Food insecurity is associated with eating disorders independent of depression and anxiety: Findings from the 2020–2021 Healthy Minds Study

Objective: To examine the association between food insecurity and eating disorder (ED) risk independent of co-occurring anxiety/depression. Method: Data were provided by 121,627 undergraduate/graduate students who participated in the 2020–2021 Healthy Minds Study (HMS). Participants responded to questionnaire measures of food insecurity and risk for EDs, depression, and anxiety. Established cut-offs were used to identify students with food insecurity and probable psychopathology. Separate modified Poisson regressions adjusted for age, gender, race/ethnicity, and socioeconomic background examined the association between food insecurity and each form of psychopathology. The association between food insecurity and probable ED was then examined in a regression further adjusted for probable depression and anxiety. Results: Food insecurity was significantly associated with all three forms of psychopathology when examined separately (prevalence ratios ranged from 1.41 to 1.54, all p’s <.001). When accounting for probable depression/anxiety, food insecurity was significantly associated with 1.19 times greater prevalence of a probable ED (p <.001). Discussion: The association between food insecurity and EDs was replicated in a large, national sample of university students. To our knowledge, this is the first study to examine the independence of this relationship after adjusting for depression/anxiety. This finding supports the hypothesis that specific mechanisms, rather than general psychological distress, likely underlie the food insecurity–ED relationship.