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
The purpose of this project is to examine
the relationships between food insecurity
and overweight in English speaking WIC
clients so that food assistance programs
can be optimally designed to reduce
prevalence of obesity while encouraging
food security.
Groundwork:
• Lynne Smith
Human subjects approval
Consent form development
Recruitment protocol
IBB forms and IRB questions
• Lisa DiGeorgio and Donna Oberg
Location of WIC sites
Interactions with WIC staff
Initial presentation to this class
• Donna Johnson
Development of class project
Where we started:
• Providing background information on food
insecurity and obesity
• Writing a plan for focus groups on food
insecurity and obesity
• Preparing a focus group procedure
manual
• Conducting a pilot focus group
What is Food Insecurity?
• Food insecurity exists when the availability of
nutritionally adequate food, or the ability to
acquire nutritionally adequate food in socially
acceptable ways, is limited or uncertain.
• Prevalence:
11% of all US households (2003)
12% of Washington State households (2002)
54% of King County WIC households (prelim)
Who is at risk for food
insecurity?
• Households with incomes at or below
185% of the poverty line
• Households with children under 18,
headed by a single woman
• Hispanic or African-American households
Who is obese?
• Low income to poor adults tend to be more
obese than higher income adults
• Obesity more prevalent in women than
men
• Percentage of obesity higher in Hispanic
and African-American populations
Possible mechanisms for a food
insecurity – obesity link:
• Physiological factors
• Psycho-social factors
• Socio-economic factors
Thoughts about a food insecurityoverweight relationship among
Seattle-King County WIC
population
• Plan for focus groups
• Protocol for focus groups
“Before” Plan
Determine GOALS
Designate ROLES
Decide WHO should be invited
Think about INCENTIVES
RECRUIT participants
CONTACTING participants
“Day of ” Plan
Setting up
Meeting and Greeting
Signing Consent Forms
Taking Notes
Wrapping-Up
Debriefing
“AFTER THE FOCUS GROUP” Plan
TRANSCRIBE Focus Group
READ Transcript
Select ANALYSIS Method
WRITE UP Report
PRESENT Findings
Pilot
What we learned…
• Recruitment process
• Conducting focus groups
• Transcription
In Summary:
• Background research, focus group
procedures, and conducted a pilot at the
Eastgate WIC clinic
• Shared our knowledge and trained
ourselves to conduct the research
• Got started…
Recruiting for focus groups
• Each group toured the facilities, taught the staff
how to recruit and determined specific logistics
for each site
-Eastgate
-Renton
-Kent
Recruited English speaking WIC clients who were
over 18.
-Used a $25 Safeway gift card as an incentive for
our clients.
Conducting the focus groups
• Two sessions at each clinic on February
18th, 2005
• Moderator conducted with at 1-2 notetakers in the room
• Worked thru the assigned questions in
discussion format with 2-8 participants
• Also collected demographic data from a
questionnaire
A note about the questions
• The questions were designed to address
the issues without making the participants
feel uncomfortable about their personal
situation. The purpose of the questions
were to get information on the following:
• Participant’s knowledge of health effects of
both food insecurity and weight status
• Reasons for food insecurity
• Coping strategies
• WIC’s role
• General experiences, observations and
ideas
After the focus groups
• Demographic data compiled
• Transcription of the raw data and notetakers notes on non-verbal communication
incorporated into the raw transcripts
– Analysis team
Demographics
NUMBER of CHILDREN on WIC
RACE
Unknown
3%
Unknown
7%
3
3%
Mixed Race
7%
0
17%
2
7%
Asian Native
3% American
3%
Black
23%
White
57%
1
70%
NUMBER of PERSONS in HOUSEHOLD
Unknown
10%
6
7%
5
7%
4
23%
2
30%
3
23%
Analysis
A subset of the class did the analysis:
- Looked for major themes over all of the
transcriptions from each site
- Summarized them in a document
Results of Analysis of
transcripts
• Main findings- 4 major themes
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.”
• “Sometimes 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 food assistance programs to
get enough food to feed their families
• They often perceive food from these programs to
be junk food, the consumption of which leads to
becoming overweight
• “When 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 by the food
insecure may contribute to overweight because of the
poor food quality in these programs
– Exercise is recognized as a way to prevent overweight, but resources to being able to exercise are
limited
– 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
Targeted Interventions
RECOMMENDATION
Access
CONCERN
Education
Food
PA
Services
Nutrition
PA
Lack of time & money
X
X
X
X
X
Stress & food insecurity
X
X
X
Use & Quality of food
assistance
X
X
X
Lack of exercise resources
X
X
X
Potential Types of Interventions
Four main categories:
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat
healthy on a budget
• Provide Education about physical activity
Potential Types of Interventions
Four main categories:
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat
healthy on a budget
• Provide Education about physical activity
Improving Access to Healthy
Foods
(Potential partners)
•
•
•
•
•
Farmer’s Market Coalitions
Transportation services
Community Centers
Community gardens
Food banks, churches, community centers, and
other emergency food assistance programs
• Storage facilities
• Worksites
Improving Access to Healthy
Foods
(WIC)
• Increase flexibility in WIC food package
• Continue to advocate for implementation of EBT
card system
• Expand WIC Farmer’s Market Program
• Provide information about emergency food
services
• Continue to offer emergency food vouchers
Potential Types of Interventions
Four main categories:
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat
healthy on a budget
• Provide Education about physical activity
Improving Access to Physical
Activity
(Potential Partners)
• Physical activity programs/Exercise
facilities
• Transportation services
• Community Centers
• Community Gardens
• Worksites
• Parks and Recreational Services
Improving Access to Physical
Activity
(WIC)
• Provide classes, referrals to classes,
scholarships, and activities that a mother
and/or her child can do together
• 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
Potential Types of Interventions
Four main categories:
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat
healthy on a budget
• Provide Education about physical activity
Nutrition Education
(Potential Partners)
•
•
•
•
•
Farmer’s Markets
Food assistance programs/Food banks
Community Gardens
Worksites
Policy makers
Nutrition Education
(WIC)
• Distribute meal planning and budgeting info
booklets
• Offer workshops- portion size, reading food
labels, food variety
• Utilize group classes to engage low-income
families in discussions about healthy eating
• Employ social marketing activities
• Establish Mother support groups
Potential Types of Interventions
Four main categories:
• Improve Access to healthy foods
• Improve Access to physical activity
• Provide Education about how to eat
healthy on a budget
• Provide Education about physical
activity
Physical Activity Education
(Potential Partners)
• Community centers, health centers, and
schools
• Physical activity programs/Exercise
facilities
Physical Activity Education
(WIC)
• Provide more information about exercise
resources for WIC mothers:
– age-appropriate information about exercise for their
children
– low-cost physical activity resources available in the
community
– walking/biking route maps, neighborhood recreational
parks
• Increase availability of physical activity groups
that parents and children can do together
• Offer post-partum workout videos
Summary
Recommendations for WIC are focused on a need for
access and education regarding food and physical
activity. We have few truly evidence-based
interventions in this area which is why we need more
studies that look for the real physiological, psychosocial, and socio-economic determinants of food
insecurity and obesity. It is our hope that the results
of this study can be used to improve the services that
WIC offers to program participants.
-Nutrition 531 class voice
Special love goes to…
The “Donnas”, Lisa DiGiorgio, Lynne Smith,
Michele Rimmer & Renton WIC staff, Ewa
Baldyze & Kent WIC staff, Saskia Schaeffer,
Katie Imberg, & Eastgate WIC staff
References
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