HOUSEHOLD FOOD INSECURITY AND OBESITY, CHRONIC DISEASE, AND CHRONIC DISEASE RISK FACTORS

Authors: STUFF, JANICE; CASEY, PATRICK; CONNELL, CAROL; CHAMPAGNE, CATHERINE; GOSSETT, JEFFREY; HARSHA, DAVID; McCabe Sellers, Beverly; ROBBINS, JAMES; SIMPSON, PIPPA; SZETO, KITTY; WEBER, JUDITH; Bogle, Margaret

Submitted to: Journal of Hunger and Environmental Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/8/2006
Publication Date: 5/1/2007
Citation: Stuff, J.E., Casey, P.H., Connell, C., Champagne, C.M., Gossett, J.M., Harsha, D., McCabe Sellers, B.J., Robbins, J.M., Simpson, P.M., Szeto, K.L., Weber, J.L., Bogle, M.L. 2007. Household food insecurity and obesity, chronic disease, and chronic disease risk factors. Journal of Hunger and Environmental Nutrition. 1(2):43-62.

Interpretive Summary: We studied whether food insecurity, a measure of food adequacy and stability, is associated with obesity and other diseases among individuals in the Lower Mississippi Delta. We found that the relationship between food insecurity and obesity may be due to income and demographic variables. Individuals with high cholesterol, heart disease, and metabolic syndrome have a high likelihood of being food insecure. These findings suggest high-risk populations with limited resources may not be able to purchase and eat diets needed to prevent and manage chronic disease conditions.

Technical Abstract: The prevalence of household food security, which reflects perceived adequacy and stability of the food supply, has been measured annually in the United States and occasionally in high-risk groups or specific regions. Studies examining the association between food insecurity and obesity in adults have produced conflicting results, and information is limited on the relationship between food insecurity and adult chronic health conditions, particularly in high-risk populations. Our objective was to examine the association between household food insecurity and self-reported weight status and chronic disease in the Lower Mississippi Delta. A two-stage stratified cluster sample representative of the population in 36 counties in the Lower Delta was selected. Data were collected in a cross-sectional telephone survey using list assisted random digit dialing telephone methodology. Measures included the US Food Security Survey Module, self-reported height and weight status (obesity=body mass index >30 kg/m2), and self-reported hypertension, high cholesterol, diabetes, heart disease stroke, and a marker for metabolic syndrome. '2 analyses were conducted to test the bivariate association between food security status and weight or health condition; multivariate logistic regression analyses was conducted to measure these associations controlling for other covariate. Statistical procedures accounted for the complex survey design. Based on a sample of 1457 households, 42.3% of food-insecure adults were obese, a significantly higher rate than food-secure adults (33.2%). After controlling for demographic variables, food insecurity was not independently associated with obesity. Income and the interaction between race and gender were significant predictors of obesity. Food insecure adults were significantly more likely to report hypertension (45.1% vs 29.5%) diabetes (15.0% vs. 9.3%), heart disease (13.5% vs 6.8%) and metabolic syndrome (10.1% vs. 4.4%). After controlling for demographic variables, food insecurity was associated with high cholesterol (AOR 1.65; 95% CI, 1.0 to 2.7), heart disease (AOR 2.7; 95% CI, 1.5 to 4.8), and metabolic syndrome (AOR 2.8; 95% CI, 1.4 to 5.5). The relationship between food insecurity and obesity in a high-risk population may be due to income and demographic variables. Patients in a rural high-risk population presenting with high cholesterol, heart disease, and metabolic syndrome have a high likelihood of being food insecure. Nutritional interventions targeting high-risk populations should address food insecurity, which may be one of the contributing factors in chronic disease.