Association of Food Insecurity and Food Addiction Symptoms: A Secondary Analysis of Two Samples of Low-Income Female Adults



      Household food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.


      Our aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.


      Secondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.


      Participants in study 1 (n = 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n = 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.

      Main outcome measures

      The primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.

      Statistical analysis

      Multivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.


      In study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P = .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P = .045).


      These findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.A.
        • Singh A.
        Household Food Security in the United States in 2019.
        US Department of Agriculture, Economic Research Service, 2020
        • Martin M.A.
        • Lippert A.M.
        Feeding her children, but risking her health: The intersection of gender, household food insecurity and obesity.
        Soc Sci Med. 2012; 74: 1754-1764
        • Wu Q.
        • Harwood R.L.
        • Feng X.
        Family socioeconomic status and maternal depressive symptoms: Mediation through household food insecurity across five years.
        Soc Sci Med. 2018; 215: 1-6
        • Laraia B.
        • Siega-Riz A.M.
        • Gundersen C.
        • Dole N.
        Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women.
        J Nutr. 2006; 136: 177-182
        • Gill M.
        • Koleilat M.
        • Whaley S.E.
        The impact of food insecurity on the home emotional environment among low-income mothers of young children.
        Matern Child Health J. 2018; 22: 1146-1153
        • Pedroso J.
        • Buccini G.
        • Venancio S.I.
        • Pérez-Escamilla R.
        • Gubert M.B.
        Maternal mental health modifies the association of food insecurity and early child development.
        Matern Child Nutr. 2020; 16: e12997
        • Moradi S.
        • Mirzababaei A.
        • Dadfarma A.
        • et al.
        Food insecurity and adult weight abnormality risk: A systematic review and meta-analysis.
        Eur J Nutr. 2019; 58: 45-61
        • Myers C.A.
        • Mire E.F.
        • Katzmarzyk P.T.
        Trends in adiposity and food insecurity among US adults.
        JAMA Netw Open. 2020; 3e2012767
        • Weihrauch-Blüher S.
        • Schwarz P.
        • Klusmann J.-H.
        Childhood obesity: Increased risk for cardiometabolic disease and cancer in adulthood.
        Metabolism. 2019; 92: 147-152
        • Becker C.B.
        • Middlemass K.
        • Taylor B.
        • Johnson C.
        • Gomez F.
        Food insecurity and eating disorder pathology.
        Int J Eat Disord. 2017; 50: 1031-1040
        • Becker C.B.
        • Middlemass K.M.
        • Gomez F.
        • Martinez-Abrego A.
        Eating disorder pathology among individuals living with food insecurity: A replication study.
        Clin Psychol Sci. 2019; 7: 1144-1158
        • Lydecker J.A.
        • Grilo C.M.
        Food insecurity and bulimia nervosa in the United States.
        Int J Eat Disord. 2019; 52: 735-739
        • Hazzard V.M.
        • Barry M.R.
        • Leung C.W.
        • Sonneville K.R.
        • Wonderlich S.A.
        • Crosby R.D.
        Food insecurity and its associations with bulimic-spectrum eating disorders, mood disorders, and anxiety disorders in a nationally representative sample of US adults.
        Soc Psychiatry Psychiatr Epidemiol. 2021; : 1-8
        • Rasmusson G.
        • Lydecker J.A.
        • Coffino J.A.
        • White M.A.
        • Grilo C.M.
        Household food insecurity is associated with binge-eating disorder and obesity.
        Int J Eat Disord. 2019; 52: 28-35
        • Middlemass K.M.
        • Cruz J.
        • Gamboa A.
        • et al.
        Food insecurity & dietary restraint in a diverse urban population.
        Eat Disord. 2021; 29: 616-629
        • West C.E.
        • Darling K.E.
        • Ruzicka E.B.
        • Sato A.F.
        Household income and loss of control eating in adolescence: Examining the role of food insecurity.
        Appetite. 2021; 165: 105291
        • Larson N.
        • Laska M.N.
        • Neumark-Sztainer D.
        Food insecurity, diet quality, home food availability, and health risk behaviors among emerging adults: Findings from the EAT 2010–2018 study.
        Am J Public Health. 2020; 110: 1422-1428
        • Laraia B.
        • Epel E.
        • Siega-Riz A.M.
        Food insecurity with past experience of restrained eating is a recipe for increased gestational weight gain.
        Appetite. 2013; 65: 178-184
        • Drewnowski A.
        The cost of US foods as related to their nutritive value.
        Am J Clin Nutr. 2010; 92: 1181
        • Small D.M.
        • DiFeliceantonio A.G.
        Processed foods and food reward.
        Science. 2019; 363: 346-347
        • Schulte E.M.
        • Avena N.M.
        • Gearhardt A.N.
        Which foods may be addictive? The roles of processing, fat content, and glycemic load.
        PLoS One. 2015; 10e0117959
        • Schulte E.M.
        • Gearhardt A.N.
        Development of the modified Yale food Addiction Scale version 2.0.
        Eur Eat Disord Rev. 2017; 25: 302-308
        • Gearhardt A.N.
        • Corbin W.R.
        • Brownell K.D.
        Preliminary validation of the Yale Food Addiction Scale.
        Appetite. 2009; 52: 430-436
        • Schulte E.M.
        • Gearhardt A.N.
        Associations of food addiction in a sample recruited to be nationally representative of the United States.
        Eur Eat Disord Rev. 2018; 26: 112-119
        • Nunes-Neto P.R.
        • Köhler C.A.
        • Schuch F.B.
        • et al.
        Food addiction: Prevalence, psychopathological correlates and associations with quality of life in a large sample.
        J Psychiatr Res. 2018; 96: 145-152
        • Zhao Z.
        • Ma Y.
        • Han Y.
        • et al.
        Psychosocial correlates of food addiction and its association with quality of life in a non-clinical adolescent sample.
        Nutrients. 2018; 10: 837
        • Flint A.J.
        • Gearhardt A.N.
        • Corbin W.R.
        • Brownell K.D.
        • Field A.E.
        • Rimm E.B.
        Food-addiction scale measurement in 2 cohorts of middle-aged and older women.
        Am J Clin Nutr. 2014; 99: 578-586
        • Minhas M.
        • Murphy C.M.
        • Balodis I.M.
        • Samokhvalov A.V.
        • MacKillop J.
        Food addiction in a large community sample of Canadian adults: Prevalence and relationship with obesity, body composition, quality of life and impulsivity.
        Addiction. 2021; 116: 2870-2879
        • Fielding-Singh P.
        • Patel M.L.
        • King A.C.
        • Gardner C.D.
        Baseline psychosocial and demographic factors associated with study attrition and 12-month weight gain in the DIETFITS trial.
        Obesity. 2019; 27: 1997-2004
        • Berenson A.B.
        • Laz T.H.
        • Pohlmeier A.M.
        • Rahman M.
        • Cunningham K.A.
        Prevalence of food addiction among low-income reproductive-aged women.
        J Womens Health (Larchmt). 2015; 24: 740-744
        • Hardy R.
        • Fani N.
        • Jovanovic T.
        • Michopoulos V.
        Food addiction and substance addiction in women: Common clinical characteristics.
        Appetite. 2017; 120: 367-373
        • Epel E.
        • Laraia B.
        • Coleman-Phox K.
        • et al.
        Effects of a mindfulness-based intervention on distress, weight gain, and glucose control for pregnant low-income women: A quasi-experimental trial using the ORBIT model.
        Int J Behav Med. 2019; 26: 461-473
        • US Department of Agriculture
        US Household Food Security Survey Module.
        US Department of Agriculture, 2012
        • Meule A.
        • Gearhardt A.N.
        Ten years of the Yale Food Addiction Scale: A review of Version 2.0.
        Curr Addict Rep. 2019; 6: 218-228
        • Myers A.M.
        • Painter M.A.
        Food insecurity in the United States of America: An examination of race/ethnicity and nativity.
        Food Secur. 2017; 9: 1419-1432
      1. SAS [computer program]. SAS Institute Inc, 2011
        • Coxe S.
        Effect size for Poisson regression.
        (Accessed September 5, 2022)
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Routledge, 2013
        • Wiss D.A.
        • Avena N.
        • Gold M.
        Food addiction and psychosocial adversity: Biological embedding, contextual factors, and public health implications.
        Nutrients. 2020; 12: 3521
        • Linardon J.
        • Messer M.
        Assessment of food addiction using the Yale Food Addiction Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance.
        Psychiatry Res. 2019; 279: 216-221
        • Gearhardt A.N.
        • White M.A.
        • Masheb R.M.
        • Morgan P.T.
        • Crosby R.D.
        • Grilo C.M.
        An examination of the food addiction construct in obese patients with binge eating disorder.
        Int J Eat Disord. 2012; 45: 657-663
        • Schulte E.M.
        • Grilo C.M.
        • Gearhardt A.N.
        Shared and unique mechanisms underlying binge eating disorder and addictive disorders.
        Clin Psychol Rev. 2016; 44: 125-139
        • Morales M.E.
        • Berkowitz S.A.
        The relationship between food insecurity, dietary patterns, and obesity.
        Curr Nutr Rep. 2016; 5: 54-60
        • Monteiro C.A.
        • Moubarac J.C.
        • Cannon G.
        • Ng S.W.
        • Popkin B.
        Ultra-processed products are becoming dominant in the global food system.
        Obes Rev. 2013; 14: 21-28
        • Stanton R.A.
        Food retailers and obesity.
        Curr Obes Rep. 2015; 4: 54-59
        • Lucan S.C.
        • Maroko A.R.
        • Sanon O.C.
        • Schechter C.B.
        Unhealthful food-and-beverage advertising in subway stations: Targeted marketing, vulnerable groups, dietary intake, and poor health.
        J Urban Health. 2017; 94: 220-232
        • Leung C.W.
        • Epel E.S.
        • Ritchie L.D.
        • Crawford P.B.
        • Laraia B.
        Food insecurity is inversely associated with diet quality of lower-income adults.
        J Acad Nutr Diet. 2014; 114: 1943-1953.e2
        • Fletcher P.C.
        • Kenny P.J.
        Food addiction: A valid concept?.
        Neuropsychopharmacology. 2018; 43: 2506-2513
        • Volkow N.D.
        • Wise R.A.
        • Baler R.
        The dopamine motive system: Implications for drug and food addiction.
        Nat Rev Neurosci. 2017; 18: 741
        • Hilmers A.
        • Hilmers D.C.
        • Dave J.
        Neighborhood disparities in access to healthy foods and their effects on environmental justice.
        Am J Public Health. 2012; 102: 1644-1654
        • Zenk S.N.
        • Odoms-Young A.M.
        • Dallas C.
        • et al.
        “You have to hunt for the fruits, the vegetables”: Environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood.
        Health Educ Behav. 2011; 38: 282-292
        • Ludwig D.S.
        • Blumenthal S.J.
        • Willett W.C.
        Opportunities to reduce childhood hunger and obesity: Restructuring the Supplemental Nutrition Assistance Program (the Food Stamp Program).
        JAMA. 2012; 308: 2567-2568
        • Kawa A.B.
        • Bentzley B.S.
        • Robinson T.E.
        Less is more: Prolonged intermittent access cocaine self-administration produces incentive-sensitization and addiction-like behavior.
        Psychopharmacology (Berl). 2016; 233: 3587-3602
        • Allain F.
        • Minogianis E.-A.
        • Roberts D.C.
        • Samaha A.-N.
        How fast and how often: The pharmacokinetics of drug use are decisive in addiction.
        Neurosci Biobehav Rev. 2015; 56: 166-179
        • Zhang L.-N.
        • Mitchell S.E.
        • Hambly C.
        • Morgan D.G.
        • Clapham J.C.
        • Speakman J.R.
        Physiological and behavioral responses to intermittent starvation in C57BL/6J mice.
        Physiol Behav. 2012; 105: 376-387
        • Avena N.M.
        • Rada P.
        • Hoebel B.G.
        Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake.
        Neurosci Biobehav Rev. 2008; 32: 20-39
        • Martin M.S.
        • Maddocks E.
        • Chen Y.
        • Gilman S.
        • Colman I.
        Food insecurity and mental illness: Disproportionate impacts in the context of perceived stress and social isolation.
        Public Health. 2016; 132: 86-91
        • Sinha R.
        Chronic stress, drug use, and vulnerability to addiction.
        Ann N Y Acad Sci. 2008; 1141: 105
        • Sinha R.
        • Jastreboff A.M.
        Stress as a common risk factor for obesity and addiction.
        Biol Psychiatry. 2013; 73: 827-835
        • Adam T.C.
        • Epel E.S.
        Stress, eating and the reward system.
        Physiol Behav. 2007; 91: 449-458
        • Keenan G.S.
        • Christiansen P.
        • Hardman C.A.
        Household food insecurity, diet quality, and obesity: An explanatory model.
        Obesity. 2021; 29: 143-149
        • Brunault P.
        • Berthoz S.
        • Gearhardt A.N.
        • et al.
        The Modified Yale Food Addiction Scale 2.0: Validation among non-clinical and clinical French-speaking samples and comparison with the full Yale Food Addiction Scale 2.0.
        Front Psychiatry. 2020; 11: 892
        • Stojek M.M.
        • Wardawy P.
        • Gillespie C.F.
        • Stevens J.S.
        • Powers A.
        • Michopoulos V.
        Subjective social status is associated with dysregulated eating behaviors and greater body mass index in an urban predominantly Black and low-income sample.
        Nutrients. 2021; 13: 3893
        • Lipsky L.M.
        • Burger K.S.
        • Faith M.S.
        • et al.
        Pregnant women consume a similar proportion of highly vs minimally processed foods in the absence of hunger, leading to large differences in energy intake.
        J Acad Nutr Diet. 2021; 121: 446-457
        • Malika N.M.
        • Hayman Jr., L.W.
        • Miller A.L.
        • Lee H.J.
        • Lumeng J.C.
        Low-income women's conceptualizations of food craving and food addiction.
        Eat Behav. 2015; 18: 25-29


      L. Parnarouskis is a doctoral candidate, Department of Psychology, University of Michigan, Ann Arbor.


      A. N. Gearhardt is an associate professor, Department of Psychology, University of Michigan, Ann Arbor.


      A. E. Mason is an associate professor, Department of Psychiatry, Osher Center for Integrative Medicine, University of California, San Francisco.


      N. E. Adler is director, Center for Health and Community, Lisa and John Pritzer Professor of Medical Psychology, Departments of Psychiatry and Pediatrics, and vice chair, Department of Psychiatry, University of California, San Francisco.


      B. A. Laraia is a professor, Public Health Nutrition, School of Public Health, University of California, Berkeley.


      E. S. Epel is a professor, Department of Psychiatry, University of California-San Franscisco Weill Institute for Neurosciences, School of Medicine, San Francisco.


      C. W. Leung is John G. Searle Assistant Professor of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.

      Linked Article

      • Measures Used with Populations with Food Insecurity: A Call for Increased Psychometric Validation
        Journal of the Academy of Nutrition and DieteticsVol. 122Issue 10
        • Preview
          How do researchers know what they are measuring when they use questionnaires? Confidence in the ability of measures to appropriately capture intended constructs for a particular population is essential to scientific rigor and a challenge for the social sciences. Parnarouskis and colleagues1 bring up a critical point in their Discussion about the limitations of using a measure for which the validation samples may not have adequately represented specific groups of interest. We appreciate the opportunity to continue this important conversation because it is a topic that is of high importance to the study of food insecurity and eating-related behaviors.
        • Full-Text
        • PDF