Azusa Saigusa, Maki Inoue, Pablo Monsivais,

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Exploring the links between Food Insecurity and
Obesity

• Azusa Saigusa, Maki Inoue, Pablo Monsivais,
• Roseann Torkelson, Ruiwen Qin, Shih-hui Yang

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How is Food Insecurity defined?

• Food Insecurity (FI) Limited or uncertain
  availability of nutritionally adequate or limited
  or uncertain ability to acquire acceptable foods
  in socially acceptable ways.
• - Food Insecurity may or may not co-exist with
  hunger
• Hunger Uneasy or painful sensation caused by a
  lack of food.
• - Food insecurity may relate to involuntary
  hunger resulting
• from not being able to afford enough
  food.

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How is FI measured?

• The U.S. Census Bureau began implementing the
  first Food Security Supplement to its Current
  Population Survey in 1995.
• Validated questionnaire that consists of 18
  questions
• Surveys conducted in person or by telephone
• Measures a persons experience over the preceding
  12 months
• National data for FI have been collected since
  1995.

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Single Item Scale
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18 Scale Items
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FI Obesity Prevalence
Food Insecurity - Households with incomes
below the poverty line - Households with
children under 18 - Women - Hispanic or
African-American - The South and West, and
central cities Obesity - Poor to low
income adults - Women in low income
households - African-American and Hispanic
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FI is linked to overweight obesity why? How?

• 1995 First publication of the potential
  association
• (Dietz et al. )
• Townsend et al.
• 2004 Kaiser et al.

Limitations - Discrepancy in measurement
tools - Few response variables -
Cross-sectional analyses
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What are the features of FI?

• Anxiety that the household food budget or food
  supply may be insufficient to meet basic needs
• The experience of running out of food, without
  money to obtain more
• Perceptions by the respondent that the food eaten
  by household members was inadequate in quality or
  quantity
• Adjustments to normal food use, substituting
  fewer and cheaper foods than usual
• Instances of reduced food intake by adults in the
  household, or consequences of reduced intake such
  as the physical sensation of hunger or loss of
  weight
• Instances of reduced food intake, or consequences
  of reduced intake, for children in the household

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Proposed Mechanisms

• Physiological factors
• Psychological factors
• Socioeconomic factors

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Physiological Mechanisms
Energy restriction only produces a transient
hypothyroid-hypometabolic state, which normalizes
on return to energy-balanced conditions.
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Dallman et al, Endocrinology 2004
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Psychological Mechanism

• Food Stamp Cycle food acquisition cycle which
  synchronizes
• 
  with food stamp distribution

42 of food stamp month households conduct
grocery shopping once per month or less.
Parke.et.al.Amer. J. Agr. Econ. 82, Feb. 2000
200-213
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Disordered Eating Periods without food could
cause individuals to overeat when food is
available. - Minnesota study - Dieters,
prisoners of war, and children with food
restrictive parents
High prevalence of obesity among low-income
women - Mothers in low-income families
sacrifice their own nutrition in order to
give more food to their children.
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Economic Mechanism

• Energy density V.S. Energy cost
• Energy-dense foods cost less
• Diet quality
• People consume less fats and refined sugar
  as their incomes increases

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Economic Mechanism

• The prevalence of fast food restaurants
• The density of fast food restaurants is
  much higher in poorest areas.
• Supersizing Value-for-money

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What are we doing about this?

• Food aid
• programs are targeted to populations who
  experience FI
• Education
• WIC education
• Food Stamp education
• EFNEP
• Other Programs
• Head Start

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The Foods Stamp Program of the USDA

• Target population goals
• The cornerstone of the Federal food assistance
  programs. FSP enables low-income (135 of
  poverty or less) families to buy nutritious food
  with coupons and Electronic Benefits Transfer
  (EBT) cards.
• Services
• Food coupons and Electronic Benefits Transfer
  (EBT) cards.
• Nutrition education The Food Stamp Nutrtition
  Education Program, aimed at helping FSP
  participants make healthy choices within a
  limited budget.
• Relation to food insecurity and obesity
• 88 of recipients are at or below the poverty
  line (2001)
• Nationally, 50 of households on the FSP are food
  insecure (1999)

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The National School lunch Program of the USDA

• Target population goals
• NSLP provides children from low-income households
  (180 of poverty or less) with nutritionally
  balanced meals for free or reduced prices.
• Services
• 26 million children served each day (2003).
• Lunches provide 1/3 of daily energy intake and
  must meet the recommendations of the Dietary
  Guidelines for Americans
• Relation to food insecurity and obesity
• Participating students are disproportionately
  black and Hispanic and more likely than non
  participating students to live in either urban or
  rural areas, rather than in the suburbs. The
  local unemployment rate is higher, on average, in
  the areas where certified students live than in
  the areas where noncertified students live
  (1992).

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The Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC)

• Target population Goals
• Safeguard the health of low-income(180 or less)
  women, infants, and children up to age 5 who are
  at nutrition risk
• Services
• Health screening, Nutrition and health education,
  Breastfeeding support
• Farmers Market Nutrition Program
• Healthy Community Project Moses Lake
• Relation to food insecurity and obesity
• 53 of WIC participants are food insecure
• focus on the maintenance of pregnant and
  postpartum women and childrens ideal body weight
  for the prevention of obesity.

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Expanded Food and Nutrition Education Program
(EFNEP)

• Target population and Goals
• To assist low-income families and youth to
  acquire the knowledge, skills, attitudes, and
  behaviors necessary for nutritionally sound diets
• To contribute to personal development and the
  improvement of total family diet and nutritional
  welfare
• Services
• Lessons on nutrition, cooking skills, food
  safety, and food budgeting
• Relation to food insecurity and obesity
• Focus on population who are most likely to be
  food insecure
• Help the higher risk population balance food
  resources and avoid obesity

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Head Start

• Target population
• - Pregnant women and children from birth
  to age 5 from low-income
• families
• Services
• - Daily nutritious meals
• - Opportunities for social, emotional, and
  intellectual growth
• - Connects children to a health care
  source
• Goal
• - Increase the school readiness of young
  children in low-income
• families
• Relation to food insecurity and obesity
• - As high as 48.8 participating
  households are food insecure
• - 9.6-28 participating kids are
  overweight. Screen obesity problems.
• - Promotes breastfeeding.

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