Gender Differences in Food Insecurity, Anxiety, and Nutrition in Israel: A Cross-Sectional Study

Food insecurity and psychological distress, especially anxiety, are often interconnected, with notable gender-based differences. Understanding these relationships is crucial for informing targeted interventions during crises such as war.

To estimate food insecurity prevalence by gender and examine its association with anxiety and diet quality among Israeli adults in 2023-2024.

A cross-sectional online survey was conducted among a representative random sample of Israeli adults (≥18 years). Food insecurity was assessed using the two-item Hunger Vital Sign, anxiety symptoms via the General Anxiety Disorder (GAD)-7, and diet quality with the Israel Mediterranean Diet Scale (I-MEDAS). The survey was fielded November 7-18, 2023, 4-6 weeks after the 7 October war broke, a period marked by nationwide school closures or partial remote learning, reserve-duty mobilization of ∼360,000 individuals, frequent air-raid sirens in multiple regions, temporary business disruptions, and government relocation/hoteling of some communities, even outside the immediate Gaza border area.

Among 530 participants, food insecurity prevalence was 8.2%. Males reported higher smoking rates (31% vs. 22.2%, p = 0.022) and physical activity levels both before (120 vs. 60 minutes, p = 0.001) and during the war (70 vs. 15 minutes, p < 0.001), while females exhibited more dietary structure changes (25.8% vs. 16.8%, p = 0.023) and supplement use (30.5% vs. 20.8%, p = 0.011). No gender differences were found in weight change or Mediterranean Diet adherence. Females had significantly higher anxiety scores (median GAD-7: 10 vs. 5, p < 0.001). Female gender, food insecurity (OR 2.436, p = 0.011), current smoking, and worsening living conditions were associated with elevated anxiety; older age was protective.

These findings highlight critical gender-based disparities in mental health and lifestyle behaviors. Higher anxiety and distinct coping strategies among women align with feminist theories of emotional labor and "crisis patriarchy," suggesting disproportionate burdens during systemic disruptions. Public health and primary care strategies should incorporate screening and tailored interventions. Future research should apply an intersectional lens to explore how ethnicity, religion, and socioeconomic status intersect with gender to influence vulnerability.