Eating as a means to combat distress: A novel pathway to explain the association between household food insecurity and food choice

Food insecurity is a lack of the financial resources needed to ensure reliable access to food to meet dietary, nutritional, and social needs. In the UK, 8.4 million people were food-insecure in 20141. Household food insecurity is associated with poor diet, malnutrition and obesity2, however the explanation for this remains unclear. Psychological/emotional distress may be a fundamental link between socio-economic disadvantage and weight gain. People might respond to this distress by eating high-calorie foods as a coping strategy3. Research Aims and Questions: To develop understanding of the impact of household food insecurity (HHFIS) on mental health, eating behaviours, diet and obesity. What is the relationship between HHFIS, psychological distress and eating as a coping strategy? Do psychological distress and eating to cope mediate the relationship between HHFIS and diet quality/obesity? Quantitative study Participants were adults (N = 608) residing in Merseyside, from a range of socio-economic backgrounds. Cross-sectional design using an online questionnaire platform. The following variables were assessed: HHFIS (US Household Food Security Survey Module), Psychological distress (Depression, Anxiety and Stress Scale), Eating to cope (Palatable Eating Motives Scale), Drinking to cope (Drinking Motives Questionnaire), Diet quality (food frequency questionnaire) Physical symptoms of stress (e.g. sleep problems, fatigue). Self-reported height, weight and body mass index (BMI). HHFIS was significantly associated with psychological distress, eating to cope, drinking to cope, physical symptoms of stress and poorer diet quality (i.e. more frequent consumption of processed foods, lower consumption of fruit and vegetables). There was a significant indirect effect of food insecurity on (poorer) diet quality via psychological distress and eating to cope (Figure 1). There was also a significant indirect effect of HHFIS on (higher) BMI via psychological distress and eating to cope. Preliminary analysis of interview transcripts revealed key themes of poor mental health and anxiety about running out of food: “I just stress. And you don’t get too much sleep. Or I panic that if it wasn’t for food banks I don’t know what I would do”. The relationship between household food insecurity and poor diet/obesity may be partly explained by psychological distress and subsequent eating as a coping strategy. Results provide novel insight into the psychological experience of being food-insecure and the factors that influence food choic