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.
AdamsE. J.Grummer-StrawnL.ChavezG. (2003). Food insecurity is associated with increased risk of obesity in California women. The Journal of Nutrition, 133, 1070–1074.
2.
AlaimoK.OlsonC. M.FrongilloE. 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.
3.
AlegriaM.VilaD.WooM.CaninoG.TakeuchiD.VeraM.. . . ShroutP. (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.
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
6.
ArcelusJ.MitchellA.WalesJ.NielsenS. (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
7.
BeckerC. 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.
8.
BeckerC. B.MiddlemassK.TaylorB.JohnsonC.GomezF. (2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 50, 1031–1040.
9.
BoggianoM. M.ArtigaA. I.PritchettC. E.Chandler-LaneyP. C.SmithM. L.EldridgeA. 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.
BoveC. F.OlsonC. M. (2006). Obesity in low-income rural women: Qualitative insights about physical activity and eating patterns. Women & Health, 44, 57–78.
11.
BruchH. (1973). Evolution of a psychotherapeutic approach to eating disorders: Obesity, anorexia nervosa, and the person within. New York, NY: Basic Books.
12.
BrueningM.MacLehoseR.LothK.StoryM.Neumark-SztainerD. (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.
CartaM. G.PretiA.MoroM. F.AgugliaE.BalestrieriM.CaraciF.. . . HardoyM. 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-WeberC.NarringF.MichaudP. A. (2005). Partial eating disorders among adolescents: A review. Journal of Adolescent Health, 37, 416–426.
15.
Coleman-JensenA.RabbittM.GregoryC.SinghA. (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-JensenA.RabbittM.GregoryC.SinghA. (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
FairburnC. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.
19.
FairburnC. G.CooperZ.ShafranR. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.
FiskeL.FallonE. A.BlissmerB.ReddingC. A. (2014). Prevalence of body dissatisfaction among United States adults: Review and recommendations for future research. Eating Behaviors, 15, 357–365.
22.
GoodmanL. A.PugachM.SkolnikA.SmithL. (2013). Poverty and mental health practice: Within and beyond the 50-minute hour. Journal of Clinical Psychology, 69, 182–190.
23.
GordonK. H.BrattoleM. M.WingateL. R. R.JoinerT. E. (2006). The impact of client race on clinician detection of eating disorders. Behavior Therapy, 37, 319–325.
24.
HadleyC.PatilC. L. (2006). Food insecurity in rural Tanzania is associated with maternal anxiety and depression. American Journal of Human Biology, 18, 359–368.
25.
HadleyC.PatilC. L. (2008). Seasonal changes in household food insecurity and symptoms of anxiety and depression. American Journal of Physical Anthropology, 135, 225–232.
26.
HartL. M.GranilloM. T.JormA. F.PaxtonS. 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.
HermanC. P.PolivyJ. (1975). Anxiety, restraint, and eating behavior. Journal of Abnormal Psychology, 84, 66–72.
28.
HudsonJ. I.HiripiE.PopeH. G.KesslerR.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358.
29.
KärkkäinenU.MustelinL.RaevuoriA.KaprioJ.Keski-RahkonenA. (2018). Do disordered eating behaviours have long-term health-related consequences?European Eating Disorders Review, 26, 22–28.
30.
KatoY.IrvinC. (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.
KazdinA. E.BlaseS. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37.
32.
KazdinA. E. (2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy, 88, 7–18.
33.
KendallA.OlsonC. M.FrongilloE. A.Jr.(1995). Validation of the Radimer/Cornell measures of hunger and food insecurity. The Journal of Nutrition, 125, 2793–2801.
34.
KeysA.BrozekJ.HenschelA.MichelsenO.TaylorH. L.SimonsonE.. . . WellsS. (1950). The biology of human starvation. Volumes 1 and 2. Minneapolis, MN: University of Minnesota Press.
35.
KleinmanR. E.MurphyJ. M.LittleM.PaganoM.WehlerC. A.RegalK.JellinekM. 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.
KrabbenborgM. A.DannerU. N.LarsenJ. K.VeerN.ElburgA. A.RidderD. T.. . . EngelsR. 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.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.
38.
LangT.BarlingD. (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.
LindsayD. S. (2015). Replication in psychological science. Psychological Science, 26, 1827–1832.
40.
LöweB.DeckerO.MüllerS.BrählerE.SchellbergD.HerzogW.HerzbergP. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46, 266–274.
41.
LundC.De SilvaM.PlagersonS.CooperS.ChisholmD.DasJ.. . . PatelV. (2011). Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries. The Lancet, 378, 1502–1514.
42.
McIntyreL.GlanvilleN. T.RaineK. D.DayleJ. B.AndersonB.BattagliaN. (2003). Do low-income lone mothers compromise their nutrition to feed their children?Canadian Medical Association Journal, 168, 686–691.
43.
MehlerP. S. (2017a). Medical complications of anorexia nervosa. In BrownellK. D.WalshB. T. (Eds.), Eating disorders and obesity: A comprehensive handbook (3rd ed., pp. 214–218). New York, NY: Guilford Press.
44.
MehlerP. S. (2017b). Medical complications of bulimia nervosa. In BrownellK. D.WalshB. T. (Eds.), Eating disorders and obesity: A comprehensive handbook (3rd ed., pp. 219–222). New York, NY: Guilford Press.
45.
MitchisonD.BastenC.GriffithsS.MurrayS. 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.
MiddlemassK. M.CruzJ.GamboaA.JohnsonC.TaylorB.GomezF.BeckerC. B. (2018). Moving beyond weight & shape: Dietary restraint and food insecurity in a marginalized population. Manuscript submitted for publication.
47.
Mulders-JonesB.MitchisonD.GirosiF.HayP. (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.
PalarK.KushelM.FrongilloE. A.RileyE. D.GredeN.BangsbergD.WeiserS. 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
PatelV.WeissH. A.ChowdharyN.NalkS.PednekarS.ChatterjeeS.. . . KirkwoodB. 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.
RadimerK. L.OlsonC. M.GreeneJ. C.CampbellC. C.HabichtJ. P. (1992). Understanding hunger and developing indicators to assess it in women and children. Journal of Nutrition Education, 24, 36S–44S.
52.
RasmussonG.LydeckerJ. A.CoffinoJ. A.WhiteM. A.GriloC. M. (2019). Household food insecurity is associated with binge-eating disorder and obesity. International Journal of Eating Disorders, 52, 28–35.
53.
RazykovI.ZiegelsteinR. C.WhooleyM. A.ThombsB. 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.
SmithL. (2005). Psychotherapy, classism, and the poor: Conspicuous by their absence. American Psychologist, 60, 687–696.
57.
SmithL. (2010). Psychology, poverty, and the end of social exclusion: Putting our practice to work (Vol. 7). New York, NY: Teachers College Press.
58.
SonnevilleK. R.LipsonS. 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.
SorsdahlK.SlopenN.SiefertK.SeedatS.SteinD. J.WilliamsD. 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.
SpitzerR. L.KroenkeK.WilliamsJ. B.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.
61.
SticeE.FisherM.MartinezE. (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.
StinsonE. J.VotrubaS. B.VentiC.PerezM.KrakoffJ.GluckM. E. (2018). Food insecurity is associated with maladaptive eating behaviors and objectively measured overeating. Obesity, 26, 1841–1848.
63.
StunkardA. J.MessickS. (1985). The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research, 29, 71–83.
64.
SwansonS.CrowS.Le GrangeD.SwendsenJ.MerikangasK. (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.
TuckerT. (2006). The great starvation experiment: The heroic men who starved so that millions could live. New York, NY: Simon and Schuster.
WeaverL. J.HadleyC. (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.
