Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Poverty, household food insecurity and obesity in children
prevalence of very low food security was 4% of households,
with these households having disrupted eating
patterns and reduced food intake during the year
because the household lacked money and other
resources for food. Some assessment has been done in
low - income countries. For example, a survey in Java,
Indonesia, at the height of the economic crisis that
struck in 1998, saw substantial household food insecurity
with 94.2% of households found to be uncertain
or insecure about their food situation in the
previous year, and 11% of respondents reported
losing weight in the previous year because of lack of
food.
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Impact of f ood i nsecurity on
a c hild ’ s w ell - b eing
A number of factors determine the food security
status of a household including financial resources,
local food access and cost, social support and networks,
skills, values and attitudes and the mental and
physical health of the primary care giver. The experience
of food insecurity for a child has both the immediate
impact of little or no food in the home but also
the long - term consequences for both child and parent
of an uncertain supply of food. Household food insecurity
has been shown to relate to poor physical and
mental health, social development, and academic performance,
including higher prevalence of inadequate
intake of key nutrients, depressive symptoms and
suicide risk in adolescents, and poor learning and
behavior problems in children. 4
The r elationship between p overty
and f ood i nsecurity and the
p revalence of o besity in c hildren
Relationship p overty and o besity
in c hildren
How can children in families that are poor or otherwise
disadvantaged be obese? Historically the image of
poverty and disadvantage was one of a wasted child
and/or parent. But this image has effectively been
turned on its head. In countries with developed and,
even developing economies, many people who are
socio - economically disadvantaged, living on low
income or in poverty, and are food insecure, are
overweight or obese.
The results of early studies looking at the relationship
between socio - economic status ( SES ) and childhood
obesity were inconsistent. Sobal and Stunkard ’ s
review in 1989 of 34 such studies from developed
countries published after 1941, found inverse associations
(36%), no associations (38%), and positive
associations (26%) were in similar proportions. 15
More recent data, however, indicate that the inverse
gradient between SES and adiposity in adults 16 is
becoming apparent in children. A systematic review
of cross - sectional studies for the period 1990 – 2005 17
indicates that, within the past 15 years, the associations
between SES and adiposity in children are
predominantly inverse, and positive associations
have all but disappeared. These findings are corroborated
by recent analyses of nationally representative
samples of children. For example in the UK,
Stamatakis et al 2005, using data from the National
Study of Health and Growth and the Health
Survey for England, found that while obesity was
increasing in all children, it was increasing more
rapidly among children from low income homes. 18 In
Australia, Wake et al 2006 in the Longitudinal Study
of Australian Children ( LSAC ) found again that
obesity in children was increasing across the board
but that children from highly disadvantaged neighborhoods
were 47% more likely to be overweight or
obese compared with those from areas with more
19
advantages.
The relationship between poverty and childhood
obesity is well described in a comparative study of
Canada, Norway and the USA. 20 These countries were
chosen because, while they are similarly affluent, they
have made quite different social policy choices and
have correspondingly different socio - economic outcomes
for children. Canada and the USA can both be
considered welfare states with relatively low levels of
public spending, income transfers which are targeted
to the poor rather than universally available and high
rates of child poverty. In contrast, Norway has higher
levels of public spending, more universal and generous
spending and much lower rates of child poverty.
In this study, the patterns of poverty and child obesity
were lowest in Norway. In both Canada and the USA,
there was a greater extent of obesity for poor than
non - poor children, and this pattern was particularly
marked for the USA. This study suggests that an association
does exist between poverty and childhood
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