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Food Insecurity and Obesity
among Adults
IOM Workshop on Food Insecurity & Obesity
November 16-18, 2010
Barbara A. Laraia, RD, Ph.D.Associate Professor
Co-Director, UCSF Center for Obesity
Assessment, Study and Treatment
Household Food Insecurity is
Multidimensional
• Psychological—Worry about enough food
– Numerous studies find an association with mental health, stress and depression
• Nutritional—Compromise quality and quantity
– Little research finds clear associations with diet variety, meal pattern, macronutrient and micronutrient intake
• Economic—Material deprivation
= Sensitive Measure that Isn’t Specific
Overview
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
Source: http://www.ers.usda.gov/publications/
US Prevalence of Household Food
Insecurity
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1.Dependence on Calorically Dense Foods
2.Diet Sensitive Chronic Disease
3.Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
Relation between the energy density of
selected foods and energy costs (¢/MJ)
Drewnowski, A. et al. Am J Clin Nutr 2004;79:6-16.
Food Insecurity & Dietary Intake
KEY FINDINGS
Dietary variety
Adult Healthy Eating Index (HEI), mean a 6.3 vs. 5.9*
Energy Intake
Adults (NHANES) b
Adults (NHANES) c
No Difference
No Difference
But, Fewer Meals
Micronutrient Intake in older adults b No DifferenceVitamin A, C, E, Folate, B-12, Ca
Lower Intake↓ Vitamin B6, Mg, Fe, Zn *
Basioti 2002a; Dixon 2001b; Zizza c
* Significant p<0.05
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
Food Insecurity, Hypertension,
Hyperlipidemia, and Diabetes
Seligman, Laraia and Kushel. J Nutr 2010
Food Insecurity and Disease Control
Seligman, Laraia and Kushel. J Nutr 2010
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
Stress Induced Non-Homeostatic
Eating• Food Insecurity—is a threat
that can stimulate HPA axis
triggering hunger and
increasing drive for feeding
• Stress induced eating
influences a desire for
palatable foods to dampen
the stress response
• Eating in the presence of
stress can lead to insulin
resistance and visceral fat
accumulation
Association of Psychosocial Factors
and Food Security Status
0
0.5
1
1.5
2
2.5
Food Secure Marginally Secure Food Insecure
Stress Anxiety Depression Chance LOC Power LOC
* Adjusted models controlling for age, children, education, income, race, and marital status
Laraia BA, et al. J Nutr 2006;136:177-182.
Beta
coeffic
ient
Decreased Protective Traits with
Increased Household Food Insecurity
0
0.2
0.4
0.6
0.8
1
1.2
Food Secure Marginally Secure Food Insecure
Self-Esteem Mastery
* Adjusted models controlling for age, children, education, income, race, and marital status
Laraia BA, et al. J Nutr 2006;136:177-182.
Beta
co
eff
icie
nt
Influence of Food Stress and Dietary
Restraint on Gestational Weight Gain
-3
-2
-1
0
1
2
3
4
Food Secure Food Insecure High Restraint Food Insecure/
High Restraint
Weight Gain Adequacy of Weight gain
* Adjusted models controlling for age, children, education, income, race, and marital status
Beta
coeffic
ient
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
Cortisol & Visceral Fat
• Stress + Junk food =
– ↑ Insulin & Neuropeptide Y (NPY)
– Greater Abdominal Fat
• 4 months later, Metabolic Syndrome!
Control Junk Diet Stress/Junk
Kuo LE et al, 2007, Nature Medicine
Block NPY
Variable Foraging Demands
• Coplan 2006: – Early VFD: No change on maternal CRF
– Late VFD: ↑ Maternal CRF
– ↑ Infant CRF with both Early & Late VFD
• Kaufman 2007:– Late VFD: ↑ weight, ↑ BMI, ↑ abdominal circumference
– ―Our data suggest that early-life stress during a
critical period of neurodevelopment can result in
the peri-pubertal emergence of obesity and insulin
resistance.‖
• Prevalence of Food Insecurity in US
• Plausibility—Lines of Evidence
1. Dependence on Calorically Dense Foods
2. Diet Sensitive Chronic Disease
3. Stress and Efficient Energy Storage
• Evidence from Animal Models
• Food Insecurity & Weight Status
– by Gender, Race and Over Time
• Future Directions
WOMEN MEN ADULTS
FI
Level
Over-
weight
Obese Obese (Women of
color)
Over-
weight
Obese Obese Weight
Gain
FI-Mild
FI-Mod
FI-
Severe
No association
Positive association
Negative association
Food Insecurity and Weight Status
Summary of Findings
WOMEN: Food Insecurity & OverweightSAMPLE & MEASURE N KEY FINDINGS
Rural NY (a) 193 BMI 28.2 vs. 25.6
CSFII (b)
FI-Mild
FI-Moderate
FI-Severe
4,509 1.3 (1.1-1.5)
No association
No association
1996/1997 Canadian Health Study(c) 24,400 No association
1999/2002 NHANES (d)
FI-Mild
FI-Moderate
FI-Severe
4,172 No association
No association
No association
1999/2002 NHANES (e)
FI-Mild
FI-Moderate
FI-Severe
4,549 No association
No association
1.67 (1.08, 2.57)Olson 1999 (a), Townsend 2001 (b), Vozoris 2003 (c), Hanson 2007 (d), Wilde 2006 (e)
WOMEN: Food Insecurity & Obesity
SAMPLE & MEASURE N KEY FINDINGS
Rural NY (a) 193 37% vs. 26%
California Women’s Health Survey (f)
FI-Moderate
FI-Severe
8,169 31.% vs. 16.%
1.4 (1.0-1.8)
No association
1999/2002 NHANES (d)
FI-Mild
FI-Moderate
FI-Severe
4,172 No association
10.8 2.6
No association
1999/2002 NHANES (e),
FI-Mild
FI-Moderate
FI-Severe
4,549 1.58 (1.11, 2.24)
1.76 (1.44, 2.15)
No Association
Olson 1999 (a), Adams 2003 (f), Hanson 2007 (d), Wilde 2006 (e)
WOMEN: Food Insecurity & Weight
Status by EthnicitySAMPLE & MEASURE N KEY FINDINGS
California Women’s Health Survey (f)
OBESITY among Non-white women
FI-Moderate
FI-Severe
8,169 1.5 (1.1-1.9)
2.8 (1.8–4.3)
Overweight, Latina women in CA (g)
FI-Moderate
FI-Severe
559 No association
No association
Obesity, Latina women in CA (g)
FI-Moderate
FI-Severe
559 No association
1.98 (1.1-3.5)
Adams 2003 (f), Kaiser 2007 (g)
ADULTS: Food Insecurity & Weight
StatusSAMPLE & MEASURE N KEY FINDINGS
CSFII (b), Overweight in Men 4,509 No association
1996/1997 Canadian Health Study (c)
Overweight among Men
Obesity among Men
25,815 0.7 (0.5–0.9)
No association
1999/2002 NHANES (d), Men
FI-Mild
FI-Moderate
FI-Severe
4,338 No association
-8.3 3.9 (OW)
No association
LA, NY BRFSS Social Context Model (i)
Enough Food-Obesity among Adults 3,945 No association
WA BRFSS Social Context Model (h)
Enough Food-Obesity among Adults 3,252 1.3 (1.0-1.8)
Townsend (b), Vozoris 2003 (c), Hanson 2007 (d), VanEenwyk 2003 (h), Laraia 2004 (i)
ADULTS: Weight Gain—Longitudinal
StudiesSAMPLE & MEASURE N KEY FINDINGS
PSID (j), Women 5,303 No association
PSID (k), Women 5,595 No association
Fragile Families (l), Women 1,707 No association
NHANES (e), Women FI-Mild
FI-Moderate
FI-Severe
Men (all levels)
4,549
4,202
1.56 (1.09, 2.23)
1.43 (1.02, 2.00)
No association
No association
Pregnancy, Infection & Nutrition Study (o), Pregnant women
810 Higher weight gain
Gestational Diabetes
Bassett Mother Health Project (n),
Pregnant women 463 Obese women became
food insecure
Jones 2006 (j), 2007 (k), Whitaker 2007 (l), Wilde 2006 (e), Olson 2008 (n), Laraia 2010 (o)
Summary
• Inconsistent results between food insecurity
and overweight among women
• Modest association between food insecurity
and obesity among women, especially
women of color
• Inverse or null association between food
insecurity and overweight among men
• Inconsistent results between food insecurity
and weight gain
Future Directions
• Could these findings suggest a spurious relationship– Do overweight/obese women perceive their household food
situation differently than normal weight women?
• Consistency in measuring the exposure and outcome– Different measures are used for both the exposure and outcome
– Some analyses restrict to middle- and low-income household, and all control for income
• Refining our conceptual framework– Focus on visceral fat instead of weight
– Identify moderators of food insecurity, such as dieting or stress
– Focus on critical periods of growth and development, aging and diet-sensitive chronic diseases
– Assess the interaction between food insecurity and the food environment
Acknowledgments
• Funding Support
– NICHD
– NIDDK
– NHLBI
• Co-authors
– Anna Maria Siega-Riz, Craig Gundersen, Nancy Dole, Hilary Seligman, Margot Kushel
• UCSF Center for Health & Community and COAST
– Nancy Adler, Elissa Epel, Irene Yen, Bethany Hendrickson, Pam Stoddard
