Examining the Relationship between Food Insecurity, Binge Eating, and Obesity in a Nationally-Representative Sample of Black Americans

Background and Purpose: Obesity continues to affect the United States in alarming proportions; over 70% of U.S. adults have a body mass index (BMI > 30) that would meet the clinical definition for a diagnosis of overweight or obesity. Food insecurity, defined as not having consistent, dependable access to healthy food, is more prevalent among those with obesity, impacting 14% vs. 11% of those without the chronic condition. Living in a food-insecure household may increase the risk for patterns of under-eating and overeating, including increased snacking and binge eating, which are associated with severe obesity. Much of what we have learned about food insecurity and obesity have been in samples that are predominately White.  Since we know that racial disparities in obesity persist, particularly among African-Americans, it is important to examine racial differences in the associations between binge eating, food insecurity and obesity. Thus, the purpose of this study is to examine the prevalence of binge eating and obesity in a nationally representative sample of Black Americans, and examine factors in the associations between food insecurity, binge eating, and obesity.

 Methods: We analyzed cross-sectional data (N = 4,789) from the National Survey of American Life, a nationally-representative dataset (of African-Americans, Afro-Caribbeans, and Non-Hispanic Whites in the United States. Key study variables included: binge eating in the past 28 days (yes or no); race (African American, Afro-Caribbean, or others, which included non-Hispanic White and all other Hispanic); BMI (obese or non-obese); and food insecurity (enough to eat or not enough to eat). Multivariable logistic regression analyses examined associations between: (a) race and binge eating; (b) race and BMI; and (c) binge eating and income poverty in the full sample.

 Results: Multivariable results indicated that African Americans (OR = 0.56, 95% CI: 0.30, 1.04) and Afro-Caribbeans (OR = 0.49, 95% CI: 0.25, 0.94) were less likely to binge eat compared to others. We also found that indicators of poverty such as receipt of one (OR = 1.42, 95% CI: 1.03, 1.95) or two or more forms (OR = 1.47; 95% CI: 0.97, 2.22) of social assistance and inability to pay one (OR = 1.61; 95% CI: 1.15, 2.27) or two or more (OR=2.27; 1.59, 3.24) households expenses were associated with a higher likelihood of binge eating. Results also indicated that African Americans were more likely to have obesity (OR = 1.55, 95%, CI: 1.08, 2.23) than others.

 Conclusion: African-Americans have the highest rates of obesity in the United States. In this sample, living in a food-insecure home increases the risk for binge eating and obesity. Furthermore, the experience of living in poverty (e.g., receiving social assistance, not being able to pay household expenses) may also influence the risk for binge eating. It is imperative that social work researchers examine the environmental dynamics behind the experience of poverty and risk for binge eating and obesity. Future research should explore factors contributing to increased binge eating among those living in a food-insecure household, and uncover additional reasons for the continued disparity in obesity rates.