Among People Facing Food Insecurity, Researchers Find a Hidden Health Issue: Eating Disorders

When Carolyn Black Becker, a psychologist who studies eating disorders, used to explain her research to colleagues, she would get blank stares. The field, after all, was disproportionately focused on young girls and women who were underweight, white, and from middle-class families. Becker herself had spent most of her career focused on the prevention of eating disorders among sorority members.

In that light, her decision to study eating disorders in people who were facing food insecurity — that is, people without reliable access to sufficient food — seemed unusual, even bizarre to some. “Everybody looked at me like I had two heads,” Becker recalled.

But she also thought she was onto something. And when she finalized the results of her first major study on the issue, conducted among clients of a food bank in San Antonio, the data were striking: In addition to seeing high levels of food restriction — the deliberate effort to reduce amount of food one eats — she and her colleagues reported high rates of binge eating and purging, such as self-induced vomiting or laxative misuse. Those rates increased depending on people’s level of food insecurity, from 2.9% among people who were only mildly food insecure to 37.6% among people who had so little food even the children went hungry.

It wasn’t just that some people experiencing food insecurity were eating more at times, which would make sense. It’s also that they felt guilty and ashamed for doing so. They reported vomiting after eating to keep from gaining weight, and 22.8% used laxatives or diuretics for the same reason.

“The thought that people are going to receive this food and robotically be able to eat perfectly and stop at fullness each time — it seems really laughable to me,” said Kimmie Singh, a dietitian in private practice in New York.

There remains precious little study of eating disorders in people facing food insecurity. But Becker, who teaches at Trinity University in San Antonio, and her colleagues are at the forefront of a field that they believe is critical, especially now.

Even before the economic fallout from the coronavirus pandemic, the U.S. Department of Agriculture estimated that 11.1% of American households experienced food insecurity. With the unemployment rate skyrocketing, the number of people being served by food banks is, anecdotally, surging. And hidden within that population, Becker and some others researchers believe, is a large and growing group of people who challenge every cliché about eating disorders.

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