Disordered eating behaviors, food insecurity and the COVID-19 pandemic among undergraduate students in the United States: a systematic review

Eating disorders are highly prevalent among undergraduate students at colleges and universities in the United States (US). These behaviors may be associated with food insecurity and the COVID-19 pandemic, as both represent stressors that may be difficult for young adults to independently manage and cope with, turning to maladaptive coping strategies that are characteristic of disordered eating. The aim of this systematic review was to understand the relationship between eating disorders, defined by DSM-5 criteria, and food insecurity among undergraduate college students in the US, with additional consideration for the effects of the COVID-19 pandemic. PubMed, Cochrane Library, Scopus, Global Health (Ovid), PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Psychology Database were searched from 2014 to 2024 to capture eating disorders as defined by the DSM-5 criteria, searching terms representing eating disorders, food insecurity, and COVID-19. Articles were screened independently by 2 researchers using inclusion criteria agreed upon by all authors. Disordered eating was associated with food insecurity and changes in behavior due to the COVID-19 pandemic. All studies were cross sectional with the number of participants ranging from 98 to 1996. Due to heterogeneity in assessment tools used in studies pooling of data and direct comparison of findings was limited. While no study measured eating disorders, food insecurity, and COVID-19 together, studies did reveal that food insecurity and COVID-19 were both associated with emotional eating that may indicate a greater risk for binge eating disorder. While the overall data is limited, studies examining the effect of food insecurity or COVID-19 on undergraduate eating behaviors found that students experienced a significant increase in depressive and anxious symptoms contributing to disordered eating patterns. This may have a long-term impact on academic and health outcomes for young adults. Systematic Review Registration: PROSPERO registration number CRD42024577588. This systematic review of peer-reviewed manuscripts published between 2013 (the year the DSM-5 was updated) and 2024 that examine disordered eating, food insecurity, and COVID-19 among undergraduate students in the United States found that food insecurity and COVID-19 were associated with higher emotional eating, particularly binge eating disorder, among undergraduate students. Although no studies examined the effect of disordered eating, food insecurity, and COVID-19 together, the relationship between major life stressors (e.g., food insecurity and COVID-19) and disordered eating behaviors highlight greater need for institution-level supports for these groups of emerging adults, as the behaviors can have long-term impacts on health and wellness.