The eating disorder risk we don't talk about: childhood hunger
It's not just wealthy white teens who are getting sick
When you hear the words “eating disorder,” what do you picture? If you imagine a thin, high-achieving teen girl from a wealthy white family, you’re not alone.
The so-called “SWAG” stereotype (skinny, white, affluent girl) is so tenacious in part because it self-perpetuates both in the media and in medicine. If you’re in that “SWAG” demographic, you’re more likely to see your experience represented, more likely to get a diagnosis (and be believed), and more likely to have access to care. Treatment providers and researchers then see a disproportionate number of patients who fit that description. Guess who’s most likely to feel safe sharing their recovery experience publicly? And the cycle continues.
But we know this stereotype doesn’t tell the whole story. Ever so slowly both healthcare professionals and the general public are starting to understand that eating disorders don’t have a “look.” For instance, more and more people now recognize that boys and men get eating disorders.
One of the most persistent assumptions, however, is that these mental illnesses occur only in the context of relative wealth.
But the truth is that experiencing food insecurity as a child actually increases the risk of developing an eating disorder.
The term “food insecurity” always feels so cold and impersonal, and it is indeed a technical term. The more relatable, visceral term “hunger” isn’t something easily measurable—that why it’s rarely used in studies, a distinction I learned when I interviewed an expert at No Kid Hungry for my latest CNN article.
I also learned that experiencing food insecurity doesn’t necessarily mean being in a state of acute hunger. But that insecurity part can be harmful in itself—it’s the not knowing whether or when there will be enough than can still do a number on you.
That uncertainty stresses the body. It stresses the mind. It stresses relationships. And it makes it hard to focus on anything else.
Menu planning, grocery shopping, and food preparation take up a lot of time and brain space even if you don’t have a tight budget. When you can’t count on having enough to eat, however, even more mental energy goes toward thinking about food. Wondering when or whether you can eat, when or whether you can feed your family. Constantly problem-solving for creative ways to get more for less.
If only we could invest in quieting that kind of “food noise” by making sure everyone has enough to eat.
But rather than trying to address our already shameful child hunger rates, the US government is set to cut funding to existing nutrition assistance programs. And, in case you haven’t heard, the current administration just announced it will no longer even track data on our nation’s food insecurity. The next report, based on the 2024 survey, is expected to come out next month (it’s normally issued annually right after Labor Day), but the government will end this data collection going forward. As many a meme has suggested this week, canceling the tracking of hunger—while making policies that will increase hunger—has big North Korea vibes.
More kids will go hungry, and more kids will develop eating disorders. And these kids will be less likely to get treatment.
If you want to learn more about this public health perfect storm—including what you can do—I hope you’ll check out the CNN piece.
To report this story, I got to interview some wonderful experts: registered dietitian Jessica Wilson and Carolyn Wait Vega at No Kid Hungry.
Research for this piece offered a powerful reminder that the human body doesn’t know why there isn’t enough food at regular intervals, and it doesn’t care. It’s just going to react.
Whether it’s an attempt to lose weight, a “healthy eating” plan for a school assignment, or the fact that SNAP benefits have already been exhausted for the month—all the body knows is that there isn’t enough predictable energy coming in.
Not having enough to eat is an existential threat that scrambles your brain as it tries to protect your body.
For many, there will be an intensified survival-driven pull toward calorie-dense foods and binge-like eating to try to compensate for periods of deprivation. For those with the genetic vulnerability to anorexia, eating can start to feel wrong and even frightening. Avoidance of certain foods, obsessive rituals around eating, and other disordered behaviors can emerge. If the GI system starts to slow down because of the lack of consistent nutrition, eating can become painful and something to dread even when food is available. Purging can bring (temporary) physical and psychological relief even as it takes its own toll. Many people with eating disorders experience a range of symptoms that don’t always fit neatly into one category.
But one of the things common to many eating disorders is energy deficit.
When a body is still growing but not getting enough food, the gap between energy needs and energy inputs is larger, and the impacts are more profound. Energy deficits during childhood and adolescence can have lasting consequences on physical and mental development. And instead of getting to practice sustainable, health-promoting eating patterns, children experiencing hunger must scramble and sacrifice.
Because it happens to be Weight Stigma Awareness Week, I want to highlight that weight stigma often makes it even harder for many poor kids to get the care and nourishment they need. This excerpt from the article (including quotations from Jessica Wilson) offers an introduction to this problem:
Contrary to popular assumptions, children experiencing food insecurity do not necessarily appear underweight. Because of genetically predetermined body size or hormonal and metabolic disruption from food insecurity and other stressors, “kids can absolutely be chubbier and still be malnourished or undernourished, which is not something that is common knowledge,” Wilson said.
Assuming a child’s body size can tell the whole story of their nutritional status leads many hungry kids to be overlooked — and even be given the counterproductive message that they’re eating “too much.”
The threats to children’s health seem to keep coming, and it’s easy to get discouraged. I take heart in knowing news outlets are even covering this issue (I know, the bar is pretty low). And I was proud to learn that Dr. Sanjay Gupta also shared the article on his health newsletter, The Results Are In. Raising awareness of the link between food insecurity and eating disorders is at least a step in the right direction.
The Brain Over Binge Podcast with Kathryn Hansen
On Brain Over Binge, Kathryn Hansen asked me some great questions (yes, that’s me on the right—a throwback to my old pre-pandemic headshot).
The Reflective Mind Podcast with Dr. Jennifer Reid
Psychiatrist Jennifer Reid, MD is such a fabulous listener. I really enjoyed the chance to go down some rabbit holes on this episode of The Reflective Mind Podcast, which Dr. Reid titled so beautifully: Bodies Are For Living, Not Perfecting: Freeing Our Kids from Diet Culture.
