Food Insecurity Associated With Obesity Status Among Adolescents in the United States

Purpose: Food insecurity and obesity adversely affect US children and adolescents, especially Black or African American, American Indian or Alaska Native, or mixed-race populations. Prior studies on food insecurity and obesity have primarily focused on younger children or specific race or ethnic groups. Our objective was to evaluate the association between food insecurity and obesity in a large sample of US adolescents. Methods: The 2019 National Survey of Children's Health included data on 14,771 adolescents, aged 10–17 years. Parents or adult caregivers reported child's height and weight. Household food security was based on a question with four categories of increasing food insecurity ranging from always being able to afford good nutritious meals (highest security, category 1) to often not able to afford enough to eat (lowest security, category 4). Obesity was classified as having a body mass index greater or equal to the 95th percentile for age and sex. Odds ratios (ORs) estimated the likelihood of obesity using logistic regression models with the highest level of food security as the reference. Models were adjusted for age, sex, race, and parent or adult caregiver's education. Results: Food-insecure households were more likely to be Black, American Indian or Alaska Native, or mixed-race families. They were also more likely to have a parent or adult caregiver with less than a high school education or incomplete college education. Compared with the most food-secure group, adolescents with greater food insecurity had higher adjusted odds of obesity: OR_{category 2} = 1.77 (95% confidence interval (CI): 1.56–2.00), OR_{category 3} = 1.97 (95% CI: 1.52–2.55), OR_{category 4} = 3.01 (95% CI: 1.77–5.12). Discussion: Our findings suggest that food insecurity is associated with higher odds of obesity in US adolescents.