parents of school-aged children at risk for FI (n = 153) completed daily text message surveys in two-week bursts. Daily FI was measured with 4 yes/no items ranging in severity: worry about food, parent eating less than they should, child eating less than they should, and skipping meals. Items were analyzed as a sum score and individually (to examine FI severity). Among parents who reported FI at least once, FI meaningfully varied day-to-day within individuals (~26% of variation). Different indicators of FI, however, had different proportions of between- and within-person variability: Worry about food, a less severe aspect of FI, had 32% daily variation, whereas the more severe aspect of meal skipping had 45% daily variation. Thus, although substantial between-person differences in FI exist, there is meaningful within-person variability in FI. -person FI variability may be related to the indicator (e.g., severe FI shows greater within-person variability). Considering within-person FI variability, and not just average FI level, may help us understand how FI undermines functioning and how and when best to intervene.

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied.

OBJECTIVES

This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo.

METHODS

This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end.

RESULTS

Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05).

CONCLUSIONS

Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

The ignored role of disadvantage in eating disorders

The misconception that eating disorders are conditions of affluence has shaped research and public understanding for decades. Here, we highlight links between socioeconomic disadvantage and eating disorder risk. With prevailing stereotypes discredited, we argue that considering disadvantage as a key eating disorder risk factor will advance science and reduce disparities.

Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity

Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.

The relation of food insecurity to eating disorder characteristics and treatment-seeking among adult respondents to the National Eating Disorders Association online screen

BACKGROUND

Food insecurity (FI), characterized by limited or uncertain access to adequate food, has been associated with eating disorders (EDs). This study explored whether FI was associated with ED behaviors, ED diagnosis, current treatment status, and treatment-seeking intentions among adults who completed an online ED screen.

METHODS

Respondents to the National Eating Disorders Association online screening tool self-reported demographics, FI, height and weight, past 3-month ED behaviors, and current treatment status. Respondents were also asked an optional question about treatment-seeking intentions. Hierarchical regressions evaluated relations between FI and ED behaviors, treatment status, and treatment-seeking intentions. Logistic regressions explored differences in probable ED diagnosis by FI status.

RESULTS

Of 8714 respondents, 25 % screened at risk for FI. FI was associated with greater binge eating (R2Change = 0.006), laxative use (R2Change = 0.001), and presence of dietary restriction (R2Change = 0.001, OR: 1.32) (ps < .05). Having FI was associated with greater odds of screening positive for a probable ED or as high risk for an ED (ps < .05). FI was not associated with current treatment status or treatment-seeking intentions (ps > .05).

CONCLUSIONS

Findings add to existing literature supporting a relation between FI and EDs. Implications include a need to disseminate EDs screening and treatment resources to populations affected by FI and to tailor treatments to account for barriers caused by FI.

Food insecurity and binge eating: A systematic review and meta-analysis

OBJECTIVE

This review synthesized literature on the relationship between food insecurity and binge eating.

METHODS

Relevant studies were identified by searching PubMed, CINAHL, PsycINFO, and gray literature from inception to October 2022. Eligible studies included primary research that assessed the relationship between food insecurity and binge eating. Data extraction was performed independently by two reviewers. Pooled odds ratios and 95% confidence intervals (CI) were obtained from random effect models with the R package meta. Analyses were stratified by binge eating versus binge-eating disorder (BED), study type (cross-sectional vs. longitudinal), and age (adults vs. adolescents).

RESULTS

We included 24 articles that reported on 20 studies, and 13 articles were included in the meta-analysis. Based on the random effects meta-analysis, the odds of adults in the food insecure group having binge eating were 1.66 (95% CI = 1.42, 1.93) times the odds of adults in the food secure group having binge eating. The odds of adults in the food insecure group having BED were 2.70 (95% CI = 1.47, 4.96) times the odds of adults in the food secure group having BED. Insufficient data were available for a meta-analysis on adolescents or longitudinal relationships.

CONCLUSIONS

These findings support that food insecurity is associated with binge eating in adults. There is a need for research to investigate the mechanisms underlying this relationship. Results highlight the importance of screening participants with food insecurity for disordered eating behaviors and vice versa. Future research is needed to examine whether interventions targeting food insecurity may help to mitigate disordered eating behaviors.

PUBLIC SIGNIFICANCE

Food insecurity is a common but under-recognized contributor to binge eating. In this article, we systematically reviewed research that has been published on the relationship between food insecurity and binge eating. We found support that food insecurity should be considered in the prevention and treatment of binge eating.

Household food insecurity is associated with greater prevalence and 18-month incidence of a range of disordered eating behaviors in a racially and ethnically diverse sample of parents

This study examined cross-sectional and longitudinal associations between household food insecurity (FI) and a range of disordered eating behaviors (DEBs) and explored whether associations differ by Supplemental Nutrition Assistance Program (SNAP)/Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Data came from 1120 racially/ethnically diverse parents (Mage = 35.7 ± 7.8 years at baseline) in the Family Matters longitudinal cohort study. Parents reported on household FI and SNAP/WIC participation at baseline, and on past-year restrictive weight-control behaviors (WCBs; e.g., fasting), compensatory WCBs (e.g., self-induced vomiting), and binge eating at baseline and 18-month follow-up. Sociodemographics-adjusted modified Poisson regressions examined baseline household FI in relation to baseline prevalence and 18-month incidence (i.e., new onset) of each type of DEB. Moderation by SNAP/WIC participation was also tested. Household FI affected 29.6 % of participants and was associated with significantly greater baseline prevalence (prevalence ratios ranging from 1.38 to 2.69) and 18-month incidence (risk ratios ranging from 1.63 to 2.93) of each type of DEB examined. The association between household FI and incident compensatory WCBs differed significantly by SNAP/WIC participation, such that household FI significantly predicted new-onset compensatory WCBs at follow-up only among those participating in SNAP/WIC. Results from this study are the first, to our knowledge, to demonstrate that FI is longitudinally associated with restrictive and compensatory DEBs, thereby highlighting FI as a risk factor not only for binge eating, but for a range of DEBs. These findings emphasize the importance of screening for FI in clinical settings and the need to address structural barriers to food security.

Disordered eating during pregnancy among individuals participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

Food insecurity is associated with adverse psychosocial and health consequences in pregnancy. In non-pregnant populations, evidence suggests that food insecurity is linked to eating pathology, independent of depression or anxiety. Food assistance programs intended to reduce food insecurity, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), may unintentionally contribute to eating pathology through a "feast-or-famine" cycle (i.e., cyclical periods of food deprivation and food access over the benefit month). Thus, the present study examined associations between WIC participation and disordered eating in pregnancy, covarying for depressive symptoms.

METHODS

The present study is a secondary analysis of the Pittsburgh Girls Study (PGS), a 21-year prospective longitudinal study that over-sampled households in low resourced neighborhoods. The present analysis included a subset of pregnant PGS participants (N = 210; 13-25 years of age) who reported on WIC participation, and disordered eating and depressive symptoms on validated measures.

RESULTS

Negative binomial regression models covarying for participant's age at conception and gestational age at assessment found that WIC participation was associated with higher scores on overall eating pathology as well as dieting and oral control subscales, but not bulimic or food preoccupation subscales, or a binge-eating item. Patterns of findings did not change when depressive symptom severity was included in models.

DISCUSSION

WIC participation was associated with eating pathology during pregnancy. Future research should clarify directional relationships among food insecurity, food assistance, and eating behavior in pregnancy to promote health equity.

The role of stress in the association among food insecurity, eating disorder pathology, and binge eating-related appetitive traits

PURPOSE

Growing literature demonstrates a positive association between food insecurity (FI) and eating disorder pathology. Additionally, FI has been associated with two appetitive traits strongly linked to binge eating, food responsiveness and emotional overeating. However, little research has investigated factors that might help to explain these associations. One hypothesis is that experiencing FI may increase stress, and that eating disorder pathology, particularly binge eating-related phenotypes, may serve as a coping strategy. This study explores stress as a potential mechanism in the association between FI and general eating disorder pathology, as well as two appetitive traits strongly associated with binge eating (food responsiveness and emotional overeating).

METHODS

Cis-gender women (N = 634) completed online questionnaires assessing FI, stress, eating disorder pathology (measured via the total score on the Short Eating Disorder Examination Questionnaire), and binge eating-related appetitive traits (measured via the Adult Eating Behavior Questionnaire). Cross-sectional indirect effects analyses with a 1000-sample bootstrap were used to test pathways among FI, stress, and eating-related constructs.

RESULTS

FI was significantly associated with eating disorder pathology and associated appetitive traits (ps < 0.001). Stress explained a significant proportion of the correlation between FI and each eating-related construct.

CONCLUSIONS

Our findings extend prior research on the relationships between FI, eating disorder pathology, and binge eating-related appetitive traits to provide preliminary evidence that stress may act as an underlying mechanism. Future studies should use longitudinal designs to assess the prospective relationships among these constructs.