Drivers and Points of Intervention for Obesity and Food Insecurity

Abstract

Poor nutrition is a leading cause of disease and death in the United States and around the world. Two key types of poor nutrition are food insecurity (a lack of reliable access to nutritious food) and obesity (excess adiposity). They are both prevalent, costly, and can have serious health consequences. This dissertation focuses on these interrelated public health nutrition issues, using rigorous epidemiological methods to examine their health effects and identify policy and programmatic approaches that may meaningfully reduce their burden in the population.

We first examine the potential impact of voluntary sugar reduction targets for packaged foods and drinks set by the National Salt and Sugar Reduction Initiative. Using nationally representative data from the National Health and Nutrition Examination Survey, we find that the targets are expected to result in meaningful reductions in added sugar intake among children and the initiative is not projected to widen existing diet-related disparities. Next, we examine the longitudinal relationship between food insufficiency – a screener measure related to food insecurity – and cardiovascular disease risk factors using data from the Coronary Artery Risk Development in Young Adults Study. We find that experiencing food insufficiency appears to worsen health over time, particularly among women and for obesity-related measures such as BMI and waist circumference. Finally, we leverage administrative data from the Massachusetts Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to examine shopping patterns related to redemption of food package benefits. We find that retail-based initiatives may need to target a wide range of store types in order to reach all WIC households and that efforts aimed at improving redemption may be especially important for WIC shoppers relying on superstores.

While the focus and scope of these papers varies, they each identify drivers and points of intervention for food insecurity and obesity. This work underscores the importance of conducting epidemiological research to aid in the development of policies and programs to reduce the burden of food insecurity and obesity in the population.