Deprivation Binge

Food insecurity associated with elevated eating disorder symptoms, impairment, and eating

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Food insecurity, or limited or uncertain access to nutritionally adequate food needed to sustain health, is a significant public health concern that is associated with numerous physical and mental health problems, including diabetes, depression, anxiety, suicidal ideation, and eating disorder pathology (Gundersen & Ziliak, 2015; Holben & Pheley, 2006; Myers, 2020). Food insecurity has been associated with greater frequency of binge eating (e.g., Becker, Middlemass, Gomez, & Martinez-Abrego, 2019; Becker, Middlemass, Taylor, Johnson, & Gomez, 2017; Bruening, MacLehose, Loth, Story, & Neumark-Sztainer, 2012; Rasmusson, Lydecker, Coffino, White, & Grilo, 2019) and compensatory behaviors (e.g., Becker et al., 2017, 2019), as well as increased shape and weight concerns (Hooper, Telke, Larson, Mason, & Neumark-Sztainer, 2020; Stinson et al., 2018; West, Goldschmidt, Mason, & Neumark-Sztainer, 2019; Zickgraf et al., 2019). This may occur because food insecurity often leads to alternating periods of food deprivation and food access, which may mimic the physiological and behavioral effects of dieting and promote overeating behaviors due to the effects of increased hunger drives. Overeating, in turn, may further promote compensatory and dieting behaviors in an effort to prevent the effects of binge eating on body weight and shape (Stinson et al., 2018; West et al., 2019). Indeed, dieting leads to increased likelihood of binge eating due to prolonged physiological hunger and abstinence violation effects. Binge eating, in turn, further reinforces the perceived need to diet to compensate for calories consumed in cultures that emphasize thinness (e.g., Steiger & Bruce, 2007; Stein et al., 2007).

Consequently, individuals with food insecurity are at a higher risk for eating disorders (EDs). For example, two studies found that approximately 17% of individuals with severe food insecurity met criteria for an ED (Becker et al., 2017, 2019). Furthermore, people with food insecurity were more likely to have a diagnosis of bulimia nervosa (Lydecker & Grilo, 2019) or binge-eating disorder (Rasmusson et al., 2019) compared with those who were food secure.

1 FOOD INSECURITY IN UNIVERSITY STUDENT POPULATIONS

University students may be vulnerable to experiencing food insecurity due to demands on financial resources, such as high costs of tuition, housing, and books (Carnevale, Smith, Melton, & Price, 2015; Senack & Donoghue, 2016; Walizer, 2018). Such demands could lead to lower food budgets, reduced food intake, and consumption of inexpensive, energy-dense foods (e.g., soft drinks, fast food) that have low nutritional value (Bruening et al., 2012). College students also must balance the time commitments of employment with their studies, which limits their earning power. A multi-institution study of food insecurity prevalence among college students found that approximately 19% of participants were food insecure, with an additional 25.3% at risk for food insecurity (El Zein et al., 2019). Furthermore, Payne-Sturges, Tjaden, Caldeira, Vincent, and Arria (2018) found prevalence of food insecurity in an undergraduate sample to be higher than the prevalence of food insecurity among community members in the same area.

Food insecurity among university students also has been associated with a myriad of negative educational outcomes such as lower academic achievement and grade point averages, behavioral and attention problems, adverse psychosocial development, and greater risk of leaving college without graduating (e.g., Alaimo, Olson, & Frongillo, 2001; Cook & Frank, 2008; Maroto, Snelling, & Linck, 2015; Martinez, Frongillo, Leung, & Ritchie, 2018; Silva et al., 2017). Additionally, because race and ethnicity are correlated with socioeconomic status in the United States, some racial and ethnic minority students may have an increased likelihood of experiencing food insecurity, impacting academic achievement among these groups and highlighting institutional disparities (Payne-Sturges et al., 2018; West et al., 2019).

A recent study on food insecurity in college students found that individuals with food insecurity are more likely to screen positive for an ED (Barry, Sonneville, & Leung, 2019); however, this study utilized the SCOFF measure (Morgan, Reid, & Lacey, 2000), which does not provide information about specific diagnoses. The present study will attempt to replicate prior work suggesting that food insecurity status is associated with increased ED pathology and frequency of ED behaviors (e.g., binge eating, purging, compensatory fasting, excessive exercise), as well as extend prior research to include a rigorous screening measure that indicates probable specific diagnoses in a university sample.

2 FOOD INSECURITY DURING THE TIME OF COVID-19

In addition, we will evaluate the influence of the COVID-19 stay-at-home orders on food security status. In an online survey conducted in Vermont following a statewide “stay-at-home” order (March 24, 2020), researchers found that, among 3,219 respondents, there was a 32.3% increase in food insecurity between the year preceding the COVID-19 pandemic and after the outbreak (Niles et al., 2020). The authors hypothesized that increasing barriers to food access, such as lower food availability, loss of access to food programs, and increased food and/or food delivery costs may exacerbate food insecurity. University students may be particularly vulnerable to food insecurity, as they depend on university meal plans and cafeterias for a reliable source of nutrition. Thus, this study will additionally examine changes in food insecurity prevalence from December 2019 to early March 2020 compared with mid-April 2020, when economic strains from COVID-19 were beginning to appear. Finally, given the emerging research suggesting that people are reporting increased ED symptoms during the COVID-19 pandemic as compared with before the pandemic (e.g., Phillipou et al., 2020), this study will also test for differences in prevalence of ED diagnoses between the two cohorts.

H1.: We predicted that there would be significantly more people with food insecurity in the subset of students sampled during COVID-19 stay-at-home orders (mid-April 2020) compared with those who were sampled before the beginning of the crisis (December 2019 to early March 2020), after controlling for demographic differences between the two samples.

H2.: We predicted that, compared with those with no food insecurity, students with food insecurity would report more objective binge-eating episodes, subjective binge-eating episodes, and compensatory behaviors. Furthermore, we predicted that students with food insecurity would report higher levels of impairment from ED symptoms.

H3.: We predicted that students with food insecurity would be more likely to have a diagnosis of bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder than students with no food insecurity.

3 METHODS

3.1 Participants

Two samples of students from the University of Kansas (KU) were recruited to take part in an online study of eating concerns, body image issues, and weight concerns in university students (N = 579; Mage = 21.75, SD = 5.27, range = 18–78). Of the 723 initiated surveys, 583 surveys were completed. The final analytic sample consisted of 579 responses (Table 1). With regards to general characteristics of KU students, median family income is $125,000 (Aisch, Buchana, Cox, & Quealy, 2017) and 69% of students receive some type of…

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