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Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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KEY WORDS: • hunger • food insecurity • women • children
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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CONCEPTUAL FRAMEWORK FOR EXAMINING CONSEQUENCES |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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elaborated a conceptualization of food insecurity,
its risk factors and consequences that is shown in Figure 1
.She indicates two sets of potential consequences of food insecurity.
These include the typical physical and physiologic symptoms of
suboptimal nutritional status, shown in the box labeled NUTRITIONAL
STATUS. The second set, is labeled as CONSEQUENCES of poor nutritional
status; these include health, in the broadest sense of including social
and mental well-being as well as physical health and overall quality of
life. Campbell makes the very important point in this figure that food
insecurity can affect health and quality of life either directly or
indirectly through nutritional status.
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). The challenge for the field of nutritional sciences
is to examine how food insecurity interacts with poverty status to
influence important health outcomes and overall quality of life. Most
of the results presented in this paper will address this fundamental
issue, i.e., the association of food insecurity with health and
well-being that is in addition to the association between poverty or
low socioeconomic status and these outcomes. This paper focuses on two
subgroups of the U.S. population for whom data are available, namely,
women of childbearing age and school-age children. Limited data are
available on these relationships in the elderly but, due to space
limitations, will not be presented here (Olson et al. 1996
). |
FOOD INSECURITY AND WOMEN'S BODY WEIGHT |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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)? Some individuals and
policy makers have questioned the validity of the claims of widespread
hunger and food insecurity in the low income population of the U.S.
because of the high prevalence of overweight and obesity in this same
population subgroup.
A randomly selected sample of 193 women, ages 20–39 y with children
living at home, participated in the household survey that included two
personal interviews. A more detailed description of the survey sample
and methods is available and only a brief summary is presented here
(Kendall et al. 1995
). During the first interview, a questionnaire
containing the Radimer/Cornell hunger and food-insecurity items was
administered and each respondent's height and weight were measured by
trained interviewers using standard research methods and equipment.
Households were first classified into one of the four food-insecurity categories using the Radimer/Cornell measures. Ninety (47%) households were defined as food secure. Fifty (26%) households were experiencing the least severe level of food insecurity and were designated as "household insecure." These households ran out of food, were uncertain about their ability to obtain sufficient food and were beginning to compromise the quality of the family diet. Another 33 (17%) households had adults who were experiencing food insecurity and 20 (10%) households had hungry children in them. This means that children were judged by parents to not be getting enough to eat or the right kinds of food and were asking for more food to eat. This is the most severe level of food insecurity.
The mean body mass indices
(BMI)2for the women in each of the food insecurity groups were calculated and
compared using the appropriate statistical tests in the Statistical
Analysis System (SAS, version 6, Cary, NC). As shown in Table 1
,BMI was significantly higher (P < 0.05) for women in
the household food-insecure group compared with women in food-secure
households (28.2 vs. 25.6 kg/m2). In addition, 37% of the
women in the household food-insecure group had a BMI >29 (obese)
compared with 26% of women in food-secure households (Institute of
Medicine 1992
). The other groups did not differ significantly on BMI
and proportion obese from the food-secure group.
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), a mean difference of 2 BMI units in the
range of the women in this study was associated with a 25% increase in
risk of death. As food insecurity became more severe and progressed to
child hunger, the sign of the regression coefficient became negative,
as might be expected.
Given the inherent limitations of observational, cross-sectional
studies in drawing causal inferences, it is useful to examine the
research literature for evidence relevant to the hypothesis that
household-level food insecurity is associated with increased BMI. The
higher prevalence of overweight and greater mean BMI among low income
women is well documented. In a study of 20- to 45-y-old women aimed at
understanding reasons for differences in body weight, Jeffery and French (1996)
found that a full multivariate model, including variables
for demographic characteristics, diet and exercise behaviors, weight
concerns and weight loss practices, did not appreciably reduce the
magnitude of the overall association between income group and BMI. Thus
they concluded that economic deprivation contributes to the high rates
of obesity among women of lower socioeconomic status in ways not
accounted for by the many variables in their model. The reasons require
further research. Their finding that meal skipping was nearly twice as
high in the income group that made <$10,000 per year than it was in
higher income groups could possibly implicate food insecurity as a
factor.
Dietz (1995)
published a case study of a 7-y-old obese girl for whom
food shortages that occurred at regular intervals in each month before
her mother received the welfare check appeared to be a contributing
factor. Dietz states, "This brief discussion suggests that either
food choices or physiologic adaptations in response to episodic food
shortages could cause increased body fat. However, confirmation of this
hypothesis requires the demonstration of obesity associated with food
insufficiency in larger cross-sectional and prospective studies." The
findings presented here from a large cross-sectional study support
Dietz's hypothesis.
Another important consideration in evaluating the plausibility of the
hypothesized relationship between household-level food insecurity and
increased BMI is a possible mechanism. The eating pattern literature
supports the idea that food deprivation can result in overeating.
Polivy (1996)
found that food restriction and deprivation, whether
voluntary or involuntary, result in a variety of cognitive, emotional
and behavioral changes such as preoccupation with food and eating.
Although it is tempting to compare the regular episodic cut-back in
food intake by women in food-insecure households to the so-called
"yo-yo" dieting and suggest that these women have an increased
efficiency in their use of dietary energy, the present state of
knowledge does not strongly support this potential mechanism (National
Task Force on the Prevention of Obesity 1994
).
In relation to the Campbell framework in Figure 1 , these findings suggest that food insecurity is related to an anthropometric measure of nutritional status. The least severe level of food insecurity (household-level) appears to be the most strongly related to BMI and thus to potential poor health outcomes. Although this hypotheses is intriguing, it must be confirmed with prospective studies controlling for additional confounding factors such as smoking and physical activity before firm conclusions about a causal relationship can be drawn.
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PSYCHOSOCIAL CONSEQUENCES OF FOOD INSECURITY AND HUNGER FOR SCHOOL-AGE CHILDREN |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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) and the Journal of
the American Academy of Child and Adolescent Psychiatry (Murphy et al. 1998
). The data for this example of a relationship between food
insecurity and health outcomes are from the second article with
additional analysis by Murphy and Hauser (see Acknowledgements). The
sample and methods are described in detail in Murphy et al. (1998)
and
will be described here only briefly. The sample consisted of 204
children, the majority of whom were in grades 3–5, from two schools in
Baltimore and two schools in Philadelphia. Eighty percent of the
children were African-American and about half were from single-parent
families. All were from families that had incomes 
185% of the
Federal poverty line.
The measure used to assess hunger was that of the Community Childhood
Hunger Identification Project (CCHIP), which allows investigators to
classify households into one of the following three groups: not hungry,
at risk of hunger and hungry. The outcome of psychosocial problems was
measured using The Pediatric Symptom Checklist (PSC). This is a brief,
widely used, parent-completed questionnaire that has been validated as
a screening measure to identify children with psychosocial problems.
The PSC consists of 35 items that are rated as "never,"
"sometimes," or "often" present and scored 0, 1 or 2,
respectively. Some examples of the items are as follows: fights with
other children, wants to be with you more than before, has trouble with
a teacher, takes things that do not belong to him/her. A total score is
obtained by adding the item scores, and impairment is defined as a
total score 
28.
Mean PSC scores increased significantly (P < 0.001)
with risk of hunger and hunger (Murphy et al. 1998
). As discussed
earlier, one of the challenges for the field of nutrition is to
understand how food insecurity interrelates with poverty status and
other measures of socioeconomic status to influence well-being. In this
example, the issue was examined using two-way ANOVA with the SPSS
package (PC+, Chicago, IL). Table 2
shows the mean PSC scores for each CCHIP category in relation to one
indicator of socioeconomic status, maternal educational level. At each
of the three different educational levels (less than high school, high
school graduate and some college), risk of hunger and hunger were
significantly and progressively associated with poorer PSC scores
(P < 0.001) . The relationship was most dramatic at
the lowest level of education.
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185% of the Federal poverty line.) Hunger was
associated with poorer PSC scores at the lowest income level, as
measured by participation in Aid to Families with Dependent Children
(AFDC), and at the highest income level, as indicated by the household
having two incomes. This same trend was not seen in the one income
group that included both single-parent families and dual-parent
families with one income. The results indicate that hunger is related to the PSC outcome beyond differences accounted for by poverty. Furthermore, the relationship of hunger and food insecurity to psychological well-being of children, as shown here, may or may not be mediated through nutritional status (see Figure 1 ). These findings require confirmation with more diverse groups of children and better measures of poverty and socioeconomic status, but they are nonetheless intriguing.
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CONCLUSIONS |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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2 Abbreviations used: AFDC, Aid to Families with
Dependent Children; BMI, body mass index; CCHIP, Community Childhood
Hunger Identification Project; PSC, Pediatric Symptom Checklist.
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REFERENCES |
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TOPABSTRACTINTRODUCTIONCONCEPTUAL FRAMEWORK FOR...FOOD INSECURITY AND WOMEN'S...PSYCHOSOCIAL CONSEQUENCES OF...CONCLUSIONSREFERENCES |
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1. Campbell C. C.. Food insecuritya nutritional outcome or a predictor variable?. J. Nutr. 1991;121:408-415.
2.
Dietz W. H.. Does hunger cause obesity?. Pediatrics 1995;95:766-767.
3. Frongillo, E. A., Jr., Olson, C. M., Rauschenbach, B. S. & Kendall, A. (1997) Nutritional Consequences of Food Insecurity in a Rural New York State County, Discussion Paper no. 1120–97, Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI. .
4. . Institute of Medicine. Subcommittee for a Clinical Application Guide. Nutrition during Pregnancy and LactationAn Implementation Guide 1992 National Academy of Sciences Washington, DC.. .
5.
Jeffery R. W., French S. A.. Socioeconomic status and weight control practices among 20- to 45-year old women. Am. J. Public Health 1996;86:1005-1010.
6. Kendall A., Olson C. M., Frongillo E. A., Jr. Validation of the Radimer/Cornell measures of hunger and food insecurity. J. Nutr. 1995;125:2793-2801.
7.
Kleinman R. E., Murphy J. M., Little M., Pagano M., Wehler C. A., Regal K., Jellinek M. S.. Hunger in children in the United Statespotential behavioral and emotional correlates. Pediatrics 1998;101:1-6.
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Link B. G., Phelan J. C.. Understanding sociodemographic differences is health—the role of fundamental social causes. Am. J. Public Health 1996;86:471-473.
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Manson J. E., Willett W. C., Stampfer M. J., Colditz G. A., Hunter D.J., Hankinson S. E., Hennekens C. H., Speizer F. E.. Body weight and mortality among women. N. Engl. J. Med. 1995;333:677-685.
10. Murphy J. M., Wehler C. A., Pagano M. E., Little M., Kleinman R. E., Jellinek M. S.. Relationship between hunger and psychosocial functioning in low-income American children. J. Am. Acad. Child Adolesc. Psychiatry 1998;37:163-170.[Medline]
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. National Task Force on the Prevention and Treatment of Obesity. Weight cycling. J. Am. Med. Assoc. 1994;272:1196-1202.
12. Olson, C. M., Kendall, A., Wolfe, W. S. & Frongillo, E. A., Jr. (1996) Understanding the Measurement of Hunger and Food Insecurity in the Elderly, Discussion Paper no. 1088–96, Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI. .
13. Polivy J.. Psychological consequences of food restriction. J. Am. Diet. Assoc. 1996;96:589-592.[Medline]
14. Radimer K. L., Olson C. M., Greene J. C., Campbell C. C., Habicht J.-P.. Understanding hunger and developing indicators to assess it in women and children. J. Nutr. Educ. 1992;24:36S-45S.
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