FOOD INSECURITY, STRESS, AND CHILDHOOD OBESITY

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: NRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 0217040
• Grant No.: 2007-35215-05223
• Proposal No.: 2008-05294
• Project Start Date: Oct 1, 2008
• Project End Date: Jan 14, 2012
• Grant Year: 2009
• Program Code: [31.5]- Human Nutrition and Obesity

Recipient Organization
UNIVERSITY OF ILLINOIS
2001 S. Lincoln Ave.
URBANA,IL 61801

Performing Department
AGRICULTURAL AND CONSUMER ECONOMICS

Non Technical Summary
Obesity and food insecurity in children are serious public health concerns in the U.S. Paradoxically, a large share of low-income children suffering from food insecurity are obese. A potential reason for these high rates of obesity is that low-income children experience high levels of stress. Using data from three large-scale data sets - the National Health and Nutrition Examination Survey (NHANES); the Panel Study of Income Dynamics (PSID); and Welfare, Children, and Families: A Three-City Study - we consider the respective roles of food insecurity and stress on obesity among children. In particular, we address three questions. What is the relationship between food insecurity and obesity in children Our use of three datasets and advanced statistical techniques will provide a more rigorous test of this relationship than previous studies. How does stress affect child obesity Until now, this question has been addressed only through small-scale epidemiological studies. We build on these studies by using large-sample surveys with rich arrays of stress indicators. What are the relative influences of food insecurity and stress on obesity in children The varieties of stress experienced by low-income children may modify the relationship between food insecurity and obesity. Previous studies have not examined the relative influences of these constructs and their potential interactive effects. The answers to these questions will inform prevention and intervention programs targeted at reducing both food insecurity and obesity among low-income children.

Animal Health Component

(N/A)

Research Effort Categories

Basic

100%

Applied

(N/A)

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
704	6020	3010	40%
802	6020	3010	40%
704	6020	1010	10%
802	6020	1010	10%

Knowledge Area
704 - Nutrition and Hunger in the Population; 802 - Human Development and Family Well-Being;

Subject Of Investigation
6020 - The family and its members;

Field Of Science
1010 - Nutrition and metabolism; 3010 - Economics;

Keywords

children

childhood obesity

stress

maternal stress

poverty

low income

bmi

food insecurity

probit models

ols models

economics

nutrition

national health and nutrition examination survey (nhanes)

panel study of income dynamics (psid)

welfare, children, and families: a three-city study

Goals / Objectives
One in every six children in the U.S. is obese, making it one of the most prevalent medical issues among youth today. Alongside the challenge of this serious public health concern, one in five children in the U.S. lives in a food insecure household, i.e., a household that does not have the financial means to access enough food to sustain active, healthy living for all members. Several studies show a positive relationship between food insecurity and obesity in low-income children. We aim to understand this relationship in greater detail by exploring how stress among children living in food insecure households may explain or exacerbate their propensity to be obese. We do so by answering the following three questions using data from three separate data sets - The National Health and Nutrition Examination Survey (NHANES); The Panel Study of Income Dynamics (PSID); and Welfare, Children, and Families: A Three-City Study. 1. What is the relationship between food insecurity and obesity in children Whereas the bivariate positive relationship between food insecurity and obesity is fairly robust, the relationship is less obvious after controlling for relevant factors. Altogether, previous research on the relationship between food insecurity and obesity is unclear. Our use of three datasets and a wide array of sophisticated statistical techniques will provide a more rigorous test of this association. 2. How does stress affect child obesity To date, this question has been addressed only through examinations of data collected in smaller epidemiological studies; it has not been addressed through analyses of large, nationally representative data. In addition, previous studies have not held constant an assortment of other relevant covariates that may influence this relationship. Our work will address both of these limitations. Of particular interest for this proposal are financial stressors (e.g., job loss, declines in income, high debt levels, lack of savings) that may affect overall stress. Financial stress may affect obesity through both biological mechanisms (e.g., activation of the body's internal stress response system resulting in chemical changes associated with obesity) and social mechanisms (e.g., changes in food procurement and consumption habits, such as relying on low-cost packaged food). 3. What are the relative influences of food insecurity and stress on obesity in children The number, type, and intensity of stressors experienced by children and families may exacerbate the relationship between food insecurity and child obesity. For example, a food insecure household that experiences unstable employment (a stressor) may be more likely to have an obese child than a food insecure household which has had steady employment. The stress associated with unemployment may lead caregivers to become less motivated to prepare healthy foods positively associated with children's long-term health. To cite another example, low savings may induce food insecure households to make inconsistent food purchases which may lead to obesity due to not being confident about what may happen to their family finances in the future.

Project Methods
Our analyses will be conducted with data from the National Health and Nutrition Examination Survey (NHANES), the Panel Study of Income Dynamics (PSID), and Welfare, Children, and Families: A Three-City Study. The NHANES, conducted by the National Center for Health Statistics, Centers for Disease Control (NCHS/CDC), is a program of studies designed to assess the health and nutritional status of adults and children in the United States through interviews and direct physical examinations. The PSID, begun in 1968, is a longitudinal, representative sample of U.S. individuals and family units. It emphasizes the dynamic aspects of economic and demographic behavior, but its content is broad, including sociological, psychological, and health measures. The Three-City Study is a six-year longitudinal, multi-method investigation designed to understand the effects of welfare reform on the well-being of low-income children and families. All three data sets are well-suited for this research as they have large samples of low-income households and detailed information on child obesity, food insecurity, stressors, and relevant covariates. Since food insecurity is proportionately a low-income issue, we restrict our samples to children in households with incomes below 200 percent of the poverty line. Our analyses will use the following major constructs: Our first is child obesity which will be measured by a continuous measure (the BMI z-score) and two binary measure of obesity using the Center for Disease Control and Prevention and the International Obesity Task Force cutoffs. Our second is food insecurity which is measured at the household level and, in the Three-City Study at the household and focal child level. Our third set of constructs is stressors. We break these down into individual stressors (at the child level), household stressors, and community stressors. To address the three objectives of this proposal (What is the relationship between food insecurity and obesity in children; How does stress affect child obesity; What are the relative influences of food insecurity and stress on obesity in children), we utilize cross-sectional and longitudinal models. The former allow us to examine the contemporaneous effects of food insecurity, stressors, and their interactions on child obesity. In cases when a binary measure of obesity is used we will estimate our models with probit maximum likelihood estimation (MLE) models. When we use continuous measures of obesity, we will estimate our models using ordinary least squares (OLS). Our longitudinal models allow us to examine a wider array of factors influencing child obesity. For example, our first set of longitudinal models - lagged regressions - allows us to assess the effects of past and contemporaneous factors on child obesity. Since child obesity does not appear suddenly, understanding the effects of previous factors is important. Our second set of longitudinal models - fixed effects models - allow us to control for unobserved factors. This is especially important since obesity is effected by a number of factors, some observed (by the researcher), others unobserved.

Progress 10/01/08 to 01/14/12

Outputs
OUTPUTS: The central goal of this project was to understand how food insecurity and stress affect childhood obesity in the United States. To this end, for this project, among other activities, we have published multiple papers in refereed journals and we have presented our work at numerous national and international conferences. PARTICIPANTS: PI - Craig Gundersen, co-PI - Steve Garasky, co-PI - Brenda Lohman, RA - Yemisi Kuku, RA - Duhita Mahatmya, RA - Monserrat Bustelo, RA - Monica Yanez-Pagans, and RA - Monserrat Bustelo. TARGET AUDIENCES: Results from our work were shared with academicians, scholars, practitioners, and policy-makers through our publications and conference presentations. In addition, the popular press coverage allowed our information to be shared internationally with the lay public. Our work highlights the pressing need to understand why millions of America's children are overweight, food insecure, or both. In attempts to disseminate our work beyond academic circles, our work has received a great deal of attention. As part of this, we have responded and addressed their questions regarding our work. Through these informal conversations we were able to deliver our science-based knowledge to those who may not typically have access to such information. We have further developed our outreach efforts through the publication of our work in Rural Connections, a newsletter from the Western Rural Development Center. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
In the course of this project, papers have been published in numerous top journals including Obesity Reviews (2 papers), Pediatrics, Journal of Nutrition (2 papers), the Journal of Adolescent Health, Social Science Research, and Applied Economics. Combined, our work has generated enormous media interest with articles appearing in print and on-line in publications across the world. This press coverage is a reflection of the impacts of food insecurity, stress, and childhood obesity on millions of low-income children in the U.S. Along with publications, in total, the work from this project has been presented at several national conferences where papers were selected via a competitive process (Association of Public Policy Analysis and Management (APPAM), Population Association of America (PAA), and American Agricultural Economic Association (AAEA)) and in several invited seminars at universities (University of Tennessee Obesity Research Center; Institute for Government and Public Affairs at University of Illinois; Department of Human and Community Development at University of Illinois). Most recently, our work served as the basis for a presentation at an Institutes of Medicine workshop on the connection between food insecurity and obesity. We gave the opening presentation on this issue for children. Along with producing work that is closely followed by researchers, policymakers, the media, and the general public, the results from this project were used to help construct the analyses used in another recently-funded NRI grant (Grant number 2009-35215-05182). That grant is "Stress, Financial Management, and Childhood Obesity." Craig Gundersen (PI) and Steven Garasky (co-PI) are joined in this project with other researchers at Iowa State University, Michigan State University, and University of Illinois.

Publications

• Gundersen, C. and Garaksy, S. 2009. Food insecurity and stress among children in the western United States. Rural Connections, 4(1), 13-14.
• Gundersen, C., Garasky, S. and Lohman, B. Food insecurity is not associated with childhood obesity as assessed using multiple measures of obesity. Journal of Nutrition, v139, 1173-1178. 2009.
• Lohman, B., Stewart, S., Gundersen, C., Garasky, S. and Eisenmann, J. 2009. Adolescent overweight and obesity: Links to food insecurity and individual, maternal, and family stressors. Journal of Adolescent Health 45(3), 230-7.
• Gundersen, C., Lohman, B., Garasky, S., Stewart, S. and Eisenmann, J. 2008. Food security, maternal stressors, and overweight among low-income U.S. children: Results from NHANES 1999-2002. Pediatrics, v122, e529-e540.
• Gundersen, C., Lohman, B., Eisenmann, J., Garasky, S. and Stewart, S. 2008. Lack of association between child-specific food insecurity and overweight in a sample of 10-15 year old low-income youth. Journal of Nutrition, v138, 371-378. 2008.
• Kuku, O., Gundersen, C. and Garasky, S. 2012. The relationship between childhood obesity and food insecurity: A nonparametric analysis. Applied Economics. 2012.
• Gundersen Mahatamaya Garasky Lohman. Forthcoming. Linking Environmental and Psychosocial Stressors and Childhood Obesity. Obesity Reviews, v12(501), e54-e63. 2011.
• Eisenmann, J., Gundersen, C., Lohman, B., Garasky, S. and Stewart, S. 2011. Is food insecurity related to overweight and obesity in children and adolescents A summary of studies, 1995-2009. Obesity Reviews, v12(501), e73-e83. 2011.
• Garasky, S., Stewart, S., Gundersen, C., Lohman, B. and Eisenmann, J. 2009. Family stressors and child obesity. Social Science Research 38, 755-766.

Progress 10/01/09 to 09/30/10

Outputs
OUTPUTS: The central goal of this project is to understand how food insecurity and stress affect childhood obesity in the United States. To this end, in the past year, among other activities, we have published two papers in refereed journals and we gave the opening address at a recent IOM conference on the connection between food insecurity and obesity. Abbreviated abstracts for the three papers published in refereed journals are as follows: "Linking Environmental and Psychosocial Stressors and Childhood Obesity": Research has established a wide array of genetic and environmental factors that are associated with childhood obesity. The focus of this review is on recent work that has established the relationship between one set of environmental factors, stressors and childhood obesity. These stressors are particularly prevalent for low-income children, a demographic group that has high rates of obesity in the U.S. and other developed countries. In this review, we begin by summarizing the psychosocial stressors faced by children followed by health outcomes associated with exposure to these stressors documented in the literature. We then summarize articles which examined the connection between stressors and obesity. Policy recommendations emerging from this research include recognizing reductions in childhood obesity as a potential added benefit of social safety net programs that reduce financial stress among families. In addition, policies and programs geared towards childhood obesity prevention should focus on helping children build resources and capacities to teach them how to cope effectively with stressor exposure. We conclude with suggestions for future research. "Adolescent Overweight and Obesity: Links to Food Insecurity and Individual, Maternal, and Family Stressors": Several nutrition-related issues confront the normal growth, maturation and development of children and adolescents including obesity and food insecurity. The purpose of this paper is to provide a review of the concept of food insecurity and a summary of studies that have examined the association between food insecurity and overweight/obesity in children and adolescents. The results are mixed with positive, negative and null associations. More recent studies with larger samples have overcome these limitations and tend to find no associations between these constructs. Nonetheless, all of the studies to date have shown that food insecurity and overweight co-exist - that is, even though there may not be statistically significant differences in overweight between food-insecure and food-secure children, the prevalence of overweight remains relatively high in food-insecure children. PARTICIPANTS: PI - Craig Gundersen; Co-PI - Steve Garasky; Co-PI - Brenda Lohman; RA - Yemisi Kuku; RA - Duhita Mahatmya; and RA - Monserrat Bustelo. TARGET AUDIENCES: Results from our work were shared with academics, scholars, practitioners, and policy-makers through our publications and conference presentations. In addition, the popular press coverage allowed our information to be shared internationally with the lay public. Our work highlights the pressing need to understand why millions of America's children are overweight, food insecure, or both. In attempts to disseminate our work beyond academic circles, our work has received a great deal of attention. As part of this, we have responded and addressed their questions regarding our work. Through these informal conversations we were able to deliver our science-based knowledge to those who may not typically have access to such information. We have further developed our outreach efforts through the publication of our work in Rural Connections, a newsletter from the Western Rural Development Center. PROJECT MODIFICATIONS: A no-cost extension was granted.

Impacts
In the past year, papers from this project have been accepted at a premier obesity research journal - Obesity Reviews. This is in addition to previous work that has appeared in the Journal of Nutrition (2 papers), the Journal of Adolescent Health, Social Science Research, Pediatrics and the Journal of Nutrition. Combined, our work has generated enormous media interest with articles appearing in print and on-line in publications across the world. This press coverage is a reflection of the impacts of food insecurity, stress, and childhood obesity on millions of low-income children in the U.S. Along with publications, in total, the work from this project has been presented at several national conferences where papers were selected via a competitive process (Association of Public Policy Analysis and Management (APPAM), Population Association of America (PAA), and American Agricultural Economic Association (AAEA)) and in several invited seminars at universities (University of Tennessee Obesity Research Center; Institute for Government and Public Affairs at University of Illinois; Department of Human and Community Development at University of Illinois). Most recently, our work served as the basis for a presentation at an Institutes of Medicine workshop on the connection between food insecurity and obesity. We gave the opening presentation on this issue for children. Along with producing work that is closely followed by researchers, policymakers, the media, and the general public, the results from this project were used to help construct the analyses used in another recently-funded NRI grant (Grant number 2009-35215-05182). That grant is "Stress, Financial Management, and Childhood Obesity." Craig Gundersen (PI) and Steven Garasky (Co-PI) are joined in this project with other researchers at Iowa State University, Michigan State University, and University of Illinois.

Publications

• Gundersen, C. Mahatamaya, D., Garasky, S. and Lohman, B. 2011. Linking environmental and psychosocial stressors and childhood obesity. Obesity Reviews.
• Eisenmann, J., Gundersen, C., Lohman, B., Garasky, S. and Stewart, S. 2011. Is food insecurity related to overweight and obesity in children and adolescents A summary of studies, 1995-2009. Obesity Reviews.

Progress 10/01/08 to 09/30/09

Outputs
OUTPUTS: The central goal of this project is to understand how food insecurity and stress affect childhood obesity in the United States. To this end, in the past year, we have published three papers in refereed journals, one paper in the Rural Connections newsletter, and one paper under review at a refereed journal. Based on this work, we have given several presentations at conferences and universities. Abbreviated abstracts for the three papers published in refereed journals are as follows. "Food Insecurity is not Associated with Childhood Obesity as Assessed using Multiple Measures of Obesity": There has been extensive previous research examining the connection between obesity and food insecurity with the use of BMI to categorize a child as obese. Although BMI is one way to categorize the obesity status of a child, other measures have not been used to understand the connection between food insecurity and obesity. In response, this study used multiple measures of obesity taken from the 2001 to 2004 NHANES. The results from logistic regression models indicated that food-insecure children were no more likely to be obese than their food-secure counterparts across all measures of obesity. This relationship held after controlling for other factors and examining subpopulations based on race/ethnicity, gender, and race/ethnicity and gender. "Adolescent Overweight and Obesity: Links to Food Insecurity and Individual, Maternal, and Family Stressors": A high proportion of adolescents living in low-income households in the United States are overweight or obese, food insecure, and/or exposed to high levels of stress. The aim of this paper was to identify the associations of food insecurity and stress with an adolescent's propensity to be overweight or obese. The sample was drawn from the Welfare, Children, and Families: A Three-City Study. Using logistic regressions models, the paper found that higher levels of individual stressors increased the probability of being overweight or obese for adolescents, whereas there was no direct association between food insecurity, maternal, or family stressors and being overweight or obese. The interaction of food insecurity and maternal stressors was significantly linked to the probability of being overweight or obese. "Family Stressors and Child Obesity": Child obesity is a public health priority with numerous and complex causes. This study focuses on factors within the family, namely stressful experiences, which may be associated with child obesity. We examine data from the Child Development Supplement of the Panel Study of Income Dynamics. Results from an ordered probit regression model of child weight categorizations (healthy weight, overweight, obese) indicate positive associations between a range of family stressors (lack of cognitive stimulation and emotional support in the household among younger children, and mental and physical health problems and financial strain in the household among older children) and child obesity. PARTICIPANTS: PI - Craig Gundersen, co-PI - Steve Garasky, co-PI - Brenda Lohman, RA - Yemisi Kuku, RA - Duhita Mahatmya, RA - Monica Yanez-Pagans, RA - Monserrat Bustelo. TARGET AUDIENCES: Results from our work were shared with academics, scholars, practitioners, and policy-makers through our publications and conference presentations. In addition, the popular press coverage allowed our information to be shared internationally with the lay public. Our work highlights the pressing need to understand why millions of America's children are overweight, food insecure, or both. In attempts to disseminate our work beyond academic circles, our work has received a great deal of attention. As part of this, we have responded to and addressed their questions regarding our work. Through these informal conversations we were able to deliver our science-based knowledge to those who may not typically have access to such information. We have further developed our outreach efforts through the publication of our work in Rural Connections, a newsletter from the Western Rural Development Center. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
In the past year, papers from this project have appeared in three leading journals, the Journal of Nutrition, the Journal of Adolescent Health, and Social Science Research. This is in addition to papers from this project that appeared in leading journals in previous years of the project including Pediatrics and the Journal of Nutrition. Combined, our work has generated enormous media interest with articles appearing in print and on-line in publications across the world. This press coverage is a reflection of the impacts of food insecurity, stress, and childhood obesity on millions of low-income children in the U.S. Along with publications, in total, the work from this project has been presented at several national conferences where papers were selected via a competitive process (Association of Public Policy Analysis and Management (APPAM), Population Association of America (PAA), and American Agricultural Economic Association (AAEA)) and in several invited seminars at universities (University of Tennessee Obesity Research Center; Institute for Government and Public Affairs at University of Illinois; Department of Human and Community Development at University of Illinois). Along with producing work that is closely followed by researchers, policymakers, the media, and the general public, the results from this project were used to help construct the analyses used in another recently-funded NRI grant (Grant number 2009-35215-05182). That grant is "Stress, Financial Management, and Childhood Obesity." Craig Gundersen (PI) and Steven Garasky (co-PI) are joined in this project with other researchers at Iowa State University, Michigan State University, and University of Illinois.

Publications

• Garasky, S., Stewart, S.D., Lohman B.J., Gundersen, C. and Eisenmann, J. 2009. Family stressors and child obesity. Social Science Research, 38, 755-766.
• Gundersen, C. and Garaksy, S. 2009. Food insecurity and stress among children in the western United States. Rural Connections, 4(1), 13-14.
• Gundersen, C., Garasky, S. and Lohman, B.J. 2009. Understanding the associations between food insecurity and multiple measures of childhood obesity. Journal of Nutrition 139, 1173-1178.
• Lohman, B.J., Stewart, S.D., Gundersen, C., Garasky, S. and Eisenmann, J.C. 2009. Adolescent overweight and obesity: Links to food insecurity and individual, maternal, and family stressors. Journal of Adolescent Health 45(3), 230-7.