Hunger and Obesity Understanding a Food Insecurity Paradigm: Workshop Summary (2011) / Chapter Skim
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2 Setting the Stage for the Coexistence of Food Insecurity and Obesity
2 Setting the Stage for the Coexistence of Food Insecurity and Obesity
Pages 7-32
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From page 7... ...
• Reducing poverty and stress in the United States would likely lead to reductions in childhood obesity, but reducing food insecurity alone would not necessarily have this effect. • Research topics that may contribute to our understanding of the relationship between food insecurity and obesity include the role of stress, better measures of food insecurity and obe sity, and the links between food insecurity and diet quality.
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From page 8... ...
monitors food security as an ongoing measure of the effectiveness of federal nutrition assistance programs, private food assistance programs, and other publicprivate initiatives in reducing the food insecurity of low-income households. "Food insufficiency" and "food insecurity" are related but distinct concepts.
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From page 9... ...
. Households had problems at times, or anxiety about, accessing adequate food, but the quality, variety, and quantity of their food intake were not substantially reduced.a Low food security A range of food insecurity in which households report multiple indications of food access problems, but typically report few, if any, indications of reduced food intake on the USDA survey (Nord et al., 2010) . Households reduced the quality, variety, and desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted. Prior to 2006, USDA described households with low food security as "food insecure without hunger."a Very low food security A severe range of food insecurity on the USDA survey in which the food intake of some household members was reduced and normal eating patterns were disrupted because of limited resources. At times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food. Prior to 2006, USDA described households with very low food security as "food insecure with hunger" (Nord et al, 2010)
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Measuring Food Insecurity Craig Gundersen, associate professor in the Department of Agricul tural and Consumer Economics at the University of Illinois at Urbana Champaign, briefly described the tool used to determine food insecurity in the United States. A household's food insecurity status is calculated from responses to a series of questions in the Core Food Security Module (CFSM)
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Responses to these questions are used to assign households to food security categories. Households are classified as food insecure (having low food security)
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. Using 1999-2003 data from the Early Childhood Longitudinal Study, BMI as a measure of obesity, and a dynamic random effects model that controls for unobserved factors, the study found no effect of food insecurity on BMI.
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From page 13... ...
. You don't observe a foodinsecure child who's food secure, and vice versa." For this reason, it is not possible to measure accurately the effects on obesity of making everyone in society food secure or food insecure (Gundersen and Kreider, 2009)
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From page 14... ...
Factors such as a job loss, divorce, or other unexpected events that are not captured by an annual income measure could affect a household's food security status. Furthermore, some households experience food insecurity episodically, even though their annual incomes are well above the poverty line (Nord et al., 2010)
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From page 15... ...
When the authors restricted their data to households with very low food security, they found more than a twofold increase in the risk of diabetes compared to those in food-secure households. Adults with diabetes in food-insecure households also exhibited higher hemoglobin A1c values than adults living in food-secure households, suggesting that food-insecure adults are not managing their disease well through their diets.
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In contrast, another study found that younger foodsecure children (under the age of 10 years) in families below 200 percent of the poverty line were more likely to be obese (Gundersen et al., 2008)
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Another line of animal research involves macaque monkeys and the variable foraging demand protocol. In this 16-week protocol, mother monkeys alternated 2-week periods in which food was relatively easy to obtain (low foraging demand)
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. To the extent that SNAP further reduces poverty, it will reduce childhood obesity, Gundersen remarked.
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"We're trying to tease out only the direct effect of food insecurity when we have this wonderful multidimensional construct that's capturing probably more than just the food security status in households," Laraia said. The conceptual framework of research in this area needs to be better defined and thought through, said Laraia.
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"This information can provide the evidence base for the design of effective interventions targeting different subgroups." Examples of key potential effect modifiers are participation in food assistance programs, caregiver stress or depression, social supports, family structure, and child age and gender. As an example of effect modification, Pérez-Escamilla cited findings from Canada suggesting that birth weight may modify the relationship between food insufficiency and the likelihood of childhood obesity later in life (Dubois et al., 2006)
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From page 21... ...
If this hypothesis is confirmed, it would indicate that improving access not only to chronic disease management care but also to much-needed mental healthcare services could lead to improvements in food security for entire households. Measuring Food Insecurity Practically all studies reviewed have measured household food insecurity using experience-based scales or subscales.
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From page 22... ...
Also, he continued, measures of food insecurity need to be more standardized, with the use of similar scales and evidence-based cutoff points. Some studies simply classify households as either food secure or food insecure, while others divide households into two or three different levels of food insecurity.
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From page 23... ...
, illustrating the need to understand how food insecurity and federal nutrition assistance program participation affect different members of the same household. "This principle can be extended to SNAP," said Pérez-Escamilla, and "to any type of food assistance program in the world." GROUP DISCUSSION Moderator: Mary Story During the group discussion period, points raised by participants included the following: Influence of the Life Course Several questions revolved around associations between food insecurity and obesity for specific age groups.
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From page 24... ...
"So this very basic idea -- that we're looking over patterns of changes in fatness as measured by BMI -- is just wrong, most likely, in a developmental sense with children." Interpretations of Measures Another consideration is whether "worry" over food supplies, which is the least severe measure of food security -- that is, in a psychometric sense -- may be one of the most important indicators of stress. "We're going to have to be thoughtful about that," said Frongillo.
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Dieting In response to a question from Elizabeth Dowler about how issues surrounding dieting to lose weight might relate to food insecurity, Laraia responded that very little research-based evidence is available on the subject. However, she also observed that because obesity is more prevalent than food insecurity, episodes of food insecurity may have a relationship to dieting during those episodes or during other parts of a person's life.
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From page 26... ...
Diet quality usually is measured through food records or recall covering the past few days, but short-term records, even if accurate, can be misleading. "We probably need to be using the 30-day retrospective food security scale and the 3 days of food recall." Also, the food propensity questionnaire being used in NHANES can capture much more information about diet.
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Adam Drewnowski, who has conducted some of that research, said that the data on diet quality when stratified by socioeconomic status show two things. First, there is a social gradient for the consumption of certain nutrients and for some food groups.
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2008. Socio-economic, behavioural and en vironmental factors predicted body weights and household food insecurity scores in the Early Childhood Longitudinal Study-Kindergarten.
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1997. Household Food Security in the United States in 1995: Summary Report of the Food Security Measurement Project.
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2010. Household food security in the United States, 2009.
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2006. Individual weight change is associated with household food security status.
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