Investigating associations between food insecurity and eating disorder pathology: A systematic review and meta-analysis

Abstract

ObjectiveFood insecurity is increasingly recognised as an important social determinant of eating disorder (ED) pathology. Although research in this area has grown substantially, evidence remains fragmented across ED pathology, diagnoses, age groups, and clinical and non-clinical populations. This review aims to update and synthesise the literature on the relationship between food insecurity and eating disorder pathology.MethodRelevant studies were identified by searching PubMed/Medline, Web of Science, PsycINFO, Scopus, and the grey literature up to September 2026. Random-effects meta-analyses and narrative synthesis were carried out. The methodological quality of the included studies was evaluated using Mixed Methods Appraisal Tool. Public and patient involvement and engagement informed the process throughout. The protocol for this review was registered with PROSPERO (CRD420261291381).Results We included 140 articles in the review (n=628,090 participants) and, of these, 72 in the meta-analysis. Food insecurity was associated with greater overall eating pathology, with pooled eORs ranging from 1.75 (1.18–2.58) to 2.36 (0.15-0.31) across the three effect-size measures. Positive associations were also observed for binge eating, dietary restriction, purging, vomiting, and laxative use, although effect sizes varied across outcomes and analyses. Findings were mixed for excessive exercise and negative body image, with some studies reporting significant associations with food insecurity and others finding no evidence of an association. Overall, the included studies were of moderate to high methodological quality.ConclusionTo date, the existing literature supports the role of food insecurity in the aetiology of eating disorder pathology and highlights the need for future theoretical frameworks and prevention interventions.

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