Economies of Eating Disorders - Exploring How Food Security Impacts Eating Disorder Recovery

This blog is part of a special 12-month series titled, “Inclusive Eating Disorder Recovery: How Yoga Therapy Can Help” written for Yoga for Eating Disorders. Through my blogs and related social media posts, I will explore how we can use the ethics of Yoga, personal practice, movement, breath, focused attention, and meditation to create recovery spaces that are inclusive and reflective of diverse lived experience. Join in the conversation on Instagram by following along @yogaforeatingdisorders and @holisticyogatherapist.

Food security (phrase): All people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for an active and healthy life.  —The United Nations' Committee on World Food Security

If you have been reading this blog series, you probably know that research indicates eating disorder features occur at similar rates across all levels of income, education, indigenous status, and urbanicity. While eating disorder research has focused on younger, white, upper-class female appearing people because they tend to be the ones who present in clinics, they are not the only group to experience the condition. They are, however, the one that has subsequently gained most of the media attention, creating a self-perpetuating problem of a significant gap in research and support for people who are experiencing food insecurity and living with or recovering from an eating disorder.

COVID-19 has made this worse by increasing the prevalence of food insecurity - which is a lack of access to sufficient, safe and nutritious food - globally. While it may seem surprising, food insecurity is associated with all forms of eating disorder and can have negative impacts on recovery. 

What the Research Says

American studies focused on food bank users found that living with hunger because of a lack of access to food can result in people restricting food more often, as well as more instances of binge eating and purging, or an increase in laxative misuse. Researchers also found that people who had less access to food often presented with a higher rate of eating disorder - 2.9% among people who were only mildly food insecure to 37.6% among people who had so little food that even the children went hungry.

Data collected suggests that income support systems can play a role, particularly when it comes to binge eating patterns since individuals who receive benefits or who may be lower income and whose spending is determined by pay cycles spend those funds on food as soon as they become available. They are more likely to eat in relative abundance to alleviate the experience of hunger when the funding runs out and are then left in a state of restriction until the next cycle. This pattern, once established, can be very difficult to break.

While these studies are a great beginning, the overall research bias towards individuals who have the income, education, and transportation and geographic access to clinical care has made it difficult to understand how not having enough food is both a risk factor for eating disorders and how being hungry exacerbates the experience.  

Researchers and care providers are starting to recognize how their issue of bias, which we explore in our February blog post, along with a lack of awareness about food (in)security can have impacts on recovery.

“Instead of assuming that eating disorders are driven by internally imposed dietary restriction, wanting to lose weight, and internalised weight bias, there might be some external factors… And if we ignore that, the problem won’t go away even with treatment,” said Janet Lydecker, a psychologist at the Yale School of Medicine.

Why Yoga Therapy Can Help

How can yoga therapy support a more inclusive eating disorder recovery for people living with both food insecurity and eating disorder? We have already explored how the yamas (yuh-muhs) and niyamas (nee-yuh-muhs) - or the first and second limbs of yoga and the one that has potential to add significant value here is satya (s-uh-t-y-uh) truthfulness.

Satya

The practice of satya is rooted in becoming aware of the truth, and acknowledging it as reality, even if it challenges what our stereotypes and general perception indicate. This applies to ourselves first - whether it is seeing the truth of a socioeconomic situation that may be impacting an eating disorder experience, or becoming aware of the biases that influence our perception of who might be living with disordered eating. 

Once we have begun to develop an awareness of the true state of things within ourselves, we can start to broaden our perception, and become aware of the true nature of the systems and structures that we exist in and maintain, and how they impact food security, and eating disorder experiences. 

These range from an awareness of where there might be food deserts in your community and which community organisations are working to address it, to how your feedback on transit planning might improve access to more appropriate foods for lower income neighbourhoods, to local poverty reduction initiatives to address the root causes of the issue. Sharing this awareness, once you have it, and being open to learning more about the sometimes uncomfortable true nature of the situation is the ongoing practice of satya.

Call to Action

If you are a researcher in this space, you might use the practice of satya to inform your work? One way might be to use tools like the Radimer/Cornell measure of food insecurity to gather data that reflects the true impact of food (in)security in your study. You might also choose to help build the body of research and knowledge around the experience of systemically excluded groups, to help fill the gaps in information about what it is like to be hungry and experience disordered eating. The practice of truthfulness, and sharing the truths that you are now aware of might also help you decolonize your approach when working with systematically excluded colleagues, or change how you work with communities.

If you are a care provider, you might use a satya practice to make space for care seekers to disclose their experience with food insecurity by gently asking questions like those in the Hunger Vital Sign. You might also ask questions about food desserts, transportation, preparation skills, or issues of scarcity so you can factor those aspects in when suggesting foods to incorporate or designing meal plans. 

Depending on the concerns you hear, you might use your increased awareness to suggest solutions that include grocery delivery services, or virtual classes to help build food preparation skills to help restore how people engage with food for careseekers who present with an eating disorder, if they are open to it. 

Research indicates that an approach that includes immediate assistance - including providing food or financial support when food insecurity is reported, along with longer term assistance in the form of referrals to resources or programs to address longer term issues is most effective. You might also share these practices to support your colleagues with resources to model how it can be done and encourage them to do something similar.

If you are seeking care for yourself, or someone else, your practice of satya might help you better express your experience with food (in)security as it relates to eating disorders to your care team and community so they can help connect you with resources and supports. If it feels comfortable you might also use the practice to inform research and to help shift the dominant narrative. You might also choose to share which forms of care or support to address ED within the context of socioeconomic stressors were most helpful so that other community members, care providers and system builders are aware and can integrate that information into their decision making.

If you are already using the practice of satya to refocus your attention internally and to drive intentional healing within yourself or in your community, we would love to learn more about what you are up to. 

Please share how it is going so far, what has worked well, and what you might set aside. Tell us in the comments, or message us on instagram at https://www.instagram.com/holisticyogatherapist/ and https://www.instagram.com/yogaforeatingdisorders.

Resources to Support Your Exploration

• Body Image Oppression 

• Food Insecurity and ED

• How to Handle Food Insecurity and an Eating Disorder