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. 

"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 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.

Involuntary Food Restriction

The researchers also found that participants with a college and post-college education were less likely to be compared with high school and GED education. "Results of our study highlight the need to devote resources towards policy reviews, 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 on a lot of 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 do not have food available – is also related to binge eating.

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 in 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

"As the paper highlighted, research has suggested a paradoxical relationship between obesity and food insecurity, and one possible hypothesized mechanism is disordered eating behaviors," said Udo. 

"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.

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.

"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.