Food Security
Food Security (FS) means having reliable access to enough nutritionally adequate food in a way that is safe and culturally acceptable. Conversely, Food Insecurity (FI) occurs when a person, family or community lacks regular access to enough safe, nutritious food to support their health and development (1). Food Security and Food Insecurity exist on a spectrum, shown below:
Source: Food and Agriculture Organisation of the United Nations (FAO) [link: https://www.fao.org/hunger/en].
Food Insecurity can affect eating, and eating disorder risk, in several ways. A group of Monash University students recently undertook a scoping review of the literature as part of their placement with NEDC. This page provides an overview of their findings.
What does the literature say?
A growing body of research suggests that food insecurity plays a role in rising eating disorder rates, with eating disorder rates among food insecure populations roughly double the rate for the general population (2). While earlier studies examining the relationship between food insecurity and eating disorders have largely been conducted in the United States (2), in the last five years studies examining these relationships have emerged in several other countries, including Canada (3), China (4), England (5), Malaysia (6) and Spain (7). While these countries each have unique cultural, economic and demographic profiles, there is a broadly similar pattern in relation to experiences of food insecurity increasing the risk of eating disorders within their populations.
People from low-socioeconomic status and marginalised populations are most affected by food insecurity and may therefore have increased risk of developing eating disorders and related co-occurring conditions. It is important that people from these populations are screened for eating disorders at the earliest indication or opportunity, to facilitate identification and intervention.
Additionally, it is vital that healthcare providers are made aware of this link so that appropriately tailored interventions can be made available to those affected.
Which populations are affected?
Globally and within Australia, there are many populations who are affected by a lack of food security and stable access to nutritious food (1, 8). The literature highlights several populations that may be at increased risk of eating disorder pathology in association with food insecurity.
In general, literature examining the relationship between ED and FI is still emerging. More research is needed to validate and deepen our understanding of how FI and ED may be experienced by these groups.
Transgender and Gender Non-conforming people
Transgender and gender non-conforming people experience some of the highest rates of eating disorders and, according to a study of Canadian young people, some of the lowest rates of food security (3). That is, both eating disorders and food insecurity are highly prevalent in this population. This study did not find a statistically significant relationship between food insecurity and eating disorders for trans and gender non-conforming young people, and suggested that this may be because the drivers of FI for this group and the drivers for ED for this group may relate to a range of other risk factors such as minority stress (3).
Practice point: It is crucial for any health professional supporting transgender or gender non-conforming people to be aware of the possibility of both eating disorders and food insecurity for this group.
People with co-occurring mental health conditions
People with a diagnosed eating disorder have an elevated risk of co-occurring mental health conditions such as depression and anxiety. Several of these conditions are also associated with low food security (9, 10).
Additionally, those who are food insecure with threshold binge-eating spectrum disorder are more likely to have higher depressive symptoms and perceived stress (11).
Practice point: Health professionals should consider screening for food insecurity and eating disorders if another mental health condition is present, and vice versa.
People with higher weight
A study of food insecurity and eating pathology in adolescents found a relationship between eating disorder pathology, BMI* and food insecurity (12). The study found that adolescents of higher weight status also had the highest levels of food insecurity and weight/shape overvaluation, and had higher frequency of binge eating. While this study was among the first to identify a relationship between food insecurity and weight/shape overvaluation, its findings in relation to the links between 1. food insecurity and higher weight, 2. food insecurity and eating disorders, and 3. higher weight and eating disorders mirrored the findings of several earlier studies of adolescents and adults (2).
Practice point: There is significant interplay between body weight/shape, body dissatisfaction, food insecurity and eating disorders. Presence of any one of these factors should prompt investigation of the possibility of the others among people with higher weight.
* NEDC notes the inherent flaws and potential harms in the use of BMI as a metric. It is referred to here in the context of the study in which it was used.
Children and Adolescents
Children and adolescents experiencing food insecurity are more likely to have more eating disorder risk factors or symptoms than their food-secure peers, with a higher overall eating disorder prevalence in food insecure girls (4, 7, 13). This has been seen across several international contexts, including Chine (4), Spain (7) and the United States (13).
Practice point: As the risk of rapid deterioration is high among children and adolescents with eating disorders, early identification and response is crucial. It is important that any child or young person known to be experiencing food insecurity is screened for an eating disorder.
Potential causes or contributing factors
‘Feast or famine’
A key factor that has been proposed is that fluctuations in food availability, where there are periods where food is scarce and periods of relative abundance, can cause a ‘feast or famine’ eating pattern. This pattern is markedly similar to a binge-restrict cycle. It may contribute to or exacerbate disordered eating, which makes people vulnerable to developing eating disorders (2).
Role of Stress
Stress has been found to play a role in eating disorder pathology. One study found that stress related to the experience of food insecurity increases the likelihood of binge eating and sustains eating disorder pathology (14).
COVID-19 – not a clear contributing factor, but worth keeping in mind
Several studies have looked at the effects of the COVID-19 pandemic on food insecurity and how this affected eating habits and eating disorders (3, 6, 15). The results of these studies were mixed and hard to generalise due to limitations placed on study conditions by the pandemic. Nevertheless, with the growing potential for catastrophic events to impact food chains, food access and experiences of distress, ongoing consideration of the possibility of food insecurity and eating disorders as an outcome of such events is warranted.
What else is needed?
To date, no Australian studies have examined the relationships between food insecurity and eating disorders. This means that we don’t yet have any data about the local manifestation of these issues – whether in relation to the numbers of people affected, what their lived experiences are like, or what models of care or service system responses may help. We do know that food insecurity is increasingly on the radar of eating disorder clinicians and that approaches to care are being devised ‘on the ground.’
Echoing an overall very limited evidence base in respect of First Nations peoples’ experiences of eating disorders, there is also to date no primary data on the relationship between food insecurity and eating disorders for First Nations people. Given the disproportionate rates at which First Nations people experience food insecurity, as well as their higher risk of experiencing eating disorders, this is an area that requires specific attention and First Nations-led action. For more information, see ‘First Nations Perspectives: Strengthening the Eating Disorder Safe Principles.’
Resources
For community members
If you are experiencing food insecurity and need access to food relief, AskIzzy can connect you with helpful services in your area.
If you want to learn more about how to support yourself, your family or others in your community who may be facing food insecurity and at increased risk of an eating disorder, check out the Eating Disorder Safe How-To Guide for Individuals and Families.
For professionals
This US-based webinar recording could be helpful for clinicians who want to learn more about working with clients experiencing FI and ED: https://accanto-health.ce-go.com/courses/recording-only-no-ce-food-insecurity-an-often-forgotten-element-impacting-eating-disorder-recovery
Information about screening for food insecurity: https://foodcommunitybenefit.noharm.org/resources/implementation-strategy/food-insecurity-screening.
Check out the Eating Disorder Safe How-To Guide for Frontline Workers for specific ideas about responding to food insecurity within your work.
References
1. Food and Agriculture Organisation of the United Nations, 2025. Hunger and Food Insecurity. Webpage: https://www.fao.org/hunger/en [last accessed 21 February 2025]
2. Hazzard VM, Loth KA, Hooper L, Becker CB. Food Insecurity and Eating Disorders: a Review of Emerging Evidence. Curr Psychiatry Rep. 2020 Oct 30;22(12):74. doi: 10.1007/s11920-020-01200-0. PMID: 33125614; PMCID: PMC7596309.
3. Hallward L, Nagata JM, Testa A, Jackson DB, Ganson KT. Associations between gender identity, eating disorder psychopathology, and food insecurity among Canadian adolescents and young adults during the COVID-19 pandemic. Eat Behav. 2023 Apr;49:101723.
4. He J, Xiao Y, Zhang Y, Wang H, Ganson KT, Nagata JM, et al. Food insecurity is related to eating disorder psychopathology beyond psychological distress in rural Chinese adolescents. Int J Eat Disord. 2024 Aug;57(8):1716–24.
5. Sampson K, Memory K, Fazel M, Moran P, Bould H. Does an Association Exist Between Food Insecurity and Eating Disorder Symptoms Among Young People Living in England? BJPsych Open. 2024 Jun;10(S1):S78–S78.
6. Tan ST, Tan CX, Tan SS. Food insecurity, eating behaviour, and relative weight change among young adults in the aftermath of the COVID-19 lockdown. Psychol Health Med. 2024 Aug;29(7):1362–74.
7. Shankar-Krishnan N, Deu AF, Sánchez-Carracedo D. Associations Between Food Insecurity And Psychological Wellbeing, Body Image, Disordered Eating And Dietary Habits: Evidence From Spanish Adolescents. Child Indic Res. 2021;14(1):163–83.
8. Ipsos Public Affairs, 2024. Foodbank Hunger Report 2024. Online: https://reports.foodbank.org.au/wp-content/uploads/2024/10/2024_Foodbank_Hunger_Report_IPSOS-Report.pdf [last accessed 28 March 2025]
9. Davis HA, Kells M, Todorov S, Kosmas J, Wildes JE. Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity. Int J Eat Disord. 2023 Jun;56(6):1087–97.
10. Hazzard VM, Barry MR, Leung CW, Sonneville KR, Wonderlich SA, Crosby RD. Food insecurity and its associations with bulimic-spectrum eating disorders, mood disorders, and anxiety disorders in a nationally representative sample of U.S. adults. Soc Psychiatry Psychiatr Epidemiol. 2022 Jul;57(7):1483–90.
11. Gardizy A, Lindenfeldar G, Paul A, Chao AM. Binge-Spectrum Eating Disorders, Mood, and Food Insecurity in Young Adults With Obesity. J Am Psychiatr Nurses Assoc. 2024;30(3):603–12.
12. Kim BH, Ranzenhofer L, Stadterman J, Karvay YG, Burke NL. Food Insecurity and Eating Pathology in Adolescents. Int J Environ Res Public Health. 2021 Aug 30;18(17):9155.
13. Barry MR, Sonneville KR, McGowan AR, Needham BL, Kobayashi LC, Leung CW. Caregiver-reported household food insecurity and child-reported food insecurity in relation to eating disorder risk factors and symptoms among preadolescent children. Int J Eat Disord. 2022 Oct;55(10):1331–41.
14. Kosmas JA, Wildes JE, Graham AK, O’Connor SM. The role of stress in the association among food insecurity, eating disorder pathology, and binge eating-related appetitive traits. Eat Behav. 2023 Apr;49:101709.
15. Christensen KA, Forbush KT, Richson BN, Thomeczek ML, Perko VL, Bjorlie K, et al. Food insecurity associated with elevated eating disorder symptoms, impairment, and eating disorder diagnoses in an American University student sample before and during the beginning of the COVID-19 pandemic. Int J Eat Disord. 2021 Jul;54(7):1213–23.