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

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.

"FBT Is for the Rich": A Qualitative Study Examining Clinicians' Experiences and Perceptions of Treatment Access and Engagement for Diverse Families in Family-Based Treatment

OBJECTIVE

Family-based treatment (FBT) is the leading evidence-based treatment for adolescent eating disorders, but research exploring access and engagement in FBT is sparse. This paper focuses on findings from a broader study, specifically addressing the social determinants of health (SDH) impeding access and engagement in FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices).

METHODS

Forty-one FBT clinicians were recruited globally using purposive and snowball sampling. Clinicians participated in individual interviews or focus groups, discussing their experiences engaging diverse families in FBT. Qualitative data were transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

The findings underscore the pervasive impact of SDH on equitable access to FBT, specifically, the critical need for tailored approaches by clinicians to enhance access and engagement in FBT for diverse families experiencing practical, resource, and systemic barriers. Recommendations include broader dissemination of FBT knowledge, telehealth options to mitigate geographical barriers, community resource collaborations, and sensitivity to cultural and systemic factors impacting treatment engagement.

DISCUSSION

Results of this study may inform future FBT planning (tailoring treatment approaches to address barriers), clinician training, clinical decision-making tools, and opportunities for supporting under-resourced families within the model, leading to more equitable FBT treatment access and engagement for diverse families.

Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes

Research into the risk of anorexia nervosa (AN) has examined twin pairs to further the understanding of the contributions of genetics, trait inheritance, and environmental factors to eating disorder (ED) development. Investigations of twin experiences of EDs have been biologically-based and have not considered the qualitative, phenomenological aspects of twin experiences. A gap in the literature exists regarding understanding of discordant twins with EDs. This research was developed in response, with the aim to deepen understanding of AN in discordant twins and to create novel ideas for further research and testing. The case studies presented in this article provide lived experience insights of two identical discordant twin pairs: one twin pair discordant for longstanding AN and one twin pair discordant for 'atypical' AN (the twin with AN has recovered). The perspectives and experiences of each co-twin (one with AN and one without) explore a number of factors that may have contributed to twin discordance in these cases, and how each twin has responded to the impact of AN in their lives. Through use of first-person accounts in case study presentation, this article centres social justice values of lived experience leadership and involvement in research. This article aims to extend current knowledge and understanding of EDs in discordant twins, particularly regarding risk for ED development, ED duration, diagnosis and treatment, and recovery processes.

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.

Food Insecurity and Food Addiction in a Large, National Sample of Lower-Income Adults

Background

Growing research has highlighted associations between food insecurity and eating-related problems. Food addiction is one important, clinically significant pattern of problematic eating, which is related to, but distinct from, eating disorders. To date, there is only one study examining the association between food insecurity and food addiction, to our knowledge. Additional research is needed to understand the complexities of this association.

Objective

We examined the association between food insecurity and food addiction in a large, national convenience sample of lower-income adults and potential heterogeneity in this association by age, gender, race, and ethnicity.

Design

A cross-sectional, web-based study was conducted among 1780 US adults (≥18 y) with household incomes <250% of the federal poverty guideline. Household food security was assessed using the Household Food Security Survey Module. Food addiction was assessed using the modified Yale Food Addiction Scale (mYFAS), version 2.0. Multivariate logistic regression models examined the associations between food insecurity and food addiction, adjusting for sociodemographic covariates.

Results

The prevalence of food addiction was 7.3%, and the prevalence of food insecurity was 51%. Compared with adults with food security, adults with food insecurity endorsed each mYFAS symptom with significantly greater frequency, including failure to fulfill major role obligations (20%), continued use despite social or interpersonal problems (18%), and craving or strong desire to use (16%). After adjustment, food insecurity was associated with 3.82-fold higher odds of food addiction (95% CI 2.36, 6.19), with no significant heterogeneity by age, gender, or race and ethnicity. The most problematic foods reported by adults with food insecurity were chips, nondiet soda, chocolate, pizza, and ice cream.

Conclusion

These findings provide additional support for the association between food insecurity and food addiction. Mechanistic studies are needed to explore the role of psychosocial factors, eating behaviors, and the food environment in contributing to these associations.