The Surprising Link between Food Insecurity and Obesity
Photo Credit © Jen Theodore on Unsplash.
The World Health Organization (WHO) stated in 2020 that worldwide obesity had tripled since 1975; by 2019, 38 million children under the age of five were medically classified as overweight or obese. In 2016, the WHO estimated overweight and obese adults over 18 as numbering 650 million worldwide. [FN1]
“What is happening to us?” could be an important question for all of us to ask. We kick off this conversation with those suffering from food insecurity in the United States.
The concept of not having enough nutritious food on a regular basis is known as “food insecurity”. Obesity is the medical condition of people who are carrying more than 20 percent above their ideal weight, or more commonly, Body Mass Index readings that present risk for serious health problems. [FN2]
That there could be a link between food insecurity and obesity may not seem logical, but these two issues are intertwined.
Obesity is a complex condition sometimes subjected to simplistic causality theories. The prevalent theory is that obesity results from lack of access to nutritious, fresh food in situations where high-calorie but nutritionally poor food is more accessible. Fresh produce and quality groceries are expensive, sometimes difficult to access, and can be difficult to prepare in palatable ways. They are also perishable and can spoil quickly. Distilling down the dominant food choices of those impacted by food insecurity, these are highly processed high-calorie food. [FN3]
However, a deeper dive reveals complexity and presents opportunities for new research and remedies. Food insecurity, obesity and nutritional education are all topics individually subjected to research and exploration; however, there are gaps in our knowledge concerning their interactions. For instance, it may be useful to conduct longitudinal studies through generations of community groups to check for crossover effects in eating behavior and shape a more nuanced etiology for obesity. [FN4]
Weight Gain: Examples of Research Findings
The search for the root mechanistic causation behind food insecurity’s association with weight gain and obesity is still on. Here are some other examples of findings:
Effects of “perceived” food insecurity on behavior when people who identify themselves as having a “low social status” faced with accessible supply of high-calorie food as part of a “Resource Scarcity Hypothesis” results in weight gain. Based on the fields of evolutionary biology, ecology, and obesity, this hypothesis sets out a tentative connection between social status and energy expenditure/metabolic efficiency. (FN3).
Effects of not having control of one’s own food supply: research into the impacts of interventions that help communities get control of access to their food supply, for example, could suggest helpful reforms of financial planning and approaches to dietary interventions. (FN3)
Effects of stress in the context of food insecurity: Cortisol, a steroid hormone sometimes referred to as the stress hormone, has long been thought to increase the risk of obesity. Because food insecurity is a stressful state to be in, chronically high cortisol levels in these individuals may also increase their risk of obesity. (FN3) Long-term stress causes many more side-effects related to cortisol effects.
Effects of food insecurity on metabolic performance: one body of evidence (based on animal studies) suggests that prolonged food insecurity may lead to metabolic inefficiency. In other words, the metabolism of those facing food insecurity mediates the risk of future lack of food by storing fat now. Human populations in food insecure situations echo this finding in terms of their higher Resting Metabolic Rate, a primary risk factor for weight gain. [FN3]
Longitudinal studies have also found that the likelihood of developing childhood obesity is 22% higher in food insecure children as compared to food secure children. [FN5]
Policy Considerations
Research, policies and best practices to reduce food insecurity are valuable, as are awareness campaigns such as discussions around US “food swamps.” ( See our related article here). Most interventions focus on participation in federal food and nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children, and working with community-based food assistance agencies. [FN6] Integrating strategic approaches to address obesity among those experiencing food insecurity should now become a priority, especially in view of comorbidity issues with Covid-19 and its variants.
Testing Financial Incentives
An initiative funded by the United States Department of Agriculture and enabled by the Farm Bill of 2008 was the Healthy Incentives Pilot (HIP) run in 2011-2012. [FN7] Of the 55,000 households in Massachusetts in the pilot catchment area, 7,500 households were randomly chosen to receive HIP incentives (30 US cents per SNAP dollar) to buy “targeted” fresh fruit and vegetables while the remainder constituted the control group and continued to receive the standard benefits. This targeting included fresh, canned and frozen vegetables without extra sugar, fats, oils or salt and excluded white potatoes and 100% fruit juice. [FN7]
According to the HIP Final Evaluation Report, participants over 16 were interviewed in the HIP phone interviews, backed up by the records of the electronic benefits transfer card credits of targeted purchases. Taken together, the main finding was that HIP participants consumed almost a quarter of a cup (or 26 percent) more targeted fruits and vegetables per day than those in the control group. Sales of vegetables were boosted more than sales of fruit. [FN8] This experiment established that financial incentives can encourage average households to purchase more vegetables. [FN9] An alternative current approach applied in Alaska, where obesity is almost endemic, is to limit severely what can be bought with SNAP dollars.
However, as briefly noted here, refining of policy and programs targeting obesity linked with food insecurity will need to be based on cross-referencing of laboratory research, inputs from specialists in overweight issues and experts in behavioral medicine to refine our understanding about what happens when food insecurity meets weight gain.
Resources and Notes
1. Please see WHO key facts here https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). Adults with BMI readings of 25 to 29 are classified as overweight; people with a BMI reading greater or equal to 30 are classifies as obese.
3. Dhurandhar E. J. (2016). The food-insecurity obesity paradox: A resource scarcity hypothesis. Physiology & behavior, 162, 88–92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394740/
4. The "crossover" effect, a phenomenon by which some minority groups switch from low to high risk for substance use as a function of age. For more on crossover effects see https://scholarworks.iupui.edu/handle/1805/21517
5. Metallinos-Katsaras, E., Must, A., Gorman, K. (2012). A Longitudinal study of food insecurity on obesity in preschool children. Journal of the academy of nutrition and dietetics, 112, 12. https://web.uri.edu/endhunger/files/6_2012_A-longitudinal-study-of-food-insecurity.pdf
6. Brown, A., Esposito, L., Fisher, R., Hicastro, H., Tabor, D., Walker, J. (2019). Food insecurity and obesity: Research gaps, opportunities, and challenges, Translational Behavioral Medicine, 9, 5, 980–987. https://academic.oup.com/tbm/article/9/5/980/5579403
7. The Food, Nutrition and Conservation Act of 2008 (also known as the Farm Bill) authorized $20 million for pilot projects to evaluate health and nutrition promotion in the Supplemental Nutrition Assistance Program (SNAP) to determine if incentives provided to SNAP recipients at the point-of-sale could boost the purchase of fruits, vegetables or other healthy foods. The pilot was run in Hampden County in Massachusetts in a mix of twenty-seven urban, suburban and rural cities and towns and involving around 55,000 SNAP households. The program ran from November 2011 through December 2012.
8. https://www.fns.usda.gov/snap/hip/final-evaluation-report
9. For full findings including the cost of this pilot, see https://fns-prod.azureedge.net/sites/default/files/ops/HIP-Final-Summary.pdf