The relationship between food insecurity and binge and night eating symptoms in prebariatric surgery patients is mediated by depressive symptoms

Background: Eleven percent of households in the United States experience food insecurity, which is a lack of access to adequate, desirable food for a healthy lifestyle. Although food insecurity is associated with increased risk of obesity and nonadherence to dietary management of chronic diseases such as diabetes, the correlates of food insecurity have not yet been studied in a bariatric surgery population. Objectives: To replicate, in a bariatric sample, previous findings that food insecurity is related to eating pathology and to test the hypothesis that this relationship is mediated by depressive symptoms. Setting: University hospital, United States. Methods: Two hundred forty bariatric surgery candidates responded to self-report measures of food insecurity and mood, night-eating, and binge-eating symptoms. The sample was 74% female and 71% white, with a mean age of 41.09 (11.84) years. Based on responses to the United States Department of Agriculture Adult Food Security Survey Model, 15.8% were categorized as food insecure and 25.8% as marginally food secure. Multiple regression models with bootstrapping for confidence interval estimates were used to explore mediation hypotheses. Results: Food insecurity was positively associated with symptoms of night eating and binge eating, and these relationships were cross-sectionally mediated by depressive symptoms. Conclusions: Food insecure bariatric candidates may be at increased risk of poorer postoperative outcomes because of lack of access to needed food and the detrimental mental health impact of this lack of access.