Food- and health-related correlates of self-reported body mass index among low-income mothers of young children

A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries

Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

Food Insecurity and Mental Health among Females in High-Income Countries

Food insecurity is a persistent concern in high-income countries, and has been associated with poor mental health, particularly among females. We conducted a scoping review to characterize the state of the evidence on food insecurity and mental health among women in high-income countries. The research databases PubMed, EMBASE, and psycINFO were searched using keywords capturing food insecurity, mental health, and women. Thirty-nine articles (representing 31 unique studies/surveys) were identified. Three-quarters of the articles drew upon data from a version of the United States Department of Agriculture Household Food Security Survey Module. A range of mental health measures were used, most commonly to measure depression and depressive symptoms, but also anxiety and stress. Most research was cross-sectional and showed associations between depression and food insecurity; longitudinal analyses suggested bidirectional relationships (with food insecurity increasing the risk of depressive symptoms or diagnosis, or depression predicting food insecurity). Several articles focused on vulnerable subgroups, such as pregnant women and mothers, women at risk of homelessness, refugees, and those who had been exposed to violence or substance abuse. Overall, this review supports a link between food insecurity and mental health (and other factors, such as housing circumstances and exposure to violence) among women in high-income countries and underscores the need for comprehensive policies and programs that recognize complex links among public health challenges.

The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden

Objectives: This study aimed to investigate the relationship between body mass index (BMI) and health-related quality of life (HRQoL) and whether this relationship is influenced by the level of income in Northern Sweden. Overweight and obesity are rising major public health problems which also affect HRQoL. While socioeconomic inequalities in health are persisting or increasing in many countries, including Sweden, little attention has been paid to the more complex roles of income in relation to health. Methods: Data were drawn from a 2014 cross-sectional survey from Northern Sweden (Health on Equal Terms), comprising individuals aged 20-84 years (N = 20,082 individuals included for analysis). BMI and HRQoL were self-reported and individual disposable income in 2012 was retrieved from population registers. Multiple linear regressions were performed with HRQoL scores regressed on BMI and income, their interaction and additional covariates. Results: The underweight, overweight and obesity groups reported significantly lower HRQoL compared to the normal weight group. Moreover, the relationship between BMI and HRQoL varied significantly by level of income, with a stronger association among those with the lowest level of income. Conclusions: Income has a role as an effect modifier in the relationship between BMI and HRQoL that can be construed as an indirect income inequality. Efforts to promote HRQoL in populations should consider the different impact of being overweight and obese in different socioeconomic groups.

Food insecurity, diet quality and body mass index of women participating in the Supplemental Nutrition Assistance Program: The role of intrapersonal, home environment, community and social factors

Obesity is a public health problem that disproportionately affects low-income populations. Moreover, participation in Supplemental Nutrition Assistance Program (SNAP) has been associated with obesity among low-income women. The goal of this study was to determine the impact of intrapersonal, home environment, community and social factors on diet quality and body mass index (BMI) of low-income women participating in SNAP. This study also aimed to examine the role of these factors in mediating the relationship between food insecurity and diet quality, and BMI. A total of 152 women receiving SNAP benefits were recruited from low-income neighborhood centers and housing communities, and administered a demographics questionnaire, the United States adult food security scale, food frequency questionnaire, and multi-dimensional home environment scale (MHES). They also were measured for height and weight to calculate BMI. The Dietary Guidelines Adherence Index 2015 was used to measure diet quality. Regression analyses were conducted to determine the MHES subscales that were significant predictors of diet quality and BMI. The Preacher and Hayes mediation model was used to evaluate the mediation of the relationship between food insecurity and diet quality, and BMI by the MHES. Emotional eating resistance and favorable social eating behaviors were positively associated with diet quality; whereas emotional eating resistance, lower availability of unhealthy food at home, neighborhood safety and favorable social eating behaviors were inversely associated with BMI in women participating in SNAP. The MHES significantly mediated the relationship between food insecurity and BMI. These results emphasize the importance of intrapersonal, home environment, community and social factors in mediating the relationship between food insecurity and BMI in low-income women.

Relationship between Self-Rated Health and Lifestyle and Food Habits in Japanese High School Students

Self-rated health (SRH), a subjective assessment of health status, is extensively used in the field of public health. It is an important and valid measure that is strongly related to morbidity, mortality, longevity and health status. Adolescence is a crucial period for the formation of health status, because health-risk behaviours (e.g., skipping breakfast) are often established during this period. In this study, we investigated the relationship of SRH with lifestyle and eating habits in Japanese high school students. In this study, 1296 students aged 16-18 years from 11 high schools in Japan participated. A questionnaire was administered to these participants that included a question on SRH, five questions on demographic characteristics, six questions on lifestyle items (e.g., wake-up time), five questions on miscellaneous health issues (e.g., anorexia), and 25 questions on food habits and attitudes towards food. We examined the differences between self-rated healthy and unhealthy groups using logistic regression analysis adjusted for gender and age. A dichotomy regression analysis was performed using a stepwise elimination method. Of the 1296 respondents, 16.7% reported feeling unhealthy, 57.7% of whom were females. The self-rated healthy group had a higher frequency of eating breakfast (odds ratio (OR): 2.13; confidence interval (CI): 1.07-4.24) and liked home meals to a greater extent (OR: 3.12; CI: 1.27-7.65) than the self-rated unhealthy group. The two groups did not differ significantly in terms of other lifestyle factors or unidentified complaints. Our results suggest that liking home meals during adolescence may lead to the development of good eating habits, i.e., eating breakfast, and better SRH.

Food Shopping Venues, Neighborhood Food Environment, and Body Mass Index Among Guyanese, Black, and White Adults in an Urban Community in the US

OBJECTIVE

To investigate relationships among food shopping venues, food environment, and body mass index (BMI).

DESIGN

Cross-sectional survey data and directly assessed food environment data were linked at the neighborhood level.

SETTING

Schenectady, NY.

PARTICIPANTS

A sample of Guyanese, black, and white adults (n = 226, 485, and 908, respectively).

MAIN OUTCOME MEASURES

BMI.

ANALYSIS

Linear regression models were constructed with 10 food shopping venues and neighborhood food environment as explanatory variables, controlling for sociodemographics, dietary behavior, physical activity, and perception of healthy food access.

RESULTS

On average, respondents used 3.5 different food shopping venues. Supermarkets and ethnic markets were associated with a lower BMI in Guyanese adults. Among black adults, farmers' markets were associated with a lower BMI, whereas supermarkets, wholesale clubs, and food pantries were associated with a higher BMI. Among white adults, food coops and supermarkets were associated with a lower BMI and wholesale clubs were associated with a higher BMI. Neighborhoods with less a favorable food environment (longer travel distance to a supermarket) were associated with a lower BMI in Guyanese adults.

CONCLUSIONS AND IMPLICATIONS

Both primary (ie, supermarkets) and secondary food shopping venues could be independent determinants of BMI. The observed variations by race and ethnicity provided insights into a culturally tailored approach to address obesity.