Depression Affects Emotional Eating and Dietary Intake and Is Related to Food Insecurity in a Group of Multiethnic, Low-income Women

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.

Food Insecurity Is Associated With Dysfunctional Eating Behaviors Among Adults in Puerto Rico

OBJECTIVE

To examine the association between food insecurity and dysfunctional eating behaviors among adults in Puerto Rico.

METHODS

Data from 865 participants were obtained from baseline interviews from the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. The association between food insecurity and emotional eating (EE) and uncontrolled eating (UE) (categorized as no/moderate/high) was examined using multinomial logistic models. Potential mediation by perceived stress was explored.

RESULTS

The prevalence of food insecurity was 20.3%. Compared with adults with food security, adults with food insecurity had higher odds of both moderate EE (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.18-3.09) and high EE (OR, 2.85; 95% CI, 1.75-4.64), and both moderate UE (OR, 1.78; 95% CI, 0.91-3.50) and high UE (OR, 3.28; 95% CI, 1.70-6.33). Perceived stress slightly attenuated these associations.

CONCLUSIONS AND IMPLICATIONS

Food insecurity was associated with a higher likelihood of engaging in dysfunctional eating behaviors. Interventions alleviating food insecurity or stress might help adults sustain healthy eating behaviors.

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.

Food insecurity as experienced by New Zealand women and their children

Food insecurity, defined as uncertainty in reliably accessing adequate quantities of nutritious food, is an issue for many families and children, including in New Zealand. Drawing on the experiences of mothers, this study explored the nature, causes and impact of food insecurity for their families. Semi-structured face-to-face interviews conducted with six female sole-parents were complemented with food insecurity data from the NZ Health Survey and Youth2000 surveys. Interviews were audio-recorded, transcribed and emergent themes analysed. The major driver of food insecurity was low income relative to essential household outgoings. Coping strategies employed invariably involved reducing the quantity and quality of food consumed. Negative impacts of food insecurity included significant stress, neglect of personal needs and missing meals in favour of children. Concerns expressed for children included reduced provision of nutritious food and constrained social and recreational opportunities. Participants described the daily struggle of feeding their household despite personal sacrifices, a range of coping strategies and community support. Quantitative data showed persistent high prevalence of household food insecurity with inequity by ethnicity and disability status. Findings highlight food insecurity as an ongoing public health issue for which urgent action is required to reduce its damaging impacts on families and children.

Examining Factors Related to the Food Insecurity-Obesity Paradox in Low-Income Mothers and Fathers

BACKGROUND

Prior research has indicated a varying relationship of food security and obesity risk between men and women yet factors affecting this relationship are unclear.

OBJECTIVE

The objective of this study was to examine factors related to the gender disparity in the food insecurity-obesity paradox within a sample of low-income parents.

METHODS

Low-income cohabiting mother and father pairs (n = 25) living with their child were interviewed individually using the United States Department of Agriculture Household Food Security Module, Center for Epidemiological Studies Depression Scale, and Coping Strategies Index to examine gendered factors related to the food insecurity-obesity paradox.

RESULTS

There was a significant (P = .003) difference in report of adults in the household sacrificing consumption to feed young children between mothers (2.91 ± 0.92) and fathers (3.59 ± 0.73), with mothers reporting greater sacrifice and compromised diet quality to feed their children, but no significant correlation among body mass index, depression, and food insecurity was detected.

CONCLUSIONS

Food insecure mothers may be more likely to compromise their diet quality to feed their children than fathers. This could help explain why the food insecurity-obesity paradox is significant only in women, and this work gives insights into gender-based differential consequences of food insecurity.

Food insecurity and depression among low-income adults in the USA: does diet diversity play a role? Findings from the 2013-2014 National Health and Nutrition Examination Survey

OBJECTIVE

Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.

DESIGN

Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity-depression link.

SETTING

Cross-sectional data from the National Health and Nutrition Examination Survey (2013-2014).

PARTICIPANTS

2636 low-income adults aged 18 years and older.

RESULTS

There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.

CONCLUSIONS

Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.

Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women

Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.

"Bad Enough to Cook for Two, Worse for One" - Mixed Method Evaluation of Eating Behavior among Community Dwelling Older Adults

Food insecurity, life events, and emotional eating can influence dietary patterns. However, their interaction among older adults requires further investigation. This mixed-method, interdisciplinary project included 7 focus groups and a cross-sectional survey (n = 55) to evaluate these factors among older adults (60-102 years of age) living in rural Ohio communities. Qualitative data highlighted critical life events, emotions and personal relationships, food insecurity, and learning how to do more with less, and resilience in dietary patterns. The majority of the participants were overweight or obese. Food insecurity, frequency of congregate meals, and age were associated with emotional eating. Attributes of diet quality correlated with emotional eating and food insecurity. Future work should address the unique needs of older adults by expanding food assistance programs, while including the older adult's perspectives with regard to life experiences, the value of social support, personal relationships, and honoring food preferences, particularly nutrient-dense foods.

Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies

Findings from observational studies investigating the association between fruit and vegetable consumption and risk of depression were inconsistent. We conducted a systematic review and meta-analysis to summarise available data on the association between fruit and vegetable intake and depression. A systematic literature search of relevant reports published in Medline/PubMed, ISI (Web of Science), SCOPUS and Google Scholar until Oct 2017 was conducted. Data from 27 publications (sixteen cross-sectional, nine cohort and two case-control studies) on fruit, vegetables and/or total fruit and vegetable consumption in relation to depression were included in the systematic review. A total of eighteen studies that reported relative risks (RR), hazard ratios or OR for the relationship were included in the meta-analysis. The pooled RR for depression in the highest v. the lowest category of fruit intake was 0·83 (95 % CI 0·71, 0·98) in cohort studies and 0·76 (95 % CI 0·63, 0·92) in cross-sectional studies. Consumption of vegetables was also associated with a 14 % lower risk of depression (overall RR=0·86; 95 % CI 0·75, 0·98) in cohort studies and a 25 % lower risk of depression (overall RR=0·75; 95 % CI 0·62, 0·91) in cross-sectional studies. Moreover, an inverse significant association was observed between intake of total fruit and vegetables and risk of depression (overall RR=0·80; 95 % CI 0·65, 0·98) in cross-sectional studies. In a non-linear dose-response association, we failed to find any significant association between fruit or vegetable intake and risk of depression (fruit (cross-sectional studies): P non-linearty=0·12; vegetables (cross-sectional studies): P non-linearty<0·001; (cohort studies) P non-linearty=0·97). Meta-regression of included observational studies revealed an inverse linear association between fruit or vegetable intake and risk of depression, such that every 100-g increased intake of fruit was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·99). With regard to vegetable consumption, every 100-g increase in intake was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·98) and 5 % reduced odds in cross-sectional studies (RR=0·95; 95 % CI 0·91, 0·98). This meta-analysis of observational studies provides further evidence that fruit and vegetable intake was protectively associated with depression. This finding supports the current recommendation of increasing fruit and vegetable intake to improve mental health.

Problematic Eating Behaviors Are More Prevalent in African American Women Who Are Overweight or Obese Than African American Women Who Are Lean or Normal Weight

Problematic eating behaviors such as overeating and loss of control over consumption can lead to obesity. Problematic eating behaviors among women of differing body mass indexes were explored through focus group methodology, the Palatable Eating Motives Scale (PEMS), and a taste test in a sample of low-income African American women (n = 45). Women who were overweight or obese (W-O/O) reported more problematic eating behaviors including eating in the absence of hunger, frequent overeating, and increased food thoughts than women who were lean or normal weight (W-L/N). The W-O/O appear to possess more problematic eating behaviors than W-L/N.

Accuracy of self-reported heights and weights in a predominately low-income, diverse population living in the USA

OBJECTIVES

This study explored the accuracy of self-reported heights and weights and factors associated with self-reported bias in a diverse American sample.

METHODS

Demographic, self-reported, and measured height and weight data from different studies with the same PI were compiled into one SPSS file and analyzed with paired t-tests to detect differences between self-reported and actual values. Kruskal-Wallis tests followed by pairwise t-tests detected differences among age, ethnicity, sex, income, and education. Stepwise regression analyses were done using anthropometric differences as the dependent variable and age category, sex, and ethnicity as independent variables to explore which variable was most predictive of anthropometric differences.

RESULTS

Individuals over-reported height and under-reported weight leading to an under-calculated BMI from self-reported height and weight by 0.6-1 kg/m² . These under-calculations of BMI led to misclassifications of obesity by 3, 6, 8, and 4% for African American, Euro-American, Native American women, and total women, and by 5, 6, 8, and 8% by African American, Euro-American, Native American men, and total men. Older individuals and males over-reported height more than younger individuals and females. African American females over-reported height to a lesser extent than other ethnicities. Asian males over-reported height to a lesser extent than other ethnicities.

CONCLUSIONS

Self-reported heights and weights lead to invalid results. Most individuals over-report height and under-report weight, resulting in an inaccurate underweight and obesity prevalence. Being misclassified into the incorrect BMI category could result in inappropriate healthcare treatment. Age, ethnicity, and sex appear to influence the misreporting of height and weight.

Food Insecurity and Mental Health among Females in High-Income Countries

Food insecurity is a persistent concern in high-income countries, and has been associated with poor mental health, particularly among females. We conducted a scoping review to characterize the state of the evidence on food insecurity and mental health among women in high-income countries. The research databases PubMed, EMBASE, and psycINFO were searched using keywords capturing food insecurity, mental health, and women. Thirty-nine articles (representing 31 unique studies/surveys) were identified. Three-quarters of the articles drew upon data from a version of the United States Department of Agriculture Household Food Security Survey Module. A range of mental health measures were used, most commonly to measure depression and depressive symptoms, but also anxiety and stress. Most research was cross-sectional and showed associations between depression and food insecurity; longitudinal analyses suggested bidirectional relationships (with food insecurity increasing the risk of depressive symptoms or diagnosis, or depression predicting food insecurity). Several articles focused on vulnerable subgroups, such as pregnant women and mothers, women at risk of homelessness, refugees, and those who had been exposed to violence or substance abuse. Overall, this review supports a link between food insecurity and mental health (and other factors, such as housing circumstances and exposure to violence) among women in high-income countries and underscores the need for comprehensive policies and programs that recognize complex links among public health challenges.