Poverty and obesity: the role of energy density and energy costs

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Breakfast Habits, Nutritional Status, Body Weight, and Academic Performance in Children and Adolescents

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI >27.3 kg/m(2) for women and 27.8 kg/m(2) for men. Food insecurity was related to overweight status for women (n = 4509, P < 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P < 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation.

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Food Insecurity Is Positively Related to Overweight in Women

OBJECTIVES: To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. PATIENTS AND METHODS: Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of child health, hospitalizations in their lifetime, and developmental risk. Children were weighed and measured. An FI screen was developed on the basis of affirmative HFSS responses among food-insecure families. Sensitivity and specificity were evaluated. Convergent validity (the correspondence between the FI screen and theoretically related variables) was assessed with logistic regression, adjusted for covariates including study site; the caregivers9 race/ethnicity, US-born versus immigrant status, marital status, education, and employment; history of breastfeeding; child9s gender; and the child9s low birth weight status. RESULTS: The sample included 30 098 families, 23% of which were food insecure. HFSS questions 1 and 2 were most frequently endorsed among food-insecure families (92.5% and 81.9%, respectively). An affirmative response to either question 1 or 2 had a sensitivity of 97% and specificity of 83% and was associated with increased risk of reported poor/fair child health (adjusted odds ratio [aOR]: 1.56; P CONCLUSIONS: A 2-item FI screen was sensitive, specific, and valid among low-income families with young children. The FI screen rapidly identifies households at risk for FI, enabling providers to target services that ameliorate the health and developmental consequences associated with FI.

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Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity

http://stacks.cdc.gov/view/cdc/34761/cdc_34761_DS1.pdf

Child and adolescent obesity: part of a bigger picture

Since 1992, the U.S. Department of Agriculture Food and Nutrition Service (FNS) has led a collaborative effort to develop a comprehensive benchmark measure of the severity and prevalence of food insecurity and hunger in the United States. Based on prior research and wide consultation, a survey instrument specifically relevant to U.S. conditions was designed and tested. Through its Current Population Survey (CPS), the U.S. Bureau of the Census has fielded this instrument each year since 1995. A measurement scale was derived from the data through fitting, testing and validating a Rasch scale. The unidimensional Rasch model corresponds to the form of the phenomenon being measured, i.e., the severity of food insufficiency due to inadequate resources as directly experienced and reported in U.S. households. A categorical measure reflecting designated ranges of severity on the scale was constructed for consistent comparison of prevalence estimates over time and across population groups. The technical basis and initial results of the new measure were reported in September 1997. For the 12 months ending April 1995, an estimated 11.9% of U.S. households (35 million persons) were food insecure. Among these, 4.1% of households (with 6.9 million adults and 4.3 million children) showed a recurring pattern of hunger due to inadequate resources for one or more of their adult and/or child members sometime during the period. The new measure has been incorporated into other federal surveys and is being used by researchers throughout the U.S. and Canada.

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Measuring Food Insecurity and Hunger in the United States: Development of a National Benchmark Measure and Prevalence Estimates

An estimated 85.5 percent of American households were food secure throughout the entire year in 2010, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.5 percent) were food insecure at least some time during the year, including 5.4 percent with very low food security — meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. The prevalence rate of very low food security declined from 5.7 percent in 2009, while the change in food insecurity overall (from 14.7 percent in 2009) was not statistically significant. The typical food-secure household spent 27 percent more on food than the typical food-insecure household of the same size and household composition. Fifty-nine percent of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2010 survey.

Household Food Security in the United States in 2010

Eighty-nine percent of American households were food secure throughout the entire year in 2006, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (10.9 percent) were food insecure at least some time during the year. About one-third of food insecure households (4.0 percent of all U.S. households) had very low food security—meaning that the food intake of one or more adults was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. Prevalence rates of food insecurity and very low food security were essentially unchanged from those in 2005. The typical food-secure household spent 31 percent more on food than the typical food-insecure household of the same size and household composition. Just over half of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to USDA’s annual Food Security Survey.

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Household Food Security in the United States, 2006

An estimated 85.1 percent of American households were food secure throughout the entire year in 2011, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.9 percent) were food insecure at least some time during the year, including 5.7 percent with very low food security—meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. The prevalence rate of very low food security increased from 5.4 percent in 2010, returning to the level observed in 2008 and 2009. The change in food insecurity overall (from 14.5 percent in 2010) was not statistically significant. The typical food-secure household spent 24 percent more on food than the typical food-insecure household of the same size and household composition. Fifty-seven percent of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2011 survey.

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Household Food Security in the United States in 2011

Eighty-five percent of American households were food secure throughout the entire year in 2009, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.7 percent) were food insecure at least some time during the year, including 5.7 percent with very low food security. In households with very low food security, the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. Prevalence rates of food insecurity and very low food security were essentially unchanged from 14.6 percent and 5.7 percent, respectively, in 2008, and remained at the highest recorded levels since 1995, when the first national food security survey was conducted. The typical food-secure household spent 33 percent more on food than the typical food-insecure household of the same size and household composition. Fifty-seven percent of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2009 survey.

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Steven Carlson

Papers

Measuring Food Insecurity and Hunger in the United States: Development of a National Benchmark Measure and Prevalence Estimates

Household Food Security in the United States in 2010

Household Food Security in the United States, 2006

Household Food Security in the United States in 2011

Household Food Security in the United States, 2009