Eating Disorder Pathology Among Individuals Living With Food Insecurity: A Replication Study

Abstract

Eating disorders (EDs) are stereotypically associated with thin, White, affluent women and girls. One result of the ED stereotype has been a relative dearth of ED research with marginalized communities. The aim of this study was to replicate recent findings showing an association between the severity of food insecurity (FI) and increased ED pathology. Participants included 891 clients of an urban food bank. Results were consistent with the findings of previous research; participants in the most severe FI group reported significantly higher levels of ED pathology, dietary restraint, anxiety, and depression. Findings provide further evidence that the thin, White, affluent, female ED stereotype offers a flawed portrait and highlight the need for additional psychological research that focuses on marginalized populations to address disparities in access to care. Both scholars and clinicians need to move away from the stereotypical portrait of who is and is not at risk for developing an ED.

Keywords

food insecurity eating disorders binge eating marginalized populations race and ethnicity

Get full access to this article

View all access options for this article.

References

Adams

E. J.

Grummer-Strawn

Chavez

(2003). Food insecurity is associated with increased risk of obesity in California women. The Journal of Nutrition, 133, 1070–1074.

Alaimo

Olson

C. M.

Frongillo

E. A.

(2002). Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. The Journal of Nutrition, 132, 719–725.

Alegria

Vila

Woo

Canino

Takeuchi

Vera

. . . Shrout

(2004). Cultural relevance and equivalence in the NLAAS instrument: Integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos. International Journal of Methods in Psychiatric Research, 13, 270–288.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Arcelus

Mitchell

Wales

Nielsen

(2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68, 724–731. doi:10.1001/archgenpsychiatry.2011.74

Becker

C. B.

(2017). From efficacy to global impact: Lessons learned about what-not-to-do in translating our research to reach. Behavior Therapy, 48, 718–730.

Becker

C. B.

Middlemass

Taylor

Johnson

Gomez

(2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 50, 1031–1040.

Boggiano

M. M.

Artiga

A. I.

Pritchett

C. E.

Chandler-Laney

P. C.

Smith

M. L.

Eldridge

A. J.

(2007). High intake of palatable food predicts binge-eating independent of susceptibility to obesity: An animal model of lean vs obese binge-eating and obesity with and without binge-eating. International Journal of Obesity, 31, 1357–1367. doi:10.1038/sj.ijo.0803614

10.

Bove

C. F.

Olson

C. M.

(2006). Obesity in low-income rural women: Qualitative insights about physical activity and eating patterns. Women & Health, 44, 57–78.

11.

Bruch

(1973). Evolution of a psychotherapeutic approach to eating disorders: Obesity, anorexia nervosa, and the person within. New York, NY: Basic Books.

12.

Bruening

MacLehose

Loth

Story

Neumark-Sztainer

(2012). Feeding a family in a recession: Food insecurity among Minnesota parents. American Journal of Public Health, 102, 520–526. doi:10.2105/AJPH.2011.300390

13.

Carta

M. G.

Preti

Moro

M. F.

Aguglia

Balestrieri

Caraci

. . . Hardoy

M. C.

(2014). Eating disorders as a public health issue: Prevalence and attributable impairment of quality of life in an Italian community sample. International Review of Psychiatry, 26, 486–492.

14.

Chamay-Weber

Narring

Michaud

P. A.

(2005). Partial eating disorders among adolescents: A review. Journal of Adolescent Health, 37, 416–426.

15.

Coleman-Jensen

Rabbitt

Gregory

Singh

(2016). Household food security in the United States in 2015 (Research Report No. ERR-215). Washington, DC: U.S. Department of Agriculture. Retrieved from https://www.ers.usda.gov/webdocs/publications/79761/err-215.pdf

16.

Coleman-Jensen

Rabbitt

Gregory

Singh

(2017). Household food security in the United States in 2016 (Research Report No. ERR-237). Washington, DC: U.S. Department of Agriculture. Retrieved from https://www.ers.usda.gov/webdocs/publications/84973/err-237.pdf

17.

Dutko

(2012). Food deserts suffer persistent socioeconomic disadvantage. Choices, 27(3). Retrieved from http://www.jstor.org/stable/choices.27.3.02

18.

Fairburn

C. G.

(2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.

19.

Fairburn

C. G.

Cooper

Shafran

(2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.

20.

Feeding Texas. (2015, April 17). National study maps food insecurity in every Texas County. Retrieved from https://www.feedingtexas.org/press/2015/04/National-Study-Maps-Food-Insecurity-In-Every-Texas-County

21.

Fiske

Fallon

E. A.

Blissmer

Redding

C. A.

(2014). Prevalence of body dissatisfaction among United States adults: Review and recommendations for future research. Eating Behaviors, 15, 357–365.

22.

Goodman

L. A.

Pugach

Skolnik

Smith

(2013). Poverty and mental health practice: Within and beyond the 50-minute hour. Journal of Clinical Psychology, 69, 182–190.

23.

Gordon

K. H.

Brattole

M. M.

Wingate

L. R. R.

Joiner

T. E.

(2006). The impact of client race on clinician detection of eating disorders. Behavior Therapy, 37, 319–325.

24.

Hadley

Patil

C. L.

(2006). Food insecurity in rural Tanzania is associated with maternal anxiety and depression. American Journal of Human Biology, 18, 359–368.

25.

Hadley

Patil

C. L.

(2008). Seasonal changes in household food insecurity and symptoms of anxiety and depression. American Journal of Physical Anthropology, 135, 225–232.

26.

Hart

L. M.

Granillo

M. T.

Jorm

A. F.

Paxton

S. J.

(2011). Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases. Clinical Psychology Review, 31, 727–735.

27.

Herman

C. P.

Polivy

(1975). Anxiety, restraint, and eating behavior. Journal of Abnormal Psychology, 84, 66–72.

28.

Hudson

J. I.

Hiripi

Pope

H. G.

Kessler

R.C.

(2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358.

29.

Kärkkäinen

Mustelin

Raevuori

Kaprio

Keski-Rahkonen

(2018). Do disordered eating behaviours have long-term health-related consequences? European Eating Disorders Review, 26, 22–28.

30.

Kato

Irvin

(2013). Flow of food and people across the city: An examination of local food access in a New Orleans food desert. Spaces and Flows, 3, 45–56. doi:10.18848/2154-676/CGP/v03i02/53693

31.

Kazdin

A. E.

Blase

S. L.

(2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37.

32.

Kazdin

A. E.

(2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy, 88, 7–18.

33.

Kendall

Olson

C. M.

Frongillo

E. A.

Jr. (1995). Validation of the Radimer/Cornell measures of hunger and food insecurity. The Journal of Nutrition, 125, 2793–2801.

34.

Keys

Brozek

Henschel

Michelsen

Taylor

H. L.

Simonson

. . . Wells

(1950). The biology of human starvation. Volumes 1 and 2. Minneapolis, MN: University of Minnesota Press.

35.

Kleinman

R. E.

Murphy

J. M.

Little

Pagano

Wehler

C. A.

Regal

Jellinek

M. S.

(1998). Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics, 101(1), Article E3. Retrieved from https://pediatrics.aappublications.org/content/101/1/e3.long

36.

Krabbenborg

M. A.

Danner

U. N.

Larsen

J. K.

Veer

Elburg

A. A.

Ridder

D. T.

. . . Engels

R. C.

(2012). The eating disorder diagnostic scale: Psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls. European Eating Disorders Review, 20, 315–320. doi:10.1002/erv.1144

37.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

38.

Lang

Barling

(2012). Food security and food sustainability: Reformulating the debate. The Geographical Journal, 178, 313–326. doi:10.1111/j.1475-4959.2012.00480.x

39.

Lindsay

D. S.

(2015). Replication in psychological science. Psychological Science, 26, 1827–1832.

40.

Löwe

Decker

Müller

Brähler

Schellberg

Herzog

Herzberg

P. Y.

(2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46, 266–274.

41.

Lund

De Silva

Plagerson

Cooper

Chisholm

Das

. . . Patel

(2011). Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries. The Lancet, 378, 1502–1514.

42.

McIntyre

Glanville

N. T.

Raine

K. D.

Dayle

J. B.

Anderson

Battaglia

(2003). Do low-income lone mothers compromise their nutrition to feed their children? Canadian Medical Association Journal, 168, 686–691.

43.

Mehler

P. S.

(2017a). Medical complications of anorexia nervosa. In Brownell

K. D.

Walsh

B. T.

(Eds.), Eating disorders and obesity: A comprehensive handbook (3rd ed., pp. 214–218). New York, NY: Guilford Press.

44.

Mehler

P. S.

(2017b). Medical complications of bulimia nervosa. In Brownell

K. D.

Walsh

B. T.

(Eds.), Eating disorders and obesity: A comprehensive handbook (3rd ed., pp. 219–222). New York, NY: Guilford Press.

45.

Mitchison

Basten

Griffiths

Murray

S. B.

(2017). Beneath the tip of the iceberg: Why so many people with eating disorders are not referred for treatment. Australian Family Physician, 46, 539–540.

46.

Middlemass

K. M.

Cruz

Gamboa

Johnson

Taylor

Gomez

Becker

C. B.

(2018). Moving beyond weight & shape: Dietary restraint and food insecurity in a marginalized population. Manuscript submitted for publication.

47.

Mulders-Jones

Mitchison

Girosi

Hay

(2017). Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLOS ONE, 12(1), Article e0170603. doi:10.1371/journal.pone.0170603.

48.

Palar

Kushel

Frongillo

E. A.

Riley

E. D.

Grede

Bangsberg

Weiser

S. D.

(2015). Food insecurity is longitudinally associated with depressive symptoms among homeless and marginally-housed individuals living with HIV. AIDS and Behavior, 19, 1527–1534. doi:10.1007/s10461-014-0922-9

49.

Patel

. (n.d.). Filmmaker Tachaiko Omawale is opening a conversation about Black women and eating disorders [Blog post]. Retrieved from https://www.nationaleatingdisorders.org/blog/filmmaker-tchaiko-omawale-opening-conversation-about-black-women-and-eating-disorders

50.

Patel

Weiss

H. A.

Chowdhary

Nalk

Pednekar

Chatterjee

. . . Kirkwood

B. R.

(2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomized controlled trial. Lancet, 18, 2086–2095.

51.

Radimer

K. L.

Olson

C. M.

Greene

J. C.

Campbell

C. C.

Habicht

J. P.

(1992). Understanding hunger and developing indicators to assess it in women and children. Journal of Nutrition Education, 24, 36S–44S.

52.

Rasmusson

Lydecker

J. A.

Coffino

J. A.

White

M. A.

Grilo

C. M.

(2019). Household food insecurity is associated with binge-eating disorder and obesity. International Journal of Eating Disorders, 52, 28–35.

53.

Razykov

Ziegelstein

R. C.

Whooley

M. A.

Thombs

B. D.

(2012). The PHQ-9 versus the PHQ-8: Is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study. Journal of Psychosomatic Research, 73, 163–168.

54.

Rentiera

(2011, September 29). Hispanics in San Antonio. San Antonio Express News. Retrieved from https://www.mysanantonio.com/sacultura/conexion/article/Hispanics-in-San-Antonio-2192950.php

55.

Royall

(2018, September 13). San Antonio ranks among nation’s highest-poverty cities. The Rivard Report. Retrieved from https://therivardreport.com/san-antonio-ranked-among-nations-highest-poverty-cities

56.

Smith

(2005). Psychotherapy, classism, and the poor: Conspicuous by their absence. American Psychologist, 60, 687–696.

57.

Smith

(2010). Psychology, poverty, and the end of social exclusion: Putting our practice to work (Vol. 7). New York, NY: Teachers College Press.

58.

Sonneville

K. R.

Lipson

S. K.

(2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51, 518–526. doi:10.1002/eat.22846

59.

Sorsdahl

Slopen

Siefert

Seedat

Stein

D. J.

Williams

D. R.

(2010). Household food insufficiency and mental health in South Africa. Journal of Epidemiology and Community Health, 65, 426–431. doi:10.1136/jech.2009.091462

60.

Spitzer

R. L.

Kroenke

Williams

J. B.

Löwe

(2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.

61.

Stice

Fisher

Martinez

(2004). Eating disorder diagnostic scale: Additional evidence of reliability and validity. Psychological Assessment, 16, 60–71. doi:10.1037/1040-3590.16.1.60

62.

Stinson

E. J.

Votruba

S. B.

Venti

Perez

Krakoff

Gluck

M. E.

(2018). Food insecurity is associated with maladaptive eating behaviors and objectively measured overeating. Obesity, 26, 1841–1848.

63.

Stunkard

A. J.

Messick

(1985). The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research, 29, 71–83.

64.

Swanson

Crow

Le Grange

Swendsen

Merikangas

(2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68, 714–723. doi:10.1001/archgenpsychiatry.2011.22

65.

Tucker

(2006). The great starvation experiment: The heroic men who starved so that millions could live. New York, NY: Simon and Schuster.

66.

U.S. Census Bureau. (2016). American Community Survey 5-year Estimates. Retrieved from https://censusreporter.org/profiles/16000US4865000-san-antonio-tx

67.

Weaver

L. J.

Hadley

(2009). Moving beyond hunger and nutrition: A systematic review of the evidence linking food insecurity and mental health in developing countries. Ecology of Food and Nutrition, 48, 263–284.