rates of wasting are much lower than the rates of stunting as well. She said a grim possibility is that the most severely wasted children are dead by the time the survey is taken. Another participant agreed, saying that these deaths probably happened early in life and that 50 percent of the deaths of children are associated with malnutrition.

Another participant commented on the issue of measurement for adults versus children, saying that when doing dietary information intake it would be considered ludicrous to expect parents to know what a teenager ate. As a result, some surveys, including NHANES, ask the teenager directly. The speaker asked if something similar could take place for the measurement of food security. The speaker also asked whether work has been done to develop the appropriate wording for requesting the information from teenagers. Frongillo said he finds that school-aged children can answer accurately, with occasional failures. For the most part, children as young as age six or seven can answer the questions, but whether that would work in the context of NHANES is a different challenge. While children are able to report experiences of pain and other things, he said middle school children are most likely to hide information. Older children do not care what they say, and younger children will talk about whatever they are thinking and whatever has happened. Frongillo said it would be possible to do a direct assessment of children, and he and his collaborators have been doing so for about a year and a half in a school district’s elementary and middle schools. They are trying to develop a model from those observations, augmented by reports from teachers and others.



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