Feasibility and Preliminary Efficacy of a Guided Self-Help Digital Intervention for Adults With Food Insecurity,...

Food insecurity is increasingly linked to binge eating and weight-related health issues like type 2 diabetes mellitus, but no eating disorder interventions have been tested among individuals with food insecurity. We conducted a single-arm pilot test of FoodSteps-FI, a guided self-help digital intervention for binge eating adapted for food insecurity, among adults with food insecurity, recurrent binge eating, and type 2 diabetes mellitus. Our aims were to test the feasibility and preliminary efficacy of FoodSteps-FI delivery.

Participants were 31 non-pregnant, English-speaking adults (≥ 18 years old) with self-reported type 2 diabetes mellitus, recurrent binge eating (≥ 12 episodes in the past 3 months), and past 30-day food insecurity who were interested in intervention and owned a smartphone with internet access. All participants received FoodSteps-FI with messaging-based coaching (~2×/weekly) for 16 weeks, and a weekly stipend. Participants completed assessments at mid-intervention (8 weeks) and post-intervention (16 weeks). Intent-to-treat analyses assessed feasibility and changes in clinical outcomes from baseline to post-intervention.

The trial demonstrated feasible recruitment, high study retention, and high intervention completion, adherence, and ratings of usability. Participants achieved improvements in binge eating, weight, past 30-day food security status, eating concerns, shape concerns, weight concerns, eating disorder impairment, depressive symptoms, shame, and guilt. Nearly all participants rated the stipend as helpful for making behavior changes, but substantially fewer said it was sufficient.

This pilot trial demonstrated the early promise of an adapted digital binge-eating intervention for this population, and the need for future research on its effectiveness and implementation.