A qualitative investigation of body weight and weight loss-related attitudes of mothers and fathers in the context of food insecurity

The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review

BACKGROUND

Food insecurity and obesity are increasing both globally and in the UK. In this review we systematically assess the lived experiences of people with obesity who are food insecure and often turn to food banks.

METHODS

We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematic analysis and narrative synthesis approach was used to analyse the extracted data.

RESULTS

Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the food environment; food practices in the home; experience of food assistance; and parental-child relationships. The cost of healthy food and psychological factors were identified as key driving factors of the relationship between food insecurity and obesity. Psychological factors such as depression, low self-esteem and stress played an important part in the lived experience of people with obesity and food insecurity.

CONCLUSION

The food environment provides context in which food decisions are made, therefore, systems change is necessary to ensure families can afford the food that enables a healthy diet. For clinicians, identification, and attention to the impact of food insecurity on people with obesity are important.

Preliminary associations of body weight, weight bias, and dietary restriction with eating disorder diagnosis in women experiencing food insecurity

Understanding the co-occurrence of food insecurity and eating disorders is a pressing concern. Several factors have been hypothesized to increase risk for eating disorders in women with food insecurity including dietary restriction, body weight, and weight-related bias, but few studies have tested these factors simultaneously to determine which are associated most strongly with eating disorder status. We tested cross-sectional associations of dietary restriction, current body mass index (BMI), weight suppression (i.e. the difference between current weight and highest weight), and weight bias with eating disorder diagnosis in a sample of 99 self-identified women with current food insecurity (54% White; mean [SD] age = 40.26 [14.33] years). Participants completed two virtual study visits consisting of electronic questionnaires and interviews. A binary logistic regression model was conducted to test relations between the hypothesized correlates and eating disorder diagnostic status in the past 12 months, controlling for age, food insecurity severity, and body dissatisfaction. Higher levels of weight suppression and weight bias, but not current BMI, were significantly associated with the presence of an eating disorder. Contrary to our hypothesis, greater dietary restriction was associated with lower likelihood of eating disorder diagnosis. Results suggest high levels of weight bias and weight suppression characterize women with food insecurity who meet criteria for an eating disorder. Women who experience food insecurity and have lost a relatively great deal of weight and/or hold biases about high weight should be screened for eating pathology in clinical settings.

Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity

Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.

Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences

Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities.

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

This study examined cross-sectional and longitudinal associations between household food insecurity (FI) and a range of disordered eating behaviors (DEBs) and explored whether associations differ by Supplemental Nutrition Assistance Program (SNAP)/Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Data came from 1120 racially/ethnically diverse parents (Mage = 35.7 ± 7.8 years at baseline) in the Family Matters longitudinal cohort study. Parents reported on household FI and SNAP/WIC participation at baseline, and on past-year restrictive weight-control behaviors (WCBs; e.g., fasting), compensatory WCBs (e.g., self-induced vomiting), and binge eating at baseline and 18-month follow-up. Sociodemographics-adjusted modified Poisson regressions examined baseline household FI in relation to baseline prevalence and 18-month incidence (i.e., new onset) of each type of DEB. Moderation by SNAP/WIC participation was also tested. Household FI affected 29.6 % of participants and was associated with significantly greater baseline prevalence (prevalence ratios ranging from 1.38 to 2.69) and 18-month incidence (risk ratios ranging from 1.63 to 2.93) of each type of DEB examined. The association between household FI and incident compensatory WCBs differed significantly by SNAP/WIC participation, such that household FI significantly predicted new-onset compensatory WCBs at follow-up only among those participating in SNAP/WIC. Results from this study are the first, to our knowledge, to demonstrate that FI is longitudinally associated with restrictive and compensatory DEBs, thereby highlighting FI as a risk factor not only for binge eating, but for a range of DEBs. These findings emphasize the importance of screening for FI in clinical settings and the need to address structural barriers to food security.

A UK-wide survey of healthcare professionals' awareness, knowledge and skills of the impact of food insecurity on eating disorder treatment

OBJECTIVE

Food insecurity (FI) is associated with significant adverse effects on health and well-being and increasingly recognised as a global problem. The current study explored the impact of FI on eating disorder (ED) clinical practice in the UK, aiming to assess healthcare professionals' (HCPs) knowledge, skills and views on the topic of FI in their patients.

DESIGN

This study was an exploratory, mixed-methods, descriptive analysis of online survey data collected from ED HCPs in the UK between September and October 2022.

MEASURES

A 15-item survey with rating and open-ended questions was circulated to ED professional organisations in the UK. Descriptive statistics were used to summarise quantitative data, including perceived prevalence of FI in ED clinical practice and confidence in knowledge on the topic. Descriptive content analyses provided insight into perspectives on FI screening and aspects to be included in guidance and resources.

RESULTS

93 ED HCPs completed the survey (40.9 % psychologists). Findings demonstrated healthcare providers' limited knowledge on FI and its relation to EDs, while they increasingly perceive it in their patients, as well as a general lack of available resources on how to address FI in ED treatment. HCPs stressed the need for practical guidance and formal training for dealing with FI in their patients, as well as implementing routine screening.

CONCLUSION

These findings provide both important directions for future research and clinical applications related to screening, assessment, treatment and support of food-insecure patients with EDs.

Exploring the intersection of multiple social determinants of health and disordered eating behaviors in a population-based sample in the United States

OBJECTIVE

Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors).

METHOD

Participants (n = 1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood.

RESULTS

The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p = .003), gender (p < .001), and everyday discrimination (p = .008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p = .008) and neighborhood safety (p = .007) in adolescence.

DISCUSSION

This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood.

PUBLIC SIGNIFICANCE STATEMENT

Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk subgroups of emerging adults that should be examined further in hypothesis-driven research.

Motivation for dietary restraint, and disordered eating among adults experiencing food insecurity in the United States

OBJECTIVE

Does engaging in dietary restraint due to weight/shape concerns versus economic hardship differentially relate to disordered eating?

METHOD

The sample consisted of 582 adults experiencing food insecurity (FI) who completed online measures assessing severity of FI, disordered eating, loss of control over eating, and dietary restraint. Participants reported their motivation for dietary restraint with options consisting of weight/shape concerns, economic hardship (i.e., insufficient funds and prioritizing others' needs), mixed reasons, and other/I do not know.

RESULTS

In the sample, 18% reported engaging in dietary restraint primarily due to weight/shape concerns, 33% due to economic hardship, 18% other/do not know, and 30% due to a mix of reasons. There were positive correlations between FI, economic hardship, dietary restraint, disordered eating, and loss of control over eating. Regression analyses revealed the association between dietary restraint and disordered eating does not differ across individuals who endorse economic hardship as a motivator for dietary restraint. Findings replicated with loss of control. However, the association between dietary restraint and disordered eating grew stronger as more dietary restraint due to weight/shape concerns was endorsed. No significant association emerged with loss of control.

DISCUSSION

Research is needed to replicate findings and examine how patterns of food scarcity impacts disordered eating in food insecure populations with and without weight/shape concerns. Findings suggest that motivation for dietary restraint may influence associations with dietary restraint and the cognitive components of disordered eating, but not the behavioral components of disordered eating.

PUBLIC SIGNIFICANCE STATEMENT

Disordered eating due to dietary restraint is most commonly associated with weight and shape concerns; however, even when dietary restraint is due to economic reasons, it can still be associated with disordered eating.

Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood

BACKGROUND

Disordered eating behaviors (DEB) are highly prevalent and are associated with negative long-term health outcomes. Extant research on DEB prevalence trajectories has predominantly focused on white women, thereby lacking both gender and ethnic/racial diversity, which may lead to preventive interventions that are not optimally timed for socially minoritized groups. The purpose of this study was to identify patterns in DEB trajectories from adolescence to adulthood across intersecting gender and ethnic/racial identities.

METHODS

Participants (n = 1314) were from Project EAT (Eating and Activity in Teens and Young Adults), a population-based sample in the United States. Unhealthy weight control behaviors and binge eating were assessed across four waves at 5-year intervals. Gender-stratified generalized estimating equations (GEE) analyses were applied to examine ethnic/racial and gender differences in the prevalence trajectories of two forms of DEB (unhealthy weight control behaviors and binge eating).

RESULTS

Hispanic/Latina young women reported heightened prevalence of unhealthy weight control behaviors and binge eating during adolescence (82.4% and 31.1%) relative to women with other ethnic/racial identities (44-70.2% and 8.8-18.2%) at any other developmental time point. Black/African American women reported linear increases in unhealthy weight control behaviors from adolescence (46.6%) to adulthood (65.5%), with nearly 20% greater prevalence relative to white women (44.6%) during adulthood. Among men, prevalence of unhealthy weight control behaviors was higher among Hispanic/Latinos (60.7-68.0%) and Asian Americans (41.9-56.7%) relative to Black/African American (24.6-36.9%) and white men (25.7-34.9%). Similarly, Hispanic/Latino young men reported up to ten or more times higher prevalence of binge eating during adolescence (22.8%) and adulthood (26.8%) relative to men from other ethnic/racial identities at any other time point (1.7-12.3%).

CONCLUSIONS

Ethnic/racial disparities in DEB prevalence vary across development, DEB subtype, and by gender. Targeted preventive interventions, or interventions that address these different trajectories, that are optimally timed may reduce these disparities.

Associations between severe food insecurity and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study

Emerging evidence suggests a cross-sectional association between food insecurity (FI) and disordered eating among adults, while evidence among adolescents is limited. Longitudinal research is needed to elucidate the temporality of this relationship and clarify whether the association differs by age. Three waves of prospective data came from 1813 participants in the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Data were collected at five-year intervals, with the baseline survey in 1998-1999 (EAT-I; M_age = 14.9 years) and follow-up surveys in 2003-2004 (EAT-II; M_age = 19.5 years) and 2008-2009 (EAT-III; M_age = 24.9 years). Severe FI was assessed as any past-year hunger with one item from the U.S. Household Food Security Survey Module, and a range of disordered eating behaviors were self-reported. Associations adjusted for sociodemographic characteristics were examined with generalized estimating equations. Effect modification by age was also tested. Cross-sectionally, severe FI was significantly associated with greater prevalence of all disordered eating behaviors examined, with the strongest associations observed for extreme weight-control behaviors (prevalence ratio [PR] = 1.49, 95% confidence interval [CI]: 1.13-1.95) and binge eating (PR = 1.49, 95% CI: 1.04-2.12). Longitudinally, severe FI significantly predicted 1.41 (95% CI: 1.05-1.90) times greater prevalence of binge eating five years later after accounting for prior binge eating. Effect modification by age indicated a stronger cross-sectional association between severe FI and unhealthy weight-control behaviors among younger participants. Results support a cross-sectional link between severe FI and disordered eating and provide longitudinal evidence suggesting severe FI is a risk factor for binge eating.

Food insecurity, dietary acid load, dietary energy density and anthropometric indices among Iranian children

OBJECTIVES

Food insecurity significantly influences diet quality which in turn has an impact on individual health. This study aimed to determine the association of food insecurity, dietary energy density (DED), dietary acid load (DAL), and the anthropometric status of children.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted in 788 6-year-old girls who were referred to health care centers affiliated with Tehran University of Medical Sciences in the south of Tehran from October 2017 to March 2018. Food frequency questionnaires (168 food items) were assessed to calculate DAL and DED. Food insecurity was assessed using the 18-item United States Department of Agriculture questionnaire. Weight and height of children were measured as anthropometric indices.

RESULTS

Protein and energy intake were higher in participants with a higher DAL and DED, respectively. Energy, fat, carbohydrate, fiber, potassium, phosphorus, calcium, iron, folate, vitamin B12, mono- and poly-unsaturated fatty acid intake was inversely related to DAL. Children characterized as food insecure were more likely to be defined as thin (OR 5.36; 95% CI 3.41-8.40) than overweight (OR 0.18; 95% CI 0.12-027) and obese (OR 0.28; 95% CI 0.08-0.98, respectively). There was no significant association between DED, potential renal acid load (PRAL), and food security status. Moreover, there was no significant association between anthropometric measure and PRAL.

CONCLUSION

Findings from our study revealed that there was no association between DAL and food insecurity. However, food insecure children were more likely to be characterized as thin than children categorized as food secure. More studies need to be performed in both genders to confirm our findings.

LEVEL OF EVIDENCE

Level V cross-sectional descriptive study.

Students with Food Insecurity Are More Likely to Screen Positive for an Eating Disorder at a Large, Public University in the Midwest

BACKGROUND

College students experience a disproportionately high prevalence of both food insecurity and eating disorders. Food insecurity is associated with stress, irregular eating patterns, weight change, depression, and body dissatisfaction, making it a possible risk factor for the onset of eating disorders. However, the association between food insecurity and eating disorders among college students is not well understood.

OBJECTIVE

This study explored the relation between food insecurity and screening positive for an eating disorder among students attending a large, public Midwestern university.

DESIGN

Cross-sectional data were collected using an online survey administered from March through June 2018.

PARTICIPANTS/SETTING

Participants were recruited from a random sample of 2,000 students, with oversampling from the following groups: racial/ethnic minorities, first-generation students, and students from lower-income households. Of those sampled, 851 students (43%) responded. The final analytic sample comprised 804 students after excluding those with missing data.

MAIN OUTCOME MEASURE

The validated 5-item Sick, Control, One stone, Fat, Food (SCOFF) questionnaire was used to screen for the presence of an eating disorder.

STATISTICAL ANALYSES PERFORMED

Poisson regression was used to model prevalence ratios for positive SCOFF screens (≥2 affirmative responses) by levels of food security (ie, high, marginal, low, or very low). Models were adjusted for sex, age, race/ethnicity, degree type, financial aid, and first-generation student status.

RESULTS

Compared to students with high food security, a higher prevalence of positive SCOFF screens was found among students with marginal food security (prevalence ratio [PR], 1.83, 95% CI 1.26 to 2.65; P = 0.001), low food security (PR 1.72, 95% CI 1.16 to 2.54; P = 0.007), and very low food security (PR 2.83, 95% CI 2.01 to 3.97; P < .0001).

CONCLUSIONS

Students with food insecurity at any level were more likely to screen positive for an eating disorder via the SCOFF questionnaire. Prospective studies are needed to determine whether food insecurity is a risk factor for the onset of eating disorders among college students.