Understanding the Coexistence of Food Insecurity a

Authors: Edward A Frongillo Jennifer Bernal

Publish Date: 2014/07/29

Volume: 2, Issue: 4, Pages: 284-290

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Abstract

Coexistence of food insecurity and obesity is expected given that both are consequences of economic and social disadvantage Food insecurity and obesity are positively associated in adult women but not men There is some evidence of association in adolescents but mixed results for children Distinct from adults children experience cognitive emotional and physical awareness of food insecurity and take responsibility for it by participating in adult strategies initiating their own strategies and taking action to obtain additional food or money for food Food insecurity is detrimental for children being associated with behavior problems disrupted social interactions compromised school performance and attendance poor dietary intake and physical activity altered daily activities and poor health Some of these outcomes increase the risk of developing obesity From life course cumulative inequality and developmental perspectives child food insecurity may have longterm effects including on risk of obesity Pediatricians can help identify and respond to children who are foodinsecure and at risk of obesityAcross the globe both adult and child overweight and obesity are increasing with the rate of increase faster among children 1 2 In low and middleincome countries early prevention of overweight and obesity have become concerns that coexist along with longstanding concerns about undernutrition and its consequent impact on morbidity mortality and impaired child development 1 In highincome countries the dual burden of inadequate nutrition and overweight and obesity has been highlighted for some timeOver the past 20 years the coexistence of household food insecurity and obesity has been labeled a paradox but we now know that there is nothing paradoxical about this coexistence 3 When this label was introduced there was little knowledge of the causes mechanisms and consequences of household food insecurity When the US national nutrition monitoring system began the conceptual framework that was used depicted that poverty resulted in household food insecurity leading to poor dietary quality and quantity undernutrition and poor health 4 Spurred in large part by the development and use of questionnaire instruments to assess food insecurity through queries about individuals’ experiences and perceptions of food insecurity and behavioral responses to it substantial new knowledge about food insecurity has been gained leading to a more comprehensive conceptual framework 4 Both indepth qualitative and quantitative studies in the US and other countries contributed to this new knowledge 3Household food insecurity occurs when an individual or set of individuals experiences uncertainty about future food availability and access insufficiency in the amount and kind of food required for health or the need to use socially unacceptable ways to acquire food 4 Several closely linked consequences are potentially part of the experience of food insecurity Hunger and malnutrition ie undernutrition or obesity may be experienced as part of food insecurity Closely linked social and psychological consequences of food insecurity may include worry and anxiety feeling alienation deprivation and distress and adverse family and social interactions 4 For example household food insecurity in Burkina Faso is closely linked with concern worries and anxiety which eventually result in weight and sleep loss feelings of alienation eg shame and deprivation eg guilt and disrupted household cohesion leading to disputes and difficulties in keeping children at home 5 That is closely linked consequences of food insecurity occur through both nutritional and nonnutritional pathways 4 Furthermore because food insecurity is a powerful form of economic and social disadvantage and food needs may compete with other needs food insecurity leads to changes in behaviors some involving tradeoffs among needs People experiencing food insecurity may reduce investments in productive assets education and children avoid risks regarding means of production or earning and emphasize survival over other goals by migrating or diversifying livelihood strategies 4 Therefore there are many potential outcomes related to food insecurityRecent reviews of the association between food insecurity and obesity have reported mixed findings 6∙ 7 8 9∙∙ Overall these reviews suggest that food insecurity and obesity are positively associated in adult women but not in adult men There is some evidence of association in adolescents but mixed results for children Few studies support a linear relationship between food insecurity and weight outcomes Furthermore the association between food insecurity and obesity is modified in addition to gender by marital status stressors and participation in food assistance programs These reviews have also pointed to methodological needs in future research including the use of longitudinal studies rather than crosssectional studies development of tools to distinguish acute and chronic food insecurity and greater inclusion of food security measurement tools in regional and local studiesMore recent studies have shed further light on possible mechanisms for how food insecurity and obesity might be linked Obesity has been discussed as a physical expression of the vulnerabilities that arise from the intersection of gender differences in childcare expectations and poverty 10 Related to this deprivation and restricted food choice that are associated with low socioeconomic status enhance food reinforcement ie a positive feedback loop in which food eaten in response to deprivation is eaten more frequently increasing risk of obesity 11 Greater concern about future overweight in infants leading to controlling feeding styles represents a potential mechanism by which food insecurity could be related to obesity in children 12 It is possible but unknown if children reflect maternal stress and manifest it in overeating or if children model maternal eating as a coping mechanismThe association of food insecurity and obesity is likely modified by some additional factors at least in some contexts For example children of underweight overweight or obese ie not normal weight mothers had greater odds of obesity with persistent household food insecurity compared to those with persistent household food security 13 An increase in maternal stressors eg unemployment and disability amplified foodinsecure adolescent’s probability of being overweight or obese 14 Dietary restraint is another potential modifier women with low dietary restraint and experiencing marginal food insecurity may be at high risk of weight gain 15Concern that participating in food assistance programs might exacerbate obesity goes back to at least 1974 16 Longterm participation in the Supplemental Nutrition Assistance Program SNAP may increase risk for excess weight gain 7 The evidence that this may occur is limited and is primarily based on observational studies For example food assistance program participation was associated with increased body size in foodinsecure youth but not foodsecure youth 17 Participants in emergency food assistance programs with food insecurity were more likely to be overweight or obese compared with participants with food security 805 vs 615  respectively 18 The use of emergency food assistance may help minimize food insecurity while providing access to foods with varying nutritional quality that may be associated with increased risk of overweight and obesity The prevailing view is that if participation in food assistance programs exacerbates obesity the effect is small 6∙

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