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Food insecurity and childhood obesity: Is there a connection?
A well-nourished population requires that all members of society have access to sufficient amounts of nutritious food. Unfortunately, food insecurity continues to be a staggering problem throughout the world with negative consequences in terms of health and well-being.
In the United States, millions of households, an estimated 1 in 8 Americans, lack access to enough food. Children growing up in food insecure households face many challenges, such as behavioral problems, lower academic achievement, disrupted social interactions and poor health. The prevailing belief is that children living in a food insecure environment are at greater risk of undernutrition, not obesity. Although this may be true in some cases, food insecurity and childhood obesity also coexist.
Because childhood food insecurity may increase obesity risk later in life, it is important to better understand the relationship between food insecurity and children's obesity, and how it varies by demographic characteristics in the United States.
A recent study published in the September 2019 issue of The Journal of Nutrition assessed the relationship between household food insecurity and child adiposity-related outcomes. This included variables such as body mass index, waist circumference and diet outcomes. The study, conducted by Lauren Au, a researcher at UC Agriculture and Natural Resources' Nutrition Policy Institute, and colleagues examined associations by age, sex, and race/ethnicity. Data collected in 2013-2015 from 5,138 U.S. schoolchildren ages 4-15 years old from 130 communities in the cross-sectional Healthy Communities Study were analyzed.
Household food insecurity was self-reported using a two-item screening instrument and dietary intake was assessed using a food frequency questionnaire. Information on dietary behaviors, physical activity and demographics was collected. To assess adiposity, children's weight, height and waist circumference were measured.
Study results support an association between food-insecure households and measures of adiposity. Children from food-insecure households had high body mass index, waist circumference, greater odds of being classified as overweight or obese, consumed more sugar from sugar-sweetened beverages, and less frequently ate breakfast and dinner with family compared to children from food-secure households. When examined by age groups, significant relationships were observed only for older children, however, results did not differ according to sex or race/ethnicity.
These results suggest that household food insecurity is associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children. Clearly, further research is needed to better understand the complexities of food insecurity, childhood obesity, and future health outcomes.
Read the full open access article.
This research was supported by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.
Children are getting healthier, but the obesity crisis is not over
Real progress has been made in tackling the epidemic of childhood obesity since the first California Childhood Obesity Conference was held 20 years ago, but there is more work to be done.
“Collectively, we have come so far,” UC Nutrition Policy Institute Director Lorrene Ritchie told an audience of 1,025 public health, nutrition education, research, and other professionals at the event in Anaheim in July 2019. NPI was one of six conference hosts.
In the last 20 years:
- Federal school meal standards have been revised so that the food children eat at school is healthier than the lunches they bring from home.
- Sugar-sweetened beverages are no longer available to students during the school day.
- Foods provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) are healthier and give mothers incentive to breast feed their babies.
- The Supplemental Nutrition Assistance Program (SNAP) education component is now linked to policy, systems and environmental changes.
- The Child and Adult Care Food Program now provides healthier meals and snacks to children in childcare centers and homes across the country.
The average quality of the diet of American children has improved, but the rate of childhood obesity in the United States is still too high.
According to the Centers for Disease Control and Prevention, 18.5% of U.S. children and adolescents 2 to 19 years old are obese – about 13.7 million youth in all. The rates trend higher in minority communities, with 25.8% of Latinx youth and 22% of African American youth obese. Obesity is also more prevalent among children in families with low incomes.
Obesity, which is defined in children as a body mass index at or above the 95th percentile of CDC growth charts, is associated with poorer mental health status, reduced quality of life, and increased prevalence of diabetes, heart disease, stroke and some types of cancer.
The vice president of UC Agriculture and Natural Resources, Glenda Humiston, pledged the organization's commitment to community health and wellbeing at the Childhood Obesity Conference. UC ANR is the umbrella organization of the Nutrition Policy Institute, UC CalFresh Healthy Living, UC Cooperative Extension, 4-H Youth Development, the UC Master Gardener Program and the California Naturalist Program, among others.
“Going forward, solutions to the obesity epidemic are multidisciplinary,” Humiston said. “NPI does world class work in conducting research to influence nutrition policy. We need to harness 4-H. Master Gardeners are increasingly focusing on edible gardens. CalNat is getting people out into nature. We are finding synergies in community wellness.”
Humiston has dedicated UC ANR resources to finding and implementing solutions to the obesity crisis.
“I'm looking forward to working with all of you – public and private organizations – to design a way to move forward,” she said.
The opening keynote presentation at the conference featured Patricia Crawford, NPI's Senior Director of Research emeritus, a pioneer in addressing the growing problem of childhood obesity during her long career. Beginning in the 1970s, she recognized that childhood obesity was on the rise and launched several studies to search for the causes and potential solutions.
In one study, Crawford followed a group of 9-year-old African American girls over a period of 10 years to determine why these youth were growing up heavier than other adolescents.
“Finally, we began to get some answers,” Crawford said. “We learned obesity wasn't the children's fault. They were living in environments that made the unhealthy choice cheaper and easier to find. It's so unfair for people who have fewer resources. Health disparities has to be the No. 1 thing we are working on to address chronic disease rates in this country.”
“The solution to obesity is prevention. It's cheaper and more effective than treatment,” Crawford continued. “Healthy food is a taste that is easy to acquire if it is not preempted by junk food.”
Crawford said she honed in on the best strategies for prevention by actively listening to people struggling to make healthy choices
“There is a chasm between research and community,” Crawford said. “We have to get people together from the research level and the policy level with folks on the ground. We need to learn from people.”
Joining forces to promote child health and wellness
According to current statistics, approximately 40 percent of school-age children in the U.S. are overweight or obese. This statistic is reflected in rising rates of diabetes, pre-diabetes, and heart disease risk factors. Nearly one-quarter of all children are pre-diabetic or diabetic at the time when they leave high school, a figure that has increased dramatically in the last decade. Dental problems, the other very common health problem of youth, carry the potential for current and future pain, infection, and tooth loss. Although low-income children and children of color are at particular risk for both conditions, risk is unacceptably high for all children.
It is important to note that these all-too-common conditions share the same critical risk factor: consumption of sugary foods and beverages. Unknown to many, over half of the added sugar consumed by children is ingested in liquid form—soda, fruit drinks, sports drinks, energy drinks, and other pre-sweetened beverages including iced teas and others. For teenagers sugar-sweetened beverages are the single largest source of calories in their daily diet. Further, research has demonstrated that liquid sugar is more highly related to obesity than added sugar coming in solid form.
To improve the medical and dental health of our children we need to help children and families find ways to reduce their consumption of sugar-sweetened beverages.
Fortunately research is being conducted to find effective ways to reduce children's sweetened beverage consumption.
- Reduce provision of sweetened beverages in the school, after school and childcare settings. UC ANR's Nutrition Policy Institute (NPI) has documented dramatic reductions in sugary beverage consumption after the enactment of state restrictions on the sale of highly sugared beverages in California schools and childcare. While much has been accomplished, more can be done to see that these kinds of restrictions are fully maintained.
- Offering children easy access to water stations and other free tap water sources in childcare settings, schools and recreational facilities provides a healthful alternative to sugary beverages.
- Encourage strong nutrition education programs for children. UC Cooperative Extension's EFNEP and statewide SNAP-Ed programs have been leading efforts to educate children on the value of a healthy diet including the risk of consuming too many sugary beverages.
- Similarly, educating families on healthy eating and on the benefits of reducing sugar-sweetened beverage consumption can support and reinforce the messages to children in the school-based programs.
A consistent message on sugary beverages delivered to families by dental and medical health practitioners, in tandem with other educational and community efforts, can substantially benefit children's health. As respected community members, dental and medical health practitioners are in a position to deliver consistent messages to families and also to work with community agencies and groups, including UC ANR and its affiliates, to initiate and support efforts to reduce children's and families' sugary beverage consumption. Our children deserve a healthy start.
For more information, see:
- Nutrition Policy Institute (http://npi.ucanr.edu)
- National Drinking Water Alliance (http://www.drinkingwateralliance.org/about)
- Dooley D, Moultrie N, Sites E, Crawford P. Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals. Journal of Public Health Dentistry, 16 June 2017. DOI:10.1111/jphd.12229.
Unen esfuerzos para promover la salud y bienestar infantiles
De acuerdo con estadísticas recientes, aproximadamente un 40 por ciento de los niños estadounidenses de edad escolar tienen sobrepeso u obesidad. Esta estadística se refleja en las crecientes tasas de diabetes y factores de riesgo de enfermedades cardiacas. Cerca de una cuarta parte de todos los niños son pre-diabéticos o diabéticos al concluir la preparatoria, una cifra que se ha incrementado dramáticamente en la última década. El aspecto dental es el otro problema de salud entre los jóvenes, con el potencial de crear dolor, infección y pérdida de dientes en el futuro. A pesar de que los niños de bajos ingresos y de color se enfrentan a un riesgo en particular en ambas condiciones, el riesgo es altamente inaceptable para todos los niños.
Es importante resaltar que todas estas condiciones comunes comparten el mismo factor de riesgo crítico: el consumo de alimentos y bebidas azucaradas. Algo que muchos desconocen es que la mitad de la azúcar agregada que consumen los niños es líquida — bebidas de frutas, deportivas y energéticas y otras bebidas previamente endulzadas, incluyendo tés fríos y otros. Para los adolescentes las bebidas endulzadas con azúcar son la mayor fuente de calorías en la alimentación diaria. Además, los estudios han demostrado que el azúcar líquido está mayormente relacionado con la obesidad que la azúcar que se agrega en forma sólida.
Para mejorar la salud médica y dental de nuestra niñez necesitamos ayudarles a los niños y sus familias a identificar formas para reducir su consumo de bebidas endulzadas con azúcar.
Afortunadamente se están realizando estudios para identificar maneras eficaces para reducir el consumo de bebidas endulzadas entre los niños.
- Reducir la existencia de bebidas endulzadas en las escuelas, después de clases y sitios que ofrecen cuidado infantil. El Instituto de Políticas sobre Nutrición de UC ANR (NPI, por sus siglas en inglés) ha documentado reducciones dramáticas en el consumo de bebidas azucaradas tras la adopción de restricciones estatales en la venta de bebidas con un alto contenido de azúcar en las escuelas y guarderías de California. Aun cuando se ha logrado mucho, todavía se puede hacer mucho más para que este tipo de restricciones continúen vigentes.
- Ofrecer a los niños un fácil acceso a bebederos y otras fuentes de agua potable sin costo en los sitios de cuidado infantil, escuelas e instalaciones recreativas representa una alternativa saludable a las bebidas azucaradas.
- Fomentar programas sólidos de educación sobre nutrición. Programas como EFNEP de Extensión Cooperativa de UC y SNAP-Ed (estatal) han encabezado los esfuerzos para educar a los niños sobre el valor de una dieta saludable incluyendo el riesgo de consumir muchas bebidas azucaradas.
- De manera similar, educar a las familias sobre una alimentación saludable y los beneficios de reducir el consumo de bebidas azucaradas puede apoyar y reforzar el mensaje que se da a los niños en los programas que se imparten en las escuelas.
Un mensaje constante de los médicos y dentistas a las familias, junto con otros esfuerzos educativos y comunitarios, pueden beneficiar substancialmente la salud de los niños. Siendo miembros respetados de la comunidad, los médicos y dentistas se encuentran en una posición en la que pueden transmitir mensajes constantes a las familias y también trabajar con agencias y grupos comunitarios, incluyendo a UC ANR y sus afiliados, para iniciar y apoyar esfuerzos con el fin de reducir el consumo de bebidas azucaradas entre niños y familias. Nuestros niños se merecen un inicio saludable.
Para más información, vea:
- Instituto de Políticas sobre Nutrición (Nutrition Policy Institute), http://npi.ucanr.edu
- Alianza Nacional para Beber Agua (National Drinking Water Alliance), http://www.drinkingwateralliance.org/about
- Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals, publicado en el Journal of Public Health Dentistry, 16 June. DOI:10.1111/jphd.12229. Dooley D, Moultrie N, Sites E, Crawford P.
La Iniciativa Alimentaria Global de UC ANR apunta hacia la seguridad alimentaria y obesidad
Las estudiantes de postgrado de la UC Berkeley Kristal Caballero, Elsbeth Sites y Sonya Zhu son las becarias de la GFI y trabajarán con académicos y personal de ANR para abordar el tema de cómo alimentar de manera sustentable y nutritiva a una población mundial que en el 2025 alcanzará los ocho mil millones de personas.
Las becarias de la GFI son parte de un grupo de 50 estudiantes y graduados de la UC que trabajan en proyectos relacionados con los alimentos en los 10 campus de la UC, la oficina del presidente de la UC, el Laboratorio Nacional Lawrence Berkeley y la UC ANR.
Las becarias de la GFI se reúnen en conferencias, viajes de estudios y eventos para hacer contactos. La primavera pasada, UC ANR llevó a cabo el recorrido de becarios por el delta de los ríos Sacramento-San Joaquín para aprender más sobre la relación entre alimentos, agricultura y medioambiente.
Las becarias de la GFI 2017-18:
Kristal Caballero, de San José, es estudiante de postgrado de la Facultad de Salud Pública de la UC Berkeley. Con su trabajo en el equipo de Comunicaciones Estratégicas de UC ANR, Caballero se enfocará en esfuerzos de divulgación de información y educación para educar al público sobre nutrición, seguridad alimentaria, programas federales de alimentos, desperdicio de alimentos, obesidad infantil y temas relacionados. Caballero utilizará una variedad de herramientas de comunicación para publicar los resultados de la investigación del Instituto de Políticas sobre Nutrición sobre temas relacionados con la nutrición y alimentos y para informar a los legisladores.
Sonya Zhu, de Iowa City, Iowa, es estudiante de postgrado de la Facultad de Políticas Públicas Goldman, de la UC Berkeley. Zhu conducirá un segundo análisis del estudio Comunidades Saludables en el Instituto de Políticas sobre Nutrición, un estudio observacional de más de cinco mil niños de entre cuatro y 15 años que fueron reclutados en 130 comunidades de todo EUA entre el 2013 y 2015. Ella examinará el efecto que tiene la inseguridad alimentaria en el hogar en la conducta dietética y actividad física.
