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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• The purpose of this project is to examine the
  relationships between food insecurity and
  overweight in English speaking WIC clients so
  that food assistance programs can be optimally
  designed to reduce prevalence of obesity while
  encouraging food security.

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Groundwork

• Lynne Smith
• Human subjects approval
• Consent form development
• Recruitment protocol
• IBB forms and IRB questions
• Lisa DiGeorgio and Donna Oberg
• Location of WIC sites
• Interactions with WIC staff
• Initial presentation to this class
• Donna Johnson
• Development of class project

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Where we started

• Providing background information on food
  insecurity and obesity
• Writing a plan for focus groups on food
  insecurity and obesity
• Preparing a focus group procedure manual
• Conducting a pilot focus group

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What is Food Insecurity?

• Food insecurity exists when the availability of
  nutritionally adequate food, or the ability to
  acquire nutritionally adequate food in socially
  acceptable ways, is limited or uncertain.
• Prevalence
• 11 of all US households (2003)
• 12 of Washington State households (2002)
• 54 of King County WIC households (prelim)

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Who is at risk for food insecurity?

• Households with incomes at or below 185 of the
  poverty line
• Households with children under 18, headed by a
  single woman
• Hispanic or African-American households

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Who is obese?

• Low income to poor adults tend to be more obese
  than higher income adults
• Obesity more prevalent in women than men
• Percentage of obesity higher in Hispanic and
  African-American populations

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Possible mechanisms for a food insecurity
obesity link

• Physiological factors
• Psycho-social factors
• Socio-economic factors

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Thoughts about a food insecurity-overweight
relationship among Seattle-King County WIC
population

• Plan for focus groups
• Protocol for focus groups

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Before Plan
Determine GOALS
Designate ROLES
Decide WHO should be invited
Think about INCENTIVES
RECRUIT participants
CONTACTING participants
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Day of Plan
Setting up
Meeting and Greeting
Signing Consent Forms
Taking Notes

Wrapping-Up
Debriefing
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AFTER THE FOCUS GROUP Plan
TRANSCRIBE Focus Group
READ Transcript
Select ANALYSIS Method
WRITE UP Report
PRESENT Findings
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PilotWhat we learned

• Recruitment process
• Conducting focus groups
• Transcription

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In Summary

• Background research, focus group procedures, and
  conducted a pilot at the Eastgate WIC clinic
• Shared our knowledge and trained ourselves to
  conduct the research
• Got started

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Recruiting for focus groups

• Each group toured the facilities, taught the
  staff how to recruit and determined specific
  logistics for each site
• -Eastgate
• -Renton
• -Kent
• Recruited English speaking WIC clients who were
  over 18.
• -Used a 25 Safeway gift card as an incentive for
  our clients.

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Conducting the focus groups

• Two sessions at each clinic on February 18th,
  2005
• Moderator conducted with at 1-2 note-takers in
  the room
• Worked thru the assigned questions in discussion
  format with 2-8 participants
• Also collected demographic data from a
  questionnaire

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A note about the questions

• The questions were designed to address the issues
  without making the participants feel
  uncomfortable about their personal situation.
  The purpose of the questions were to get
  information on the following

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• Participants knowledge of health effects of both
  food insecurity and weight status
• Reasons for food insecurity
• Coping strategies
• WICs role
• General experiences, observations and ideas

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After the focus groups

• Demographic data compiled
• Transcription of the raw data and note-takers
  notes on non-verbal communication incorporated
  into the raw transcripts
• Analysis team

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Demographics
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Analysis

• A subset of the class did the analysis
• Looked for major themes over all of the
  transcriptions from each site
• Summarized them in a document

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Results of Analysis of transcripts

• Main findings- 4 major themes
• 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 over-eating 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 food assistance programs to
  get enough food to feed their families
• They often perceive food from these programs 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 didnt 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 by the food
  insecure may contribute to overweight because of
  the poor food quality in these programs
• Exercise is recognized as a way to prevent
  over-weight, but resources to being able to
  exercise are limited
• 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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Targeted Interventions
  RECOMMENDATION RECOMMENDATION RECOMMENDATION RECOMMENDATION RECOMMENDATION
  Access Access Access Education Education
CONCERN Food PA Services Nutrition PA
Lack of time money X X X X X
Stress food insecurity X   X X  
Use Quality of food assistance X   X X  
Lack of exercise resources   X X   X
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Potential Types of Interventions

• Four main categories
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat healthy on a
  budget
• Provide Education about physical activity

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Potential Types of Interventions

• Four main categories
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat healthy on a
  budget
• Provide Education about physical activity

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Improving Access to Healthy Foods(Potential
partners)

• Farmers Market Coalitions
• Transportation services
• Community Centers
• Community gardens
• Food banks, churches, community centers, and
  other emergency food assistance programs
• Storage facilities
• Worksites

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Improving Access to Healthy Foods(WIC)

• Increase flexibility in WIC food package
• Continue to advocate for implementation of EBT
  card system
• Expand WIC Farmers Market Program
• Provide information about emergency food services
• Continue to offer emergency food vouchers

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Potential Types of Interventions

• Four main categories
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat healthy on a
  budget
• Provide Education about physical activity

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Improving Access to Physical Activity (Potential
Partners)

• Physical activity programs/Exercise facilities
• Transportation services
• Community Centers
• Community Gardens
• Worksites
• Parks and Recreational Services

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Improving Access to Physical Activity(WIC)

• Provide classes, referrals to classes,
  scholarships, and activities that a mother and/or
  her child can do together
• 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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Potential Types of Interventions

• Four main categories
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat healthy on a
  budget
• Provide Education about physical activity

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Nutrition Education(Potential Partners)

• Farmers Markets
• Food assistance programs/Food banks
• Community Gardens
• Worksites
• Policy makers

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Nutrition Education(WIC)

• Distribute meal planning and budgeting info
  booklets
• Offer workshops- portion size, reading food
  labels, food variety
• Utilize group classes to engage low-income
  families in discussions about healthy eating
• Employ social marketing activities
• Establish Mother support groups

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Potential Types of Interventions

• Four main categories
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat healthy on a
  budget
• Provide Education about physical activity

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Physical Activity Education(Potential Partners)

• Community centers, health centers, and schools
• Physical activity programs/Exercise facilities

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Physical Activity Education(WIC)

• Provide more information about exercise resources
  for WIC mothers
• age-appropriate information about exercise for
  their children
• low-cost physical activity resources available in
  the community
• walking/biking route maps, neighborhood
  recreational parks
• Increase availability of physical activity groups
  that parents and children can do together
• Offer post-partum workout videos

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Summary
Recommendations for WIC are focused on a need for
access and education regarding food and physical
activity. We have few truly evidence-based
interventions in this area which is why we need
more studies that look for the real
physiological, psycho-social, and socio-economic
determinants of food insecurity and obesity. It
is our hope that the results of this study can be
used to improve the services that WIC offers to
program participants. -Nutrition 531 class
voice
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Special love goes to

• The Donnas, Lisa DiGiorgio, Lynne Smith,
  Michele Rimmer Renton WIC staff, Ewa Baldyze
  Kent WIC staff, Saskia Schaeffer, Katie Imberg,
  Eastgate WIC staff

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