F
Roundtable Discussions

On the afternoon of the workshop’s first day, the participants divided into groups to discuss six key questions.

  1. What intervention strategies seem most promising to reduce food insecurity and obesity? What are the key target populations and why?

  2. How can we better elucidate the mechanisms underpinning the relationship between food insecurity and obesity?

  3. What are current knowledge research- and policy-related gaps in obesity and food security research, and why?

  4. What are key questions for setting research priorities that would further the understanding of the relationship between food insecurity and obesity and help identify approaches that would reduce both food insecurity and obesity?

  5. What are the methodological limitations associated with current research focused on the relationship between obesity and food insecurity?

  6. How can these limitations be overcome with new data, new designs, alternative analyses, or different research approaches?

The following answers to these questions have been compiled from notes generated by the breakout groups and their reports at a subsequent plenary session.



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F Roundtable Discussions On the afternoon of the workshop’s first day, the participants divided into groups to discuss six key questions. 1. What intervention strategies seem most promising to reduce food insecurity and obesity? What are the key target populations and why? 2. How can we better elucidate the mechanisms underpinning the relationship between food insecurity and obesity? 3. What are current knowledge research- and policy-related gaps in obesity and food security research, and why? 4. What are key questions for setting research priorities that would further the understanding of the relationship between food insecu- rity and obesity and help identify approaches that would reduce both food insecurity and obesity? 5. What are the methodological limitations associated with current research focused on the relationship between obesity and food insecurity? 6. How can these limitations be overcome with new data, new de- signs, alternative analyses, or different research approaches? The following answers to these questions have been compiled from notes generated by the breakout groups and their reports at a subsequent plenary session. 225

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226 HUNGER AND OBESITY 1. What intervention strategies seem most promising to reduce food inse- curity and obesity? What are the key target populations and why? • In the reauthorization of the Farm Bill, deemphasize corn, soy, and wheat and emphasize fruits and vegetables. • Reform nutrition education to have a more hands-on approach, as in home economics classes. • Reconsider inconsistent U.S. Department of Agriculture (USDA) policy (for example, USDA recommends limiting fats but also helped Dominos to reformulate pizza with twice as much cheese). • Create a more healthful school foods environment (for example, by removing vending machines and providing more healthful foods at parties). • Monitor the proximity of food vendors and the quality of food available near schools. • Promote and support farmers’ markets. • Reduce marketing to children. • Focus interventions on specific subpopulations, including minority women, groups with the lowest incomes, rural populations, and areas of concentrated urban poverty. • Tailor approaches to the specific geographic, cultural, and eco- nomic context. • Provide point-of-contact interventions—a “one stop shop” for all programs. • Conduct more public education on assistance programs and ben- efits, and address stigma and fears. • Partner with rather than “target” populations. • Identify and address food deserts and/or unhealthful food swamps, and increase access to healthful foods. • Include the food industry in interventions. • Reduce poverty through income transfers (such as the Supple- mental Nutrition Assistance Program [SNAP]), community-based prevention funds, and other measures. • Take a comprehensive community-based approach that includes more than food in the solution. 2. How can we better elucidate the mechanisms underpinning the rela- tionship between food insecurity and obesity? • Study the mechanisms that influence food choice, such as taste, cost, convenience, how filling a food is, and how people socialize over certain foods. • Ascertain why people make obesogenic food choices.

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227 ROUNDTABLE DISCUSSIONS • Develop understanding of what makes poor people susceptible to food insecurity and obesity. • Conduct research on the episodic nature of food insecurity to iden- tify the long-term link to obesity and health. • Investigate the role of temporality in nutrition and obesity. • Broaden the research lens through such methods as longitudinal studies, the use of mixed methods, and interdisciplinary research. • Examine social capital to determine if food-related variables are being overlooked. • Examine the influence of family roles and kinship networks on eat- ing, food security, physical activity, and obesity. • Study cultural factors (for example, food sharing). • Broaden the study of obesity to all of society. 3. What are current knowledge-, research-, and policy-related gaps in obesity and food security research, and why? • How can food assistance programs help provide a healthful diet? (For example, is there a link between obesity and intake of micronutrients?) • What is the impact of food insecurity on dietary quality, and is this impact changing over time and within specific populations? • Where do food-insecure populations access food, and what are the implications of this access for dietary quality and health? • How do stress and other psychosocial factors affect food insecurity and obesity? • What are the biological effects of such factors as feast versus fam- ine and variations in the food supply? • What are the pathways through which poverty and deprivation lead to food insecurity, obesity, and poor health outcomes from a chronic disease and life course perspective? • What are the implications of interventions to address food insecu- rity in such areas as household perceptions of food insecurity and the use of additional resources? • What coping strategies do individuals and households use in re- sponse to food insecurity? • What are the implications for women who protect their children from food insecurity? • What role should emergency food assistance play—for example, what types of food should be distributed? • What are the characteristics and effects of food purchased with SNAP dollars? • How can measures of both obesity and food insecurity be standardized?

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228 HUNGER AND OBESITY • How can populations of need be identified to enable access to benefits? • What role does stigma play in food-insecure and obese populations? 4. What are key questions for setting research priorities that would fur- ther the understanding of the relationship between food insecurity and obesity and help identify approaches that would reduce both food insecurity and obesity? • What should the role of private organizations be, and what types of foods should they provide? • What is the quality of people’s diets, and where do these foods come from? • Where and how do people access food? • How can causal relations between food insecurity and obesity be identified and studied? • How do poverty and deprivation lead to chronic disease? • How can policies, such as restrictions on SNAP benefits or menu la- beling, be studied and then implemented if shown to be effective? • How can the existing infrastructure and resources be leveraged to reduce food insecurity? (Examples include increasing SNAP ben- efits, conducting SNAP outreach, and increasing participation in an evidence-based context that recognizes such factors as dietary quality.) 5. What are the methodological limitations associated with current research focused on the relationship between obesity and food insecurity? • Most data do not include retrospective information, but experi- ences with food insecurity and obesity typically go back to early childhood. • Research needs to be conducted to validate retrospective measures. • New questions and data need to be inserted into existing surveys and datasets, such as the Early Childhood Longitudinal Study (ECLS), Head Start, and PACE. • All relevant factors need to be considered, including nontraditional items such as perceptions of the food environment. • New techniques such as area measures and maps should be used. • Food insecurity should be reframed from a life course perspective. Does it affect the poorest of the poor? What is the role of the food environment? Is understanding sentinel groups more important than understanding obesity?

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229 ROUNDTABLE DISCUSSIONS • Can children be used as a sentinel population, and if so how? • Are the right groups being studied? Do possible groups to study include people in transition, the homeless, or illegal immigrants? • Use mixed methods. • Conduct more targeted sampling for surveillance. • Study how people who are food insecure, but not overweight, have managed to avoid gaining weight. • Add measures of food insecurity, stress, depression, and how people use their time to studies that measure body composition using dual x-ray absorptiometry (DXA). These studies should be comprehen- sive but not overly burdensome with respect to collecting data. • Examine the very early origins of the relationship between food insecurity and obesity. • Improved measures are needed of overweight, food insecurity, di- etary quality, and physical activity. • Publication bias against negative results needs to be overcome. • How can lifelong relationships with food insecurity and obesity be studied using cross-sectional studies? • Data on contextual factors for subpopulations or sentinel pop- ulations are needed yet are not currently collected by national surveys. • Food insecurity may change in a short time, but body mass in- dex (BMI) may take time to change, even with a change in food security. • The persistence of food insecurity for some households and indi- viduals and the cyclicity of food insecurity for others need to be studied. • What is a typical episode of food insecurity? • What other common factors or pathways besides poverty exist between food insecurity and obesity? 6. How can these limitations be overcome with new data, new designs, alternative analyses, or different research approaches? • Add new or existing questions to more surveys. • Overlap time sets for risk measures, physical activity, and sedentary activity. • Use better measurements of obesity (e.g., DXA), stress (e.g., corti- sol in hair), and depression. • Study short-term and long-term persistence of food insecurity. • Expand sampling to underrepresented groups such as the homeless and illegal immigrants.

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230 HUNGER AND OBESITY • Study how acute or chronic food insecurity relates to obesity. • Conduct longitudinal studies that explore the relationship between food insecurity and obesity among children and adults. • Use mixed methods to identify, for example, the contextual factors beyond those provided in quantitative studies. • Study how the experience and interpretation of food insecurity and obesity differ among groups, households, and individuals. • Study how parents or caregivers perceive food insecurity and obe- sity among their children. • Study aspects of physical activity such as variations by social class, the presence of physical activity deserts, the influence of the built environment, and correlations with poverty. • Consider factors such as stress, depression, and mental health as mediating factors or pathways to both food insecurity and obesity. • Examine how nutrition assistance programs (such as SNAP) could provide incentives for families and households to purchase health- ful foods.