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Household food insecurity and childhood obesity/overweight among children with special healthcare needs: Results from a nationally representative sample of 10–17 years old U.S. children

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Pediatric Obesity
Authors:
Elvin Khanjahani at Duquesne University
Elvin Khanjahani
Sheridyn Pawcio
Sheridyn Pawcio
Sheridyn Pawcio
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Abstract and Figures

Background Food insecurity is linked to an increased risk of childhood obesity and other adverse health issues. Objectives To examine the disproportionate impact of food insecurity on childhood obesity among children with special healthcare needs (CSHCN). Methods In this cross‐sectional study, we pooled data from 4 years (2016 to 2019) of the National Survey of Children's Health (NSCH) for a nationally representative sample of 10 to 17 years old noninstitutionalized U.S. children (N = 68 942). Using logistic regression models, we examined the odds of childhood obesity or overweight by including an interaction between family food situation and CSHCN status. Results Among 10–17 years old U.S. children, 31% (95% confidence interval [CI]: 30.1%–31.9%) had obesity or overweight, 24.1% had special healthcare needs, 27.2% were from families with food insecurity, and 6.4% were from families with food insufficiency. CSHCN were more likely to be impacted by obesity or overweight than non‐CSHCN (Odds Ratio [OR] = 1.29, 95% CI = 1.18–1.141). Moreover, children living in food insecurity (OR = 1.75, 95% CI = 1.52–1.92) and food insufficiency (OR = 2, 95% CI = 1.67–2.4) were more likely than those living in food‐secure families to be impacted by obesity or overweight. CSHCN living in food insecurity were significantly more likely to be impacted by obesity or overweight than non‐CSHCN in similar households. Conclusions It appears that food insecurity can put CSHCN at disproportionately greater risk of obesity or overweight than non‐CSHCN. The findings underscore considering CSHCN status in conjunction with household food insecurity in designing and implementing medical interventions or public policies targeted at childhood obesity or overweight.
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ORIGINAL RESEARCH
Household food insecurity and childhood obesity/overweight
among children with special healthcare needs: Results from a
nationally representative sample of 10–17 years old U.S.
children
Ahmad Khanijahani | Sheridyn Pawcio
John G. Rangos School of Health Sciences,
Duquesne University, Pittsburgh,
Pennsylvania, USA
Correspondence
Ahmad Khanijahani, Department of Health
Administration and Public Health, John
G. Rangos School of Health Sciences,
Duquesne University, 600 Forbes Avenue
Pittsburgh, PA 15282, USA.
Email: khanijahania@duq.edu
SUMMARY
Background: Food insecurity is linked to an increased risk of childhood obesity and
other adverse health issues.
Objectives: To examine the disproportionate impact of food insecurity on childhood
obesity among children with special healthcare needs (CSHCN).
Methods: In this cross-sectional study, we pooled data from 4 years (2016 to 2019)
of the National Survey of Children's Health (NSCH) for a nationally representative
sample of 10 to 17 years old noninstitutionalized U.S. children (N=68 942). Using
logistic regression models, we examined the odds of childhood obesity or overweight
by including an interaction between family food situation and CSHCN status.
Results: Among 10–17 years old U.S. children, 31% (95% confidence interval [CI]:
30.1%–31.9%) had obesity or overweight, 24.1% had special healthcare needs, 27.2%
were from families with food insecurity, and 6.4% were from families with food insuffi-
ciency. CSHCN were more likely to be impacted by obesity or overweight than non-
CSHCN (Odds Ratio [OR] =1.29, 95% CI =1.18–1.141). Moreover, children living in
food insecurity (OR =1.75, 95% CI =1.52–1.92) and food insufficiency (OR =2, 95%
CI =1.67–2.4) were more likely than those living in food-secure families to be impacted
by obesity or overweight. CSHCN living in food insecurity were significantly more likely
to be impacted by obesity or overweight than non-CSHCN in similar households.
Conclusions: It appears that food insecurity can put CSHCN at disproportionately
greater risk of obesity or overweight than non-CSHCN. The findings underscore con-
sidering CSHCN status in conjunction with household food insecurity in designing
and implementing medical interventions or public policies targeted at childhood obe-
sity or overweight.
KEYWORDS
children with special healthcare needs, food insecurity, food insufficiency, pediatric obesity,
socioeconomic status
Abbreviations: BMI, body mass index; CDC, Centers for Disease Control and Prevention; CI, confidence interval; CPS-FSS, Current Population Survey Food Security Supplement; CSHCN,
children with special healthcare needs; FPL, federal poverty level; HPS, Household Pulse Survey; MCAR, Missing Completely at Random; MEPS, Medical Expenditure Panel Survey; non-CSHCN,
children without special healthcare needs; NSCH, National Survey of Children's Health; OR, odds ratio; USDA, US Department of Agriculture; WIC, Special Supplemental Nutrition Program for
Women, Infants and Children.
Received: 17 May 2022 Revised: 17 December 2022 Accepted: 6 February 2023
DOI: 10.1111/ijpo.13015
Pediatric Obesity. 2023;18:e13015. wileyonlinelibrary.com/journal/ijpo © 2023 World Obesity Federation. 1of10
https://doi.org/10.1111/ijpo.13015
... A recent meta-analysis of cross-sectional study indicated a positive association between food insecurity and obesity in children and adults 43 . With regard to the US population, studies conducted among old children 44 , adolescents 45 , and young adults 36 suggested a positive association between food insecurity and odds of obesity in the US. However, compared to previous research in the US, this study is the largest conducted using data from a representative sample of US adults. ...
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... HFI is a strong predictor of childhood malnutrition due to its close connection with the accessibility and quality of food in a household. Various studies have also found that food insecurity can contribute to both underweight and overweight among young people, making it a potential barrier to preventing and treating obesity (7)(8)(9). ...
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... To identify children who might be experiencing FI, we assessed the food situation in a household variable utilizing the survey question, "Which of these statements best describes your household's ability to afford the food you need during the past 12 months?" Respondent answers included: "we could always afford to eat good nutritious meals; we could always afford enough to eat but not always the kinds of food we should eat; sometimes we could not afford enough to eat; often we could not afford enough to eat." [17,19] Although this question is titled 'Food Insufficiency' in the NSCH questionnaire, the item captures more than household food shortage within the first two responses addressing the quality of the meals the family could afforda suitable proxy measure for the definition of FI, which has been utilized in many studies [20]. ...
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... screening-anxiety-children-adolescents *** https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/ screening-depression-suicide-risk-children-adolescents have increased prevalences of various negative health outcomes, including overweight or obesity (6). A healthy, age-appropriate diet is strongly recommended as a treatment strategy for children and adolescents with arthritis (7). ...
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Background: Childhood obesity has increased globally during the past four decades. Food insecurity could heighten the risk of obesity. However, little is known about the underlying mechanism. This study aims to investigate the mediating role of sleep duration in the association between food insecurity and childhood obesity and whether there are differences by age, sex, and race/ethnicity. Method: Data from the National Survey of Children's Health for the years 2016-2020 were used, including children 10-17 years of age. We employed causal mediation analysis within a counterfactual framework to decompose the total effect of food insecurity into natural direct and indirect effects and estimate the proportion mediated. Result: The prevalence of obesity was 15.8% in our study sample. Children with food insecurity had 78% higher odds [odds ratio (OR) = 1.78, 95% confidence interval (CI): 1.70-1.86] of having obesity compared with children who were food secure. Overall, only 6.13% of this association was mediated by sleep duration. The association between food insecurity and obesity was stronger in females (OR = 1.96, 95% CI: 1.84-2.10) than males (OR = 1.66, 95% CI: 1.56-1.75), but the proportion mediated by sleep duration was larger in males (7.13%) than females (5.22%). Evidence of mediation was more pronounced in children 10-11 years of age and non-Hispanic Asian children (proportion mediated = 14.85% and 11.21%, respectively). Conclusion: Food insecurity is associated with an increased prevalence of obesity among children. Although a small proportion of this association is mediated by sleep duration, these results suggest that sleep should be considered when assessing the link between food insecurity and childhood obesity.
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Food Insecurity And Health Outcomes
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Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and foodinsecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes. © 2015 Project HOPE The People-to-People Health Foundation, Inc.
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