tant issues, questions, and concerns about the relationship between food insecurity and obesity.

Athens, Ohio, is a rural Appalachian community that is searching for solutions to food insecurity, said David Holben, professor in the School of Applied Health Sciences and Wellness at Ohio University and registered dietitian. More Supplemental Nutrition Assistance Program (SNAP) benefits have been used at its farmers’ markets than in all the other farmers’ markets in the state of Ohio combined. The U.S. Department of Agriculture (USDA) has funded an incubator kitchen that has spawned many new food-based businesses. Also, gleaning of produce grown in the Ohio River valley, including tomatoes, peppers, pumpkins, and potatoes, is an important part of coping with community food insecurity in the region.

Obesity is a multifactorial disease, Holben observed. A person may have a genetic susceptibility to becoming overweight or obese, but that person also has been exposed to an environment that encourages obesity through diet, chemical exposures, lack of physical activity, and so on. Furthermore, these gene-environment interactions take place in a natural environment, a policy environment, and a social environment. The complexity of these circumstances points toward many of the research gaps that exist in the extremely heterogeneous field of nutrition.

Food insecurity can lead to poor dietary intake, malnutrition, and negative health outcomes. Various risk factors can contribute to food insecurity, including limited resources, functional constraints, and poor management strategies. Again, the complexity of even this simplified framework points toward a variety of research gaps.

One of the most basic gaps involves the measurement of food security and obesity. Does the current measure of food insecurity fully capture the experience among children? Is body mass index (BMI) enough to measure obesity, or should a measure such as waist circumference be added?

The relationship between food insecurity and obesity is especially trouble some, as this workshop made clear. If there is a causal relationship, in which direction does causation extend, or does it extend in both directions?