Food Insecurity Increases the Odds of Obesity Among Young Hispanic Children

Abstract

Obesity is a growing public health concern and is more prevalent among low-income and minority populations. Food insecurity may increase the odds of obesity in children. We investigated the association between food insecurity and obesity among low-income, Hispanic, mother-child dyads (n = 74). The United States Department of Agriculture 18-item Household Food Security Survey was used to determine food security status. The majority of households were food insecure (74 %) and one-third (30 %) of children were obese. Food insecurity increased the odds of childhood obesity (OR 10.2; 95 % CI 1.2, 85.5) with stronger associations found within households where mothers were also overweight/obese compared to normal weight (p-for interaction < 0.05). Rates of household food insecurity and childhood obesity were high among this low-income Hispanic sample. Future studies should elucidate the mechanisms through which food insecurity impacts childhood obesity.

Full text

ORIGINAL PAPER
Food Insecurity Increases the Odds of Obesity Among Young
Hispanic Children
Mia A. Papas
1
•Jillian C. Trabulsi
1
•Alicia Dahl
1
•Gregory Dominick
1
ÓSpringer Science+Business Media New York 2015
Abstract Obesity is a growing public health concern and
is more prevalent among low-income and minority popu-
lations. Food insecurity may increase the odds of obesity in
children. We investigated the association between food
insecurity and obesity among low-income, Hispanic,
mother–child dyads (n =74). The United States Depart-
ment of Agriculture 18-item Household Food Security
Survey was used to determine food security status. The
majority of households were food insecure (74 %) and one-
third (30 %) of children were obese. Food insecurity
increased the odds of childhood obesity (OR 10.2; 95 % CI
1.2, 85.5) with stronger associations found within house-
holds where mothers were also overweight/obese compared
to normal weight (p-for interaction \0.05). Rates of
household food insecurity and childhood obesity were high
among this low-income Hispanic sample. Future studies
should elucidate the mechanisms through which food
insecurity impacts childhood obesity.
Keywords Food insecurity Childhood obesity 
Hispanic Maternal and child health
Background
Obesity is one of the leading causes of morbidity and
premature mortality in the United States [1]. Since 1970,
the prevalence of obesity has tripled and continues to
remain a serious public health concern [2–4]. The Hispanic
population is the fastest growing ethnic minority group
comprising 17 % of the U.S. total population [5]. Hispanic
women are 40 % more likely to be obese when compared
to non-Hispanic white women [2–4]. This race/ethnic dis-
parity is also evident among children where 21 % of His-
panic children are obese compared to 14 % of non-
Hispanic whites [6,7].
Food insecurity, defined as limited access to adequate
food due to a lack of financial and other resources [8], may
play a role in obesity. Over the past two decades, as obesity
rates have increased, so have rates of food insecurity (low
or very low food secure), especially among Hispanic
households [8,9]. In 2011, 15 % of non-Hispanic house-
holds in the United States were food insecure compared to
27 % of Hispanic households. This raises concern since
adults living in food insecure environments are at risk for
cardiovascular disease, diabetes, poor mental and physical
health, and obesity [10–12].
Dietz [13] first posited the food insecurity-obesity
paradox in 1995. Since then there has been a growing body
of evidence examining the co-existence of food insecurity
and obesity. In theory, the relationship between obesity and
food insecurity is contradictory because obesity suggests an
excess of energy (food) intake compared to energy
requirements, and food insecurity indicates inadequate
food supply and/or accessibility to food compared to
requirements [13,14]. Individuals living in food insecure
households may have increased intakes of energy dense
and nutrient poor foods such as salty snacks, desserts, and
high fat foods that are accessible, available and affordable
within low-income communities [15,16].
Food insecurity and obesity associations have been
found to depend upon gender, income, age and race/eth-
nicity [17]. Within Hispanic American women, food
&Mia A. Papas
mpapas@udel.edu
1
Department of Behavioral Health and Nutrition, College of
Health Sciences, University of Delaware, 013 Carpenter
Sports Building, 26 North College Avenue, Newark,
DE 19716, USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-015-0275-0

insecurity has been associated with both maternal under-
weight status [18] as well as maternal overweight [19–23].
For children, results are also mixed. Evidence indicates that
children from more food insecure household have a lower
body mass index (BMI) due to food restriction and smaller
food supplies [24] yet also have higher BMIs [25–27], due
to diets low in nutritional value, a risk factor for obesity.
The relationship between food insecurity and obesity
among Hispanic children may be restricted to families
where the maternal caregiver is also overweight [28], but
more research is needed.
Given that Hispanic children are more likely to be
overweight and to live in food insecure households than
non-Hispanic whites, it is important to gain a better
understanding of associations within this high-risk com-
munity. The purpose of this study is to investigate the
association between food insecurity and obesity among
low-income Hispanic children residing in rural Pennsyl-
vania. We further sought to understand the moderating role
that maternal weight may play in a minority population.
Methods
Participants
This was a cross-sectional investigation of adult Hispanic
mothers and their children. Subjects were recruited from La
Comunidad Hispana (LCH), a federally qualified health
clinic in Kennett Square, Pennsylvania, offering health and
social services to low-income Hispanic families. Inclusion
criteria were: mothers who were equal or greater than
18 years of age with at least one child between 2 and
8 years of age residing in their homes.
Data Collection
In-person interviews were conducted by a trained bilingual
interviewer in the participants’ preferred language.
Mothers brought the youngest child in their care between
the ages of 2 and 8 years to the interview appointment.
Childcare was provided for all children. Participants
completed the informed consent process privately with the
interviewer and signed child assent forms for participation
in the study. Compensation was provided to participants in
the form of a $30 gift card to a local supermarket. All study
procedures were approved by the University of Delaware
and Bryn Mawr College Institutional Review Boards.
Measures
Demographic information included education level, marital
status, number of children in the household, employment
status, monthly income, health history, place of origin,
preferred language, and length of stay in the United States.
Trained research assistants measured heights and
weights. Using a stadiometer (Seca model 213, SECA
Corp., Hamburg, Germany, 2008), research staff measured
height to the nearest 0.1 cm. A digital calibrated scale
(Seca model 869, SECA Corp., Hamburg, Germany, 2008)
was used to measure weight of participants to 0.1 kg. Two
measures of height and weight were taken and if the two
measures were not within 0.5 cm and 0.1 kg respectively, a
third measure was taken. Measures were averaged together
to produce a final height and weight measure. Body Mass
Index (BMI) was computed for mothers by dividing weight
in kilograms by height in meters squared. Maternal BMI
classification was determined as underweight
(BMI \18.5), normal (BMI C18.5 and BMI \25),
overweight (BMI C25 and BMI \30) and obese
(BMI C30) [1]. For children, BMI percentiles were cal-
culated using the Center for Disease Control and Preven-
tion BMI-for-age growth chart [29]. Children were then
classified as underweight (\5th percentile), healthy weight
(C5th percentile and \85th percentile), overweight (C85th
and \95th percentile), and obese (C95th percentile).
Food security was measured using the validated Spanish
translation of the United States Department of Agriculture
(USDA) Household Food Security Survey Module [9].
This module includes 19 total questions, 11 questions about
food eaten in the household in the past 12 months and the
affordability of that food as well as an additional eight
questions about child food security. Affirmative responses
to the sequence of conditions and behaviors were summed
to provide a raw score on the continuum of household food
security. These scores were then classified into three cat-
egories of food security for households with one or more
children: very low food security, low food security, or food
secure (food secure included both high and marginal food
security). Households with very low or low food security
were classified as food insecure and compared to those
households who responded they were food secure.
Analysis
Differences in the prevalence of demographic characteris-
tics and food insecurity by maternal and child overweight
and obesity were evaluated using Chi square analyses for
categorical variables and ttests for continuous variables.
Logistic regression models were fit to examine the asso-
ciation between demographic characteristics, food insecu-
rity and overweight and obesity. Variables investigated
included household income, marital status (married/single),
number of years living in the U.S., number of children in
the household, highest level of education, access to trans-
portation (yes, no), and participation in food assistance
J Immigrant Minority Health
123

programs [Women, Infants and Children (WIC) partici-
pant/not WIC participant].
Logistic regression models were then fit to estimate the
association between food insecurity and overweight and
obesity among mothers and children. Potential covariates
included in the model were household income, number of
children in the household, length of time living in the
United States, and educational attainment (primary, sec-
ondary, high school, beyond high school). Similar trends in
associations were seen for both overweight and obese
mothers as well as overweight and obese children sepa-
rately. Therefore these two groups were collapsed into one
group labeled overweight/obese. The level of statistical
significance for all tests was set at pB0.05. Statistical
analyses were conducted using the SPSS Statistical Pack-
age version 17.0 (SPSS Inc., Chicago, IL, 2008).
Results
A total of 112 mothers were eligible and 80 mothers
completed the in-person interview (71 % response). Of the
80 mothers, 5 were removed due to pregnancy and 1 had
missing data leaving an analytic sample of 74 mothers and
children.
Maternal age ranged from 23 to 45 years (Mean =32.7;
SD =5.5) and the average number of children in the
household was 2.6 (SD =1.0). All participants were of
Hispanic origin; with the majority (93 %) from Mexico;
and all spoke Spanish as the primary language. The mean
number of years mothers reported living in the United
States was 9.3 (SD =4.7). Most mothers (73 %) were
married and unemployed (61 %). Over half (58 %) repor-
ted household incomes below the Federal poverty line [30].
In addition, many families participated in a food assistance
program including Women, Infants and Children (WIC)
(69 %), free or reduced school meals (70 %), and/or food
stamps (26 %) (Table 1).
Three-quarters of mothers were overweight (39 %) or
obese (37 %), with an average BMI of 28.3 kg/m
2
(SD =4.6). Overweight and obese mothers were com-
bined into one overweight/obese category and compared to
normal weight mothers. Married female participants were
more likely to be overweight/obese compared to single,
divorced or separated moms (OR 5.8; 95 % CI 1.8, 18.2).
In addition, the number of children residing in the house-
hold was associated with maternal overweight/obesity (OR
1.8; 95 % CI 1.0, 3.3) (Table 2).
Children ranged in age from 2 to 8 years (Mean =4.8;
SD =1.9). About half were normal weight (55 %) and half
were overweight (15 %) or obese (30 %). Overweight and
obese children were combined into one overweight/obese
category and compared to normal weight children. Child
overweight and/or obesity were not associated with any of
the demographic characteristics examined (Table 2).
Table 1 Demographics and weight status of 74 mother/child dyads
Mean (SD) Min, max
Maternal characteristics
Age (years) 32.7 (5.5) 22.6, 44.8
Children in household 2.6 (1.0) 1, 5
Years living in United States 9.3 (4.7) 0, 25
N Percentage (%)
Education level completed
Primary (1–6th grade) 31 42
Secondary (7th–9th grade) 21 29
High school (10th–12th grade) 18 24
Post high school education 4 5
Monthly household income
Less than $500 8 11
$500–999 8 11
$1000–1999 26 36
$2000–2999 27 37
$3000–3999 4 5
Marital status
Single/separated/divorced 20 27
Married 54 73
Employment status
Unemployed 45 61
Employed 29 39
Weight status
Normal weight (BMI \25.0) 18 24
Overweight (25.0 BBMI \30.0) 29 39
Obese (BMI C30.0) 27 36
Mean (SD) Min, max
Child characteristics
Age 4.8 (1.9) 1.9, 8.6
BMI percentile 73.0 26.0
N Percentage (%)
Males 32 43
Females 42 57
Child weight status
Normal weight (BMI \85th %) 41 55
Overweight (BMI C85th %) 11 15
Obese (BMI C95th %) 22 30
Household food security
Food secure 19 26 %
Low food security 43 58 %
Very low food security 12 16 %
J Immigrant Minority Health
123

There was no statistically significant relationship
between maternal and child weight status (V
2
=3.05;
pvalue =0.8). Among normal weight children, twenty-
five percent had a normal weight mother, 39 % had an
overweight mother and 36 % had an obese mother.
The prevalence of household food insecurity was 74 %.
The majority of food insecure families were classified as
low food security (78 %), with 12 % of food insecure
households experiencing very low food security. Approx-
imately one-quarter of households reported being food
secure (26 %). None of the other child or maternal
demographic characteristics were associated with food
insecurity. Household income was associated with food
insecurity status. Households with incomes greater than
$23,500 (the federal poverty line for a household of 4) were
less likely to be food insecure than those who were living
on incomes below the federal poverty line (OR 0.23; 95 %
CI 0.08, 0.71). There were no statistically significant dif-
ferences in child gender, age, or maternal characteristics
including maternal age, the number of children residing in
the household, the number of years living in the US,
marital status, employment and income (all pval-
ues C0.05). After adjusting for marital status, monthly
household income, and the number of children in the
household, food insecurity status was significantly associ-
ated with childhood overweight/obesity (OR 10.2; 95 % CI
1.2, 85.5). Food insecurity was not associated with
maternal overweight (OR 0.5; 95 % CI 0.1, 1.5) or obesity
(OR 0.7; 95 % CI 0.2, 3.2) (data not shown). Maternal
overweight/obesity moderated the association between
food insecurity and childhood overweight/obesity
(Table 3). The association between food insecurity and
child overweight/obesity was restricted to children with
overweight or obese mothers. In addition, the greater the
severity of food insecurity, the increased likelihood that the
child was overweight/obese. Low food security increased
the odds of child overweight/obesity 10-fold (OR 9.5;
95 % CI 1.2, 81) whereas very low food security increased
the odds 30-fold (OR 32; 95 % CI 2.6, 391).
Discussion
Overweight/obesity were common within this sample of
low-income, Mexican–American mothers with three-quar-
ters of the mothers being overweight or obese. Rates of
obesity for Mexican–American women in the U.S. have
been increasing over the past decade. Data from the
2009–2010 National Health and Nutrition Examination
Survey (NHANES) revealed a prevalence of obesity among
Mexican–American women of 45 % compared to 35 % in
1988–1994 [6]. Recent evidence demonstrates a decreased
acceleration rate in obesity prevalence among non-His-
panic Whites and Blacks yet for Mexican–Americans the
Table 2 Associations [crude
odds ratios (OR) and 95 %
confidence intervals (CI)]
between demographic
characteristics and maternal and
child overweight/obesity for 74
maternal/child dyads
Maternal overweight/obesity Child overweight/obesity
OR (95 % CI) OR (95 % CI)
Maternal characteristics
Age (years) 1.1 (0.9, 1.2) 1.0 (0.9, 1.1)
Children in household 1.8 (1.0, 3.3)
a
1.1 (0.7, 1.6)
Years living in United States 1.1 (0.9, 1.2) 0.9 (0.8, 1.1)
Years school completed 0.9 (0.7, 1.2) 0.9 (0.7, 1.2)
Monthly household income
Below poverty line 1.0 (ref) 1.0 (ref)
Above poverty line 0.7 (0.3, 1.9) 1.0 (0.4, 2.5)
Marital status
Single/separated/divorced 1.0 (ref) 1.0 (ref)
Married 5.8 (1.8, 18.2)
b
1.3 (0.5, 3.7)
Employment status
Unemployed 1.0 (ref) 1.0 (ref)
Employed 1.3 (0.5, 3.9) 0.5 (0.2, 1.3)
Child characteristics
Age (years) 0.8 (0.6, 1.1) 1.1 (0.9, 1.5)
Gender
Male 1.0 (ref) 1.0 (ref)
Female 1.1 (0.4, 3.1) 1.0 (0.4, 2.1)
a
p\0.05;
b
p\0.01
J Immigrant Minority Health
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rate continues to be accelerating rapidly [31]. Current
prevention efforts have not had a significant impact on
obesity rates within this subgroup of the population.
Understanding the risk factors for overweight and/or obe-
sity is critical for developing effective programs.
An increase in the number of children in the household
was associated with an increased likelihood of maternal
obesity. After birth, many women have a difficult time
losing weight. Postpartum weight retention is a significant
predictor of subsequent maternal overweight [32,33]. The
cycle continues when pregnancies are spaced close toge-
ther, since pre-pregnancy weight also contributes to post-
partum weight retention. Excessive postpartum weight
retention is more likely to occur among minority women
[34]. Culturally relevant obesity prevention programs tar-
geting Mexican American women should focus on efforts
to reduce postpartum weight retention.
Household food insecurity was present in three-quarters
of the families. This rate is three times the prevalence of
food insecurity for Hispanic households in the U.S. in 2013
[8,9]. Since migrant work is seasonal, fluctuations in
income may lead to limited resources for purchasing food
[35–37]. Other studies have found that food insecurity rates
are much higher among immigrant populations. Food
insecurity rates of nearly 80 % have been found among
legal immigrants of Latino descent in California, Texas and
Illinois [37]. The rates in our current study are consistent
with these data documenting tremendous disparity in food
insecurity in immigrant populations.
Household food insecurity was not associated with
maternal overweight and/or obesity. This adds to the
growing body of knowledge that has produced conflicting
results for this association. Previous studies within other
Hispanic American populations have found positive
associations between food insecurity with maternal over-
weight [19–21]. Larger studies focused on understanding
the association between household food insecurity and both
maternal under and overweight are needed to continue to
investigate the impact of limited food availability on
weight and weight gain among Hispanic women.
Childhood overweight/obesity was also common among
children in this sample. National data from 2011 to 2012
have documented the highest prevalence of obesity among
Hispanic youth (22.4 %) compared to non-Hispanic white
youth (14.1 %) [7]. In the current study, rates of over-
weight/obesity were higher than the National average with
forty-five percent of children either overweight or obese,
the majority obese (30 %). Childhood obesity did not differ
by gender or household socioeconomic status in this study.
In a large study examining predictors of childhood obesity
among children in Mexico compared to those of Mexican
decent in the U.S., gender differences as well as socioe-
conomic differences were found only among the sample in
Mexico, but not those in the U.S [38]. Males and children
from lower income families living in Mexico were more
likely to be obese compared to females and those from
higher socioeconomic families, but this was not found for
the children residing in the U.S. The U.S. sample in that
study was from California, which has a large percentage of
migrant farm workers, similar to the population in Kennett
Square. Among this population, males and females might
be as equally likely to be overweight and/or obese. In
addition, the entire sample was predominantly low income
in both the California and Kennett Square populations,
where obesity rates are highest.
Surprisingly, maternal and childhood obesity were not
associated. Previous studies have documented clustering of
overweight and obesity within families due to both shared
Table 3 Crude (OR) and adjusted odds ratios (AOR)
a
and 95 % confidence intervals (CI) examining odds of child overweight/obesity for food
insecure households compared to food secure households
Any food insecurity Low food security Very low food security
OR (95 % CI) AOR (95 % CI) OR (95 % CI) AOR (95 % CI) OR (95 % CI) AOR (95 % CI)
Child overweight
All children 2.1 (0.7, 6.3) 2.5 (0.8, 8.0) 1.7 (0.5, 5.4) 2.1 (0.7, 6.9) 6.5 (1.1, 42.2)
b
8.2 (1.2, 56.9)
b
Normal weight mothers 2.3 (0.2, 27.4) 2.0 (0.2, 25.6) 1.5 (0.2, 19.4) 1.2 (0.08, 17.3) 1.3 (0.03, 3.2) 1.0 (0.47, 2.3)
Overweight/obese mothers 2.1 (0.6, 7.2) 3.0 (0.8, 11.7) 1.9 (0.5, 6.8) 2.8 (0.7, 11.4) 4.0 (0.5, 29.8) 6.2 (0.7, 54.8)
Child obesity
All children 11.1 (1.4, 89.5)
b
10.2 (1.2, 85.5)
b
8.7 (1.1, 71.8)
b
9.5 (1.2, 80.6)
b
30 (2.5, 354.9)
c
32.2 (2.6, 391)
c
Normal weight mothers 1.0 (0.1, 1.7) 1.0 (0.01, 11.0) 0.5 (0.02, 10.2) 0.3 (0.01, 10.5) 1.0 (0.06, 15.9) 1.0 (0.7, 3.2)
Overweight/obese mothers 9.0 (1.1, 74.9)
b
9.9 (1.1, 86.9)
b
6.7 (0.8, 58) 9.0 (1.0, 83.3)
b
28 (2, 394)
c
42.2 (2.5, 714)
c
a
Models adjusted for marital status, monthly household income, and number of children in household
b
p\0.05;
c
p\0.01
J Immigrant Minority Health
123

genetics and environment [39]. Zhang et al. [40] recently
investigated differences in the strength of the association
between parental obesity and childhood obesity by socio-
demographic characteristics. Associations between mater-
nal and child obesity were weakest among minority fami-
lies compared to non-Hispanic whites. The lack of a strong
association between maternal and child obesity among
minority families might be due to differences in parenting
styles, food habits, generational habits due to immigrant
status of the parents, as well as an increased reliance on
foods/meals obtained outside the home for children who
rely on school and community based food safety net
programs.
Food insecurity increased the odds of childhood obesity
within this sample of low-income Mexican immigrant
families. This relationship was strongest for children
residing in households where mothers were also over-
weight and/or obese. There are mixed results that come
from investigations examining the relationship between
food insecurity and childhood obesity [24–27]. Maternal
weight status has previously been found to moderate the
impact of food insecurity on childhood obesity among low-
income samples [28]. Overweight/obese mothers may be
more likely to engage in parenting or feeding styles that
might put a child at risk for being overweight. Hispanic
mothers in food insecure families have displayed greater
restrictive and pressuring feeding styles and have increased
concern for their children becoming overweight [41]. This
may be one possible pathway through which food insecu-
rity might be impacting child obesity, especially among the
Hispanic population. More investigations are needed to
help elucidate the causal mechanisms that link food inse-
curity with childhood obesity, especially among specific
race/ethnic groups.
This study had several limitations. The generalizability of
the findings from the current study may be impacted by the
small sample size and the recruitment strategy for partici-
pation. All mother/child dyads were recruited from a clinic
serving the low-income community in Kennett Square,
Pennsylvania. In addition, the majority of mothers and
children were already overweight and/or obese. Given the
lack of variability in the outcome, this study had a limited
ability to detect small associations. Finally, this was a cross
sectional study, which limits the ability to make any causal
inferences about the relationship between food insecurity
and childhood and/or maternal obesity within this sample.
New Contributions to the Literature
There are conflicting results examining the relationship
between food insecurity and childhood obesity among
Hispanic populations. This study adds to the literature by
demonstrating that maternal weight status moderates the
association between food insecurity and childhood obesity;
food insecure children residing in families whose mothers
are overweight and/or obese are at greater risk for obesity.
Since Hispanics are the fastest growing minority group in
the United States, carry with them the greatest share of the
obesity burden, and are at greatest risk for living in food
insecure families, it is critical to apply this knowledge to
existing programs to increase the effectiveness of obesity
prevention and treatment efforts at both the community and
individual level.
Acknowledgments The authors wish to thank Lakshmi Somasun-
daram and Olivia Cosides for assistance in collecting and compiling
the data and the staff at La Comunidad Hispana for allowing us to use
their facility and aiding the collection of data used for this study. We
also would like to thank all the mother and child study participants;
without their participation none of this would be possible.
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