Scientists from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and Trinity University are partnering with the San Antonio Food Bank for a four-year study on eating disorders in a highly targeted population of city residents.
Lisa Smith Kilpela, PhD, associate director of the Center for Research to Advance Community Health (ReACH), associate professor with the Department of Medicine, and Carolyn Black Becker, PhD, professor of psychology at Trinity University, are the lead investigators for the study titled Prospective Health Impacts of Chronic Binge Eating Disorder in Hispanic Older Women Living with Food Insecurity (PROSPERA) that was awarded $2.2 million by the National Institutes of Health National Institute on Aging. This transformative study aims to redefine how we understand and address the intersection of binge eating, food insecurity and health disparities among older Hispanic women. The goal is to reduce multimorbidity, pioneer scalable interventions and deliver actionable insights for policymakers.
Getting past the label
Kilpela, a leading expert on eating disorders in older women, said her first clinical research was on eating disorders within the population that fits the preconception for the disease — young, white, affluent and female.
“We’ve put a great deal of our time, our energy and our money into understanding how eating disorders affect a very specific population, based on this stereotype,” Kilpela said.
Older women are almost completely neglected in eating disorder research and Kilpela said most geriatricians she’s spoken with had never asked their patients about eating disorders. Research suggests that up to 20% of women over the age of 60 have chronic binge eating disorder, defined as eating abnormally large amounts of food in one sitting while feeling out of control, one or more times per week over at least three months. Reasons for the disorder vary from person to person, but some correlations include stress, poor body image and depression.
Recent data reveal that binge eating disorders and related health conditions are significantly more common among older women, particularly those experiencing food insecurity. These women often struggle with poorer mental health, reduced quality of life and a higher prevalence of chronic illnesses such as diabetes, heart disease and high blood pressure.
Kilpela shared that during her postdoctoral fellowship with Becker, they discussed the widespread assumptions about eating disorders, including the stereotype that body image concerns and related eating disorders naturally improve with age. Diving into the data, they found that women aged 60 years and older have some of the highest levels of body dissatisfaction.
“Why do we think that body image or eating disorders would get better with age when what you see everywhere on TV and the media is not just the thin ideal, but the young, thin ideal?” Kilpela said.
Intersection of age, food insecurity, culture
Kilpela said co-lead investigator Becker is a pioneer in the study of eating disorders among people living with food insecurity. When Kilpela saw a grant opportunity related to underserved populations, she was enthusiastic about the opportunity to partner with her to better understand how food insecurity, age and culture intersect to affect the health of Hispanic women living with binge eating disorder. Findings from this study could inform treatment options and policy changes.
A study published in 2023 by Kilpela, Becker and other scientists found between 17% and 20% of a sample of women aged 51 or older who visited the San Antonio Food Bank met the criteria for severe binge eating disorder. This new study will build off those findings, narrowing the scope to discover potential health impacts for Hispanic women. One of the objectives of the study is to create a brand-new risk index of the health burden of binge eating disorder among older, Hispanic women who face food insecurity. Factors that typically predict binge eating behaviors may not be as relevant for some people, including women of color and underrepresented populations.
“The goal is understanding in this population, living with significant intersectional disadvantage, how do the trajectories of both food insecurity and binge eating over time operate independently on health and how do they transact and potentially influence one another,” Kilpela said.
This proposed study will include 250 Hispanic women, age 50 or older, living with food insecurity, with 125 who meet the criteria for chronic binge eating disorder and 125 who have no history of an eating disorder. Throughout the study, researchers will assess the impact of binge eating disorders on participants’ mental and physical health compared to participants who are food insecure but do not have an eating disorder. The study will include qualitative interviews with participants about their lived experiences and major life events.
A voice for those left behind
In the end, researchers hope to pinpoint certain factors that influence the health burden of binge eating disorder among older Hispanic women living with food insecurity and develop relevant interventions that health care providers and nonprofit organizations can use.
“Many of our older women know they’ve been left behind. They know they’ve been struggling but say nobody ever asked them about this. It’s significant to be able to give a voice to people who are very aware that they have been marginalized,” Kilpela said. She emphasized the importance of this research, stating, “That is why a big part of our work is to give a voice to those who’ve been left behind, to serve the underserved, to tackle health disparities where they exist and where we don’t even realize they exist.”
Community partnerships
“What makes this study truly innovative is the leveraging of three great San Antonio institutions — UT Health San Antonio, Trinity University and the San Antonio Food Bank (SAFB) — to address the health needs of an underserved community in San Antonio all while advancing science in a critically needed area. This is a San Antonio study from start to finish,” Becker said.
During the study, the San Antonio Food Bank will serve as a centralized location for study-related activities and provide infrastructure to support the research process.
“By serving as the central point of contact for both participants and researchers, the SAFB will help enhance participant engagement and support the overall success of the study,” said Emily De Maria, MPAff, chief programs officer with the San Antonio Food Bank.
Study participants can access point-of-care testing, health counseling and case management. As part of the research plan, UT Health San Antonio and Trinity University scientists pledge to conduct annual virtual food drives for the San Antonio Food Bank and complete at least 40 volunteer hours annually. The study will provide compensation totaling $45,000 to participants through HEB gift cards, the value of the health screenings, one-hour phone counseling sessions and connections to additional resources.
Throughout the project, the team will conduct focus groups with community members and stakeholders, gather community input and conduct qualitative interviews to determine what steps to take next.
“We wanted to make sure that we are coming to the community physically, but also coming to the community and giving back,” Kilpela said.