HMN 2026: How Coping with chronic disease when food is scarce takes its toll on mental health

Twenty-five years into her diabetes and youth research, epidemiology professor Angela Liese and her team continue to increase our understanding of this uniquely vulnerable population. The team’s recent findings reveal that youth and young adults who have diabetes and experience food insecurity have higher rates of mental health symptoms, including disordered eating.

Diabetes is the third most common chronic disease among children and adolescents and hits some regions of the country harder than others. With its elevated rates of diabetes prevalence and complications, South Carolina has played an important role in representing the Southeastern United States.

“[The research] revealed increasing rates of both type 1 and type 2 diabetes, particularly among racial and ethnic minorities, both nationwide and in South Carolina,” says Liese, who pioneered the first statewide diabetes surveillance system for children and young adults.

Published in BMJ Open Diabetes & Research Care with epidemiology doctoral student Ali Alfalki as lead author, the recent paper confirmed a high prevalence of food insecurity among youth and young adults with diabetes. The longitudinal study also revealed a correlation between this uncertain access to adequate, nutritious food (whether intermittent or prolonged) and a higher incidence of mental health symptoms, such as depression, anxiety, and stress.

Alarmingly, 30% of the participants expressed some level of food insecurity across the four-year study—putting them at ongoing and compounding risk for poor disease management and subsequent adverse health outcomes.

Postdoctoral fellow Emmanuel Julceus took the lead in compiling the team’s findings from a cross-sectional study that they had previously published in the International Journal of Eating Disorders. Looking at food insecurity at the household level, the authors found that youth with diabetes and food insecurity were more likely to exhibit disordered eating behaviors, such as binge eating, chronic dieting, over-exercising, and other compensatory behaviors.

Previous research had shown that youth with type 1 diabetes were already more than twice as likely to engage in disordered eating compared to those without the condition, and this new research suggests an additionally heightened risk for adolescents with diabetes with food insecurity.

“These findings point toward intersecting, exacerbating risk factors where food insecurity makes diabetes management more difficult, and together, this dual status increases the likelihood of mental health issues,” Liese says. “In turn, mental health symptoms, such as depression, and disordered eating behaviors, can make diabetes management and other types of self-care even more challenging, leading to higher rates of complications and poorer health overall.”

To disrupt this cycle, the researchers recommend integrated models of care, including routine screenings for mental health concerns. With complicated, chronic conditions, like diabetes, youth and young adults require good health care coverage and access to individualized care.

Further, those with food insecurity benefit greatly from nutrition assistance programs. However, all of these essentials have recently been challenged by the federal cuts to health care access, health insurance supports, and nutrition assistance programs, a trend against which the American Diabetes Association has vehemently spoken out.

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