In this systematic review being early released this month in Pediatrics, St. Pierre et al outline the challenges in addressing food insecurity and healthy body weights for pediatric patients (10.1542/peds.2021-055571). This review delineates many of our seemingly counterintuitive observations that children can simultaneously experience food insecurity and have elevated body mass indices (BMI). They reference the historic observed relationship between low income and those populations that experience both food insecurity and obesity1 and the lack of data on why that association exists.
The authors performed a review of 13 longitudinal studies that met search criteria (out of an original 2,272 that were initially searched for) published between January 2000 and November 2022 among children ages 1 to 19. Two independent reviewers screened candidate articles. Article quality was assessed using the National Institutes of Health’s quality assessment tool.
Although the overall evidence linking food insecurity and obesity were mixed, there were subgroups for whom associations were observed highlighting the complex relationship existing between variables. Among the 13 studies included, the strongest association between food insecurity and obesity was found in early childhood (infants through middle school aged children). Additionally, an association between food insecurity and increased BMI (or BMI z-score) was observed for girls and not boys.
The most obvious of the limitations noted in this review were that some studies were noted to have missing participant data especially among families of lower socioeconomic status—a population that is at increased risk of experiencing food insecurity. Other studies used a range of outcome measures when delineating the association between food insecurity and obesity further complicating the ability to draw clear conclusions.
This study is timely given the recent increase in food insecurity observed since the onset of the COVID-19 pandemic which reversed a decade’s worth of declines in food insecurity2. Additionally, this study builds upon and expands upon recent investigations highlighting the links between food insecurity and cardiometabolic markers 3. While there is still much to be learned regarding the link between food insecurity and obesity in childhood, this review lays the groundwork for both future studies and needed action to address this issue. The inflationary increases in food prices we are all experiencing at the grocery store domestically make this topic even more relevant.
References:
- Ogden CL, Carroll MD, Fakhouri TH, et al. Prevalence of obesity among youths by household income and education level of head of household—United States 2011–2014. Morbidity and mortality weekly report. 2018;67(6):186
- Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2020. USDA Economic Research Service Report Number 298. 2021
- Maldonado LE, Sortres-Alvares, D, Mattei J, et al. Food Insecurity and Cardiometabolic Markers: Results From the Study of Latino Youth. Pediatrics. 2022;149(4): e2021053781
