Emily Altman MPH Capstone, Spring 2017 The association between food insecurity and body satisfaction among children in California Emily Altman MPH Capstone, Spring 2017

Background: Food Insecurity Defined as the uncertain or limited ability to obtain adequate food due to lack of financial resources or access Affects 13 million children in the United States Associated with poor health outcomes, body mass index (BMI), and racial/ethnic disparities Health outcomes: cognitive problems, anxiety, increased hospitalizations, asthma, and poor oral health, poor mental health, and unhealthy dietary intake Racial disparities: FI higher among minority populations, with 25% of black non-Latino households and 22% of Latino households with children facing food insecurity. Conversely, 13% of white non-Latino households and 13% of other non-Latino households with children are FI

Background: Low Body Satisfaction Defined as being unhappy with your height, weight, body shape, body build, or health Affects up to 46% of children in the United States Associated with poor health outcomes, BMI, and racial/ethnic disparities Health outcomes: disordered eating, smoking cigarettes, low self-esteem and depression Racial disparities: Latino, Asian American, and white children struggle with body- and weight-related concerns and behaviors more than black children

Research Hypothesis Race/ ethnicity BMI Child food insecurity Low body satisfaction Age Gender

Methods Data from the Fit Study Cross-sectional Surveyed children in grades 4-8 in 76 schools in California N=14,870 3 categories food insecurity 2 categories body satisfaction Multivariate logistic regression Adjusted for age, gender Tested for effect modification by BMI and race/ethnicity Define confounders and cross sectional

Results: overall Child food insecurity was associated with higher odds of lower body satisfaction Effect modification by BMI and race/ethnicity

Results: by BMI & Race/Ethnicity

Results: normal weight white children Moderately food insecure children had 2.12 times the odds of low body satisfaction Highly food insecure children had 2.14 times the odds of low body satisfaction - Moderately food insecure children had 2.12 times the odds of low body satisfaction than food secure children Highly food insecure children had 2.14 times the odds of low body satisfaction than food secure children NOTE: all food insecure white children more prone to low body satisfaction, not just normal weight

Results: overweight black children Moderately food insecure children had 1.99 times the odds of low body satisfaction Highly food insecure children had 1.81 times the odds of low body satisfaction

Results: obese black children Moderately food insecure children had 2.00 times the odds of low body satisfaction Highly food insecure children had 1.88 times the odds of low body satisfaction

Results: normal weight Latino children Moderately food insecure children had 0.77 times the odds of low body satisfaction

Results: normal weight Asian children Moderately food insecure children had 0.72 times the odds of low body satisfaction

Discussion White children overall have lower body satisfaction Food insecurity associated with low body satisfaction among normal weight  synergistic relationship Black children overall have higher body satisfaction Food insecurity associated with low body satisfaction among overweight/obese  nuanced relationship Asian and Latino children overall have lower body satisfaction Food insecurity associated with high body satisfaction among normal weight  contradictory

Limitations Temporality could not be assessed Missing covariates (mental health, self-esteem, parental wellbeing, socio-economic position) Loss of power with stratification Self-reported measures

Implications This is the first study to look at this association among children The findings point to a complex relationship between food insecurity and body satisfaction Future research is needed to further understand this relationship among children

Questions? A special thank you to: Kris Madsen Lorrene Ritchie Maureen Lahiff Lia Fernald Jenny Linchey Hannah Kleiner PHN Cohort

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