Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18–65 y participating in the NHANES (1999–2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04–1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09–1.55), but not diabetes (ARR 1.19; 95% CI, 0.89–1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04–1.41) and diabetes (ARR 1.48; 95% CI, 0.94–2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44–4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.

Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants

One in seven American households experience food insecurity at times during the year, lack of money and other resources hinder their ability to maintain consistent access to nutritious foods. Low-income, ethnic minority, and female-headed households exhibit the greatest risk for food insecurity, which often results in higher prevalence of diet-related disease. The food insecurity-obesity paradox is one that researchers have explored to understand the factors that influence food insecurity and its impact on weight change. The aim of this inquiry was to explore new evidence in associations of food insecurity and obesity in youth, adult, and elderly populations. A literature search of publication databases was conducted, using various criteria to identify relevant articles. Among 65 results, 19 studies conducted since 2005 were selected for review. Overall, the review confirmed that food insecurity and obesity continue to be strongly and positively associated in women. Growing evidence of this association was found in adolescents; but among children, results remain mixed. Few studies supported a linear relationship between food insecurity and weight outcomes, as suggested by an earlier review. New mediators were revealed (gender, marital status, stressors, and food stamp participation) that alter the association; in fact, newer studies suggest that food stamp participation may exacerbate obesity outcomes. Continued examination through longitudinal studies, development of tools to distinguish acute and chronic food insecurity, and greater inclusion of food security measurement tools in regional and local studies are warranted.

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Exploring mediators of food insecurity and obesity: a review of recent literature

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Food Insecurity Is Inversely Associated with Diet Quality of Lower-Income Adults

Food insecurity is associated with obesity among US adults in 12 states

During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states Although this relationship has not been repeatedly seen in men, research suggests a correlation in women Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults—especially women—but not in children This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity–obesity relationship This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention

The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play

This study examined the effects of an environmental intervention promoting more non-energy-containing beverage consumption compared to sugar-sweetened soft drink consumption through vending machines in an urban college setting. Eight soft drink vending machines were randomly selected and assigned to one of three conditions over a 9-week period: energy-content labels on non-energy-containing beverage selection panels (intervention I), labels plus motivational posters (intervention II), or control. The totals of all beverages sold and machine revenue were recorded at baseline (2 weeks), intervention (5 weeks), and postintervention (2 weeks) periods. Use of energy-content labels and motivational posters, compared with control group, resulted in a significantly lower growth rate of sugar-sweetened beverage sales (P<0.05). Total revenue for all beverages increased during the intervention period. It is estimated that the non-energy-containing beverages combined accounted for 70.52% of the increased revenue. Results of this study suggest that energy-content labels and motivational posters on beverage vending machines may be an effective way to influence beverage sales.

Dara Bergen

Papers

The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play

Effects of energy-content labels and motivational posters on sales of sugar-sweetened beverages: stimulating sales of diet drinks among adults study