Food Insecurity Linked to Binge Eating Disorder, Obesity

Fran Lowry

January 02, 2019

Food insecurity stems from limited financial resources, yet paradoxically, it is associated with binge eating disorder (BED) and excess weight, new research shows.

"Some research has shown a relationship between binge eating and food insecurity, but we wanted to know if food insecurity was related to binge eating that reached the severity level of binge eating disorder," co-author Janet Lydecker, PhD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News.

Symptoms of BED include eating an objectively large amount of food while feeling a loss of control, with episodes occurring at least once a week for at least 3 months.

"Associations between binge eating disorder and food insecurity are not known, yet this is important to examine because binge eating is associated with more severe mental and physical health problems than overeating or obesity alone," she said.

The study was published online December 19 in the International Journal of Eating Disorders.

Obesity Link

Led by Grace Rasmusson, MPH, Yale School of Public Health, the researchers recruited 1251 participants online via Amazon Mechanical Turk, a web-based recruitment platform. Body mass index (BMI) was calculated using participants' self-reported weight and height.

Participants were categorized into three groups. More than half (56.8%, n = 710) were classified as having a healthy weight (BMI, 18.5-24.4 kg/m2) with no eating disorder, 85 participants (6.8%) had BED, and 456 patients (36.5%) were obese with no eating disorder.

Participants were deemed to have food security if they had no difficulty affording regular nutritious meals; low food security if they modified food quality, variety, or desirability to satisfy hunger; and very low food security if they reduced food intake or quality to the point of repeated instances of physiological hunger.

One third (33.7%, n = 422) of participants met the criteria for food insecurity; 18.5% (n = 231) had low food security; and 15.3% (n = 191) had very low food security.

Compared with healthy weight individuals, participants with low food security were 2.5 times more likely to have BED (odds ratio [OR], 2.45; 95% CI, 1.42 - 4.24).

In addition, those with very low food security were almost twice as likely to have BED (OR, 1.91; 95% CI, 1.01 - 3.61).

Similarly, low food security and very low food security were also associated with an increased likelihood of being obese.

For participants with low food security, the OR of being obese was 1.56 (95% CI, 1.13 - 2.15), and for those with very low food security, the OR of being obese was 1.03 (95% CI, 1.02 - 1.04).

Involuntary Food Restriction

The researchers also found that participants with a college and post-college education were less likely to be obese compared with high school and GED education.

"Results of our study highlight the need to devote resources towards policy revisions, preventive interventions, and psychiatric treatments aimed at decreasing the overall association of food insecurity with BED and obesity among low-income Americans," Lydecker said

"As clinicians, we traditionally think about self-imposed dieting, such as skipping meals or cutting back a lot on calories to lose weight, as part of the cause of binge eating.

"Our findings suggest that externally imposed restrictions on food — skipping meals or cutting back on how much you eat because you don't have food available — is also related to binge eating.

"Because binge eating is highly associated with weight gain and obesity, the pattern of fluctuations in meal size and food availability that can come from food insecurity may also contribute to weight gain," she said.

Lydecker added she would recommend that physicians, particularly primary care providers, ask patients about both food insecurity and binge eating.

Psychologists should also ask patients about food insecurity, she said.

"Food insecurity could be a factor making it more difficult for patients to get better if they are not able to address it. In doing this, clinicians and patients with BED can collaborate more effectively to reduce the barriers to treating binge eating," she said.

Potential Mechanism

Commenting on the study for Medscape Medical News, Tomoko Udo, PhD, School of Public Health, University at Albany, SUNY, said the findings were "innovative and important."

"As the paper highlighted, research has suggested a paradoxical relationship between obesity and food insecurity, and one possible hypothesized mechanism is disordered eating behaviors. However, there has been little empirical research that tested this relationship," said Udo, who was not involved in the research.

"The finding of links between food insecurity and obesity and BED are particularly important with low income or food insecure populations. I think we tend to focus on the nutritional quality of food, which is definitely important for health.

"However, a study like this one suggests that to address health disparities, assessment and discussion of how they eat food, in addition to what they eat, should also be part of the conversation in the healthcare setting," she said.

Also commenting on the study for Medscape Medical News, Elizabeth W. Cotter, PhD, American University, Washington, DC, said the findings shed light on a specific mechanism by which food insecurity may lead to obesity.

This may be explained through "the dietary restraint model of binge eating, which suggests that when a person engages in dietary restriction, whether purposefully as a method of controlling caloric intake or because of lack of access to food, they are more likely to engage in binge eating later in response to this deprivation," she said  

Healthcare providers should consider screening for food insecurity and maintaining a list of helpful referrals they can provide to patients, such as food assistance programs and local food banks, Cotter added.

Food insecurity and financial difficulties are also related to stress, anxiety, and depression, which may further exacerbate the risk for BED and obesity, she noted.

"Indeed, research suggests that some people with binge eating disorder are using food as a coping strategy to distract from these negative emotions. Further research should examine which binge eating triggers — for example, emotional distress, dietary restriction — are most relevant in food insecure populations in order to develop more effective interventions," said Cotter.
The study was funded by the National Institutes of Health. Lydecker, Rasmusson, Udo, and Cotter have reported no relevant financial relationships.

Int J Eating Disorder. Published online December 19, 2018. Abstract

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