The Puzzle of Food Insecurity, Diet Quality, and Obesity

Though we hate to say it, we are entering into a time of increased food insecurity. Of course that will bring a toll of death from hunger. It also likely means a further rise will come in non-communicable diseases such as obesity. But why? Why is it that food insecurity has such a link to an increased risk of obesity? What is the role of diet quality in this relationship? New research at ENDO 2022 gives us further clues about the puzzle of food insecurity and obesity. It leaves us with more questions, too.

Clues from NHANES Data

Lisa Morselli, Roland James, and Srividya Kidambi analyzed data on 5,821 persons from the 2015-2016 cycle of NHANES. They looked at food security, diet quality, caloric intake, and various measures of BMI and body composition. Their goal was to test the idea that diet quality explains the relationship between obesity and food insecurity. What they found, though, was that it’s not so simple.

More Than Diet

In fact, diet quality could explain some, but not all, of the the relationship. They conducted a mediation analysis to dig into this question. Total energy intake could explain the effect of food insecurity on fat mass, but not BMI or waist circumference. Measures of diet quality only partially explained the relationship of food insecurity on waist circumference. But it told them nothing about the relationship with BMI or fat mass. Simply stated, food insecurity might lead to changes in diet quality that may explain some of this puzzle that is the relationship between food insecurity and obesity. But those changes clearly do not tell the whole story. Morselli says that non-diet factors are probably important, too:

“Factors such as stress, discrimination, poor sleep, unstable housing or employment likely play a role in the increased risk of obesity associated with food insecurity. Therefore, measures to combat the adverse health consequences of food insecurity should include interventions to improve both diet quality and the overall living environment.”

Syndemic Theory

Social factors beyond food insecurity are interacting with the ongoing pandemic, obesity, and other diet-related chronic diseases, say David Himmelgreen and colleagues. They suggest that syndemic theory can help us make sense of these complex relationships.

Perhaps these scholars can help us with this puzzle. But in the meantime, it’s not so hard to understand that the stresses of a pandemic – with added stress of food insecurity, social injustice, and economic disparities – can add up to a greater burden of non-communicable diseases such as obesity and its complications. In the midst of such a perfect storm, privileged concepts about healthy lifestyles fly out the window.

Survival becomes the immediate priority.

Click here for the research abstract from Morselli, James, and Kidambi, and here for their press release. For the paper on syndemic theory and food insecurity, click here.

Father with Magnifying Glass, woodcut by M.C. Escher / WikiArt

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June 13, 2022