Transcript Food Insecurity and Overweight in WIC Clients A Community Nutrition Project by University of Washington Students Winter 2005

Food Insecurity and
Overweight in WIC
Clients
A Community Nutrition Project by
University of Washington Students
Winter 2005
Food insecurity
• Food insecurity (FI): Occurs whenever the availability
of nutritionally adequate and safe foods, or the ability
to acquire acceptable foods in socially acceptable ways,
is limited in socially acceptable ways is limited or
uncertain.1
• Prevalence of FI:
– US: 11.0%2
– WIC clients: 53.7%1
• FI in King county -- BRFSS survey results1
– Percent of adults concerned about having enough
food for themselves or their families in the past 30
days:
– Seattle: 5.5%; North: 4.7%; East: 2.7%; South: 4.6%
The FI-obesity link
• People in poor to low income households are
more likely to be obese than people in
higher income households
• The association of food insecurity and
obesity is more prevalent in women than in
men, and more prevalent in AfricanAmerican and Hispanic populations than in
other ethnic groups3,4,5,6,7
Socioeconomic and
Environmental Factors
• People with FI have limited food choices
due to their financial constraints
• Cheaper foods are often energy dense and
higher in refined sugar and fat8
• Higher density of fast food outlets in low
income communities9
Psychophysiological factors
• People with FI have elevated levels of stress
• Chronic stress can result in a series of
physiological events that lead to impaired
energy balance regulation: increased food
intake and reduced energy expenditure10
• Periods of hunger or fear of hunger lead to
overeating when food is available, which can
lead to an increased total energy intake11
– Food acquisition cycle in low-income households: 42%
of food stamp households conduct grocery
shopping ≤1 time per month12
Conducting focus groups in
WIC clinics
Focus groups: a common qualitative research
tool used to generate data from a small group
of a selected population.13
• 6 focus groups at 3 WIC sites
– Participation: 2-8 participants per group, total 30
females
– Locations: Eastgate , Kent Alder Square, and Renton
– Date: February 18, 2005
• Eligibility: WIC clients; at least 18 years old;
English speaking
Conducting Focus Groups in
WIC Clinics (cont.)
• Recruitment: UW students introduced the study
and gave flyers to potential participants at each
site for two weeks before the focus groups
session
• Incentive: $25 gift certificate for participation
in the discussion
• Data analysis:transcriptions were analyzed and
coded based on common themes -- four
overarching themes were identified
Overview of focus groups
questions
• Goal: to obtain clients' perspective &
suggestions about the link between
FI and overweight
• The questions are divided into two
parts:
– Food insecurity
– Healthy weight
Sample focus group questions
• How do you think a child’s health is affected by not having enough
food?
• What do you think are some reasons why some families have trouble
having enough food to feed their families?
• If you knew someone (a friend) who was worried about running out of
food, what are some things you would tell her to do?
• If you were in the situation of running out of food and not having
enough money for food for you and your children, what could WIC do
that would be most helpful?
• People who don’t have money to buy enough food, compared to those
that do, are more likely to be overweight. What do you think could
be the cause of this?
• If a woman on WIC wanted help with her weight after having a baby,
what could WIC offer or provide that would be most helpful to her?
This is only a partial list of all the questions asked.
Main findings14
Participants indicated that they know the
differences between healthy and
unhealthy foods – it is other factors that
are leading to becoming overweight
• Lack of time and financial resources
• Stress and fear of hunger
• Poor quality of food in emergency food
programs
• Lack of exercise resources
Lack of financial and time
resources
• Participants identify cheaper foods as “bad” foods and
“healthy” foods as expensive foods
• “Bad” foods are also more convenient and easy to
prepare
“Sometimes when people don’t have enough money to buy
food, then that makes them prone to go get whatever
is cheaper...”
“People are so pressed for time, they have to fit so many
things into the day, you have all these dollar menus and
everything and you don’t want to get out of the car so
you are looking for things that are only
drive-thru.”
Stress and fear of hunger
• Participants identified a relationship between stress,
hunger, and overweight
• A fear of future hunger can lead to overbuying and
overeating food now
“Food hording; oh yes!!! Because when you don’t think
you’re going to have enough you buy too much, and you
will end up eating it.”
“[S]ometimes you just eat because you’re stressed out, so
you get ice cream...you keep eating and eating ‘cause
you don’t have enough food, you don’t have any food so
you just want to eat. That makes you feel
better.”
Poor quality of food in
emergency food programs
• Participants look to emergency food assistance
programs to get enough food to feed their families, in
cases where the WIC amount wasn’t enough
• They often perceive food from these sources to be
junk food, the consumption of which leads to becoming
overweight
“[W]hen you run out of food and go down to the food
banks they load you up with donuts and bread and it’s
hard to balance your diet that way.”
Lack of exercise resources
• Participants recognize exercise as being part of a way
to address the problem of overweight
• They would like more information and resources for
themselves and for their children, and some would like
a health professional to give the information
“I didn't know that there were certain things I could do
with him when he was 3 months old, like swimming or
whatever or like that, that could have stopped him
from being in the 97th percentile.”
WIC focus group findings compared to
the existing literature
• New relationships identified:
– Use of emergency food programs in addition to using
WIC, may contribute to overweight because of the
poor food quality in some of these programs
– Lack of resources can prevent people from
exercising, although participants recognize that
exercise is an effective way to prevent overweight
– In addition to a lack of financial resources, leading
to the purchase of cheaper, “bad” foods, people lack
the time to prepare healthier meals and find
it more efficient to purchase these foods
Recommendations
• Increasing access to and education about
nutrition and physical activity addresses
the concerns raised by the focus group
participants
• Increasing access to and expanding
existing services will also address the main
problems identified in the focus groups
Recommendations for Access
• Increase flexibility of WIC benefits
– Selection should incorporate alternatives for food
allergies and cultural preferences
– Consider increasing the number of stores clients are able
to purchase food from
– Implement EBT system for clients to be able to use WIC
benefits more flexibly
• Establish a network of organizations that offer
nutrition and physical activity programs and
activities, so that referrals can be made for sites
that are most appropriate and convenient
for each mother and child
Recommendations for Education
Nutrition:
• Offer suggestions for increasing food variety
and give recipes to make “quick,” healthy
meals
• Hold workshops and create booklets about
meal planning and budgeting
Physical Activity:
• Provide information about exercise for
mothers and age-appropriate information
about exercise for children
• Offer post-partum workout videos
Suggested interventions for WIC
• Continue advocating for use of EBT cards to
purchase WIC food items to make food
acquisition more flexible for clients
• Improve nutrition education by providing
practical cooking demonstrations about how
to cook culturally appropriate recipes on a
budget
• Increase the availability of physical activity
groups that parents and children can do
together
• Provide information on low-cost physical
activity resources available in the
community
References
1.
DiGiorgio, L. & Oberg, D. WIC & Food Insecurity: UW Community Nutrition – 531. Powerpoint Presentation.
January 7, 2005.
2.
ERS. Household Food Security in the United States, 2003. www.ers.usda.gov/publications/fanrr42/
3.
Olson CM. Nutrition and health outcomes associated with food insecurity and hunger. J Nutr. 1999;129(2S
Suppl):521S-524S.
4.
Adams EJ, Grummer-Strawn L, Chavez G. Food Insecurity is Associated with Increased Risk of Obesity in California
Women. J Nutr. 2003;133:1070-1074.
5.
Kaiser LL, Townsend MS, Melgar-Quinonez HR, Fujii ML, Crawford PB. Choice of instrument influences relations
between food insecurity and obesity in Latino women. Am J Clin Nutr. 2004;80:1372-1378.
6.
Alaimo K, Olson CM, Frongillo EA Jr. Low Family Income and Food Insufficiency in Relation to Overweight in US
Children: Is there a paradox? Arch Pediatr Adolesc Med. 2001;155:1161-1167.
7.
DOH. The Health of Washington State-Nutrition. www.doh.wa.gov/HWS/doc/RPF/RPF_Nut.doc
8.
Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr.
2004;79:6-16.
9.
Reidpath DD, Burns C, Garrard J, Mahoney M, Townsend M. An ecological study of the relationship between social
and environmental determinants of obesity. Health Place. 2002;8:141-5.
10.
Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev. 2001;2:73-86.
11.
Frogillo AE, Olson MC, Rauschenbach SB, Kendall A. Nutritional consequences of food insecurity in a rural New
York State county. University of Wisconsin-Madison, Institute for Research on Poverty. Discussion paper. 1997:11201197.
12.
Parke E Wilde, Christine K Ranney. The monetary food stamp cycle: Shopping frequency and food intake decisions in
an endogenous switching regression framework. Am J Agric Econ. 2000;82:200-213.
13.
Krueger, RA. Moderating Focus Groups. from Focus Group Kit. Sage Publications. 1998.
14.
Nutrition 531: Community Nutrition. University of Washington. “Analysis Summary: WIC Focus Groups.” 2005.
Thank you!