Associations between food insecurity, food insufficiency, and disordered eating behaviors among U.S. adolescents

Disordered eating behaviors (DEBs) are common among adolescents and are associated with an increased risk for clinical eating disorders. Using 2022-2023 National Survey of Children's Health data, we examined associations between food insecurity and food insufficiency and DEBs among U.S. adolescents aged 10-17 years. We hypothesized that adolescents experiencing food insecurity and food insufficiency would have higher rates of overall DEBs, compensatory behaviors, avoidant/restrictive food intake disorder (ARFID) behaviors, and binge eating behavior. Using modified Poisson regression models on a weighted sample (n = 42,844, representing 30,303,175 adolescents), we estimated crude and adjusted risk ratios (aRR) and 95% confidence intervals (CIs) for overall DEBs, compensatory behaviors, ARFID behaviors, and binge eating behavior. The overall DEB prevalence was 29.7%. Compared to adolescents with food security, those with food insecurity had a 17% (aRR: 1.17; 95% CI, 1.09-1.24) increased risk of any DEB, a 12% increased risk of compensatory behaviors (aRR: 1.12; 95% CI, 1.01-1.25), an 18% increased risk of ARFID behaviors (aRR: 1.18; 95% CI: 1.09-1.28), and a 25% increased risk of binge eating behavior (aRR: 1.25; 95%CI, 1.04-1.52). Those with food insufficiency had a 19% (aRR: 1.19; 95% CIs: 1.06-1.35) increased risk of any DEB, a 24% increased risk of compensatory behaviors (aRR: 1.24; 95% CI, 1.01-1.51), a 23% increased risk of ARFID behaviors (aRR: 1.23; 95%CI: 1.07-1.42), and a 16% increased risk of binge eating behavior (aRR: 1.16; 95% CI, 0.88-1.54). These findings underscore the need for public health policies and clinical practice to prioritize food security among U.S. adolescents to reduce the risk of DEBs.