The food-insecurity obesity paradox: A resource scarcity hypothesis

The development and validation of the food insecurity physical activity concerns scale

Food insecurity - defined as having limited access to nutritious foods - is linked with obesity. Previous research has also shown that food insecurity is associated with lower levels of leisure-time physical activity (physical activity performed outside of essential activities). This association may occur in part due to concerns about preserving levels of energy during times of food shortage. Currently, no scale exists which measures this construct. Therefore, we aimed to develop and validate such a scale - the food insecurity physical activity concerns scale (FIPACS). Participants (N = 603, individuals with food insecurity = 108) completed an online survey, consisting of the FIPACS, the International Physical Activity Questionnaire short-form (IPAQ), the restraint subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), the amotivation subscale of the Behaviour Regulation In Exercise Questionnaire-2 (BREQ-2), and the Behavioural Inhibition System/Behavioural Approach System Reactivity scale (BIS/BAS) to assess convergent and divergent validity. An exploratory factor analysis revealed a four-factor model of the FIPACS - namely 'Concerns relating to hunger', 'Concerns of replenishment and calories', 'Concerns of physiological effects of exercise' and 'Compensatory behaviours' which was verified through a confirmatory factor analysis. To assess test-retest reliability, 100 participants completed the FIPACS again two weeks later. The FIPACS had good internal, test-retest reliability and divergent validity. However, there was limited evidence of convergent validity. Future studies could incorporate this scale when investigating the association between food insecurity and physical activity.

Translational Science Approaches for Food Insecurity Research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

The Association Between Prenatal Food Insecurity and Breastfeeding Initiation and Exclusive Breastfeeding Duration: A Longitudinal Study Using Oregon PRAMS and PRAMS-2, 2008-2015

Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women. Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used (n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics. Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]). Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.

Unraveling the rationale and conducting a comprehensive assessment of KD025 (Belumosudil) as a candidate drug for inhibiting adipogenic differentiation-a systematic review

Rho-associated kinases (ROCKs) are crucial during the adipocyte differentiation process. KD025 (Belumosudil) is a newly developed inhibitor that selectively targets ROCK2. It has exhibited consistent efficacy in impeding adipogenesis across a spectrum of in vitro models of adipogenic differentiation. Given the novelty of this treatment, a comprehensive systematic review has not been conducted yet. This systematic review aims to fill this knowledge void by providing readers with an extensive examination of the rationale behind KD025 and its impacts on adipogenesis. Preclinical evidence was gathered owing to the absence of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study's quality was assessed using the Joanna Briggs Institute (JBI) Checklist Critical Appraisal Tool for Systematic Reviews. In various in vitro models, such as 3T3-L1 cells, human orbital fibroblasts, and human adipose-derived stem cells, KD025 demonstrated potent anti-adipogenic actions. At a molecular level, KD025 had significant effects, including decreasing fibronectin (Fn) expression, inhibiting ROCK2 and CK2 activity, suppressing lipid droplet formation, and reducing the expression of proadipogenic genes peroxisome proliferator-activated receptor gamma (PPARγ) and CCAAT/enhancer-binding protein α (C/EBPα). Additionally, KD025 resulted in the suppression of fatty acid-binding protein 4 (FABP4 or AP2) expression, a decrease in sterol regulatory element binding protein 1c (SREBP-1c) and Glut-4 expression. Emphasis must be placed on the fact that while KD025 shows potential in preclinical studies and experimental models, extensive research is crucial to assess its efficacy, safety, and potential therapeutic applications thoroughly and directly in human subjects.

Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents

BACKGROUND

Food insecurity, a social and economic condition of limited availability of healthy food, is a risk factor for adverse cardiovascular health outcomes among adults; few studies have been conducted in adolescents. This study explores the association between food insecurity and cardiovascular health risk factors among a nationally representative sample of US adolescents, adopting the American Heart Association's Life's Essential 8 metric.

METHODS AND RESULTS

We analyzed data from 2534 adolescents aged 12 to 19 years from the 2013 to 2018 National Health and Nutrition Examination Surveys. In the sample, 24.8% of adolescents lived in food-insecure households. After multivariable adjustment, food insecurity was associated with a 3.23-unit lower total Life's Essential 8 score (95% CI, -6.32, -0.15) and lower scores on diet quality (β=-5.39 [95% CI, -8.91, -1.87]) and nicotine exposure (β=-4.85 [95% CI, -9.24, -0.45]). Regarding diet, food insecurity was associated with 5% lower Healthy Eating Index-2015 scores [95% CI, -7%, -2%], particularly lower intakes of whole grains and seafood/plant proteins and marginally higher intake of added sugar. Regarding nicotine exposure, food insecurity was associated with ever use of a tobacco product among m (odds ratio, 1.74 [95% CI, 1.20-2.53]). Compared with their food-secure counterparts, food-insecure male (odds ratio, 1.98 [95% CI, 1.07-3.65]) and female (odds ratio, 3.22 [95% CI, 1.60-6.45]) adolescents had higher odds of living with a current indoor smoker.

CONCLUSIONS

In this nationally representative sample of adolescents, food insecurity was associated with multiple indicators of cardiovascular health risk. These findings underscore the need for public health interventions and policies to reduce food insecurity and improve cardioprotective behaviors during adolescence, with particular efforts targeting diet quality and nicotine exposure.

"It's just a constant concern in the back of my mind": Lived experiences of college food insecurity

Objective: Food insecurity is a growing concern to the health and wellbeing of college students. This study aims to examine the lived experiences of students at-risk of food insecurity and associated challenges in a public urban campus. Participants: The study recruited 21 college students at risk of food insecurity using purposive sampling. Methods: We performed qualitative interviews with three focus groups and conducted a thematic analysis to explore themes that emerged from participant discussions. Results: Three central themes emerged from our qualitative analysis: (a) barriers to accessing stable and healthy food; (b) impacts of food insecurity on academic performance and physical and mental health; and (c) coping strategies for navigating food insecurity. Conclusions: The study highlights the distinct natures of food hardship and responses specific to urban public college students. Suggestions for academics and college administrators to mitigate college food insecurity are discussed.

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Turkish adaptation, validation and reliability of the US Adult Food Security Survey Module in university students

OBJECTIVE

To evaluate the validity and reliability of the Turkish version of the US Adult Food Security Survey Module (AFSSM).

DESIGN

A cross-sectional study collected data from 117 university students. The AFSSM questionnaire was completed by all participants. Psychometric evaluation for scale, content, construct, and convergent validity and reliability of the scale was tested. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on data collected from university students. Cronbach's α (internal consistency) and composite reliability were used to assess the reliability (P < 0·05).

SETTING

Students were recruited from the university.

PARTICIPANTS

This research was conducted with volunteer university students with a mean age of 22·74 ± 4·19 years.

RESULTS

Three factors were extracted from eight items through EFA: (1) inadequate nutrition, (2) economic concern and (3) hunger. These factors accounted for 77·4 % of the total variance, and factor loadings ranged from 0·755 to 0·953. Cronbach's α was 0·769. The results of the CFA suggested the fit indices were acceptable (χ2/sd = 0·235, root mean error of approximation: 0·034, goodness-of-fit index: 0·994, comparative fit index: 0·992 and normed fit index: 0·986).

CONCLUSIONS

This is the first study that validates and reports the Turkish version of AFSSM in university students, and the results of our study show that the Turkish AFSSM is a valid and reliable tool for determining food security in university students. AFSSM can be used by researchers to examine the food security of university students.

Adolescent food insecurity in female rodents and susceptibility to diet-induced obesity

Food insecurity is defined as having limited or uncertain access to nutritious foods, and adolescent food insecurity is associated with obesity and disordered eating behaviors in humans. We developed a rodent model of adolescent food insecurity to determine whether adolescent food insecurity per se promotes increased susceptibility to diet-induced obesity and altered eating behaviors during adulthood. Female juvenile Wistar rats were singly housed and assigned to three experimental diets: food-secure with standard chow (CHOW), food-secure with a high-fat/sugar Western diet (WD), and food-insecure with WD (WD-FI). Food-secure rats (CHOW and WD) received meals at fixed feeding times (9:00, 13:00, and 16:00). WD-FI rats received meals at unpredictable intervals of the above-mentioned feeding times but had isocaloric amounts of food to WD. We investigated the impact of adolescent food insecurity on motivation for sucrose (Progressive Ratio), approach-avoidance behavior for palatable high-fat food (Approach-Avoidance task), and susceptibility to weight gain and hyperphagia when given an obesogenic choice diet. Secondary outcomes were the effects of food insecurity during development on anxiety-like behaviors (Open Field and Elevated Plus Maze) and learning and memory function (Novel Location Recognition task). Rodents with adolescent food insecurity showed a greater trend of weight gain and significantly increased fat mass and liver fat accumulation on an obesogenic diet in adulthood, despite no increases in motivation for sucrose or high-fat food. These data suggest that adolescent unpredictable food access increases susceptibility to diet-induced fat gain without impacting food motivation or food intake in female rodents. These findings are among a small group of recent studies modeling food insecurity in rodents and suggest that adolescent food insecurity in females may have long-term implications for metabolic physiology later in life.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms.

OBJECTIVE

The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women.

METHODS

We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load.

RESULTS

This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023.

CONCLUSIONS

We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52193.

Tackling diet inequalities in the UK food system: is food insecurity driving the obesity epidemic? (The FIO Food project)

By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.

A Systematic Review of Interventions for Obesity Among Adults With Food Insecurity

OBJECTIVE

Food insecurity is associated with reduced dietary quality and excess weight gain. However, interventions that are effective for obesity among individuals with food insecurity are unclear. The purpose of this systematic review was to synthesize studies in which authors examined interventions for obesity among adults with food insecurity.

METHODS

PubMed, PsycINFO, CINAHL, and EMBASE were searched from inception to October 2022. Studies were included if their authors reported on nonpharmacological and nonsurgical interventions that focused on adults with food insecurity and overweight/obesity and reported weight loss.

RESULTS

A total of 1360 titles were reviewed during the electronic search, and only 5 studies met inclusion criteria. There were 2 primary types of interventions that have been tested: first, behavioral weight loss counseling with or without tailoring for individuals with food insecurity and, second, subsidies for food. Findings of the benefits of one type of intervention over another are mixed.

CONCLUSIONS

This systematic review highlights that the current evidence for interventions that address food insecurity and obesity is mixed and limited in scope. There is a need for rigorous controlled trials to examine the effectiveness and cost-effectiveness of interventions for weight management among individuals with food insecurity and obesity while considering sustainability.

Late-life food insecurity and cognition: exploring timing, duration, and mechanisms among older Mexican adults

BACKGROUND

Food insecurity (FI) remains a global public health problem. FI is more prevalent in low-and middle-income countries than high-income countries. FI is related with worse cognitive outcomes including cognitive function, cognitive decline, and cognitive impairment. Few studies have sought to identify how patterns of FI relate with cognitive function in old age and the potential mechanisms underlying this association.

METHODS

Data from the 2015 and 2018 waves of the Mexican Health and Aging Study (n = 9,654, age 50+) were used in this study. Reports of FI in 2015 and 2018 were combined to create four patterns of FI groups: "persistently food secure", "became food secure", "became food insecure", and "persistently food insecure". Linear regression was used to estimate associations between patterns of FI and cognitive task performance. The mediating roles of depressive symptoms, body mass index, and chronic conditions were tested using Karlson, Holm, and Breen methodology.

RESULTS

Approximately half of the sample were persistently food secure, 17% became food secure, 14% became FI, and 15% experienced persistent FI. When adjusting for demographic/socioeconomic confounders, persistent FI related with worse Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency performance compared to the persistently food secure. Becoming FI related with worse Verbal Learning, Visual Scanning, and Verbal Fluency. Mediation analyses provided support for depressive symptoms mediating associations between FI and poorer cognition, where 48% of the association between persistent FI and worse Verbal Recall performance was attributed to higher depressive symptoms. Becoming food secure was not associated with cognitive performance compared to the persistently food secure.

CONCLUSIONS

FI may represent an important modifiable risk factor for poorer cognitive outcomes among older adults. Public health efforts should focus on providing stable food access to older adults, especially those living in poverty.

Association between dietary Intake, eating behavior, and childhood obesity among children and adolescents in Ethiopia

Introduction

The upsurge of overweight/obesity (OW/OB) among children and adolescents is as a result of complex interactions between lifestyle behaviours and socioeconomic factors. The objective of this study was to determine socioeconomic and sociodemographic factors, dietary intake and eating behaviours of children and adolescents in Ethiopia and their association with OW/OB.

Methods

A cross-sectional study was conducted among 632 children and adolescents-parent dyads. To identify overweight/obese among children and adolescents, body mass index-for-age Z-scores by sex and age relative to WHO 2007 reference was calculated using WHO AnthroPlus software. A multivariable logistic regression model fitted to determine the adjusted associations between the outcome and the predictors selected from the bivariate analyses. Data analysis was carried out using STATA V.15.0.

Results

The proportion of participants with low, medium and high dietary diversity scores was 7.28%, 22.5%, and 70.2%, respectively. Participants aged 13-18 years were less likely to be overweight or obese [adjusted OR (aOR) = 0.40; 95%CI: 0.26, 0.64] to those aged 5-12 years. Children in a family with the richest or highest socioeconomic status (SES) were more likely to be overweight or obese than those in families with the poorest or lowest status. Children and adolescents who consumed soft drinks (sugar-sweetened beverages) four or more times per week [aOR = 3.24; 95%CI: 1.13, 7.95] were more likely to be overweight or obese to those who did not consume soft drinks.

Conclusions

The study identified factors such as younger age (<12 years), high SES and consumption of soft drinks as key contributors to overweight and obesity among children and adolescents. Therefore, interventions targeting behavioural prevention and reduction of overweight and obesity among children and adolescents should be cognizant of the above factors during implementation in order to achieve desired outcomes, further guided by exploratory qualitative studies to identify public perceptions and attitudes affecting dietary practices.

Food insecurity among adult females with a history of breast cancer compared to adult females without cancer in the USA

PURPOSE

To determine the prevalence of food insecurity (FI) among females with a history of breast cancer compared to females without cancer in the USA and the sociodemographic characteristics that may explain their FI.

METHODS

Using the 2019 National Health Interview (NHIS) survey that included the US Department of Agriculture's (USDA's) 10-item Household Food Security Survey Module, participants with high/moderate food security were considered food secure and low/very low food security were considered food insecure. Analyses accounted for complex survey design and included descriptive statistics, bivariate analyses, and multivariate regression analyses.

RESULTS

Eligible females (40+ years old) included 557 with a history of breast cancer and 9678 without a cancer history. FI was experienced by an estimated 4.4% of females with breast cancer, compared to 9.3% of females without cancer. Controlling for age, race/ethnicity, education level, general health status, and body mass index, the prevalence ratio between the two study groups was 0.50 (95% CI 0.33-0.78).

CONCLUSIONS

In this national sample, the prevalence of FI among females with a history breast cancer was lower than females without a history of cancer.

IMPLICATIONS FOR CANCER SURVIVORS

FI is low among breast cancer survivors, and routine FI screening among breast cancer survivors may not be warranted for all patients. Healthcare providers, however, should be aware of FI as a social determinant of health and consider it when there are known financial issues among cancer survivors.

Food insecurity as a cause of adiposity: evolutionary and mechanistic hypotheses

Food insecurity (FI) is associated with obesity among women in high-income countries. This seemingly paradoxical association can be explained by the insurance hypothesis, which states that humans possess evolved mechanisms that increase fat storage to buffer against energy shortfall when access to food is unpredictable. The evolutionary logic underlying the insurance hypothesis is well established and experiments on animals confirm that exposure to unpredictable food causes weight gain, but the mechanisms involved are less clear. Drawing on data from humans and other vertebrates, we review a suite of behavioural and physiological mechanisms that could increase fat storage under FI. FI causes short-term hyperphagia, but evidence that it is associated with increased total energy intake is lacking. Experiments on animals suggest that unpredictable food causes increases in retained metabolizable energy and reductions in energy expenditure sufficient to fuel weight gain in the absence of increased food intake. Reducing energy expenditure by diverting energy from somatic maintenance into fat stores should improve short-term survival under FI, but the trade-offs potentially include increased disease risk and accelerated ageing. We conclude that exposure to FI plausibly causes increased adiposity, poor health and shorter lifespan. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

Parents, but not their children, demonstrate greater delay discounting with resource scarcity

BACKGROUND

Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity.

METHODS

The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested.

RESULTS

Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders.

CONCLUSIONS

These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.

Relationships between early-life family poverty and relative socioeconomic status with gestational diabetes, preeclampsia, and hypertensive disorders of pregnancy later in life

PURPOSE

Low early-life absolute and relative socioeconomic status (SES) may contribute to socioeconomic disparities in pregnancy complications (i.e., gestational diabetes mellitus [GDM], preeclampsia/eclampsia [PE], hypertensive disorders of pregnancy [HDP; preeclampsia/eclampsia, gestational hypertension, chronic hypertension]), but their independent associations with pregnancy complications have not been studied. This study investigated associations of early-life poverty and relative SES with risks of GDM, PE, and HDP.

METHODS

National Longitudinal Study of Adolescent to Adult Health data were used (GDM n = 802; PE n = 813; HDP n = 801). Objective poverty was defined as wave I low-income or receipt of federal nutrition assistance benefits. Relative SES was self-reported at wave V (ages 33-39) by asking whether the participant's family was financially worse off than average when growing up. Logistic regressions assessed relationships between poverty, relative SES, and self-reported lifetime diagnoses of GDM, PE, or HDP.

RESULTS

Lifetime prevalences of GDM, PE, and HDP were 9.23%, 12.00%, and 21.93%, respectively. Low relative SES (odds ratio: 2.04 [1.07, 3.89]) and poverty (odds ratio: 1.81 [0.97, 3.38]) were independently associated with GDM but not with PE or HDP.

CONCLUSIONS

Early-life poverty and relative SES are associated with GDM; understanding the mechanisms underlying these associations may help identify novel intervention targets to reduce socioeconomic disparities in GDM.

Addressing food insecurity: what is the role of healthcare?

Food insecurity - when individuals or households have difficulty accessing sufficient, safe, culturally appropriate and nutritious food due to lack of money or other resources - is a global public health concern. Levels of food insecurity have increased across the UK in recent years, due in part to a decade of austerity, widespread loss of income during the COVID-19 pandemic and the more recent cost-of-living crisis, leading to rising use of food banks. The stress of living with uncertain access to food and going periods without food is damaging to physical and mental health. Food insecurity is linked to both obesity and malnutrition, as often the most readily available foods are processed, high in fats, sugars and salt, but low in essential nutrients for health. While recognising that many of the drivers of food insecurity, and health inequalities more broadly (i.e. the social determinants of health) lie outside the health service, it is increasingly acknowledged that the National Health Service - and primary care in particular - has a key role to play in mitigating health inequalities. This review considers the potential role of healthcare in mitigating food insecurity, with a focus on primary care settings. Recent initiatives in Scotland, such as community links workers and general practitioner practice-attached financial advice workers, have shown promise as part of a more community-oriented approach to primary care, which can mitigate the effects of food insecurity. However, a more 'upstream' response is required, including 'cash first' interventions as part of broader national strategies to end the need for food banks.

Household Food Security and Consumption of Sugar-Sweetened Beverages among New York City (NYC) Children: A Cross-Sectional Analysis of 2017 NYC Kids' Data

Food insecurity is a stressor associated with adverse health outcomes, including the consumption of sugar-sweetened beverages (SSBs). Our study tests the hypothesis that other socioeconomic vulnerabilities may magnify this effect using cross-sectional data from the 2017 New York City (NYC) Kids Survey. Households providing an affirmative response to one or both food security screener questions developed by the US Department of Agriculture were coded as households with low food security. The number of sodas plus other SSBs consumed was standardized per day and categorized as 1 = none, 2 = less than one, and 3 = one or more. We tested the joint effect of low food security with chronic hardship, receipt of federal aid, and immigrant head of household on a sample of n = 2362 kids attending kindergarten and beyond using ordinal logistic regression and accounting for the complex survey design. Only having a US-born parent substantially magnified the effect of low household food security on SSB consumption (OR = 4.2, 95%CI: 2.9-6.3, p < 0.001) compared to the reference group of high household food security with an immigrant parent. The effect of low food security on SSB consumption among NYC children warrants intersectional approaches, especially to elucidate US-based SSB norms in low-food-security settings.

Breaking down silos: the multifaceted nature of obesity and the future of weight management

The continued global increase in the prevalence of obesity prompted a meeting at the Royal Society of London investigating causal mechanisms of the disease, 'Causes of obesity: theories, conjectures, and evidence' in October 2022. Evidence presented indicates areas of obesity science where there have been advancements, including an increased understanding of biological and physiological processes of weight gain and maintenance, yet it is clear there is still debate on the relative contribution of plausible causes of the modern obesity epidemic. Consensus was reached that obesity is not a reflection of diminished willpower, but rather the confluence of multiple, complex factors. As such, addressing obesity requires multifactorial prevention and treatment strategies. The accumulated evidence suggests that a continued focus primarily on individual-level contributors will be suboptimal in promoting weight management at the population level. Here, we consider individual biological and physiological processes within the broader context of sociodemographic and sociocultural exposures as well as environmental changes to optimize research priorities and public health efforts. This requires a consideration of a systems-level approach that efficiently addresses both systemic and group-specific environmental determinants, including psychosocial factors, that often serve as a barrier to otherwise efficacious prevention and treatment options. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.

Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

BACKGROUND

As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF.

METHODS

We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics.

RESULTS

The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025).

CONCLUSIONS

Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.

Food insecurity in people living with obesity: Improving sustainable and healthier food choices in the retail food environment-the FIO Food project

At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.

Assessing and Monitoring Nutrition Security to Promote Healthy Dietary Intake and Outcomes in the United States

The US Department of Agriculture's Economic Research Service leads the federal government in data development and research on food security in US households. Nutrition security is an emerging concept that, although closely related, is distinct from food security. No standard conceptualization or measure of nutrition security currently exists. We review the existing research on nutrition security and how it is informed by the more robust literature on food security and diet quality. Based on this review, we propose a conceptual framework for understanding nutrition security and its relationship to food security. We identify two constructs (healthy diets and nutritional status) and multiple subconstructs that form the basis of nutrition security. The proposed framework and corresponding constructs are intended to provide (a) understanding of how nutrition security arises and how it differs from food security, (b) background on why assessment and monitoring of nutrition security is important, and (c) guidance for a research agenda that will further clarify the meaning of nutrition security and its measurement.

The determinants of the nutritional quality of food provided to the homeless population: a mixed methods systematic review protocol

BACKGROUND

Studies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population.

METHODS

This mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed.

DISCUSSION

Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector.

SYSTEMATIC REVIEW REGISTRATION

This mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.

Differentials and predictors of food insecurity among Federally Qualified Health Center target populations in Philadelphia: a cross-sectional study

BACKGROUND

Over the past decade, the prevalence of food insecurity declined in the United States but curiously climbed in Philadelphia, Pennsylvania, a sizable metropolitan area where many households experience food insecurity and are dependent on programs like SNAP. Therefore, we aimed to determine the burden of food insecurity among populations near Philadelphia Federally Qualified Health Center (FQHC) clinic sites.

METHODS

This cross-sectional study was conducted in North Philadelphia, a populous and impoverished section of Philadelphia with many zip codes reporting 30-45% or more of the population below the federal poverty line. Students and clinicians affiliated with a local FQHC conducted surveys on residents (n = 379) within 1-mile radiuses of three FQHC sites, using the Hunger Vital Sign™, a validated food security tool. Survey data were collected through door-to-door visits in the summer of 2019. We used simple, age-adjusted bivariable, and multivariable logistic regression models to predict food insecurity with independent variables, including age, sex, language preference, and BMI category.

RESULTS

Food insecurity in North Philadelphia was much higher (36.9%) than previously reported in Philadelphia and nationwide. Food insecurity was inversely associated with age (AOR = 0.98, 95% CI: 0.97, 1.00), overweight (AOR = 0.58, 95% CI: 0.32, 1.06), and obesity (AOR = 0.60, 95% CI: 0.33, 1.09).

CONCLUSION

In North Philadelphia, the burden of food insecurity is higher than in the greater Philadelphia area, Pennsylvania state, and the rest of the nation and is predicted by age and BMI of residents. These findings demonstrate a need for more locally targeted research and interventions on food insecurity in impoverished urban settings.

Is intuitive eating a privileged approach? Cross-sectional and longitudinal associations between food insecurity and intuitive eating

OBJECTIVE

To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood.

DESIGN

Longitudinal population-based study. Young people reported IE and FI (two items from the US Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item US Household Food Security Module in adolescence.

SETTING

Adolescents (Mage = 14·3 ± 2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage = 22·1 ± 2 years).

PARTICIPANTS

The analytic sample (n 1372; 53·1 % female, 46·9 % male) was diverse across race/ethnicity (19·8 % Asian, 28·5 % Black, 16·6 % Latinx, 14·7 % Multiracial/Other and 19·9 % White) and socio-economic status (58·6 % low/lower middle, 16·8 % middle and 21·0 % upper middle/high).

RESULTS

In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (P = 0·02) and emerging adulthood (P < 0·001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (P = 0·01). Those who remained food-insecure (P = 0·05) or became food-insecure (P = 0·02) had lower IE in emerging adulthood than those remaining food-secure. All effect sizes were small.

CONCLUSIONS

Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.

Socioeconomic position and the influence of food portion size on daily energy intake in adult females: two randomized controlled trials

BACKGROUND

Reducing portion sizes of commercially available foods could be an effective public health strategy to reduce population energy intake, but recent research suggests that the effect portion size has on energy intake may differ based on socioeconomic position (SEP).

OBJECTIVE

We tested whether the effect of reducing food portion sizes on daily energy intake differed based on SEP.

METHODS

Participants were served either smaller or larger portions of food at lunch and evening meals (N = 50; Study 1) and breakfast, lunch and evening meals (N = 46; Study 2) in the laboratory on two separate days, in repeated-measures designs. The primary outcome was total daily energy intake (kcal). Participant recruitment was stratified by primary indicators of SEP; highest educational qualification (Study 1) and subjective social status (Study 2), and randomisation to the order portion sizes were served was stratified by SEP. Secondary indicators of SEP in both studies included household income, self-reported childhood financial hardship and a measure accounting for total years in education.

RESULTS

In both studies, smaller (vs larger) meal portions led to a reduction in daily energy intake (ps < .02). Smaller portions resulted in a reduction of 235 kcal per day (95% CI: 134, 336) in Study 1 and 143 kcal per day (95% CI: 24, 263) in Study 2. There was no evidence in either study that effects of portion size on energy intake differed by SEP. Results were consistent when examining effects on portion-manipulated meal (as opposed to daily) energy intake.

CONCLUSIONS

Reducing meal portion sizes could be an effective way to reduce overall daily energy intake and contrary to other suggestions it may be a socioeconomically equitable approach to improving diet.

TRIAL REGISTRATION

These trials were registered at www.

CLINICALTRIALS

gov as NCT05173376 and NCT05399836.

A Spatial Analysis of Food Insecurity and Body Mass Index with Income and Grocery Store Density in a Diverse Sample of Adolescents and Young Adults

Food insecurity occurs when a household lacks consistent access to food and is more prevalent in ethnic and racial minority populations. While there has been a proliferation of research linking food insecurity to obesity, these findings are mixed. It may be helpful to consider some additional geographic factors that may be associated with both factors including socioeconomic status and grocery store density. The purpose of the current study aimed to examine spatial relationships between food insecurity and SES/store density and BMI and SES/store density in a diverse sample of adolescents and young adults across two studies in a large, urban city. GIS analysis revealed that participants with the highest food insecurity tend to live in the zip codes with the lowest median income. There did not appear to be clear a relationship between food insecurity and store density. Participants with the highest BMI tend to live in zip codes with lower median income and participants with higher BMI tended to live in the south and west sides of Chicago, which have a relatively lower concentration of grocery stores in the city. Our findings may help to inform future interventions and policy approaches to addressing both obesity and food insecurity in areas of higher prevalence.

Effects of the nutrition education intervention on food security, anthropometry, and body composition in women: A randomized controlled trial

BACKGROUND

Food insecurity as a social determinant of health is associated with adverse physical health outcomes such as obesity.

AIM

This study aimed to evaluate the effects of nutrition education intervention based on the transtheoretical model (TTM) on food security, anthropometry, and body composition status.

METHODS

In this randomized controlled trial, an intervention was conducted over months (five weeks) using the TTM among 160 women aged 19-64 years. Food security status, anthropometry, and body composition were determined three times: at baseline, three months, and six months after the intervention.

RESULTS

In the intervention group, food insecurity significantly decreased before, immediately after, and six months after the intervention, these changes were significant in follow-up time and treatment effect. After six months of follow-up, the intervention group significantly decreased weight (-1.29 kg), body mass index (-0.54), and waist circumference (-3.48 cm). Although differences between the two groups were not statistically significant except in the interaction between follow-up time and intervention groups. Also, the mean of fat mass and total body water decreased in the intervention group and differences between the two groups were statistically significant in follow-up time (p < 0.001 and p = 0.01, respectively) and interaction between follow-up time and intervention group (p < 0.001 and p = 0.005, respectively).

CONCLUSION

In the current study, the findings of a six-month TTM-based intervention among women were positive that revealed to be a strategy that may improve anthropometric and nutritional status. Therefore, government programs that offer nutrition counseling should be prioritized to help the population to improve their eating habits.

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

Purpose of Review

The relationship between cardiovascular health and diet is evolving. Lifestyle modifications including diet changes are the primary approach in managing cardiometabolic risk factors. Thus, understanding different diets and their impact on cardiovascular health is important in guiding primary and secondary prevention of cardiovascular disease (CVD). Yet, there are many barriers and limitations to adopting a heart healthy diet.

Recent Findings

Diets rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages, are recommended by prevention guidelines. The Mediterranean, DASH, and plant-based diets have all proven cardioprotective in varying degrees and are endorsed by professional healthcare societies, while other emerging diets such as the ketogenic diet and intermittent fasting require more long-term study. The effects of diet on the gut microbiome and on cardiovascular health have opened a new path for precision medicine to improve cardiometabolic risk factors. The effects of certain dietary metabolites, such as trimethylamine N-oxide, on cardiometabolic risk factors, along with the changes in the gut microbiome diversity and gene pathways in relation to CVD management, are being explored.

Summary

In this review, we provide a comprehensive up-to-date overview on established and emerging diets in cardiovascular health. We discuss the effectiveness of various diets and most importantly the approaches to nutritional counseling where traditional and non-traditional approaches are being practiced, helping patients adopt heart healthy diets. We address the limitations to adopting a heart healthy diet regarding food insecurity, poor access, and socioeconomic burden. Lastly, we discuss the need for a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations. Understanding the limitations and finding ways to overcome the barriers in implementing heart-healthy diets will take us miles in the path to CVD prevention and management.

Low subjective social status is associated with daily selection of fewer healthy foods and more high-fat/high sugar foods

Socioeconomic status has been related to poorer eating behaviors, potentially due to feeling of lower status relative to peers. Despite experimental evidence that temporarily feeling of lower status can contribute to greater caloric intake, it remains unclear how feeling of lower social status relate to eating behavior in daily life. This study aimed to test whether lower subjective social status (SSS)-the feeling of having relatively lower social status-in American society and relative to college peers were related to daily food selection. A sample of 131 young adults (Mage = 20.3, SD = 0.8; 60% female; 46% Latinos; 34% European American; 15% Asian American; 5% of other ethnicities) reported their SSS in society and in college and completed 15 daily reports regarding the number of daily servings they had of fruits, vegetables, fried foods, fast foods, desserts, and sugary drinks. Multilevel models with days nested within individuals were used to test whether low SSS in society or college related to daily food intake. Next, we examined whether associations were driven by young adults' perceived stress and daily stressors. Analyses controlled for age, gender, ethnicity, family and personal income, and parents' education to test the unique associations between subjective status and food intake. Whereas SSS in society was not related to food intake, young adults with lower SSS in their college consumed fewer daily servings of healthy foods and more daily servings of high-fat/high-sugar foods. Although lower college SSS was related to greater perceived stress, perceived stress and daily stressors were consistently unrelated to daily food intake. Findings suggested that lower SSS in local environments (e.g., college) may impact young adults' daily food choices through processes beyond heightened stress.

What's to Eat and Drink on Campus? Public and Planetary Health, Public Higher Education, and the Public Good

Public higher education institutions (PHEIs) have a unique and important role in responding to the public and planetary health crisis-they are centers of research on public and planetary health and of learning for young people, and have a public good mission. Yet, PHEI campus food environments are predominantly unhealthy and environmentally unsustainable, and associated with unhealthy food choices and unhealthy students. PHEIs are addressing high levels of student food insecurity (FI) that disproportionately affect the most vulnerable groups. Yet, because student FI is measured as individual access to adequate quantities of food, campus responses to FI often overlook unhealthy food environments. These environments result from neoliberal PHEI business policies that prioritize short-term revenue and encourage superfluous consumption, and unhealthy, environmentally harmful diets. PHEIs need to move beyond neoliberalism to honor their public good mission, including prioritizing health, the environment, and equity, in decisions about food on campus. My goal in this perspective is to encourage inclusive campus discussion about why this change is required to adequately respond to the crisis of student, public, and planetary health, and about how to begin.

Gender Differences in the Relationship Between Food Insecurity and Body Mass Index Among Adults in the USA

BACKGROUND

In the USA, nearly 40% of adults ≥ 20 years have a body mass index (BMI) ≥ 30, and 11% of households are reported as food insecure. In adults, evidence shows women are more likely than men to be food insecure. Among adults with food insecurity, differences in BMI exist between men and women with women reporting higher BMI. Factors associated with this difference in BMI between genders are less understood.

OBJECTIVE

The aim of this study was to assess gender differences in the relationship between food insecurity and BMI.

DESIGN

Hierarchical models were analyzed using a general linear model by entering covariates sequentially in blocks (demographics, lifestyle behaviors, comorbidities, and dietary variables) and stratified by gender.

PARTICIPANTS

The sample included 25,567 adults in the USA from the National Health and Nutrition Examination Survey (NHANES), 2005-2014.

MAIN MEASURES

The dependent variable was BMI, and food insecurity was the primary predictor.

KEY RESULTS

Approximately 51% of the sample was women. Food insecure women were significantly more likely to have higher BMI compared to food secure women in the fully adjusted model after controlling for demographics (β = 1.79; 95% CI 1.17, 2.41); demographic and lifestyle factors (β = 1.79; 95% CI 1.19, 2.38); demographic, lifestyle, and comorbidities (β = 1.21; 95% CI 0.65, 1.77); and demographic, lifestyle, comorbidities, and dietary variables (β = 1.23; 95% CI 0.67, 1.79). There were no significant associations between food insecure and food secure men in the fully adjusted model variables (β = 0.36; 95% CI - 0.26, 0.98).

CONCLUSION

In this sample of adults, food insecurity was significantly associated with higher BMI among women after adjusting for demographics, lifestyle factors, comorbidities, and dietary variables. This difference was not observed among men. More research is necessary to understand this relationship among women.

Diet Quality, Health, and Wellbeing within the Irish Homeless Sector: A Qualitative Exploration

Financial barriers and limited cooking facilities are major obstacles to healthy dietary practices among the homeless population. Homelessness is currently at crisis point and up-to-date evidence from multiple stakeholders is needed to address dietary inequalities. The aim of this study was to understand dietary practices, barriers to healthy eating within homeless services from multiple perspectives. Twelve service users and five healthcare and social service providers participated in semi-structured interviews. Data were analysed thematically. Four themes were identified which included: lack of control over diet and food supply; sources of food for the homeless population; practical barriers to good nutrition; and the impact of diet on emotional and physical wellbeing. Frequent consumption of energy-dense, nutrient-poor foods was reported. Food insecurity resulted in perceived depressive symptoms and stress. Barriers to healthy diet included financial constraints and a lack of access to cooking and storage facilities. Our study highlights low levels of food skills and healthy eating knowledge among service users and service providers. In order to address diet-related health disparities, health promotion initiatives should be targeted at building healthy public policy in relation to diet and nutrition and developing food skills with members of this population and service providers.

Binge Eating in Patients Pursuing Bariatric Surgery: Understanding Relationships with Food Insecurity and Adverse Childhood Experiences

BACKGROUND

Positive relationships exist between adult food insecurity and binge eating, and between adverse childhood experiences and binge eating. However, the nature of these relationships remains to be determined.

OBJECTIVES

The current study sought to examine the association between binge eating and childhood abuse and/or neglect and household dysfunction and to explore whether the strength of the relationship between adverse childhood experiences and binge eating differs across levels of food insecurity in patients seeking bariatric surgery.

SETTING

University Hospital in the Appalachian region of United States.

METHODS

A total of 366 adults seeking bariatric surgery completed validated questionnaires as a component of a routine psychological evaluation prior to surgery.

RESULTS

Only childhood experiences of abuse and/or neglect were positively related to adult binge eating, r(363) = .13, P = .011. Food insecurity moderated the relationship between adverse childhood experiences and binge eating, F(4, 358) = 242.98, P < .001, such that the relationship was stronger for individuals who endorsed the presence of both food insecurity and adverse childhood experiences (M = 15.90; standard deviation [SD] = 8.38), relative to individuals who endorsed the absence of both food insecurity and adverse childhood experiences (M = 11.19; SD = 7.91; Tukey P = .005; d = .58).

CONCLUSIONS

Food insecurity strengthens the relationship between adverse childhood experiences and adult binge eating. Results suggest that healthcare providers should include assessments of both adverse childhood experiences and food insecurity to identify patients who may be at risk for disordered eating prior to surgery, as these individuals may require additional interventions to address binge eating and related factors.

Food insecurity as a risk factor of sarcopenic obesity in older adults

Sarcopenic obesity is characterized by the loss of muscle strength, mass and muscle functionality and increased adipose tissue (obesity) according to different criteria and cut-off points. The prevalence of sarcopenic obesity among older adults is growing worldwide, and many factors are involved in its development. Diet and food security have been described as the main contributors to the development of obesity and sarcopenia. Food insecurity consists of limited or uncertain access to adequate and nutritious foods. This narrative review aims to summarize the existing data on food insecurity as a risk factor for sarcopenic obesity in the elderly.

Individual differences in decision-making: evidence for the scarcity hypothesis from the English Longitudinal Study of Ageing

We report the results of a pre-registered analysis of data from the English Longitudinal Study of Ageing that was designed to test the hypothesis that economic scarcity is associated with individual differences in decision-making. We tested this hypothesis by comparing time preferences for different socio-economic groups and in geographical areas ranging from the most deprived to the least deprived in England using the English indices of multiple deprivation. The data supported this hypothesis: people in the most deprived areas were more likely to prefer smaller-sooner rewards than people from the least deprived areas. Similarly, people in technical or routine occupations tended to prefer smaller-sooner rewards than people in professional or intermediate occupations. In addition, we found that gender, cognitive function and subjective social status also predicted time preferences. We discuss these results in the context of theoretical models of scarcity-based models of choice behaviour and decision-making.

Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

What's New in Pediatric Orthopaedic Health Care Disparities?

BACKGROUND

Health care disparities are prevalent within pediatric orthopaedics in the United States. Social determinants of health, such as income, race, social deprivation, place of residence, and parental involvement, all play a role in unequal access to care and disparate outcomes. Although there has been some effort to promote health equity both within pediatric orthopaedics and the US health care system altogether, disparities persist. In this review, we aim to identify major sources of inequality and propose solutions to achieve equitable care in the future.

METHODS

We searched the PubMed database for papers addressing disparities in pediatric orthopaedics published between 2016 and 2021, yielding 283 papers.

RESULTS

A total of 36 papers were selected for review based upon new findings. Insurance status, race, and social deprivation are directly linked to poorer access to care, often resulting in a delay in presentation, time to diagnostic imaging, and surgery. Although these disparities pervade various conditions within pediatric orthopaedics, they have most frequently been described in anterior cruciate ligament/meniscal repairs, tibial spine fractures, adolescent idiopathic scoliosis, and upper extremity conditions. Treatment outcomes also differ based on insurance status and socioeconomic status. Several studies demonstrated longer hospital stays and higher complication rates in Black patients versus White patients. Patients with public insurance were also found to have worse pain and function scores, longer recoveries, and lower post-treatment follow-up rates. These disparate outcomes are, in part, a response to delayed access to care.

CONCLUSIONS

Greater attention paid to health care disparities over the past several years has enabled progress toward achieving equitable pediatric orthopaedic care. However, delays in access to pediatric orthopaedic care among uninsured/publicly insured, and/or socially deprived individuals remain and consequently, so do differences in post-treatment outcomes. Reducing barriers to care, such as insurance status, transportation and health literacy, and promoting education among patients and parents, could help health care access become more equitable.

LEVEL OF EVIDENCE

Level IV-narrative review.

The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination

This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7−10 dyads & 53 parent/adolescent aged 15−17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.

Risk of Food Insecurity in Young Adulthood and Longitudinal Changes in Cardiometabolic Health: Evidence from the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

Studies have demonstrated relations between food insecurity, the lack of access to enough nutritious food, and greater risk of diet-sensitive chronic diseases. However, most prior evidence relies on cross-sectional studies and self-reported disease.

OBJECTIVES

The objective was to assess the longitudinal relation between risk of food insecurity in young adulthood and changes in diet-sensitive cardiometabolic health outcomes across 10 y among non-Hispanic white, non-Hispanic black, American Indian or Alaska Native, and Hispanic adults.

METHODS

Data from the fourth and fifth waves (n = 3992) of the National Longitudinal Study of Adolescent to Adult Health were used. Measures included risk of food insecurity, body weight, diabetes, and sociodemographic characteristics. Body weight and diabetes were assessed with direct measures. Mixed-effects models assessed the association of risk of food insecurity with BMI, obesity, and diabetes while accounting for sociodemographic characteristics and the complex survey design.

RESULTS

Risk of food insecurity was associated with increases in BMI as well as incidence of obesity and diabetes from young to middle adulthood in unadjusted and adjusted models (all P < 0.01). In models stratified by race and ethnicity, the relations of risk of food insecurity with body weight outcomes and diabetes varied.

CONCLUSIONS

Risk of food insecurity in young adulthood was related to BMI and obesity during young and middle adulthood but not in changes over time. Risk of food insecurity in young adulthood related to an increased incidence of diabetes in middle adulthood. However, the relations among specific racial and ethnic groups were unclear. Estimates of the relation between food insecurity and cardiometabolic health outcomes within racial and ethnic groups experiencing the highest prevalence of these conditions should be refined.

A cluster-randomized controlled trial to assess the impact of a nutrition intervention on dietary behaviors among early care and education providers: The Create Healthy Futures study

Create Healthy Futures is a self-paced, web-based intervention on improving healthy eating behaviors among Early Care and Education (ECE) providers. We examined the impact of web-based Create Healthy Futures on diet quality measured by the Alternative Healthy Eating Index (AHEI) 2010, dietary behaviors, and related psychosocial and environmental factors among ECE providers. A cluster randomized controlled trial (CRCT) was implemented with baseline surveys administered from October 2019-January 2020, intervention implementation from April-May 2020, and post-intervention from May 2020-August 2020. Centered-based ECE programs under the Pennsylvania Head Start Association (n = 12) were recruited and randomized to intervention (n = 5) or comparison (n = 7) groups. A total of 186 ECE providers completed the post-intervention surveys (retention rate: 86.1%). At baseline, 31.5% of ECE providers were food insecure. Pre-to-post intervention demonstrated no significant within-or-between-group changes in the AHEI-2010 diet quality scores. ECE providers in the intervention group reported a significant decrease from baseline to post-intervention in the number of days eating out (aMD = -0.8, CI:-1.6, -0.1, P = 0.03). Process evaluation showed that 89.9% of the intervention group completed all online module, and 82.9% attended all of wellness session groups. Although the Create Healthy Futures intervention did not improve ECE providers' diet quality and dietary behaviors, it confirmed critical needs to provide health support to ECE providers. Future studies should employ strategies that improve access to healthy foods and nutrition education, and address social determinants of health such as food insecurity to improve diet quality and health in ECE provider population.

The impact of increasing the availability of lower energy foods for home delivery and socio-economic position: a randomised control trial examining effects on meal energy intake and later energy intake

Increasing the availability of lower energy food options is a promising public health approach. However, it is unclear the extent to which availability interventions may result in consumers later 'compensating' for reductions in energy intake caused by selecting lower energy food options and to what extent these effects may differ based on socio-economic position (SEP). Our objective was to examine the impact of increasing availability of lower energy meal options on immediate meal energy intake and subsequent energy intake in participants of higher v. lower SEP. In a within-subjects design, seventy-seven UK adults ordered meals from a supermarket ready meal menu with standard (30 %) and increased (70 %) availability of lower energy options. The meals were delivered to be consumed at home, with meal intake measured using the Digital Photography of Foods Method. Post-meal compensation was measured using food diaries to determine self-reported energy intake after the meal and the next day. Participants consumed significantly less energy (196 kcal (820 kJ), 95 % CI 138, 252) from the menu with increased availability of lower energy options v. the standard availability menu (P < 0·001). There was no statistically significant evidence that this reduction in energy intake was substantially compensated for (33 % compensated, P = 0·57). The effects of increasing availability of lower energy food items were similar in participants from lower and higher SEP. Increasing the availability of lower energy food options is likely to be an effective and equitable approach to reducing energy intake which may contribute to improving diet and population health.

Exploring the Links between Obesity and Psoriasis: A Comprehensive Review

Obesity is a major public health issue worldwide since it is associated with the development of chronic comorbidities such as type 2 diabetes, dyslipidemias, atherosclerosis, some cancer forms and skin diseases, including psoriasis. Scientific evidence has indicated that the possible link between obesity and psoriasis may be multifactorial, highlighting dietary habits, lifestyle, certain genetic factors and the microbiome as leading factors in the progress of both pathologies because they are associated with a chronic pro-inflammatory state. Thus, inflammation management in obesity is a plausible target for psoriasis, not only because of the sick adipose tissue secretome profile but also due to the relationship of obesity with the rest of the immune derangements associated with psoriasis initiation and maintenance. Hence, this review will provide a general and molecular overview of the relationship between both pathologies and present recent therapeutic advances in treating this problem.

The Relationship between Food Security and Gestational Diabetes among Pregnant Women

The objective were to: (1) evaluate associations between food security and women diagnosed with gestational diabetes mellitus (GDM) and (2) evaluate if women in food insecure (FI) households had adverse maternal and neonatal outcomes. This was an observational study from October 2018 until September 2019. Postpartum resident clinic patients who delivered term, singleton infant at 37 weeks' or longer gestation were screened. Participants completed a survey using the U.S. Household Food Security Survey Module (US HFSSM). Survey responses were classified as: food secure (FS) and FI (marginal, low, very low FS). The primary outcome was GDM. Our secondary outcome was neonatal intensive care unit (NICU) admissions for hypoglycemia. We evaluated the rate of GDM in FS and FI groups. Demographic data included: prepregnancy body mass index, total weight gain during pregnancy, birth weight, and mode of delivery. A logistic regression model was used to analyze the association between food insecurity and GDM. A p -value of less than 0.05 was considered statistically significant. There were 150 patients screened to participate; of these, 70 patients were enrolled (36 GDM and 34 without GDM [NGDM]). More patients in FI households, 71% ( n  = 17), were diagnosed with GDM, compared with 33% ( n  = 15) in the FS (FS) households (adjusted odds ratio 7.05; p  < 0.01). Of patients who reported FI, 50% ( n  = 12) were black, 46% ( n  = 11) Hispanic, and 4% ( n  = 1) Caucasian, compared with 13% ( n  = 6) black, 30% ( n  = 14) Hispanic, and 57% ( n  = 26) Caucasian in patients who reported FS ( p  < 0.001). Although not significant, 25% ( n  = 6) of neonates from an FI household had an NICU admission for hypoglycemia compared with 7% ( n  = 3) from an FS household ( p  = 0.054). Pregnant women with GDM are more likely to experience FI than those with NGDM. Infants of mothers in FI households also had increased rates of NICU admission for hypoglycemia.

Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households

The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5-9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use 'my own car or vehicle' 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between' 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., 'French fries' 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., 'canned pasta' meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of 'fried vegetables' 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.

The association between food insecurity and gestational weight gain: A systematic review and meta-analysis

Gestational weight gain has been one of the most important risk factors for adverse maternal, perinatal, and long-term outcomes. Our systematic review and meta-analysis aimed to incorporate the evidence regarding the association between gestational weight gain and food insecurity (FI). We performed a systematic review and meta-analysis on the possible association between FI and insufficient or excessive gestational weight gain by conducting a systematic search in PubMed, Scopus, ISI, and Google Scholar from January 1, 1990 until February 1, 2022. Odds Ratio (OR) was pooled using a random-effects model. Standard methods were used for the assessment of heterogeneity and publication bias. Data included fifteen studies with 7651 individual participants from different countries pooled for the meta-analysis. Of the fifteen studies included in the final meta-analysis, seven had a cross-sectional and eight had a longitudinal design. In the pooled analysis, FI had significant relationship with both inadequate (OR = 1.49; 95% CI = 1.26 to 1.76) and excessive weight gain in pregnancy (OR = 1.27; 95% CI = 1.05 to 1.54). In conclusion, FI during pregnancy was directly associated with both inadequate and excessive gestational weight gain. Therefore, changes at a policy level should be considered to increase food security in pregnant women.