Weighing in on the Obesity Pandemic

One in six American children are food insecure, defined by the USDA as inadequate access to enough food needed for an active, healthy life.  This is often complicated by an environment of food swamps, which are food retail areas with a high density of fast food and corner stores. Food insecurity affects children of various socioeconomic backgrounds and contributes to several adverse outcomes, including lower scores on cognitive tests, anxiety, anemia, and decreased bone mineral density. Since 1970, childhood obesity has skyrocketed with the U.S. leading the international community in this global pandemic. More than 50% of obese children become obese adults, which increases the risk of developing chronic diseases such as cancer and cardiovascular disease. But what do inadequate access to healthy food and the prevalence of childhood obesity have in common? 

A recent study followed 8,000 children over three years to assess the relationship between food insecurity and increased body mass index (BMI) standardized for age and sex as well as their obesity risk from kindergarten through third grade. The study found that food insecurity is present in approximately 10% of U.S. households with a child in kindergarten and is an independent risk factor for increased standardized BMI in first grade. 

The authors speculated a relationship between learned over-eating behaviors and increasing exposure to high-calorie, less nutritious, inexpensive foods. Obesity increased with each additional grade regardless of food security status, however was more prevalent among food insecure compared with food secure children. The authors found that minority status, lower levels of parental education, parental disabilities, and reduced food preparation time were associated with increased food insecurity.   

The relationship between food insecurity, obesity, and food swamps creates an opportunity for public policy changes. Policies should create environments where nutrition and health education can reach children in places such as schools, recreation centers, and in low-income neighborhoods. Allowing for Supplemental Nutrition Assistance Payment (SNAP) or physician fruit/vegetable prescriptions use at mobile farmers markets and community supported corner store conversions has proven beneficial.  Zoning policies can be used to restrict the high numbers of fast food establishments within low-income communities. Tackling obesity, a multifaceted public health problem, requires impacting one of its facets, food insecurity, by creating a built environment conducive to healthy eating.

This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Roselyn Hicks, MD. She is a Health Policy Leadership Fellow.

Abstract

OBJECTIVE: The aim of this study was to determine if food insecurity is an independent risk factor for obesity in U.S. children.

METHODS: We analyzed data from a nationally representative sample of children participating in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011. Statistical analyses were performed to evaluate longitudinal associations between food security and body mass index (BMI) z-score. All regression models included race/ethnicity, household income, and parental education. Survey and anthropometric data was collected from teachers and parents of 8167?U.S. children entering kindergarten in fall 2010 with regular follow-up through third grade. Complete data regarding food security, socioeconomic assessment, and BMI z-score data were included for statistical analyses. All analyses were weighted to be nationally representative.

RESULTS: Children with household food insecurity had increased obesity prevalence from kindergarten through grade 3; for example, at kindergarten, with food insecurity 16.4% (95% confidence interval [CI], 13.7-19) versus food secure 12.4% (95% CI, 11.3-13.6). Adjusted means analysis showed first-grade food insecurity was significantly correlated with increased BMI z-score in first through third grades; for example, at first grade, with food insecurity 0.6 (95% CI, 0.5-0.7) versus food secure 0.4 (95% CI, 0.4-0.5). Logistic regression showed first-grade food insecurity was correlated with increased risk for obesity in that grade (odds ratio 1.4; 95% CI, 1.1-2).

CONCLUSION: Obesity is more prevalent among food-insecure children. First-grade food insecurity is an independent risk factor for longitudinal increases in BMI z-score. There are differences in the association between food insecurity and weight status between kindergarten and first grade.

PMID: 29547734 

Lee, A, et al. Nutrition Journal. 2018; 51-52:1-5.