Overview

The coexistence of obesity and food insecurity (which in its severe form is commonly referred to as hunger) in the same families and communities and even the same individuals is recognized by researchers and increasingly by the broader public. Though the coexistence of these two phenomena may appear inconsistent and thus policy makers may be tempted to question the rationale for nutrition assistance programs based on the fact that many recipients are obese, it is important to examine the complexity of the relationship before curtailing such programs based on this observation. Recent research findings raise questions about whether food insecurity significantly contributes to excess weight gain that leads to obesity, why food insecurity may be related to obesity, and the pathways through which food insecurity may affect weight status. The Workshop on Understanding the Relationship Between Food Insecurity and Obesity, held in Washington, DC, from November 16 to 18, 2010, was designed to provide an opportunity to explore and illuminate the relationship between food insecurity and obesity, the current state of research, and data and analyses needed to advance understanding of the relationship as a way of countering both hunger and obesity in the United States.

The workshop was organized by the Institute of Medicine (IOM) at the request of the U.S. Department of Agriculture’s Food and Nutrition Service. To plan the workshop, the IOM appointed a Workshop Planning Committee chaired by Patricia B. Crawford of the University of California at Berkeley. Each member of the planning committee contributed substantively to organizing the agenda, and each moderated sessions during the



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Overview The coexistence of obesity and food insecurity (which in its severe form is commonly referred to as hunger) in the same families and communities and even the same individuals is recognized by researchers and increasingly by the broader public. Though the coexistence of these two phenomena may appear inconsistent and thus policy makers may be tempted to ques- tion the rationale for nutrition assistance programs based on the fact that many recipients are obese, it is important to examine the complexity of the relationship before curtailing such programs based on this observation. Recent research findings raise questions about whether food insecurity sig- nificantly contributes to excess weight gain that leads to obesity, why food insecurity may be related to obesity, and the pathways through which food insecurity may affect weight status. The Workshop on Understanding the Relationship Between Food Insecurity and Obesity, held in Washington, DC, from November 16 to 18, 2010, was designed to provide an oppor- tunity to explore and illuminate the relationship between food insecurity and obesity, the current state of research, and data and analyses needed to advance understanding of the relationship as a way of countering both hunger and obesity in the United States. The workshop was organized by the Institute of Medicine (IOM) at the request of the U.S. Department of Agriculture’s Food and Nutrition Service. To plan the workshop, the IOM appointed a Workshop Planning Committee chaired by Patricia B. Crawford of the University of California at Berkeley. Each member of the planning committee contributed substan- tively to organizing the agenda, and each moderated sessions during the 1

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2 HUNGER AND OBESITY workshop. More than 40 experts in the field addressed important questions during formal presentations. The workshop also offered an opportunity for presenters, participants, and the public to contribute to the discussion of the relationship between food insecurity and obesity. The workshop itself engendered many ex- changes between presenters and other participants, which are summarized in the sections labeled “Group Discussion” in this report. Additionally, roundtable discussions were held at the end of the first day of the workshop with the goal of eliciting ideas from participants on how better to under- stand the relationship between food insecurity and obesity. Participants split into a number of small groups to discuss specific questions related to that goal, and the summary is in Appendix F of this report. Finally, after the workshop concluded, its participants and the general public had the oppor- tunity to submit comments on the topic to a section of the IOM website. The workshop created a dialogue among people who might not nor- mally be talking with each other in depth: specialists focused on hunger and specialists focused on overweight/obesity, academics and activists, and qualitative and quantitative researchers. In so doing, the workshop under- scored the importance of this kind of broad communication. This workshop summary is organized according to the chronological order of the proceedings, except for notes from roundtable discussions, which are found in Appendix F. The goals of the workshop are presented in Chapter 1, followed by a stage-setting chapter that examines the evidence on the relationship between food insecurity and obesity in adults and in children. Chapter 3 examines the food insecurity and obesity relationship as it is influenced by socioeconomic disparities. Chapter 4 examines the rela- tionship in sentinel populations, including young children, immigrants, Na- tive Americans, and rural populations. Chapters 5 through 8 walk through four levels of a socioecological model—individual, family and household, environmental, and institutional, respectively, and Chapter 9 discusses a framework to integrate the perspectives of the four levels. Research applica- tions that target both food insecurity and obesity are discussed in Chapter 10. Chapter 11 explores major research questions, from the perspective of four disciplines—nutrition, sociology, psychology/human development, and economics—that if addressed will likely help us to better understand the relationship between food insecurity and obesity and may help the research and policy communities integrate these disciplinary perspectives when de- signing programs and policies. Chapter 12 describes research methods and measures that may be useful in addressing the research gaps identi- fied throughout the workshop, including strategies such as data modeling, qualitative research, and geographic information system mapping. Chapter 13 conveys the perspectives of government agencies and foundations on research priorities and considers how to address proposed priorities, as well

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3 OVERVIEW as foster potential partnerships, that would further the understanding of the relationship between food insecurity and obesity. A number of appendixes provide details about the workshop agenda, participants, and proceedings. The workshop agenda is reproduced in Appendix A; the workshop planning committee and speaker biographical sketches appear in Appendixes B and C, respectively; and a list of work- shop participants is compiled in Appendix D. For convenience, a guide to the acronyms used throughout this report is provided in Appendix E. As mentioned above, Appendix F contains notes from roundtable discussions. Appendix G contains comments submitted by the public regarding this workshop and its statement of work, and Appendix H provides a brief list of recurring themes that were discussed by participants during the course of the workshop.

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