Food Insecurity and Overweight in WIC Clients

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Food Insecurity and Overweight in WIC Clients

• A Community Nutrition Project by
• University of Washington Students
• Winter 2005

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Food insecurity

• Food insecurity (FI) Occurs whenever the
  availability of nutritionally adequate and safe
  foods, or the ability to acquire acceptable foods
  in socially acceptable ways, is limited in
  socially acceptable ways is limited or
  uncertain.1
• Prevalence of FI
• US 11.02
• WIC clients 53.71
• FI in King county -- BRFSS survey results1
• Percent of adults concerned about having enough
  food for themselves or their families in the past
  30 days
• Seattle 5.5 North 4.7 East 2.7 South
  4.6

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The FI-obesity link

• People in poor to low income households are more
  likely to be obese than people in higher income
  households
• The association of food insecurity and obesity is
  more prevalent in women than in men, and more
  prevalent in African-American and Hispanic
  populations than in other ethnic groups3,4,5,6,7

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Socioeconomic and Environmental Factors

• People with FI have limited food choices due to
  their financial constraints
• Cheaper foods are often energy dense and higher
  in refined sugar and fat8
• Higher density of fast food outlets in low income
  communities9

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Psychophysiological factors

• People with FI have elevated levels of stress
• Chronic stress can result in a series of
  physiological events that lead to impaired energy
  balance regulation increased food intake and
  reduced energy expenditure10
• Periods of hunger or fear of hunger lead to
  overeating when food is available, which can lead
  to an increased total energy intake11
• Food acquisition cycle in low-income households
  42 of food stamp households conduct grocery
  shopping 1 time per month12

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Conducting focus groups inWIC clinics

• Focus groups a common qualitative research tool
  used to generate data from a small group of a
  selected population.13
• 6 focus groups at 3 WIC sites
• Participation 2-8 participants per group, total
  30 females
• Locations Eastgate , Kent Alder Square, and
  Renton
• Date February 18, 2005
• Eligibility WIC clients at least 18 years old
  English speaking

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Conducting Focus Groups inWIC Clinics (cont.)

• Recruitment UW students introduced the study and
  gave flyers to potential participants at each
  site for two weeks before the focus groups
  session
• Incentive 25 gift certificate for participation
  in the discussion
• Data analysistranscriptions were analyzed and
  coded based on common themes -- four
  overarching themes were identified

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Overview of focus groups questions

• Goal to obtain clients' perspective
  suggestions about the link between FI and
  overweight
• The questions are divided into two parts
• Food insecurity
• Healthy weight

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Sample focus group questions

• How do you think a childs health is affected by
  not having enough food?
• What do you think are some reasons why some
  families have trouble having enough food to feed
  their families?
• If you knew someone (a friend) who was worried
  about running out of food, what are some things
  you would tell her to do?
• If you were in the situation of running out of
  food and not having enough money for food for you
  and your children, what could WIC do that would
  be most helpful?
• People who dont have money to buy enough food,
  compared to those that do, are more likely to be
  overweight. What do you think could be the cause
  of this?
• If a woman on WIC wanted help with her weight
  after having a baby, what could WIC offer or
  provide that would be most helpful to her?
• This is only a partial list of all the
  questions asked.

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Main findings14

• Participants indicated that they know the
  differences between healthy and unhealthy foods
  it is other factors that are leading to becoming
  overweight
• Lack of time and financial resources
• Stress and fear of hunger
• Poor quality of food in emergency food programs
• Lack of exercise resources

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Lack of financial and time resources

• Participants identify cheaper foods as bad
  foods and healthy foods as expensive foods
• Bad foods are also more convenient and easy to
  prepare
• Sometimes when people dont have enough money to
  buy food, then that makes them prone to go get
  whatever is cheaper...
• People are so pressed for time, they have to fit
  so many things into the day, you have all these
  dollar menus and everything and you dont want to
  get out of the car so you are looking for things
  that are only drive-thru.

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Stress and fear of hunger

• Participants identified a relationship between
  stress, hunger, and overweight
• A fear of future hunger can lead to overbuying
  and overeating food now
• Food hording oh yes!!! Because when you dont
  think youre going to have enough you buy too
  much, and you will end up eating it.
• Sometimes you just eat because youre stressed
  out, so you get ice cream...you keep eating and
  eating cause you dont have enough food, you
  dont have any food so you just want to eat.
  That makes you feel better.

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Poor quality of food in emergency food programs

• Participants look to emergency food assistance
  programs to get enough food to feed their
  families, in cases where the WIC amount wasnt
  enough
• They often perceive food from these sources to be
  junk food, the consumption of which leads to
  becoming overweight
• When you run out of food and go down to the
  food banks they load you up with donuts and bread
  and its hard to balance your diet that way.

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Lack of exercise resources

• Participants recognize exercise as being part of
  a way to address the problem of overweight
• They would like more information and resources
  for themselves and for their children, and some
  would like a health professional to give the
  information
• I didn't know that there were certain things I
  could do with him when he was 3 months old, like
  swimming or whatever or like that, that could
  have stopped him from being in the 97th
  percentile.

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WIC focus group findings compared to the existing
literature

• New relationships identified
• Use of emergency food programs in addition to
  using WIC, may contribute to overweight because
  of the poor food quality in some of these
  programs
• Lack of resources can prevent people from
  exercising, although participants recognize that
  exercise is an effective way to prevent
  overweight
• In addition to a lack of financial resources,
  leading to the purchase of cheaper, bad foods,
  people lack the time to prepare healthier meals
  and find it more efficient to purchase these
  foods

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Recommendations

• Increasing access to and education about
  nutrition and physical activity addresses the
  concerns raised by the focus group participants
• Increasing access to and expanding existing
  services will also address the main problems
  identified in the focus groups

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Recommendations for Access

• Increase flexibility of WIC benefits
• Selection should incorporate alternatives for
  food allergies and cultural preferences
• Consider increasing the number of stores clients
  are able to purchase food from
• Implement EBT system for clients to be able to
  use WIC benefits more flexibly
• Establish a network of organizations that offer
  nutrition and physical activity programs and
  activities, so that referrals can be made for
  sites that are most appropriate and convenient
  for each mother and child

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Recommendations for Education

• Nutrition
• Offer suggestions for increasing food variety and
  give recipes to make quick, healthy meals
• Hold workshops and create booklets about meal
  planning and budgeting
• Physical Activity
• Provide information about exercise for mothers
  and age-appropriate information about exercise
  for children
• Offer post-partum workout videos

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Suggested interventions for WIC

• Continue advocating for use of EBT cards to
  purchase WIC food items to make food acquisition
  more flexible for clients
• Improve nutrition education by providing
  practical cooking demonstrations about how to
  cook culturally appropriate recipes on a budget
• Increase the availability of physical activity
  groups that parents and children can do together
• Provide information on low-cost physical
  activity resources available in the community

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References

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Thank you!