Large Eating Episodes, Cannabis Use, and Health in US Adults: A Cross-Sectional and Exploratory Mortality Analysis

Cannabis use is common and increases appetite, which may lead to large eating episodes that overlap with binge eating pathology. However, whether large eating episodes are related to health outcomes among individuals who use cannabis is not known. To address this gap, we analyzed seven cycles of the National Health and Nutrition Examination Survey (NHANES; 2005 to 2018) including 18,709 adults aged 20 to 59 years (2,578 current, 7,394 past, and 8,737 never cannabis users). A large eating episode was defined as an eating occasion of at least 1,500 kcal on either of two 24-hour dietary recalls. Among current cannabis users, survey-weighted logistic regression with Benjamini-Hochberg correction estimated adjusted associations between large eating episodes and 29 health outcomes. The weighted prevalence of a large eating episode was 30.3% among current cannabis users, 22.2% among past users, and 19.3% among never users. Among current users, a large eating episode was associated with higher odds of fair or poor self-rated health (adjusted odds ratio [OR] = 1.75, 95% CI [1.27, 2.41], p < .001, q = .022). No other association remained significant after correction, although nominal associations were observed for household food insecurity, obesity, abdominal obesity, and elevated glycated hemoglobin. Notably, adults with both current cannabis use and a large eating episode had higher odds of fair or poor health than each of the other three groups (ORs = 1.79 to 1.85, all p < .001). In exploratory analyses, the hazard of death was higher for adults with both exposures after adjustment for age and sex (hazard ratio [HR] = 2.08, 95% CI [1.31, 3.31]), though it did not remain significantly higher after full adjustment (HR = 1.40, 95% CI [0.88, 2.21]). Findings suggest that asking about eating patterns may help clinicians identify individuals who use cannabis and may be experiencing health-related distress. Longitudinal studies measuring loss of control over eating, cannabis frequency, and product type are critical for determining whether eating patterns affect health.