Household food insecurity, diet quality and obesity : an explanatory model

Objectives: Food insecurity (a lack of stable access to nutritious food) is reliably associated with poor diet, malnutrition and obesity; however, the underlying mechanisms are unclear. Here, we tested the hypothesis that these relations are explained by higher levels of distress, due to experiencing food insecurity, and unhealthy coping behaviours (eating high-calorie foods, drinking alcohol). Methods: Adults from the United Kingdom (N = 604), recruited online and at food banks, completed questionnaire measures of: household food insecurity, physical stress, psychological distress, eating to cope, drinking to cope, diet quality and self-reported height and weight to calculate body mass index (BMI). Results: Structural equation modelling was used to test the hypothesised relationships, including a multilevel structural model controlling for the effect of income. As predicted, food insecurity was indirectly associated with higher BMI via greater distress and eating to cope. Food insecurity was directly associated with poorer diet quality, but this relationship was not explained by distress and eating to cope. Conclusions: Our data provide novel insight into the psychological experience of being food-insecure and how maladaptive coping mechanisms might play some role in the association between food insecurity, diet and obesity