Prospective Health Impacts of Chronic Binge Eating Disorder in Hispanic Older Women Living with Food Insecurity (PROSPERA) - ABSTRACT Women live longer than men, yet they also experience greater morbidity, which makes understanding how specific chronic conditions further impact multimorbidity in women essential. Importantly, chronic conditions disproportionately affect certain women, including those who are historically underrepresented, understudied, and underreported (U3) in biomedical research. Binge Eating Disorder (BED) involves discrete episodes (≥1/week) of eating abnormally large amounts of food in one sitting while feeling out of control. BED is more common among women than men and is associated with poor cardiometabolic and mental health profiles, adjusting for BMI. As with many chronic conditions, disparities exist in both the prevalence and understanding of chronic BED within subpopulations of women. Specifically, because eating disorders are stereotyped as disorders of youth, white race, and affluence, data in populations beyond this stereotype are highly limited. Yet, recent evidence indicates greater BED prevalence and negative health correlates among women in two understudied areas: 1) older age, and 2) economically disadvantaged. Cross-sectional research suggests nearly 20% of women aged ≥60 years may meet BED severity criteria, and that those with BED experience poorer mental health and quality of life, and profound cardiometabolic morbidity. Recent research among largely Hispanic/Latino (H/L) samples living with food insecurity (FI) found that 17-20% of older women (aged ≥51 years) met BED severity criteria. One limitation to this research is its cross-sectional nature. Thus, the prospective health impacts of BED among older H/L women living with FI remains unknown. Another limitation is the insufficient exploration of environmental factors (e.g., psychosocial; social determinants of health [SDoH]) that influence cardiometabolic risk in older H/L women who have chronic BED and live with FI. The specific research objectives of this R01 are to determine the prospective mental and cardiometabolic health impacts of chronic BED in older H/L women living with FI, thus creating a risk index for the health burden of BED and FI in later life for H/L women. The proposed study will include 250 older (≥50 years) H/L women living with FI (n =125 with chronic BED & n = 125 no lifetime history of any eating disorder) to assess the prospective impact of BED on cardiometabolic health (e.g., HbA1C, BMI change), sarcopenic obesity, menopause quality of life, physical functioning, and depression over 2 years, and to explore SDoH factors between groups on outcomes (Aim 1); examine longitudinal trajectories of BED and FI (Aim 2); and explore the lived experiences and major life events among participants with and without BED in a concurrent nested mixed-method design (Aim 3). The long-term objectives of this research program are to a) elucidate potential factors of influence (e.g., mediators/moderators) on the health burden of chronic BED in older H/L women living with FI, b) develop U3 relevant, scalable interventions so that healthcare providers and hunger relief organizations can improve services, and c) generate data for policy change to ultimately reduce multimorbidity in this U3 population.
