Food Insecurity and Obesity among Adults

Food Insecurity and Obesity among Adults IOM Workshop on Food Insecurity & Obesity November 16-18, 2010 Barbara A. Laraia, RD, Ph.D. Associate Professor Co-Director, UCSF Center for Obesity Assessment, Study and Treatment

Household Food Insecurity is Multidimensional Psychological Worry about enough food Numerous studies find an association with mental health, stress and depression Nutritional Compromise quality and quantity Little research finds clear associations with diet variety, meal pattern, macronutrient and micronutrient intake Economic Material deprivation = Sensitive Measure that Isn t Specific

Overview Prevalence of Food Insecurity in US Plausibility Lines of Evidence 1. Dependence on Calorically Dense Foods 2. Diet Sensitive Chronic Disease 3. Stress and Efficient Energy Storage Evidence from Animal Models Food Insecurity & Weight Status by Gender, Race and Over Time Future Directions

Prevalence of Food Insecurity in US Plausibility Lines of Evidence 1. Dependence on Calorically Dense Foods 2. Diet Sensitive Chronic Disease 3. Stress and Efficient Energy Storage Evidence from Animal Models Food Insecurity & Weight Status by Gender, Race and Over Time Future Directions

US Prevalence of Household Food Insecurity Source: http://www.ers.usda.gov/publications/

Relation between the energy density of selected foods and energy costs ( /MJ) Drewnowski, A. et al. Am J Clin Nutr 2004;79:6-16.

Food Insecurity & Dietary Intake KEY FINDINGS Dietary variety Adult Healthy Eating Index (HEI), mean a 6.3 vs. 5.9* Energy Intake Adults (NHANES) b Adults (NHANES) c Micronutrient Intake in older adults b No Difference No Difference But, Fewer Meals No Difference Vitamin A, C, E, Folate, B-12, Ca Lower Intake Vitamin B6, Mg, Fe, Zn * * Significant p<0.05 Basioti 2002 a ; Dixon 2001 b ; Zizza c

Food Insecurity, Hypertension, Hyperlipidemia, and Diabetes Seligman, Laraia and Kushel. J Nutr 2010

Food Insecurity and Disease Control Seligman, Laraia and Kushel. J Nutr 2010

Stress Induced Non-Homeostatic Eating Food Insecurity is a threat that can stimulate HPA axis triggering hunger and increasing drive for feeding Stress induced eating influences a desire for palatable foods to dampen the stress response Eating in the presence of stress can lead to insulin resistance and visceral fat accumulation

Beta coefficient Association of Psychosocial Factors and Food Security Status 2.5 2 1.5 1 0.5 0 Food Secure Marginally Secure Food Insecure Stress Anxiety Depression Chance LOC Power LOC * Adjusted models controlling for age, children, education, income, race, and marital status Laraia BA, et al. J Nutr 2006;136:177-182.

Beta coefficient Decreased Protective Traits with Increased Household Food Insecurity 1.2 1 0.8 0.6 0.4 0.2 0 Food Secure Marginally Secure Food Insecure Self-Esteem Mastery * Adjusted models controlling for age, children, education, income, race, and marital status Laraia BA, et al. J Nutr 2006;136:177-182.

Beta coefficient Influence of Food Stress and Dietary Restraint on Gestational Weight Gain 4 3 2 1 0-1 -2-3 Food Secure Food Insecure High Restraint Food Insecure/ High Restraint Weight Gain Adequacy of Weight gain * Adjusted models controlling for age, children, education, income, race, and marital status

Cortisol & Visceral Fat Control Junk Diet Stress/Junk Block NPY Stress + Junk food = Insulin & Neuropeptide Y (NPY) Greater Abdominal Fat 4 months later, Metabolic Syndrome! Kuo LE et al, 2007, Nature Medicine

Variable Foraging Demands Coplan 2006: Early VFD: No change on maternal CRF Late VFD: Maternal CRF Infant CRF with both Early & Late VFD Kaufman 2007: Late VFD: weight, BMI, abdominal circumference Our data suggest that early-life stress during a critical period of neurodevelopment can result in the peri-pubertal emergence of obesity and insulin resistance.

Food Insecurity and Weight Status Summary of Findings WOMEN MEN ADULTS FI Level Obese Obese (Women of color) Overweight Overweight Obese Obese Weight Gain FI-Mild FI-Mod FI- Severe No association Positive association Negative association

WOMEN: Food Insecurity & Overweight SAMPLE & MEASURE N KEY FINDINGS Rural NY (a) 193 BMI 28.2 vs. 25.6 CSFII (b) FI-Mild FI-Moderate FI-Severe 4,509 1.3 (1.1-1.5) No association No association 1996/1997 Canadian Health Study(c) 24,400 No association 1999/2002 NHANES (d) FI-Mild FI-Moderate FI-Severe 4,172 No association No association No association 1999/2002 NHANES (e) FI-Mild FI-Moderate FI-Severe 4,549 No association No association 1.67 (1.08, 2.57) Olson 1999 (a), Townsend 2001 (b), Vozoris 2003 (c), Hanson 2007 (d), Wilde 2006 (e)

WOMEN: Food Insecurity & Obesity SAMPLE & MEASURE N KEY FINDINGS Rural NY (a) 193 37% vs. 26% California Women s Health Survey (f) FI-Moderate FI-Severe 1999/2002 NHANES (d) FI-Mild FI-Moderate FI-Severe 1999/2002 NHANES (e), FI-Mild FI-Moderate FI-Severe 8,169 31.% vs. 16.% 1.4 (1.0-1.8) No association 4,172 No association 10.8 2.6 No association 4,549 1.58 (1.11, 2.24) 1.76 (1.44, 2.15) No Association Olson 1999 (a), Adams 2003 (f), Hanson 2007 (d), Wilde 2006 (e)

WOMEN: Food Insecurity & Weight Status by Ethnicity SAMPLE & MEASURE N KEY FINDINGS California Women s Health Survey (f) OBESITY among Non-white women FI-Moderate FI-Severe Overweight, Latina women in CA (g) FI-Moderate FI-Severe Obesity, Latina women in CA (g) FI-Moderate FI-Severe 8,169 1.5 (1.1-1.9) 2.8 (1.8 4.3) 559 No association No association 559 No association 1.98 (1.1-3.5) Adams 2003 (f), Kaiser 2007 (g)

ADULTS: Food Insecurity & Weight Status SAMPLE & MEASURE N KEY FINDINGS CSFII (b), Overweight in Men 1996/1997 Canadian Health Study (c) Overweight among Men Obesity among Men 1999/2002 NHANES (d), Men FI-Mild FI-Moderate FI-Severe LA, NY BRFSS Social Context Model (i) Enough Food-Obesity among Adults 4,509 No association 25,815 0.7 (0.5 0.9) No association 4,338 No association -8.3 3.9 (OW) No association 3,945 No association WA BRFSS Social Context Model (h) Enough Food-Obesity among Adults 3,252 1.3 (1.0-1.8) Townsend (b), Vozoris 2003 (c), Hanson 2007 (d), VanEenwyk 2003 (h), Laraia 2004 (i)

ADULTS: Weight Gain Longitudinal Studies SAMPLE & MEASURE N KEY FINDINGS PSID (j), Women PSID (k), Women Fragile Families (l), Women NHANES (e), Women FI-Mild FI-Moderate FI-Severe Men (all levels) Pregnancy, Infection & Nutrition Study (o), Pregnant women Bassett Mother Health Project (n), Pregnant women 5,303 No association 5,595 No association 1,707 No association 4,549 4,202 1.56 (1.09, 2.23) 1.43 (1.02, 2.00) No association No association 810 Higher weight gain Gestational Diabetes 463 Obese women became food insecure Jones 2006 (j), 2007 (k), Whitaker 2007 (l), Wilde 2006 (e), Olson 2008 (n), Laraia 2010 (o)

Summary Inconsistent results between food insecurity and overweight among women Modest association between food insecurity and obesity among women, especially women of color Inverse or null association between food insecurity and overweight among men Inconsistent results between food insecurity and weight gain

Future Directions Could these findings suggest a spurious relationship Do overweight/obese women perceive their household food situation differently than normal weight women? Consistency in measuring the exposure and outcome Different measures are used for both the exposure and outcome Some analyses restrict to middle- and low-income household, and all control for income Refining our conceptual framework Focus on visceral fat instead of weight Identify moderators of food insecurity, such as dieting or stress Focus on critical periods of growth and development, aging and diet-sensitive chronic diseases Assess the interaction between food insecurity and the food environment

Acknowledgments Funding Support NICHD NIDDK NHLBI Co-authors Anna Maria Siega-Riz, Craig Gundersen, Nancy Dole, Hilary Seligman, Margot Kushel UCSF Center for Health & Community and COAST Nancy Adler, Elissa Epel, Irene Yen, Bethany Hendrickson, Pam Stoddard