Household Food Insecurity is Associated With Greater Growth in Body Mass Index Among Female Children from Kindergarten Through Eighth Grade

The potential role of social care in reducing childhood obesity

PURPOSE OF REVIEW

This review evaluates the current evidence for relationships of social factors with childhood obesity and for a role of social care in reduction of childhood obesity.

RECENT FINDINGS

Most literature on the relationship between social factors and childhood obesity has examined food insecurity as a risk factor for obesity. Associations between food insecurity and excess weight in children are most consistent during infancy and among those with food insecurity at more than one time point. A few pilot food security interventions that link patients with produce or groceries show feasibility and potential promise for reducing childhood obesity risk factors. However, full-scale, randomized studies to examine interventions that reduce social needs and their effects on childhood obesity are lacking. Future research is needed to examine holistic social care approaches to effectively reduce childhood obesity risk factors.

SUMMARY

Food insecurity acts as a barrier to childhood obesity prevention and treatment. Patient-centered, validated measures of social needs and effective interventions to address social needs are needed to equitably prevent and treat childhood obesity.

Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry

BACKGROUND

Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity.

OBJECTIVES

This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya.

METHODS

We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose.

RESULTS

We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm.

CONCLUSIONS

This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.

Caregiver-reported household food insecurity and child-reported food insecurity in relation to eating disorder risk factors and symptoms among preadolescent children

OBJECTIVE

To examine the relation of caregiver-reported household food insecurity (FI) and child-reported FI with eating disorder (ED) risk factors and symptoms, including effect modification by gender, in preadolescent children.

METHOD

Data were from the Family Food Study, a cross-sectional study of households with incomes ≤200% of the federal poverty line in southeastern Michigan. Children aged 8-10 years (n = 194) and their female primary caregivers reported separately on FI status. Children reported ED risk factors/symptoms via the 24-item Children's Eating Attitudes Test (ChEAT-24), with higher scores indicating more ED risk factors/symptoms. Linear mixed models were used to examine associations between FI measures with the ChEAT-24 total score, plus subscale scores for dieting, food preoccupation, weight preoccupation, vomiting, and social pressure to eat/gain weight. Models were adjusted for child age, child gender, caregiver race/ethnicity, caregiver education, and household income.

RESULTS

Among all children, child-reported FI, but not caregiver-reported household FI, was associated with more ED risk factors/symptoms. Child-reported FI (vs. no FI) was associated with higher average ChEAT-24 total score (β = 2.41, 95% CI: 0.57, 4.25). Child-reported FI was also associated with more food preoccupation, more weight preoccupation, and more social pressure to eat. Caregiver-reported household FI was marginally associated with less dieting in girls, and child-reported FI was associated with more dieting in boys.

DISCUSSION

Child-reported FI may be more salient than caregiver-reported household FI as a risk factor for ED-related outcomes in preadolescent children. Gender may modify the association between FI and dieting behavior.

PUBLIC SIGNIFICANCE STATEMENT

More child-reported food insecurity, but not parent-reported household food insecurity, was associated with more eating disorder risk factors and symptoms among preadolescent boys and girls. These findings emphasize the need for future studies that investigate the role of food insecurity in the development of eating disorders, especially studies that measure child-reported experience of food insecurity.

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.

Food Insecurity and Childhood Obesity: A Systematic Review

BACKGROUND AND OBJECTIVES

Addressing food insecurity while promoting healthy body weights among children is a major public health challenge. Our objective is to examine longitudinal associations between food insecurity and obesity in US children aged 1 to 19 years.

METHODS

Sources for this research include PubMed, CINAHL, and Scopus databases (January 2000 to February 2022). We included English language studies that examined food insecurity as a predictor of obesity or increased weight gain. We excluded studies outside the United States and those that only considered the unadjusted relationship between food security and obesity. Characteristics extracted included study design, demographics, methods of food security assessment, and anthropometric outcomes.

RESULTS

Literature searches identified 2272 articles; 13 met our inclusion criteria. Five studies investigated the relationship between food insecurity and obesity directly, whereas 12 examined its relationship with body mass index or body mass index z-score. Three studies assessed multiple outcomes. Overall, evidence of associations between food insecurity and obesity was mixed. There is evidence for possible associations between food insecurity and obesity or greater weight gain in early childhood, for girls, and for children experiencing food insecurity at multiple time points. Heterogeneity in study methods limited comparison across studies.

CONCLUSIONS

Evidence is stronger for associations between food insecurity and obesity among specific subgroups than for children overall. Deeper understanding of the nuances of this relationship is critically needed to effectively intervene against childhood obesity.

Household food insecurity and obesity risk in preschool-aged children: A three-year prospective study

BACKGROUND

Household food insecurity (FI) is a pressing social, economic and public health issue. However, little is known regarding the effect of FI exposure during the first few years of life, the most active postnatal time for neurobiological and physiological development, on patterns of weight gain during early childhood. It is also unknown whether dietary quality would serve as a pathway through which FI affects children's weight development.

METHOD

This was a secondary data analysis from a three-year randomized clinical trial with five hundred and thirty-four parent/child dyads. Household FI in the past year was reported by parents at baseline when children were 2-4 years of age using the USDA Household Food Security Survey Module-Six Item Short Form. Children's dietary quality at baseline was measured by the US Department of Agriculture Healthy Eating Index (HEI). Child body mass index (BMI) was measured following standardized protocols at baseline and 12-, 24-, and 36-month follow-up. A latent growth curve model was used to examine 1) the association between baseline FI and sex-and-age-adjusted BMI z-scores in children and 2) the HEI pathway between the FI- BMI association.

RESULTS

FI early in life was associated with higher baseline BMI z-scores. Children who had higher BMI at baseline maintained their higher BMI status over the next three years. Children's dietary intake quality did not explain the association between baseline FI and BMI z-scores.

CONCLUSION

Early exposure to FI was associated with higher BMI in children as early as two years of age, setting them up for an increased likelihood of persistently high BMI-for-age in later childhood. These data suggest that the first few years may be a critical time for developing obesity risk, calling for policy and practices designed for early intervention of food insecurity.

Urban Youth Perspectives on Food Insecurity during the COVID-19 Pandemic: Evidence from the COACHES Study

School disruptions during the COVID-19 pandemic were a likely threat to food security and exacerbated risk factors associated with poor nutrition and health outcomes among low-income youth. As part of an ongoing school-based study aimed at improving physical activity and dietary behaviors (the COACHES study), associations between youth-reported food insecurity and dietary intake across the pandemic-affected academic year of 2020-2021 were examined. Middle school students (6th and 7th grade, 94% Black/African-American, 92% free-/reduced-price lunch eligible) answered validated surveys on food insecurity and diet and were measured for height and weight for calculation of weight status during Fall 2020 (n = 88) and Spring 2021 (n = 56). During this time, schools underwent a combination of in-person, hybrid, and remote learning. Nearly half of participants were overweight or obese (47%), and self-reported food insecurity was near 30% at both time points. Less than one-third of youth met fruit and vegetable intake guidelines, and more than half drank two or more sugar-sweetened beverages daily. While controlling for sex, maternal education, and weight status, food insecurity was not significantly associated with fruit and vegetable or sugar-sweetened beverage intake. Independent of weight status, youth were aware of being food insecure, yet it did not have an apparent impact on these food groups of concern. These findings highlight the need for greater understanding of youth perceptions of food insecurity in order to adequately address dietary quality and quantity concerns among children.

The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia

BACKGROUND

Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia.

METHODS

An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested.

RESULTS

A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models.

CONCLUSIONS

Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.

Changing from a highly food secure household to a marginal or food insecure household is associated with decreased weight and body mass index z-scores among Latino children from CHAMACOS

BACKGROUND

Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration.

OBJECTIVES

Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12.

METHODS

We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood.

RESULTS

Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households.

CONCLUSIONS

Changes in food security status and duration of food insecurity were associated with changes in children's growth.

Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study

Objective:

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Design:

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

Setting:

A total of 130 communities in the USA.

Participants:

In sum, 5138 US children aged 4–15 years.

Results:

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Conclusions:

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

Maternal Stress Moderates the Relationship of Food Insufficiency with Body Mass Index Trajectories from Childhood to Early Adulthood among U.S. Rural Youth

Background: Findings on the relationships between household food insufficiency (HFI), maternal stress, and youth body mass index (BMI) are mixed, possibly due to cross-sectional study designs and measurement issues. Furthermore, little is known about how childhood exposure to HFI and maternal stress influences BMI into young adulthood among rural youth. We aimed to determine the independent and moderating relationships of HFI and maternal perceived stress on youth BMI trajectories from age 9 to 24 years. Methods: We used longitudinal data from rural New York youth (n = 341). At youth age 9 years, parents reported HFI using a reliable one-item measure, and mothers responded to the 10-item Perceived Stress Scale (PSS; range: 0-40). BMI was calculated (kg/m²) from objective measures of height and weight at 9, 13, 17, and 24 years. Multivariate random-intercept trajectory models estimated the relationships of HFI and PSS on BMI trajectories (p < 0.05 for main effects, p < 0.10 for interactions). Results: At age 9 years, 16.4% experienced HFI and mean (standard deviation) BMI and PSS were 18.4 (3.6) kg/m² and 7.7 (2.9), respectively. HFI and PSS were not associated with BMI trajectories (p = 0.18, p = 0.64, respectively), but their interaction was significant (p < 0.01). Each one-unit increase in PSS was associated with 0.6 (0.2) kg/m² higher mean change in BMI trajectories for youth in food-insufficient, compared with food-sufficient, households. Conclusions: Higher levels of maternal stress in food-insufficient households may lead to greater increases in BMI from childhood to young adulthood. Public health interventions should simultaneously address parental stress and quality food access among low-income rural households.

Food insecurity and the extremes of childhood weight: defining windows of vulnerability

BACKGROUND

Weight extremes and food insecurity (FIS) represent public-health challenges, yet their associations in childhood remain unclear. We aimed to investigate the longitudinal time-specific relationship between FIS and risk of overweight/obesity and underweight in kindergarten through 8th grade.

METHODS

In the prospective Early Childhood Longitudinal Study-Kindergarten Cohort (1998-2007) of 6368 children, household FIS was assessed by the validated US Household Food Security Survey Module in kindergarten, 3rd, 5th and 8th grades. Multivariable linear-regression and Poisson-regression models were computed.

RESULTS

Compared with children experiencing food security (FS), children exposed to FIS in 5th grade had 0.19 [95% confidence interval (CI): 0.07-0.30] and 0.17 (0.06-0.27) higher body mass index z-score (BMIZ) in the 5th and 8th grades, respectively, whereas FIS in the 8th grade was associated with a 0.29 (0.19-0.40) higher BMIZ at the same wave, after adjusting for covariates and FIS at earlier waves. Children with FIS vs FS had 27% (relative risk: 1.27, 95% CI: 1.07-1.51), 21% (1.21, 1.08-1.35) and 28% (1.28, 1.07-1.53) higher risk of overweight/obesity in the 3rd, 5th and 8th grades, respectively, adjusting for covariates and FIS at prior wave(s). Children with FIS vs FS in kindergarten had a 2.76-fold (1.22-6.25) higher risk of underweight in the 8th grade.

CONCLUSIONS

Proximal exposure to household FIS was associated with a higher risk of overweight/obesity in the 3rd, 5th and 8th grades. FIS in kindergarten was associated with a risk of underweight in the 8th grade. Thus, FIS coexists in weight extremes during vulnerable early-life windows in the USA, similarly to the global burden of FIS.

Social and Health Risk Factor Levels of Preschool Children Living Along the Texas-Mexico Border

BACKGROUND

Childhood obesity is a public health concern that disproportionately affects populations from low socioeconomic status (SES) and minority groups. Evaluation of social and health risk factors of preschool children living along the Texas-Mexico border provides feedback to design health interventions.

METHODS

South Texas Early Prevention Study-PreK (STEPS-PreK) is a cluster randomized trial designed to assess the effect of the Bienestar coordinated school health program on children's health outcomes. Family characteristics, dietary intake, fitness, and anthropometric data were collected from 1277 preschool students enrolled in 28 preschools.

RESULTS

The response rate was 67%. Overall, 57% of families lived in poverty. The mean age of students was 4.7 years, 95% were Hispanic, and 51% were male. The average serving of fruits and vegetables per day were 1 and 1/3, respectively. Of these, students consumed 39.7% of fruits and 18.9% of vegetables. Obesity prevalence for boys was 19.2% and for girls 16.8%. Nearly one-half reported some form of food insecurity.

CONCLUSIONS

Children living in low-income areas are affected by high levels of social and health risk factors. It is these families who should be targeted with early-age and culturally appropriate health programs.

Association of household food insecurity and childhood weight status in a low-income population

One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross-sectional study of 3019 low-income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z-score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census-tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36-0.87). Tobacco exposure (1.63; 1.10-2.44), additional siblings (1.16; 1.04-1.30), and residence census tract with high poverty rate (1.02; 1.01-1.03) were all associated with HFI. We concluded that food-insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food-secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.

The association of food insecurity with the relative reinforcing value of food, BMI, and gestational weight gain among pregnant women

OBJECTIVE

Food insecurity is associated with obesity among adults. During pregnancy, food insecurity increases obesity risk among mothers and infants. This study investigated the association of food security with pre-pregnancy body mass index (BMI), gestational weight gain (GWG) adequacy to date, and the relative reinforcing value (RRV) of food during pregnancy.

METHODS

This secondary data analysis examined 258 pregnant women (mean gestational age = 21.21 ± 10.21 weeks) surveyed on pre-pregnancy weight, height, pregnancy due date and GWG to date, current diagnoses related to eating and pregnancy, and demographics. The survey also assessed current food security and RRV of meals, snacks, cognitive activities, and active activities. BMI was calculated from pre-pregnancy height and weight (kg/m²). Gestational weight gain adequacy to date was derived from the Institute of Medicine guidelines. Multivariable linear regression models were used to examine the relation of food security with pre-pregnancy BMI and RRVs of foods/activities. The relation between food security and GWG adequacy to date was examined using multinomial regression models.

RESULTS

Lower food security was related to both greater pre-pregnancy BMI (β = 0.60, p < .001) and greater RRV of snack foods (β = 3.46, p < .05), after controlling for covariates. Lower food security was also related to GWG to date below recommended levels (OR = 1.25, p < .05).

CONCLUSIONS

Food insecurity is related to higher relative food reinforcement during pregnancy, and greater pre-pregnancy weight status. Future research should replicate and extend these findings by assessing them longitudinally to better evaluate the directions of these relationships.

Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study

BACKGROUND

Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.

OBJECTIVE

The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.

METHODS

Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity.

RESULTS

Children from food-insecure households had higher BMI-z (β: 0.14; 95% CI: 0.06, 0.21), waist circumference (β: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (β: 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (β: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (β: -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity.

CONCLUSIONS

Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old.

Food Security Status and Overweight/Obesity Among 2- to 5-Year-Old Boys and Girls in a Community-Based Clinic

The purpose of this study was to examine relationships between food security, parental health behaviors, and overweight/obesity among 2- to 5-year-old children in West Tennessee (N = 264). Results from logistic regression models indicate that the association between parental characteristics and child weight status varies by child sex and household food security. These findings highlight the need for more nuanced analysis that can produce results that inform and shape the development of precise health promotion and intervention strategies designed for diverse low-resource populations.

Child food insecurity in the UK: a rapid review

Background

Food insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Objective

To determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Data sources

The databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).

Methods

A rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.

Results

In total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.

Limitations

There was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.

Conclusions

A number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.

Future research

There is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Food Insecurity Is Associated with Body Dissatisfaction among Children in California

BACKGROUND

Food insecurity affects 13 million children in the United States. Body dissatisfaction is also prevalent, affecting up to 46% of children. Both food insecurity and body dissatisfaction are associated with poor health outcomes, and both are associated with body weight and racial/ethnic disparities. The association between food insecurity and body dissatisfaction among children has not been examined.

OBJECTIVE

The purpose of this study was twofold: to examine, in a sample of children in grades 4 through 8, the relationship of child food insecurity with body dissatisfaction and to gain an understanding of the interactive roles of body mass index (BMI), race/ethnicity, and sex in the relationship between food insecurity and body dissatisfaction.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

This study examined data obtained from 14,768 children in grades 4 through 8 from 54 public schools in California between 2014 and 2016.

MAIN OUTCOME MEASURES

The primary outcome of interest was body dissatisfaction (five items converted to a binary indicator), and the exposure of interest was child-reported food insecurity (three items converted to a binary indicator). Subsets of validated questionnaires were used to assess body dissatisfaction and food insecurity.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using multivariable logistic regression, and effect modification was examined by BMI category (underweight, normal, overweight, obese), race/ethnicity, and sex.

RESULTS

In this large and diverse sample, after adjusting for cofounders, children experiencing food insecurity, in all BMI categories and from all racial/ethnic backgrounds, had higher odds of body dissatisfaction than their food-secure counterparts. The strength of the relationship differed by BMI and race/ethnicity, with the strongest associations observed for African-American children (odds ratio=2.32; P<0.001) and children with a normal children (odds ratio=1.76; P<0.001).

CONCLUSIONS

Experiencing food insecurity was associated with greater body dissatisfaction, with the magnitude of the association modified by BMI and race/ethnicity.

An investigation of maternal food intake and maternal food talk as predictors of child food intake

Though parental modeling is thought to play a critical role in promoting children's healthy eating, little research has examined maternal food intake and maternal food talk as independent predictors of children's food intake. The present study examines maternal food talk during a structured eating protocol, in which mothers and their children had the opportunity to eat a series of familiar and unfamiliar vegetables and desserts. Several aspects of maternal talk during the protocol were coded, including overall food talk, directives, pronoun use, and questions. This study analyzed the predictors of maternal food talk and whether maternal food talk and maternal food intake predicted children's food intake during the protocol. Higher maternal body mass index (BMI) predicted lower amounts of food talk, pronoun use, and questions. Higher child BMI z-scores predicted more first person pronouns and more wh-questions within maternal food talk. Mothers of older children used fewer directives, fewer second person pronouns, and fewer yes/no questions. However, maternal food talk (overall and specific types of food talk) did not predict children's food intake. Instead, the most robust predictor of children's food intake during this protocol was the amount of food that mothers ate while sitting with their children. These findings emphasize the importance of modeling healthy eating through action and have implications for designing interventions to provide parents with more effective tools to promote their children's healthy eating.