Understanding the paradox of obesity and food insecurity

Adults and children living in under-resourced communities experience disproportionate exposure to obesity risk factors.

A graphic illustration of a family standing in front of a heart.
Photo: Gerd Altmann/Pixabay.

The existence of food insecurity and obesity in the same space may, on the surface, seem counterintuitive. Yet research studies suggest that adults and children who experience food insecurity may be at an increased risk for obesity in the United States and around the world.

The association between food insecurity and obesity has been referred to as the “obesity-food insecurity paradox.” While the links between obesity and inadequate food resources are yet to be fully understood, environmental risk factors faced by under-resourced communities appear to play a significant role.

Food insecurity

Food insecurity is defined as “the state where there is limited, inadequate, or unreliable availability or access to obtain nutritionally sufficient and safe foods in socially acceptable ways.”

The U.S. Department of Agriculture (USDA) report of Household Food Security in the United States in 2022 cites that 12.8 percent of American households (17.0 million households) were food insecure in 2022, meaning that they had difficulty at some time during the year providing enough food for all their household members because of a lack of resources. This was up from 10.2 percent recorded in 2021 (13.5 million households) and 10.5 percent reported in 2020 (13.8 million households).

While poverty is a key contributor to food insecurity, race and ethnicity are also connected. The USDA Household Security report states that rates of food insecurity in 2022 were statistically significantly higher than the national average (12.8 percent) for households with Black, non-Hispanic (22.4 percent) and Hispanic (20.8 percent) persons.

Social determinants of health and childhood obesity

The American Academy of Pediatrics (AAP) acknowledges that obesity is more complex than the personal choices individuals make around the calories they consume and the calories they expend. In fact, obesity affects population groups unequally, with higher rates of childhood obesity for those living in poverty, in under-resourced communities, in families that have immigrated, and in populations that have experienced racism. Differences in health outcomes by populations that have been marginalized are examples of health disparities.

In low-income and minority communities, factors referred to as social determinants of health appear to influence obesity prevalence. According to the Centers for Disease Control and Prevention (CDC), social determinants of health are “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” Examples of social determinants can be job opportunities and income, access to education, healthcare, transportation, housing and a safe physical environment, as well as the experience of structural racism.

The AAP’s Clinical Practice Guideline outlines social determinants of health that are associated with obesity among children and adolescents in low-income communities. Findings include:

  • Inequalities in poverty, unemployment and homeownership attributable to structural racism, as well as racism experienced in everyday life, are linked to increased obesity rates in children.
  • Adverse childhood experiences (ACEs), such as family turmoil and violence, financial hardship, loss of a parent, divorce, neglect and family member mental illness, are associated with obesity. The greater number of ACEs, the greater risk for obesity.
  • Poverty and associated toxic stresses in utero and early childhood have been suggested to produce adaptations that lead to obesity which can persist throughout the lifetime.

The AAP Clinical Practice Guideline also suggests that “under-resourced communities are settings in which obesity risk factors can predominate over health promoting factors.” These risk factors include environmental variables that influence inequities in food and physical activity options for adults and children in low-income and racial and ethnic minority communities. Environmental influences on obesity:

  • Physical factors, such as limited access to full-service grocery stores and fresh produce; ready access to fast food, convenience food, and sugar-sweetened beverages; limited parks and safe playground equipment; and barriers to outdoor activity due to traffic, crime and air quality.
  • Economic factors, such as unemployment or underemployment; lack of personal or public transportation for regular grocery trips; cost of nutritious versus readily available convenience food; and limited investment in parks and recreational facilities.
  • Policy/political factors, such as governmental policies related to nutrition and income assistance; regulations on food advertising; and school wellness policies.
  • Sociocultural factors, such as food-related cultural practices; caregiver beliefs and feeding practices; screen time and exposure to food advertising; and gender norms around physical activity and body image.

The CDC asserts that addressing differences in social determinants of health can make progress toward health equity, which is “a state in which every person has the opportunity to attain their highest level of health.” Health equity, therefore, is a path to obesity prevention.

For more information and resources, visit MSU Extension's Food & Health website.

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