Analysis concluded no greater likelihood of overweight or risk of overweight for food secure versus food insecure adolescents. The third study was performed by Smith and colleagues to explore relationships between dietary intake, perceived insecurity, and obesity risk among homeless Minnesotan adolescents ages 9 to Dietary examination revealed under-consumption of fruits, vegetables, and dairy and, conversely, excessive servings of fats, oils, and sweets. About half of the sample was overweight or at risk for overweight.
Moreover, half reported food insecurity, with one in four reported going to bed hungry. Forty-five percent reported inadequate food supply. In other words, as this particular measure of food insecurity increased, the likelihood of overweight decreased. However, females who reported going to bed hungry were significantly more likely to be overweight.
Six studies examined food insecurity and obesity in adults; one of these studies included children and has been summarized previously. The first study, by Hanson et al, examined the relationship between food insecurity and body weight, and whether gender and marital status influenced that relationship. This study revealed differential impacts of marital status on the food insecurity-obesity relationship. After controlling for demographic differences, divorced men were at significantly greater risk than never married men to live in a household with very low food security.
Marginally food secure men had significantly higher mean BMI scores than food-secure counterparts and exhibited tendencies toward overweight and obesity, though the latter observations did not reach significance. However, males experiencing low food security were significantly less likely than food-secure others to overweight or obese. Conversely, when compared with fully food-secure women, those with low food security were more likely to be obese. Additionally, marginal food security among women was significantly associated with overweight compared to food-secure counterparts.
Lastly, a significant interaction between marital status and food insecurity among women revealed that food-insecure married, partnered, and widowed women were significantly more likely to be obese than food-secure never-married women. This interaction was not significant among men. Another study, led by Sullivan, used data from four Boston-area hospitals to ascertain food insecurity and related medical conditions and expenditures among adult emergency department ED patients ages 18 and older. However, when stratified by gender, higher mean BMI remained significant only among women.
Food-insecure patients were also more likely than food-secure counterparts to report chronic disease and mental health problems i. Webb and colleagues used a sample of low-income adults to explore food insecurity and participation in government-sponsored food programs—two factors purported to contribute to BMI. However, after controlling for demographic factors and food stamp program FSP participation, these findings lost significance.
In contrast, FSP participation or previous year participation in any government-sponsored food program was significantly associated with higher BMI, even after controlling for food security status and other factors. Among current FSP participants, enrollment for six months or more was significantly associated with lower BMI when compared to those who had participated for a shorter period. Data from the — NHANES were used by Wilde and Peterman to explore weight change in response to household food security status in about 10, adults.
Among women, all levels of food insecurity were significantly associated with higher BMI and overweight when compared to full food security. Moreover, women experiencing marginal food security or food insecurity without hunger were significantly more likely to be obese than food-secure counterparts. In men, food insecurity without hunger was significantly associated with lower BMI and smaller proportion of overweight and obesity when compared to full food security. However, in multivariate analysis, men experiencing marginal food security were 1.
Analysis of weight change only yielded significant findings in women.
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A fifth study, conducted by Holben and Pheley, assessed the relationship of food security to various chronic health indicators among rural residents of Appalachian Ohio. Food insecurity was significantly associated with higher BMI and higher proportions of obesity; however, no differences were found in diastolic blood pressure, total cholesterol, and random blood glucose. Among women, the results were more pronounced.
BMI and HbA1c levels were significantly higher in food insecure versus fully secure women. Lastly, Martin and Ferris, as aforementioned, used a convenience sample of low-income parents to examine the relationship between food insecurity and obesity. Unlike the children in the sample, food insecure adults were nearly 2. Education level was significantly and positively associated with overweight among adults. Four studies addressed food insecurity and obesity in female populations.
After adjusting for covariates, food insecure women were three times more likely to be severely obese before pregnancy than those who were food secure. Contrarily, weight change and prevalence of excessive weight gain, though significantly higher among food-insecure women, did not maintain significance in regression analysis. Another conclusion drawn from the study was that food insecure women were more than twice as likely to experience gestational diabetes mellitus during pregnancy.
Another study led by Olson followed healthy adult women from early pregnancy to two years postpartum, to analyze impacts of food insecurity on weight at and between both time points. However, obesity in early pregnancy was significantly and positively associated with food insecurity at two years postpartum. Women who were both obese and food insecure in early pregnancy were significantly more likely to maintain this status in the postpartum period. A third study by Whitaker and colleagues followed over 1, mothers of preschool children for two years to assess the impact of baseline food security status on weight change.
The authors found significant positive associations between baseline food insecurity and obesity at baseline and follow-up. However, these associations lost significance after controlling for demographic variables. Other analysis demonstrated no significant differences in weight change based on either baseline food security status or change in food security status. A final study by Jones and Frongillo found that persistent food insecurity was significantly associated with weight loss of nearly 7 kilograms over a two-year period. No significant associations between change in food insecurity status and weight change existed.
Moreover, after testing the interaction of FSP participation, one of the two models demonstrated it was significantly associated with greater positive weight change among persistently food-insecure women. One study, by Kim et al, examined the effect of food security and participation in food assistance programs on overweight and depression among elders and their spouses. Specifically, food-insecure elders at follow-up had significantly higher BMI, and those who were food-insecure at baseline experienced greater increases in BMI than food-secure counterparts.
Additionally, as food-secure elders became insecure, BMI increased. Current food-insecure elders had significantly higher depression scores than food-secure others in both samples. Participation in food assistance programs as a modifier of food insecurity was associated with significant decreases on BMI in the AHEAD sample, except in one model. Analysis of the HRS sample demonstrated some evidence of decreasing depression among food-insecure elders participating in food assistance programs.
Overall, the studies reviewed maintained mixed evidence of positive associations between food insecurity and obesity across age and gender groups. Food insecurity-obesity links among women remained consistent, with growing evidence among adolescents, mixed evidence among children, and sparse evidence among men one study.
Two studies demonstrated a linear association between food insecurity and obesity levels. Some theories about the food insecurity-obesity link continue to hold true; others lack support. The sacrifice theory has been heavily documented to explain inconsistent links in children and strong links among women. Mothers are thought to sacrifice their food supply to ensure that children remain food secure.
This theory is supported by evidence that only half of food-insecure households with children are also child food-insecure. Studies summarized in this review revealed new factors that may influence the food insecurity-obesity relationship.
Maternal stressors demonstrated significant, but mixed, impacts on youth and adolescents. These factors deserve continued investigation. An updated review of the role of food assistance programs in explaining this paradox was recently published. The underlying review has several strengths. First, the studies reviewed here are more comparable than those reviewed by Dinour, due to greater consistency in definition and measurement of food security and weight status.
This was a limitation mentioned in the previous review. Our studies also provide more information about other factors that potentially mediate the food insecurity-obesity relationship, including stressors, marital status, and participation in food assistance programs. Additionally, the use of longitudinal analyses provides greater insight about the impact of food insecurity over time on weight status. Among longitudinal studies reviewed, none supported a food insecurity-obesity link. Still, enhanced measurement and continued investigation of food security are warranted.
Current tools do not distinguish acute and chronic food insecurity. Moreover, few longitudinal surveys evaluate food insecurity and weight status at various time points. Given the accessibility of the CFSM, food security evaluation can also be incorporated easily into local and regional studies. Lastly, future studies should explore factors influencing differential weight outcomes among groups at greatest risk for food insecurity e.
National Center for Biotechnology Information , U. Author manuscript; available in PMC Feb 1. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at J Community Health.
EXPLORING MEDIATORS OF FOOD INSECURITY AND OBESITY: A REVIEW OF RECENT LITERATURE
See other articles in PMC that cite the published article. Abstract One in seven American households experience food insecurity at times during the year, lack of money and other resources hinder their ability to maintain consistent access to nutritious foods. Table 1 Definitions for food security and weight status measures used in studies. Variable Source Measure Category Definition Food security USDA [CFSM 18 items ; Short form 6 items ; Youth Module 12 years and older 9 items ] Food secure High food security Households had no problems, or anxiety about, consistently accessing adequate food Marginal food security Households had problems at times, or anxiety about, accessing adequate food, but the quality, variety, and quantity of their food intake were not substantially reduced.
Food insecure Low food security Households reduced the quality, variety, and desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted. Very low food security At times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food. Open in a separate window. Table 2 Summary of studies reviewing food insecurity and weight outcomes.
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In the absence of stressors, children in food-insecure households more likely to be overweight. Children from hungry families were more likely to be obese and more likely to report poor health than food secure counterparts. HH food insecurity associated with being ARO or greater for groups: Child food insecurity associated with being ARO or greater for: After controlling for covariates, significant association between child food insecurity and ARO held.
HH food insecurity with hunger associated with greater likelihood of overweight in girls 2—5 years. As maternal stressors increase, greater likelihood of overweight or obesity exists among food insecure. Significant association between marital status and weight outcomes for women—greater likelihood of obesity in food insecure: Patients from food insecure households more likely to be obese; association remained significant in women only. Participation in government funded programs for more than 6 months resulted in slightly lower BMI. Food insecure women 3 times more likely to be severely obese pre-pregnancy after controlling for covariates.
Food insecure women gained more weight during pregnancy, more likely to exceed expected weight gain than food secure counterparts, after controlling for covariates. Food insecurity associated with increased risk of obesity at 2 years postpartum; association lost significance after controlling for covariates. Food insecurity significantly associated with obesity at both periods ; significance lost after controlling for covariates.
Previous food insecure elders who were overweight had greater BMI change than overweight food secure counterparts HRS, lagged. Food insecurity and overweight among youth Six articles examined food insecurity and obesity in youth ages 3 to 17 ; two of these studies were led by Gundersen[ 14 — 19 ]. Food insecurity and overweight among adolescents Three studies among adolescent populations that studied food insecurity and overweight associations are summarized next. Food insecurity and overweight among adults Six studies examined food insecurity and obesity in adults; one of these studies included children and has been summarized previously.
Food insecurity and overweight among women Four studies addressed food insecurity and obesity in female populations. Food insecurity and overweight among elders One study, by Kim et al, examined the effect of food security and participation in food assistance programs on overweight and depression among elders and their spouses. Household food security in the United States, Measuring food security in the United States prevalence of food insecurity and hunger, by state, — Position of the American Dietetic Association: Journal of the American Dietetic Association.
Poverty and food intake in rural America: Obesity, diets, and social inequalities. Food insecurity and compensatory feeding practices among urban black families. Access to healthful foods among an urban food insecure population: Journal of Urban Health. American Journal of Preventive Medicine. Food insecurity is associated with diabetes mellitus: Journal of General Internal Medicine. Food insecurity and dyslipidemia among adults in the United States. The economic cost of domestic hunger: The food insecurity-obesity paradox: The association of child and household food insecurity with childhood overweight status.
Food insecurity is not associated with childhood obesity as assessed using multiple measures of obesity. Rather than comparing the relative peacefulness of unipolarity, multipolarity, and bipolarity, he identifies causal pathways to war that are endemic to a unipolar system. He does not question the impossibility of great power war in a unipolar world, which is a central tenet of William C.
Wohlforth in his book World Out of Balance: International Relations and the Challenge of American Primacy. Put another way, the first two decades of unipolarity, which make up less than 10 percent of U. The earliest prophet of unipolarity seems to be Fichte , although he did not use the term using instead "Universal Monarchy". Paradoxically, the Father of the German nationalism and convinced adherent of the balance of power, he appears to be the path-breaker.
Back in , Fichte wrote Characteristics of the Present Age. It was the year of the battle at Jena when Napoleon overwhelmed Prussia. The challenge of Napoleon revealed to him the precarious nature of the balance of power and a much deeper and dominant historical trend:. There is necessary tendency in every cultivated State to extend itself generally Such is the case in Ancient History … As the States become stronger in themselves and cast off that [Papal] foreign power, the tendency towards a Universal Monarchy over the whole Christian World necessarily comes to light… This tendency Whether clearly or not—it may be obscurely—yet has this tendency lain at the root of the undertakings of many States in Modern Times Although no individual Epoch may have contemplated this purpose, yet is this the spirit which runs through all these individual Epochs, and invisibly urges them onward.
The first thinker to anticipate both the unipolar world and the American Primacy seems to be British politician William Gladstone Alexis de Tocqueville in the mid-nineteenth century had expected the bipolar world centered on America and Russia but had not advanced beyond bipolarity. In , Gladstone wrote:. While we have been advancing with portentous rapidity, America is passing us by as if a canter.
There can hardly be a doubt, as between America and England, of the belief that the daughter at no very distant time will … be unquestionably yet stronger than the mother … She [America] will probably become what we are now—head servant in the great household of the world… [10]. In , the Chinese Philosopher, K'ang Yu-wei published his One World Philosophy , where he based his vision on the evidence of political expansion which began in the immemorial past and went in his days on.
Finally, the present Powers of the world were formed. This process [of coalescing and forming fewer, larger units] has all taken place among the 10, countries over several thousand years. The progression from dispersion to union among men, and the principle [whereby] the world is [gradually] proceeding from being partitioned off to being opened up, is a spontaneous [working] of the Way of Heaven or Nature and human affairs. No factor, he believed, in the long run could resist the "laws of empires.
This will hasten the world along the road to One World. K'ang Yu-wei belonged to a civilization, which experienced the millennia-long unipolar order. He knew how in his civilization it emerged and several times reemerged. Naturally, his theory is very realist, deep, and developed relatively to his Western contemporaries convinced in the universality of the balance of power or, at most, having abstract ideas of the "Parliament of men, the Federation of the world.
Son Role Social published in Similarly to K'ang Yu-wei, he outlined the logistic growth of empires from the Bronze Age till his days, when "six states govern Vacher de Lapouge did not bet on Washington and Berlin in the final contest for world domination like K'ang Yu-wei. Similarly to de Tocqueville, he guessed the Cold War contenders correctly but he went one step further. He estimated the chances of the United States as favorite in the final confrontation:.
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The latter… is the true adversary of Russia in the great struggle to come… I also believe that the United States is appealed to triumph. Otherwise, the universe would be Russian.
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The year after Vacher de Lapouge published his vision, H. Wells and William Thomas Stead were borne out. The United States is the only country in the early 21st century that possesses the ability to project military power on a global scale, providing its full command of the global commons. With no viable challenger on the horizon in the short term, the current distribution of power overwhelmingly favors the United States, making the world order it set out to construct in more robust. Kenneth Waltz , the founder of Neorealism , in his epochal Theory of International Politics precluded the possibility of unipolarity.
Two, he stated Within twelve years, unipolarity emerged. War is rooted in the anarchic structure, or a self-help environment, of the international system, Waltz argues. Simply changing the domestic political structure of countries will not eliminate war, Waltz notes.
The second challenge to realist theory argues that economic interdependence promotes peace.
Waltz believes this causal logic is backward: Peace can promote economic interdependence. Peace abounds when a political monopoly on force, or a favorable balance of power, prevents revisionist powers from altering the status quo. After all, Waltz argues, strong economic interdependence did not prevent war in The third challenge that Waltz confronts is the rise of international institutions as primary actors in international politics.
Waltz argues that the structure of power in the international system determines the role of institutions. NATO , for example, is often cited as an institution that has outlived its original mandate—preventing a Soviet onslaught of Western Europe. With no great power to check its adventurism, the United States will weaken itself by misusing its power internationally. In conclusion, the U. An Unbalanced Future Our discipline has tarried too long in the wreckage of history, spent too long trying to recover something familiar from the ruins We must complete the realist theory, integrating an understanding of unipolarity into our knowledge of multipolarity and bipolarity.
Realists expect states to balance against rising powers, which would prevent a unipolar distribution of power from developing. To states with a proud past as an international actor, unipolarity seems intolerable… To those who wish to teach history and international relations, unipolarity seems Fukuyamish.
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Although unipolarity is generally undesirable, it prevails: In particular, some have advanced the concept of soft balancing —balancing that does not balance at all. In his view, realist predictions of power balancing did not bear fruit because the United States engaged in strategic restraint after World War II, thereby convincing weaker states that it was more interested in cooperation rather than domination.
The liberal basis of U. The Military Foundation of U. A key to U. Posen believes that the Bush Doctrine was problematic because it not only created unease among U. Bipolarity is a distribution of power in which two states have the majority of economic, military, and cultural influence internationally or regionally. After this, the two powers will normally maneuver for the support of the unclaimed areas. Which in the case of the Cold War means Africa, etc.
The bipolar system can be said to extend to much larger systems, such as alliances or organizations, which would not be considered nation-states, but would still have power concentrated in two primary groups. Neutral nations, however, may have caused what may be assessed as an example of tripolarity as well within both of the conflicts.
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