Post-Intervention perspectives on adapting a digital binge eating intervention for food insecurity: A qualitative study

Food insecurity is strongly associated with binge eating, obesity, and type 2 diabetes mellitus (T2DM). Individuals with food insecurity face distinct financial, structural, and psychosocial barriers that may limit the relevance and effectiveness of standard behavioral interventions. FoodSteps-FI is a 16-week digital intervention, comprised of an app and stipend to support healthy behavior changes, adapted to address binge eating and health behaviors among adults with food insecurity and T2DM. This qualitative study engaged FoodSteps-FI users post-intervention to (1) characterize food insecurity-related challenges that users experienced while using the program and (2) identify user-driven recommendations to improve the design and implementation of FoodSteps-FI. We conducted interviews with adults with food insecurity, recurrent binge eating, and a self-reported diagnosis of T2DM who completed a pilot trial of FoodSteps-FI. Interviews explored users’ lived experiences of managing food insecurity during the intervention and their suggestions for improving FoodSteps-FI’s relevance and impact. We used thematic analysis to analyze data and generate themes. Participants described multiple, interconnected challenges that complicated their efforts to reduce binge eating and engage in health-promoting behaviors, including constrained finances, rising food costs, limited access to affordable and nutritious foods, stress and shame associated with food insecurity and binge eating, and “feast-or-famine” eating patterns linked to the timing of food assistance benefit distribution. Participants recommended several intervention enhancements, including budgeting and spending tools, increased or alternative financial supports, guidance on nutritious eating on a budget (e.g., low-cost recipes), partnerships with grocery stores and community organizations to provide discounts or resources, referrals to local resources, and opportunities for peer support. Integrating financial, nutritional, and community resources may enhance the equity, relevance, and effectiveness of FoodSteps-FI and other eating disorder interventions for people with food insecurity. Future research is needed to evaluate how these adaptations may improve clinical outcomes and their impact on individuals with food insecurity, binge eating, and T2DM. NCT06348251 Food insecurity, or limited access to affordable and healthy food, is common in the United States and is linked to health problems like binge eating, obesity, and diabetes. People experiencing food insecurity often face cycles of having too little food and skipping meals, followed by overeating when food becomes available again. Stress, financial problems, and low access to healthy foods can worsen these patterns. Existing treatments for binge eating may not fully address these challenges, so we need to learn how to better support people with food insecurity. In this study, we interviewed individuals who completed FoodSteps-FI, an app created for people with binge eating, type 2 diabetes, and food insecurity, to learn how to improve the program to meet their needs. Participants described challenges following through with healthy behaviors during the program due to high food costs, difficulty accessing healthy foods, stress, and cycles of overeating linked to their paychecks and benefit cycles. Participants suggested improvements to FoodSteps-FI, including more financial support, budgeting tools, low-cost healthy recipes, and community resources. They also wanted more social and educational support. Overall, addressing financial and food access barriers may improve the effectiveness of binge eating treatments in people with food insecurity.