Food insecurity and anxiety in the Israel-Gaza War of 2023-2024

Background: Armed conflict can disrupt food production and distribution, leading to food insecurity. It can also lead to displacement, interfere with typical food preparation, cause psychological stress, and deteriorate diet quality. Objectives: The present cross-sectional study was designed to estimate food insecurity prevalence and its association with anxiety and diet quality measures during the ongoing Israel-Gaza war. Methods: This study was conducted online in a representative random sample of Israeli adults aged > 18 years. Food insecurity was assessed using the two-question Hunger Vital Sign questionnaire. Anxiety was measured using the General Anxiety Disorder (GAD)-7 screener. Diet quality was measured using the Israel Mediterranean Diet Scale (I-MEDAS). Results: The study population included 534 Israeli adults, of which 44 (8.2%) reported food insecurity. Food-insecure respondents were younger; had fewer years of education; were less likely to be Jewish; were more religious; reported more weight gain and a greater deterioration of diet quality; and had more restricted access to cooking facilities since the war began. The GAD-7 score was 13.5 (10.75) in people with vs. 7 (9) in people without food insecurity, p<0.001. Anxiety was a robust predictor of food insecurity even after controlling for age, sex, and religion. Discussion: In this novel examination of food patterns and emotional outcomes during a period of armed conflict, food insecurity was associated with increased anxiety, deteriorating diet quality, and weight gain, suggesting that public health interventions should include both nutrition and mental health components during periods of war.