Association of household food insecurity and childhood weight status in a low‐income population

Abstract

Summary One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross‐sectional study of 3019 low‐income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z‐score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census‐tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36‐0.87). Tobacco exposure (1.63; 1.10‐2.44), additional siblings (1.16; 1.04‐1.30), and residence census tract with high poverty rate (1.02; 1.01‐1.03) were all associated with HFI. We concluded that food‐insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food‐secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.

A mixed‐method systematic review and meta‐analysis of the influences of food environments and food insecurity on obesity in high‐income countries

“…Total sample size was 63,152, ranging from 10 (Cooksey Stowers et al, 2020) to 8333 (Nguyen et al, 2015) in individual studies. Thirty‐two studies considered adult samples (>18 years) (Bauer et al, 2012; Bhawra et al, 2015; Bruening et al, 2012; Byker Shanks et al, 2020; Cooksey Stowers et al, 2020; Dharod et al, 2013; Domingo et al, 2021; Franzen & Smith, 2009; Gosliner & Shah, 2020; Holston et al, 2020; Huelskamp et al, 2021; Kaiser et al, 2019; Keenan et al, 2021; Leung & Villamor, 2011; McCurdy et al, 2015; Mercille et al, 2012; Nettle & Bateson, 2019; Nguyen et al, 2015; Ong et al, 2021; Ro & Osborn, 2018; Robaina & Martin, 2013; Rodriguez et al, 2021; Sanjeevi et al, 2018; Santarossa et al, 2021; Shinwell et al, 2021; Vadiveloo et al, 2020; van der Velde et al, 2020; Vedovato et al, 2016; Walch & Holland, 2021; Watt et al, 2013; Webb et al, 2008; Wilcox et al, 2020; Yau et al, 2020), 11 studies focused on children or adolescents (Benjamin‐Neelon et al, 2020; Genuis et al, 2015; Gorski Findling et al, 2018; Jennings et al, 2020; Kerpan et al, 2015; Kral et al, 2017; Matheson et al, 2002; Poulsen et al, 2019; Smith & Richards, 2008; Widome et al, 2009; Wirth et al, 2020) and three studies included both children/adolescents and adults (Hooper et al, 2020; Niu et al, 2021; Thompson et al, 2018). Twenty‐three quantitative studies directly measured anthropometric indices (Bauer et al, 2012; Benjamin‐Neelon et al, 2020; Dharod et al,...…”

“…Tools included in studies for assessment of food insecurity status were 6‐item US Household Food Security Survey Module (HHFSM) (Bauer et al, 2012 ; Bruening et al, 2012 ; Hooper et al, 2020 ; Kaiser et al, 2019 ; Kral et al, 2017 ; Leung & Villamor, 2011 ; Poulsen et al, 2019 ; Ro & Osborn, 2018 ; Shinwell et al, 2021 ). 18‐item the Food Security Core Module (FSCM) or simply the US Household Food Security Survey Module (USDA HFSSM) (i.e., by ‘simply’ we mean that FSCM and USDA HFSSM are the same tool, but are called either interchangeably; Benjamin‐Neelon et al, 2020 ; Domingo et al, 2021 ; Matheson et al, 2002 ; McCurdy et al, 2015 ; Mercille et al, 2012 ; Robaina & Martin, 2013 ; Rodriguez et al, 2021 ; Santarossa et al, 2021 ; van der Velde et al, 2020 ; Vedovato et al, 2016 ; Webb et al, 2008 ), 10‐item US adult food security survey (Keenan et al, 2021 ; Sanjeevi et al, 2018 ; Walch & Holland, 2021 ; Webb et al, 2008 ; Yau et al, 2020 ), the National Health and Nutrition Examination Survey Food Security Survey Module (NHANES FSSM; Nguyen et al, 2015 ; Watt et al, 2013 ), 10‐item Radimer/Cornell Hunger Scale (Dharod et al, 2013 ), 11‐item USDA Adult Food Security Survey Module (Huelskamp et al, 2021 ), USDA's 30‐day Adult Food Security Scale (Gorski Findling et al, 2018 ), 2‐item adapted from the 1999 USDA Food Security/Hunger Core Module (Widome et al, 2009 ), the Hunger Vital Sign (HVS) screener tool (Wirth et al, 2020 ), and a modified USDA's instrument on food security (Smith & Richards, 2008 ; Vadiveloo et al, 2020 ).…”

“…To analyze the association between food insecurity and obesity, the OR of 36,113 cases in 24 studies (Bauer et al, 2012 ; Benjamin‐Neelon et al, 2020 ; Bruening et al, 2012 ; Dharod et al, 2013 ; Domingo et al, 2021 ; Huelskamp et al, 2021 ; Kaiser et al, 2019 ; Keenan et al, 2021 ; Kral et al, 2017 ; Matheson et al, 2002 ; Nettle & Bateson, 2019 ; Nguyen et al, 2015 ; Poulsen et al, 2019 ; Ro & Osborn, 2018 ; Robaina & Martin, 2013 ; Rodriguez et al, 2021 ; Sanjeevi et al, 2018 ; Santarossa et al, 2021 ; Smith & Richards, 2008 ; van der Velde et al, 2020 ; Vedovato et al, 2016 ; Webb et al, 2008 ; Widome et al, 2009 ; Wirth et al, 2020 ), involving both adults and children, was pooled together for the meta‐analysis. These studies used a cross‐sectional approach in addition to one cohort study.…”

“…& Holland, 2021;Watt et al, 2013;Webb et al, 2008;Widome et al, 2009;Wilcox et al, 2020;Wirth et al, 2020;Yau et al, 2020) and one cohort study(Benjamin-Neelon et al, 2020) were included.Eleven studies were included for the qualitative section of the review(Bhawra et al, 2015;Byker Shanks et al, 2020;Cooksey Stowers et al, 2020;Franzen & Smith, 2009;Genuis et al, 2015;Gosliner & Shah, 2020;Holston et al, 2020;Jennings et al, 2020;Kerpan et al, 2015;Ong et al, 2021;Thompson et al, 2018).Included studies were primarily conducted across the USA (36)(Bauer et al, 2012;Benjamin-Neelon et al, 2020;Bruening et al, 2012;Byker Shanks et al, 2020;Cooksey Stowers et al, 2020;Dharod et al, 2013;Franzen & Smith, 2009;Gorski Findling et al, 2018;Gosliner & Shah, 2020;Holston et al, 2020;Hooper et al, 2020;Huelskamp et al, 2021;Jennings et al, 2020;Kaiser et al, 2019;Kral et al, 2017;Leung & Villamor, 2011;Matheson et al, 2002;McCurdy et al, 2015;Nettle & Bateson, 2019;Nguyen et al, 2015;…”

Moving Pediatric Healthy Weight Interventions into Real-World Settings, Using Implementation Science to Address Access, Flexibility, and Sustainability

“…5 These disparities are often related to contextual differences and social determinants of health, including poverty and socioeconomic status, parental education, early adverse childhood events, and access to healthier food options and safe and affordable physical activity opportunities. [6][7][8][9] Childhood obesity is a multifactorial condition that requires multifaceted systemic approaches to address (1) the root causes of unhealthy weight and related chronic conditions, (2) barriers to access to healthy nutrition, active living, and effective treatment, and (3) disparate prevention and treatment efforts. Major advances in effective treatment of pediatric obesity have occurred over the past decade.…”