Prevalence and contributing factors to recurrent binge eating and obesity among black adults with food insufficiency: findings from a cross-sectional study from a nationally-representative sample

Background Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations. Methods We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally-representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating. Results In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0–11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses. Conclusion The present study reveals a more complex relation between food insufficiency and binge eating than previously thought—although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participants.

The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review

(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.

Associations of household food insufficiency with childhood depression and anxiety: a nationwide cross-sectional study in the USA

ObjectiveHousehold food insufficiency (HFIS) is a major public health threat to children. Children may be particularly vulnerable to HFIS as a psychological stressor due to their rapid growth and accelerated behavioural and cognitive states, whereas data focusing on HFIS and childhood mental disorders are as-yet sparse. We aimed to examine the associations of HFIS with depression and anxiety in US children.DesignCross-sectional study.SettingThe 2016–2018 National Survey of Children’s Health, a nationally-representative study.ParticipantsPrimary caregivers of 102 341 children in the USA.Primary and secondary outcome measuresPhysician diagnosed depression and anxiety were assessed by questionnaires administered to primary caregivers of 102 341 children. Multivariable logistic regression models estimated adjusted OR (aOR) for current depression or anxiety associated with HFIS measured through a validated single-item instrument.ResultsAmong children aged 3–17 years, 3.2% and 7.4% had parent-reported physician-diagnosed current depression and anxiety, respectively. Compared with children without HFIS, children with HFIS had approximately twofold higher weighted prevalence of anxiety or depression. After adjusting for covariates, children with versus without HFIS had a 1.53-fold (95% CI 1.15 to 2.03) and 1.48-fold (95% CI 1.20 to 1.82) increased odds of current depression and anxiety, respectively. Associations were slightly more pronounced among girls (aOR (95% CI): depression 1.69 (1.16 to 2.48); anxiety 1.78 (1.33 to 2.38)) than boys (1.42 (0.98 to 2.08); 1.32 (1.00 to 1.73); both P-for-interaction <0.01). The associations did not vary by children’s age or race/ethnicity.ConclusionsHFIS was independently associated with depression and anxiety among US children. Girls presented slightly greater vulnerability to HFIS in terms of impaired mental health. Children identified as food-insufficient may warrant mental health assessment and possible intervention. Assessment of HFIS among children with impaired mental health is also warranted. Our findings also highlight the importance of promptly addressing HFIS with referral to appropriate resources and inform its potential to alleviate childhood mental health issues.

Food insufficiency and mental health service utilization in the U.S. during the COVID-19 pandemic

Objective: To estimate the association between food insufficiency and mental health service utilization in the U.S. during the COVID-19 pandemic. Design: Cross-sectional study. Multiple logistic regression models were used to estimate the associations between food insufficiency and mental health service utilization. Setting: U.S. Census Household Pulse Survey data collected in October 2020. Participants: Nationally representative sample of 68,611 U.S. adults. Results: After adjusting for sociodemographic factors, experiencing food insufficiency was associated with higher odds of unmet mental health need (adjusted odds ratio [AOR] 2.90; 95% CI 2.46-3.43), receiving mental health counseling or therapy (AOR 1.51; 95% CI 1.24-1.83), and psychotropic medication use (AOR 1.56; 95% CI 1.35-1.80). Anxiety and depression symptoms mediated most of the association between food insufficiency and unmet mental health need but not the associations between food insufficiency and either receiving mental health counseling/therapy or psychotropic medication use. Conclusions: Clinicians should regularly screen patients for food insufficiency, especially in the wake of the COVID-19 pandemic. Expanding access to supplemental food programs may help to mitigate the need for higher mental health service utilization during the COVID-19 pandemic.

Regional differences in the impact of the COVID-19 pandemic on food sufficiency in California, April-July, 2020: Implications for food programs and policies

Objective: To evaluate regional differences in factors associated with food insufficiency during the initial months of the COVID-19 pandemic among three major metropolitan regions in California, a state with historically low participation rates in the Supplementation Nutrition Assistance Program, the nation’s largest food assistance program. Design: Analysis of cross-sectional data from Phase 1 (April 23 – July 21, 2020) of the U.S. Census Household Pulse Survey, a weekly national online survey. Setting: California, and three Californian Metropolitan Statistical Areas (MSAs), including San Francisco-Oakland-Berkeley, Los Angeles-Long Beach-Anaheim, and Riverside-San Bernardino-Ontario MSAs. Participants: Adults aged 18 years and older living in households. Results: Among the three metropolitan areas, food insufficiency rates were lowest in the San Francisco-Oakland-Berkeley MSA. Measures of disadvantage (e.g. having low-income, being unemployed, recent loss of employment, and pre-pandemic food insufficiency) were widely associated with household food insufficiency. However, disadvantaged households in the San Francisco Bay Area, the area with the lowest poverty and unemployment rates, were more likely to be food insufficient compared to those in the Los Angeles-Long Beach-Anaheim and Riverside-San Bernardino-Ontario MSAs. Conclusions: Food insufficiency risk among disadvantaged households differed by region. To be effective, governmental response to food insufficiency must address the varied local circumstances that contribute to these disparities.

State minimum wage, paid sick leave, and food insufficiency during the COVID-19 pandemic

IntroductionPeople in low-income households face a disproportionate burden of health and economic consequences brought on by the COVID-19 pandemic, including COVID-19 and food insufficiency. State minimum wage and paid sick leave policies may affect whether people are vulnerable to employment and health shocks to income and affect food insufficiency.MethodsWe evaluated the relationship between state minimum wage policies and the outcome of household food insufficiency among participants younger than 65 during the COVID-19 pandemic. We used data from biweekly, state representative Census Pulse surveys conducted between August 19 and December 21, 2020. We conducted analyses in the full population under age 65 years, who are most likely to work, and in households with children. The primary exposure was state minimum wage policies in four categories: less than $8.00, $8.00 to $9.99, $10.00 to $11.99, and $12.00 or more. A secondary exposure was missing work due to COVID-19, interacted with whether participants reported not having paid sick leave. Food insufficiency was defined as sometimes or often not having enough to eat in the past seven days. Very low child food sufficiency was defined as children sometimes or often not eating enough in the past seven days because of inability to afford food. We conducted a multivariable modified Poisson regression analysis to estimate adjusted prevalence ratios and marginal effects. We clustered standard errors by state. To adjust for state health and social programs, we adjusted for health insurance and receipt of supplemental nutrition assistance program benefits, unemployment insurance, and stimulus payments. We conducted subgroup analyses among populations most likely to be affected by minimum wage policies: Participants who reported any work in the past seven days, who reported <$75,000 in 2019 household income, or who had a high school education or less. We conducted falsification tests among participants less likely to be directly affected by policies, ≥65 years or with >$75,000 in 2019 household income.ResultsIn states with a minimum wage of less than $8.00, 14.3% of participants under age 65 and 16.6% of participants in households with children reported household food insufficiency, while 10.3% of participants reported very low child food sufficiency. A state minimum wage of $12 or more per hour was associated with a 1.83 percentage point reduction in the proportion of households reporting food insufficiency relative to a minimum wage of less than $8.00 per hour (95% CI: −2.67 to −0.99 percentage points). In households with children, a state minimum wage of $12 or more per hour was associated with a 2.13 percentage point reduction in household food insufficiency (95% CI: −3.25 to −1.00 percentage points) and in very low child food sufficiency (−1.16 percentage points, 95% CI: −1.69 to −0.63 percentage points) relative to a state minimum wage of less than $8.00 per hour. Minimum wages of $8.00 to $9.99 and $10.00 to $11.99 were not associated with changes in child food insufficiency or very low child food sufficiency relative to less than $8.00 per hour. Subgroup analyses and sensitivity analyses were consistent with the main results. Estimates were of a lesser magnitude (<0.6 percentage points) in populations that should be less directly affected by state minimum wage policies. Missing work due to COVID-19 without paid sick leave was associated with a 5.72 percentage point increase in the proportion of households reporting food insufficiency (95% CI: 3.59 to 7.85 percentage points).DiscussionFood insufficiency is high in all households and even more so in households with children during the COVID-19 pandemic. Living in a state with at least a $12 minimum wage was associated with a decrease in the proportion of people reporting food insufficiency during the COVID-19 pandemic. Not having paid leave was associated with increases in food insufficiency among people who reported missing work due to COVID-19 illness. Policymakers may wish to consider raising the minimum wage and paid sick leave as approaches to reducing food insufficiency during and after the COVID-19 pandemic.