Understanding the Food Insecurity and Obesity Relationship by Examining Potential Mediators: An Exploratory Analysis

The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review

BACKGROUND

Food insecurity and obesity are increasing both globally and in the UK. In this review we systematically assess the lived experiences of people with obesity who are food insecure and often turn to food banks.

METHODS

We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematic analysis and narrative synthesis approach was used to analyse the extracted data.

RESULTS

Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the food environment; food practices in the home; experience of food assistance; and parental-child relationships. The cost of healthy food and psychological factors were identified as key driving factors of the relationship between food insecurity and obesity. Psychological factors such as depression, low self-esteem and stress played an important part in the lived experience of people with obesity and food insecurity.

CONCLUSION

The food environment provides context in which food decisions are made, therefore, systems change is necessary to ensure families can afford the food that enables a healthy diet. For clinicians, identification, and attention to the impact of food insecurity on people with obesity are important.

The prevalence of overweight/obesity and its association with household food insecurity among women living with HIV in rural Eswatini

BACKGROUND

Eswatini is currently afflicted by an extremely high prevalence of HIV (27%) and malnutrition (both under-and over-nutrition). While rates of overweight/obesity in the general adult population have been documented, data on overweight/obesity and associated risk factors among women living with HIV (WLHIV) in Eswatini is limited. This study examines the prevalence of overweight/obesity and associated risk factors, with an emphasis on clarifying the association between household food insecurity and overweight/obesity for WLHIV in rural Eswatini.

METHODS

This cross-sectional study was conducted among WLHIV (n = 166) in rural communities of Eswatini. Data were collected using an interviewer-administered survey questionnaire between October and November, 2017. Body Mass Index (BMI) was calculated to determine overweight and obesity among study participants. Women with BMI values of 25 kg/m² or greater were classified as being overweight/obese. Multivariable log-binomial regression models were used to examine associations between household food insecurity and overweight/obesity in our study.

RESULTS

Nearly a third (32.5%) of the women in our study were overweight and almost a quarter were obese (22.9%). We found significant associations between household food insecurity and overweight/obesity, with women who experienced household food insecurity the most being 0.38 times less likely to be overweight/obese compared to those who experienced household food insecurity the least (ARR: 0.38, 95% CI: 0.2-0.71). In our study sample, women who perceived themselves as being in poor health were less likely to be overweight/obese compared to those who perceived themselves as being in good health (ARR: 0.58, 95% CI: 0.39-0.86). We found significant associations between overweight/obesity and alcohol use, with the risk of overweight/obesity nearly 1.5 times higher among women who consumed alcohol compared to those who did not (ARR: 1.49, 95% CI: 1.07-2.05).

CONCLUSIONS

The high prevalence of overweight/obesity among food insecure women in poverty stricken communities may pose significant challenges for nutritional health and HIV management. With an increasing prevalence of overweight/obesity in food insecure households, there is a need to re-evaluate current strategies and develop multi-level targeted interventions that include prevention of excessive weight gain among women, particularly those living with HIV in rural Eswatini. HIV programs could include screening to identify individuals at risk for overweight/obesity in this population, and provide nutrition education for weight management for those individuals.

Food insecurity and obesity among US young adults: the moderating role of biological sex and the mediating role of diet healthfulness

OBJECTIVE

To examine the association between food insecurity (FI) and obesity, measured by BMI and waist circumference (WC), among young adults and test the moderating role of biological sex and the mediating role of diet healthfulness (DH).

DESIGN

Cross-sectional.

SETTING

National Health and Nutrition Examination Survey 2011-2016.

PARTICIPANTS

The sample included 4667 young adults aged 18-35 years.

RESULTS

Given the interaction terms between sex and FI, biological sex was a moderator between both FI and WC (P = 0·031) and FI and BMI (P = 0·007) among young adults. FI was associated with a 1·16 kg/m2 higher BMI (95 % CI 0·27, 2·05) and a 2·09 cm larger WC (95 % CI 0·05, 4·14) among young female adults, while FI was associated with a 0·26 kg/m2 higher BMI (95 % CI -0·65, 1·16) and a 0·78 cm larger WC (95 % CI -1·13, 2·89) among young male adults. DH mediated the relationships between both FI and BMI (indirect effect β = 0·14; 95 % CI 0·05, 0·23) and FI and WC (indirect effect β = 0·31; 95 % CI 0·10, 0·51) among females. Females with FI had poorer DH and thus had higher BMI and larger WC.

CONCLUSIONS

Young female adults with FI were more likely to experience overall and abdominal obesity compared with their male counterparts. Results also suggest that females with FI had poorer DH and thus had increased risk of both abdominal and overall obesity.