The Meal

How Food Insecurity Factors into Obesity Care

It might seem surprising, but rising food insecurity may make public health issues with obesity even worse. Even before the pandemic, declines in food security seemed to be a factor in rising obesity prevalence. But now research is emerging to suggest that food insecurity might make obesity harder to shake.

A new analysis in Annals of Internal Medicine shows that the effectiveness of an intensive program of lifestyle changes was significantly lower in subjects with food insecurity.

No Benefit After 24 Months

This was a post-hoc analysis of the PROPEL study. The primary analysis last year in NEJM showed that an intensive lifestyle program, delivered in primary care, could produce clinically significant weight loss after 24 months.

But this new analysis looked at the program’s effectiveness in food secure and insecure populations within this study. The difference was stark. Both groups lost weight in the first six months, though the food insecure group lost less. But that success quickly faded for the insecure group. At the end of 24 months, the program was still effective for people with food security. For those without it, the effect of the program was insignificant.

The authors, led by Candice Myers, explain that this has important implications for health equity:

“To address effective and equitable obesity prevention and treatment, tailored weight loss approaches that simultaneously address food insecurity and obesity are needed.”

Food Insecurity on the Table Now More than Ever

A year of living with the pandemic has produced stresses for almost everyone. But one stress has come very unevenly. Many families have seen no effect on food security. Of course, shopping habits might have changed for all. However, food insecurity came to 45 million Americans in 2020 – many for the first time in their lives. In fact, all over the world, food security declined.

Less food security will be with us for some time, even if we can put the COVID-19 pandemic behind us. It will leave us with wider disparities in health and quality of life. It will make the global rise obesity prevalence even harder to reverse.

Click here for the new analysis in Annals and here for the PROPEL study in NEJM. For more on food insecurity and the pandemic, click here, here, here, and here.

The Meal, painting by Paul Gauguin / WikiArt

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March 17, 2021