The hidden costs of food insecurity
How food insecurity and underlying inequalities increase the risk of eating disorders
Food insecurity has become one of the defining issues of British politics in recent years, as socio-economic inequality has increased. With rising levels of poverty across the country, the prevalence of food insecurity has increased sharply. A survey by the Food Foundation earlier this year found that 14% of households were food insecure, representing 7.3 million adults. A shocking 5% did not eat for a whole day because they could not afford or access food. At greatest risk of food insecurity are households with children, single-parent families, people in receipt of Universal Credit, and the disabled. Record numbers of people have been turning to food banks in recent years. With the cost of living crisis, the two-child benefit cap and the after-effects of the COVID pandemic, millions of people, including many children, are going without.
The impacts of food insecurity are devastating at any age, but particularly for the young. Without enough food, the body and mind cannot develop to their full extent. Children’s mental health, cognitive function, and bone and teeth health are all negatively impacted, with downstream effects on academic performance and attendance.
However, one important but less widely discussed impact of food insecurity is the effect that it has on our broader relationship to food and eating itself.
A growing body of research suggests that food insecurity is associated with an increased risk of developing eating disorders. Far from the stereotype that eating disorders are ‘diseases of affluence' for pretty, thin, white, middle-class girls, they affect people across the socio-economic spectrum. Research by Katherine Smith at University College London finds a clear association between economic insecurity and eating disorders; adolescent participants who were severely food insecure were more likely to report binge eating behaviours, including vomiting, laxative or diuretic use, fasting and excessive exercise, and to meet the criteria for having an eating disorder. Hazzard et al (2023) conducted a systematic review of the literature on socio-economic status and eating disorders, finding again that food insecurity was associated with increased risk of developing bulimic-type disorders, defined by periods of binging and purging. Another study by Rasmusson et al (2018) finds that low food security is associated with higher incidence of binge eating disorders, as well as obesity.
The relationship between food insecurity and eating disorders has been explained as a result of several potentially interrelated mechanisms:
First, when food is scarce, it can lead to “feast or famine” cycles, where people have to restrict the amount of food they can eat when food is scarce, and potentially overeat when food becomes available again
Second, the experience of food insecurity is riddled with stress, anxiety, and depression; food can be a way to manage these negative feelings, and so people can become stuck in cycles of binging
Third, with the cost of living crisis and lack of affordable healthy food, people struggling financially may turn to eating more energy dense, cheaper foods, which can also lead to binging, harming their mental and physical health
Eating disorders, left untreated, have devastating effects on people's lives. They can damage heart health, create metabolic issues, lead to stomach pain, nausea, vomiting, and constipation, and result in a weaker immune system, liver inflammation, hair loss, and osteoporosis. Brain health also takes a hit, people struggle to sleep, the hormonal system stops functioning, women can lose their periods, people cannot concentrate and thinking becomes very rigid. The risk of anxiety, depression, and even suicide all increase too. The health impacts of eating disorders are expensive, with BEAT and PWC estimating in 2015 that eating disorders cost the economy between £6 billion and £8 billion per year due to lost productivity alone.
People can recover from eating disorders, and the chances of this are greater when we intervene early. However, on average, people wait at least a year before they seek help, and when they do so it rarely arrives quickly. Post-COVID, waiting list times for eating disorders have increased dramatically, as demand for treatment has increased but the supply remains limited. The wait for help can mean that people become sicker, and may need even more help to recover in the long run, as disordered thoughts and behaviours become more deeply enmeshed in the individual’s brain. Recovery is still possible, but it's a much more uphill battle, even more so for the food insecure - who may also be less likely to seek out and access treatment in the first place.
Without financial and food security, recovery from eating disorders is much harder. The process takes time, and requires access to food alongside a strong social support system and motivation. People need to eat enough and regularly if they want to bring their mental and physical health back off the ledge of severe illness and to move towards recovery.
I know this because I am someone who has had an eating disorder for more than half of their life. I didn’t grow up in a food insecure household. I went to Disneyland. I was fine. I still developed an eating disorder as a young teenager, and it continued into my adult life. I was in and out of therapy for years. When my NHS-funded therapy stopped, I could afford to pay for my own therapy. I had savings and parents to help me cover the costs of private therapy. I had a safe and secure home to live in, and could eat whenever I wanted (or, more realistically, when I knew that I had to). I cannot imagine trying to recover while suffering from the stress of financial insecurity and the lack of food, housing, and social support that comes with it.
Recovery from eating disorders is so much harder for the financially insecure. This is yet another way in which existing health inequalities, which owe much to underlying socio-economic inequalities (the ‘social determinants of health’), are reinforced through a vicious cycle.
What can be done? We know that the socio-economic drivers of food insecurity are not being addressed. The two-child benefit cap remains in place. The cost-of-living crisis doesn’t show any signs of easing up. We never needed another reason to tackle food poverty, but here it is. We risk keeping a hidden feedback loop in place: the financially and food insecure are at greater risk of eating disorders, but are less likely to seek help or access treatment, and then are less able to recover, not least because of the impacts of continuing food insecurity. Among the many other long-term health implications of economic insecurity, a lack of government action to reduce poverty and inequalities is damaging people’s bodies in ways that we might not have expected.
There’s a new article by Will Snell in the latest RSA Journal: Myths of merit in an unequal society. When it comes to social mobility, we may be looking ahead – but are we hitting the mark?
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