One of the key social determinants of health that practicing pediatricians ask families about is food insecurity. One of the surprising associations with food insecurity that clinicians and researchers worry about is obesity. This might happen because when families cannot afford healthy, nutritious foods, they buy low-cost energy-dense foods which are often poorly nutritious. But is this really a problem? In a study we are early releasing, Drennen et al. (10.1542/peds.2019-0824) studied whether food insecurity is associated with obesity and overall health and development.
Drennan et al. surveyed caregivers of 28,184 children less than 4 years of age in a multi-ethnic sampling cross-sectionally at medical centers in 5 US cities between 2009 and 2017. They further divided their sample into different exposure groups—those who were not food insecure, those where the overall household was food insecure (HFI) but the child was not food insecure, and those that were household food insecure and child food insecure—and then looked at the association with obesity, being underweight, experiencing stunted growth, and with their overall health and development. Only between 25-36 months of age was there an association between food insecurity and obesity; otherwise, neither household food insecurity nor child food insecurity was associated with obesity, being underweight, or having stunted growth. What both household and child food insecurity did demonstrate was increased odds of having fair to poor overall health and developmental risk.
These findings run counter to our popular belief that food insecurity is strongly associated with obesity. So why are the results ones that are not expected? To answer this question, we asked Drs. Rachel Gross and Alan Mendelsohn from New York University to weigh in with an accompanying commentary (10.1542/peds.2019-2430). They remind us of the limitations of cross-sectional nature of the data and offer explanations for the lack of anthropometric associations with food insecurity and the associations with poor overall health and developmental delay. They suggest ways that food insecurity can result in poor health in the setting of economic difficulties and associated family stressors. Drs. Gross and Mendelsohn provide an excellent rationale for continuing to screen for food insecurity.
If the commentary is not enough to convince you to continue to screen for food insecurity, we offer another study on food insecurity this week—this one on the association between food insecurity and healthcare utilization. Peltz and Garg (10.1542/peds.2019-0347) share with us a retrospective study of almost 8000 US children ages 1-17 years in a 2016 Medical Expenditures Panel Survey. The authors looked at annual health expenses and quality of care indicators (e.g. ED and inpatient utilization, primary and specialty care visits, patient experience measures, school absenteeism). While the good news is that those children who were food insecure showed no differences from those who were not in annual health expenses and hospitalizations, there were higher odds of an ED visit, school absenteeism, and poorer access to routine or illness care.
If these two studies of food insecurity don’t convince you of its importance and need for screening, we finish our focus on this social determinant of health with a third study. Thomas et al. (10.1542/peds.2019-0397) used a national dataset (the National Health Interview Study) involving over 29,000 children ages 2 to 17 years, comparing those who were and were not food insecure across a variety of other child health outcomes. The authors found that those who were food insecure demonstrated higher rates of asthma and depression, as well as emergency department use. There were no differences between those food secure and insecure in regard to other health outcomes including most infectious diseases, anemia, and diabetes.
There are lots of food for thought to digest in the three studies I have summarized, and the accompanying commentary and I believe it will make you even more eager to make sure food insecurity is top of mind. Link to these studies and commentary to learn more.