At a time when overweight and obesity are commanding attention, it is easy to overlook the fact that "food insecurity continues to be a significant (and in recent years growing) public health problem as well," the Food Research and Action Center (FRAC) reported at its annual conference in Washington, D.C., February 27.

"Food insecurity," defined as "not having enough money to buy food" was first measured nationally in 1995 and showed a downward trend until 2000, when it began to climb again, reaching 11.9 percent of all households in the year 2005, according to the Bureau of the Census Current Population Survey. In the same period of time, rates of overweight and obesity grew.

In a report that looked for possible linkages between those statistics, FRAC found that both food insecurity and overweight/obesity rates were highest for low-income people, particularly women, and a striking finding was that the two conditions—weight gain and food insecurity—"can affect the same individuals and households, as well as communities."

"For poor people and communities, food insecurity and obesity are a kind of negative ‘double whammy.’ This dual nutrition problem thus is an enormous challenge for policy-makers, communities, and practitioners. How can these two public health problems be dealt with simultaneously, in an effective and sensitive manner?"

Not that everyone, adult or child, who is overweight is also poor, the FRAC report is careful to point out. There are many and complicated variations. For children, as income increases, the risk of obesity decreases for white girls and boys but increases for Hispanic boys. Asian boys have lower rates of obesity at both low and high incomes, compared with middle-income Asian families. The rate of obesity among African-American boys varies very little by family income but the prevalence of obesity among African-American girls is lowest for those from middle-income families and highest for girls from families with low and high incomes. Asian girls have lower obesity prevalence overall, while Hispanic girls at all incomes have comparatively high rates of obesity.

What Do We Know about Obesity?

Until very recently, the FRAC report points out, the primary and sometimes only cause of obesity in the minds of many people was lack of personal responsibility. "According to this belief, the prescription for change was individual—nutrition education, improved parental responsibility, and increased strength of character."

But while not losing sight of the important role of individual parental and child responsibility, researchers have now identified a range of environmental or external causes and changes in recent decades that have contributed to the obesity epidemic by contributing to increased food intake (and especially less intake of healthful foods) and to decreased physical activity.

The FRAC report outlines some of the conditions that contribute to overweight: "Children have less physical education at school and face the temptations of vending machines and high-fat snack sales in schools at all hours. Entertainment, for both children and adults, as well as children’s schooling and adults’ work experience, tend to be more sedentary, with multi-channel televisions, computers, and other engaging electronic gadgets. Many communities are laid out in ways that discourage physical activity, and parents are often fearful about children walking home from school or playing outside, for safety reasons and because parents are not at home after school. Large amounts of super-sized tempting high-fat foods are readily accessible all around us—at every shopping mall, in many public buildings, and, it sometimes seems, on every street corner—and are advertised to both children and adults on television and in many other venues."

The report points out that low-income families and neighborhoods "face all of these challenges and more." Low-income neighborhoods lack full-service grocery stores and those stores that do exist are more likely to offer high-calorie foods than fruits, vegetables, or skim milk. There may be few safe or attractive places to be physically active, and under-funded schools may lack suitable cafeterias or physical education facilities.

The report also notes that schools and school districts in both high- and low-income communities "have entered into contracts for the sale of certain products in vending machines that end up bringing cash resources to the school at the expense of children’s nutrition. Schools may also choose for financial reasons to sell profitable items in cafeteria ‘a la carte’ lunch lines (additional lines that sell individual foods, sometimes of questionable healthfulness, in competition with the school lunch program). The foods on these a la carte lines, like the contents of school vending machines, are not controlled by strong nutritional standards."

The FRAC report also points out that social and emotional factors may be causes of obesity among children. "Several studies have shown an association between depression in children and the development of obesity. Moreover, some researchers are beginning to suggest that the brain’s response to stress may lead to central fat deposition and insulin resistance in adults. Stress could also affect children in similar ways."

What Is Hunger?

"It is difficult for people to believe that hunger exists in the United States in the 21st century," the report acknowledges. "Food and images of food are everywhere we look, and obesity is the major nutrition concern being expressed. Our country is extraordinarily wealthy."

Yet hunger persists, the report points out, "not as often the nutritional deficiency diseases physicians saw in the 1960s, but rather a chronic, cyclical, poverty-related inadequacy in household food supplies." To try to measure that new form of hunger, the Food Research and Action Center developed the first national survey of families with at least one child below the age of 12, using a new definition of the term "food insecurity" to mean that "the availability of nutritionally adequate and safe foods is limited or uncertain." "Hunger" was defined as "the uneasy or painful sensation caused by lack of food."

What the surveys found was that low income (due to low-wage jobs, involuntary part-time or part-year work, job loss, unemployment, illness, inadequate public income supports, etc.) often leaves households with insufficient money or other resources to obtain enough food. In the United States, according to the latest data available (2004), that’s 11.9 percent of households—7.4 million adults and 3.3 million children.

And recent research has uncovered that one of the potential consequences of food insecurity is obesity, the report states. The authors concede that "At first blush, it is counterintuitive that hunger and food insecurity can co-exist with obesity in the same individual," and they concede that there is only a limited amount of research on that connection in children. They note, however, that the effects of food insufficiency may affect children "directly in food intake, indirectly in learned food patterns, and potentially indirectly in ways not yet understood, with lifelong consequences."

In a lengthy discussion of the current status of federally subsidized food programs for children—subsidized lunch and breakfast, after-school snacks and meals, the summer food service program, the child and adult care food program for preschoolers, and WIC (the Special Supplemental Food Program for Women, Infants, and Children)—the FRAC report concludes that these programs, if fully implemented, could play a large role in reducing food insecurity and obesity.

"There are still many children who are not receiving the benefits of these programs. Barriers to participation must be overcome to ensure that all children and especially low-income children can take full advantage of the nutritious meals and snacks offered by these programs. If seen and utilized as important allies in the battles against obesity and food insecurity, the child nutrition programs can help lead many low-income households on a healthier path."

The report "Obesity, Food Insecurity and the Federal Child Nutrition Programs" is available online at www.frac.org.

See also Childhood Overweight What the research tells us at http://www.healthinschools.org/sh/obesityfs.asp and Keeping Kids Healthy: Overweight, Nutrition & Physical Activity at http://www.healthinschools.org/sh/obesity.asp