Oona Hanson is a writer, educator and parent coach who specializes in helping families navigate diet culture and eating disorders.
A common misconception about eating disorders is that they afflict only the wealthy. But this stereotype is contradicted by the research, which shows that coming from a low-income family actually increases the risk of developing these illnesses.
Eating disorder symptoms are more common among young people who grow up with fewer economic resources, according to a new UK study published in the journal JAMA Network Open. This latest research adds to the existing body of evidence linking food insecurity to a higher vulnerability to eating disorders. Eating disorders are serious and potentially life-threatening mental illnesses that currently affect nearly 10% of the population worldwide.
In the United States, 1 in 5 children — that’s about 14 million kids — currently live in a food insecure household. With rising grocery costs and planned cuts to nutrition programs for kids and their families, we can expect even higher rates of hunger and eating disorders among lower income children.
What is most concerning is that these kids are the least likely to have access to eating disorder treatment. This public health perfect storm is something schools, families, pediatricians and government leaders need to take seriously.
How childhood food insecurity fuels eating disorder risk
Lacking consistent access to food harms children’s physical health and well-being in the short term and puts them at higher risk for significant mental health problems in the future. One of the lesser-known impacts of hunger is eating disorders, noted Jessica Wilson, a registered dietitian in Sacramento, California, and author of “It’s Always Been Ours: Rewriting the Story of Black Women’s Bodies.”
Food insecurity contributes to eating disorders through a range of physiological and psychological processes. “Caloric deficits create this perpetual fight-or-flight state, which can increase stress hormones, and that can lead to all-or-nothing thinking and other cognitive struggles,” Wilson said.
Experiencing hunger also directly affects how children relate to food and their bodies: “One, it can teach kiddos to ignore hunger cues, which is something that we see in all types of eating disorders,” Wilson said. “And two, it can also turn off signals of fullness, something we see in eating disorders, too.”
Just like dieting or other intentional restriction, economically driven scarcity can interfere with a child’s relationship with food. Without consistent access to enough food — for whatever reason — young people can struggle to develop healthy eating patterns.
While it’s natural to eat in larger quantities after a period of undereating, for some, that deprivation drives intense cravings, where certain foods can take on more “power” or have a “charge” around them, Wilson said. Hoarding and sneaking food are common to both food insecurity and eating disorders.
Even when food is available, some kids who have experienced nutritional deprivation aren’t always able to get their needs met. Because of the stigma around school lunches, some students choose to go hungry because of shame, something Wilson has seen firsthand in her work with low-income communities.
Misinformation perpetuates a negative characterization of cafeteria food, even though many children get their healthiest meal of the day at school.
Back at home, “some kids can develop a value of going without. So, if they notice that funds are tight in the household, they can get into a pattern of wanting to skip their meals and give the food to others,” Wilson said. “Not nourishing yourself, thinking that somebody else’s needs are higher than your own is also what we see in anorexia, this feeling of not being worthy of having food.”
Wilson even sees this in adult clients who grew up “ignoring their own needs” because there was not enough food to go around. She has patients with eating disorders who say, “I was able to get through, you know, a decade of my life without having to feed or care for my body. Like, why do I have to start now?”
Eating disorders and malnutrition don’t have a ‘look’
While the poorest children are most vulnerable, even families living above the poverty line can experience food insecurity because of other expenses, such as medical bills and the high cost of housing and childcare, according to Carolyn Wait Vega, associate director of policy analysis at Share Our Strength, which runs the national No Kid Hungry campaign.
Food insecurity doesn’t necessarily mean kids are going to bed with growling stomachs every night. Instead, it might look like “parents not being able to buy the quality of food they want to provide, food running low by the end of the month, and making a lot of trade-offs,” Vega said.
This ongoing family stress has dramatic health impacts on children. “We know that the effects are serious, that they have an immediate effect on how well kids are able to do in school, as well as on their long-term health and academic achievement,” she added.
Contrary to popular assumptions, children experiencing food insecurity do not necessarily appear underweight. Because of genetically predetermined body size or hormonal and metabolic disruption from food insecurity and other stressors, “kids can absolutely be chubbier and still be malnourished or undernourished, which is not something that is common knowledge,” Wilson said.
Assuming a child’s body size can tell the whole story of their nutritional status leads many hungry kids to be overlooked — and even be given the counterproductive message that they’re eating “too much.” For kids, “going without food is devastating, both to their physiology but also their mood, their ability to learn, their ability to engage, their ability to be physically active,” Wilson said.
Not enough educators and medical professionals understand “the variety of ways that eating disorders can present,” Wilson said. “It’s not just thin, White, affluent girls.”
Children in all body sizes experience eating disorders. Bigger kids are often assumed to be eating “too much” when in fact they may be struggling with both food insecurity and an eating disorder. Shaming their food choices or reducing their access to food only moves them further away from health.
“Oftentimes, when kids either with restrictive eating disorders or some types of disordered eating present to a doctor’s clinic, and their weight is higher, they get feedback that they need to lose weight or get praised for not eating,” Wilson said.
This common approach “will just perpetuate that cycle and they may try to restrict more — when in fact they actually need to be eating more to help regulate their energy levels and metabolism and cognitive functioning,” she added.
With added systemic barriers to accessing nutritious food, children and their health will continue to suffer. Assuming all these planned funding cuts go into effect, “kids are going to be more malnourished, and there are going to be even fewer resources to support kids with eating disorders,” Wilson warned.
Child hunger is likely to get worse
Despite an already significant child hunger problem in the US, Congress recently approved reductions to the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps. The reconciliation bill passed by Congress and signed into law by President Donald Trump in July included “the biggest cuts to SNAP in the program’s history,” Vega said.
In addition to reducing food access for struggling families, these cuts will have “far-ranging ripple effects” to school lunch programs because of the way SNAP beneficiaries are often automatically enrolled in free school meals. More districts will face difficulty providing food for students, including those who weren’t previously enrolled in assistance programs. Communities may also lose their local grocery stores as the result of SNAP cuts.
What concerned parents can do
For families struggling to put food on the table, Feeding America makes it easy to identify local food banks and other resources. This nonprofit also supports parents navigating the application process for nutrition assistance programs. The Harvard T.H. Chan School of Public Health outlines practical strategies for shopping and meal planning on a tight budget.
To try to lessen the impacts of SNAP cuts on school programs, Vega encourages all families to submit meal application forms even if they assume they won’t qualify — and for parents of all income levels to be more open to kids eating school lunches.
“Even if you’re not eligible for free or reduced-price meals, having your child participate in school meals helps the school nutrition department work better and provide better food for everyone,” she said.
Vega acknowledges that misconceptions about cafeteria food may lead some families to send a packed lunch along with the message that school lunches are inadequate or even harmful. But that’s not correct.
“Parents may still have memories of what school meals were like whenever they were in school, but school meals have changed a lot over the past 10 to 15 years since the Healthy, Hunger-Free Kids Act took effect,” Vega added.
For those eager to see a return of broader support for child nutrition, Wilson has hope. “I would say that parents, especially moms, have often been the ones to demand change. It’s not too late to advocate to not make those cuts.”
Vega agreed: “It’s a long-term goal to see these changes reversed, and so I think the more people understand what the implications are, to be able to raise that up to their members of Congress to say, hey, I didn’t think this was the right thing to do. Like, let’s reconsider.”