Hunger and Obesity Paradox

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Hunger and Obesity Paradox

• Presented by
• Fern Gale Estrow, MS, RD, CDN NATIONAL HUNGER
  AWARENESS DAY
• USDA Community Food Security Initiative at the
  LSU AgCenter
• June 3, 2004

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LOUISIANA
3
The Statistics

• Poverty
• Food Insecurity
• Food Insecure with Hunger

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What is obesity?

• A nutritional disorder related to the increased
  consumption of energy dense (high fat, high
  sugar, high salt) processed foods and beverages
• A lifestyle disorder in advanced economies and
  urbanising societies
• A medical disorder associated with around 35
  diseases (e.g. Type II diabetes mellitus, severe
  osteoarthritis, hypertension, heart disease)

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What is obesity? (cont)

• Obesity is part of a new world-wide trend of
  chronic lifestyle-based non-communicable
  diseases (WHO). It is
• Found in societies also suffering both food
  surplus and insufficiency
• Has poor and expensive treatment implications
• Requires whole-society preventive
  considerations similar in complexity and scope
  to those of drugs or HIV.

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Inaction in the face of the obesity epidemic has
massive consequences for society to economic
efficiency and medical and human costs Geof
Rayner, PhD ICD 2004
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Obesity Trends Among U.S. Adults between 1985 and
2002

• Definitions
• Obesity having a very high amount of body fat in
  relation to lean body mass, or Body Mass Index
  (BMI) of 30 or higher
• Body Mass Index (BMI) a measure of an adults
  weight in relation to his or her height,
  specifically the adults weight in kilograms
  divided by the square of his or her height in
  meters

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Obesity Trends Among U.S. Adults between 1985 and
2001

• Source of the data
• The data shown in these maps were collected
  through CDCs Behavioral Risk Factor Surveillance
  System (BRFSS). Each year, state health
  departments use standard procedures to collect
  data through a series of monthly telephone
  interviews with U.S. adults

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
13
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
14
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
15
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
21
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
22
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. Adults BRFSS, 1991,
1995 and 2001
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1991-2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
2002
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. Adults between 1985 and
2002

• Source of the data
• The data shown in these maps were collected
  through CDCs Behavioral Risk Factor Surveillance
  System (BRFSS). Each year, state health
  departments use standard procedures to collect
  data through a series of monthly telephone
  interviews with U.S. adults
• Prevalence estimates generated for the maps may
  vary slightly from those generated for the states
  by BRFSS (http//aps.nccd.cdc.gov/brfss) as
  slightly different analytic methods are used.

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CDC National Trends and Statistics 2002 (NHANES)

• 21 Adults Obese
• Over 60 overweight
• 8,800,000 children 6-19yo Overweight or Obese
• 1963-2000 changes
• 6-11yo 4.2 15.3
• 12-19yo 4.6 15.5

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More Definitions

• Food Insecurity
• Hunger
• FRAC definition of Hunger in America
• Mild Malnutrition
• Food Insufficiency
• Food Security

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• Nutrition Security
• Community Food Security
• also ADA Definition
• Food Restriction

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Children Overweight vs. Obese

• Term overweight is used to describe children in
  lieu of obese
• 95th percentile is considered overweight
• 85th percentile at risk for obesity

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BMI

• Overweight is defined as over 25 kg/m2
• Not used consistently
• Establish the benchmark in use when reading
  research.

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The Food Security Model Survey Categorization

• Food Secure
• Food Insecure
• Food Insecure with Hunger (mild/severe)

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Food Security Measurement

• National food security survey
• Developed in early 1990s in response to National
  Nutrition Monitoring process
• Core module consists of 18 scaled items
• All items in context, because there was no
  money or stamps to buy food. Involuntary
  vs. voluntary food restriction.
• Now included in
• numerous state surveys including CA
  
• national surveys (NHANES IV)
• supplement to Current Population
  Survey since 1995

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• Questions Asked
• Anxiety that the household budget is inadequate
  to buy enough food
• Inadequacy in the quantity or quality
• And instances of reduced food intake or
  consequences of reduced food intake for adults
  and for children.
• Food Use

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The Paradox

• What actually is it?
• High Prevalence of obese overweight
• Low income Food Insecure
• - Watch
• Terminology
• Data Sets
• Keep trends in mind

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• Olsen et.al. in 1993 study Women
• Female BMI significantly higher (P lt 0.05)
• Food secure households 25.6
• Food insecure households 28.2
• 37 had BMIs in excess of 30

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• Basiotis LIno (2002)- Women
• NHANES HEI
• Women 19-55
• Lower Diet Quality (HEI 58.8 vs 62.7)
• BMI 25-30 Overweight food sufficient 42
• BMI 25-30 Overweight food insufficient 58

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• Townsend et.al. - Adults/Women
• CSFII
• Overweight Defined at 27.3 vs. 25 (new standard)
• Examination of Food Insecurity
• Low income outcomes (excluding severely food
  insecure households)
• Food Secure - 34 Overweight
• Mildly Food Insecure - 42 Overweight
• Moderately Food Insecure -52Overweight

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Townsend Cont.

• Food Stamp Recipient Outcomes
• Food Secure 48.4
• Mildly Food Insecure 53.7
• Moderately Food Insecure 68.3
• Food Insecurity a predictor of overweight and
  above the effect of income (P lt 0.0001)
• Women significantly at risk and men not

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The Food Stamp Component

• Perez-Escamilla et al (2000)
• When Food Stamps Last the Entire Month
• Food Security greater
• Food Insecurity lower
• Possibility of Consistent Food Intake

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• Anand et.al. (1999) Children
• Using NHANES (Food Insufficiency)
• Higher parents BMI the higher the risk for their
  child
• Positively Associated with Fat and Protein
• Negatively Associated with Total Caloric Intake,
  but what is consumed is high fat
• Avid TV watching (Safety/Society?)

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Overweight Children

• Children with overweight parents
• 5x more likely to be overweight (Guo)
• The higher the parents BMI
• the greater the risk that the child will have a
  high BMI (Anand)

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The Food Environment/Quality

• Supersizing
• Marketing
• High Fat, High Sugar - often cheap
• Bottle Feeding

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The Living Environment

• Television
• Computers
• Safety of Community

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Bringing it All Together
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• Limitations of existing data
• Sample size
• Historically focus food insufficiency not food
  security
• NHANES is family measure with the same values for
  children and adults

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The Food Stamp Cycle Hypothesis

• Townsend
• Promotion of wt gain
• (1-3 wks food secure period)
• Binging possible
• Promotion of wt loss
• (3-4wks food insecure period)
• Involuntary Restriction
• Metabolic impact
• Studies to date

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Deterrents to Access
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• Food Access
• Food Deserts
• Equipment
• Transportation
• Elderly
• Skills Education
• Preparation
• Media Literacy
• Housing
• Lack of affordable housing less funds for food

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• Unemployment
• Lack of Education
• Seasonal Employment
• Changing Market Needs
• Psychological Components
• Depression
• Stress

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Immediate Actions
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• Significant Food Stamp outreach to eligible
  households
• Enhanced transportation for low income and rural
  communities
• Improved access to fresh fruits and vegetables

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• Support of both WIC and Senior Farmers Market
  Nutrition Programs
• Incorporate Food Security Core Survey Module into
  clinical settings, and consider when making diet
  prescriptions
• Encourage Breastfeeding Baby Friendly Hospital
  Initiative

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• Adequate funding for Child Nutrition Programs
• Expansion and outreach for Child Nutrition
  Programs (assisting Summer Food Program sponsors,
  WIC, CACFP)
• Incorporation of education component into Child
  Nutrition Reauthorization

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Why Breastfeeding?

• Breastfed Babies evidence of less weight gain
• Higher insulin levels prolonged insulin
  response assoc w/weight gain
• Higher levels of leptin
• Breast fed babies may develop better internal
  cues stop feeding/eating when they are full vs.
  overfeeding that is associated with bottle
  feeding
• Formula increases affinity for fatty and sweet
• Made with sucrose (sweeter) vs. lactose

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Long Term Barriers - Actions

• Research we need more
• Food Cycle Hypothesis
• Studies of Food Insecure Populations
• Federal Nutrition Programs need to examine
• Policy
• Purchasing
• Preparation

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Long Term Barriers - Actions (cont.)

• Living Wage
• Support of Child Care
• Food stamp levels that ensure adequate nutrition.
• More flexible rules to allow people on TANF to
  pursue education and job training.
• Affordable housing opportunities.

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Expanded Concept ofCommunity Food Security
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• Community Food Security
• Community food security (CFS) is defined as a
  situation in which all community residents obtain
  a safe, culturally acceptable, nutritionally
  adequate diet through a sustainable food system
  that maximizes community self-reliance and social
  justice.
• Hamm MW, Bellows AC. Community Food Security
  Background and Future Directions. Available from
  Journal of Nutrition Education and Behavior
  serial online. May 2003 issue 35.

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Incorporate the 6 Basic Principals of Food
Security

• Established by the
• Community Food Security Coalition

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Six Basic Principals

• Meet the Food Needs of Low Income Individuals
• Promote Self Reliance
• Prevention Orientation and Planning Approach
• Community Orientation
• Systems Approach
• Local Agriculture

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Community Food Security Toolkit

• 6 components
• Profiling of community food characteristics and
  resources
• Tools to assess
• Household Food Security
• Food Resource Accessibility
• Food Availability
• Food Affordability
• Community Food Production Resources

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OUTREACH

• Faith Based
• Schools
• Workplace
• Farmers Markets
• Cultural Events
• Other Professionals/Collaborators
• COMMUNITY COLLABORATIONS ARE KEY

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EDUCATION

• FEDERAL
• REGIONAL
• STATE
• LOCAL