Nearly 23% of people with obesity in the United States have reported food insecurity, compared with 15% of people with moderate weight. This association with obesity has doubled since 1999–2000, according to a recent analysis of trends in food insecurity.
“Food insecurity” refers to a lack of access to enough food for an active, healthy life. In the West, this issue is most often due to limited financial resources.
People with low food security report concerns that food will run out before they can afford to buy more and being unable to afford balanced meals.
Internationally, food insecurity more often relates to the frequency of conflict and to climate-related failure of harvests. Very low food security is more likely to lead to reduced food intake and undernourishment.
While there are varying degrees, low food security can reduce the “quality, variety, and desirability” of a person’s diet, even in wealthy nations like the U.S. Very low food security in the U.S., for example, leads to skipping meals and the disruption of regular eating patterns.
In 2019, 10.5% of U.S. households had some level of food insecurity — 6.4% had low food security, and 4.1% had very low food security. Now, there are concerns that COVID-19 may be exacerbating this problem.
Recent Census Bureau data show that before the pandemic, 1 in 10 respondents said that they “sometimes or often did not have enough to eat.” In early March, this figure rose to 25%.
The survey respondents mentioned not having enough money to buy food or being unable to get out to buy food as reasons for the insecurity.
Food insecurity is associated with a range of negative health outcomes. For children, these include anemia, asthma, poor cognitive performance, and behavior problems. In adults, there is a higher risk of depression, asthma, diabetes, and hypertension.
Meanwhile, the link between obesity and food insecurity has been a topic of debate. In 2011, a review of 42 articles concluded that while women with food insecurity were more likely to have overweight or obesity, there was no evidence that food insecurity caused weight gain over the long term.
More recently, researchers have proposed a resource scarcity hypothesis to explain the ongoing associations between food insecurity and increased weight.
According to the theory, an increased intake of inexpensive, high-calorie foods forms a cycle with skipping meals and intermittent hunger. This, in turn, leads to physiological changes that encourage the deposition of fat and decreased energy and exercise.
National trends in food insecurity
The new analysis was based on data from over 46,000 adults in the U.S. collected through the National Health and Nutrition Examination Survey (NHANES). The goal of NHANES is to assess the health and nutritional status of people in the U.S. through regular surveys.
To better understand trends in obesity and food insecurity in the U.S., the analysis, from the Pennington Biomedical Research Center, in Baton Rouge, LA, analyzed data collected between 1999 and 2016. The researchers focused on measures relating to food security and body fat — body mass index, or BMI, and waist circumference.
Their findings, which feature in the journal JAMA Network, point to a significant increase in food insecurity rates during this time, reaching 18.2% in 2015–2016. This is in contrast to declines in food insecurity before the COVID-19 pandemic.
At the beginning of the study, in 1999–2000, 12% of women with obesity were food insecure, compared with 7% who were not. By 2015–2016, the number of women with obesity and food insecurity had risen to 25%, compared with 16% of women with moderate weight, what the researchers referred to as “normal” weight.
In men, there was a similar trend. At the beginning of the study, in 1999–2000, food insecurity was more prevalent in men with normal weight (10%), compared with 9% of those with obesity. By 2015–2016, food insecurity was more prevalent in men with obesity (20%), compared with those who had normal weight (16%).
Food insecurity and obesity
“Food insecurity and obesity are not mutually exclusive […] Rather, these health issues are linked in such a way that a solution will require public policy that addresses both at the same time.”
– Dr. Candice Myers, an assistant professor at the Pennington Biomedical Research Center and the study’s lead author
The prevalence of food insecurity was highest among people with obesity. This may be partly because the cheapest and most accessible foods are often the least healthful.
The fact that food insecurity can coexist with obesity — and in fact correlate with it — highlights the importance of making healthy and nutritious food affordable for all.
The researchers also identified differences that aligned with race and ethnicity, with food insecurity in 2015–2016 being greater among Black participants (29.1%) and Hispanic participants (35%), compared with their white counterparts (13%).
A critical public health concern
The researchers observe that rising rates of food insecurity following the start of the ongoing pandemic in the U.S. are a critical public health concern.
“The COVID-19 pandemic has undoubtedly worsened the situation. The country may face long-term economic and health consequences unless we solve this public health crisis,” says Dr. Myers.
The researchers recommend various ways that public health professionals can combat rising levels of food insecurity — including using screening tools to identify people at risk of this issue, who can then be referred to support services, such as food banks.
They also recommend further research to better understand the link between food insecurity and obesity, as well as the racial and ethnic disparities in food security.
Dr. John Kirwan, executive director of the Pennington Biomedical Research Center, concluded, “Our research has set the stage to not only continue our current efforts to explore these issues, but also develop new and innovative projects that delve into understanding their impact on the health of the citizens of our community, state, and the entire country.”
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