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Running Head: POOR & PUDGY

Poor and Pudgy:

A look at why American low-income children are obese

Garett M. Brownlee

University of Texas

POOR & PUDGY 2

Over the last decade, surging obesity rates among American adolescents has received

national attention (Kaye, Tucker, Bragg, & Estampador, 2011). This problem has specifically

impacted minority populations, revealing striking numbers of obese low-income children

(Tartamella, Herscher, and Woolston, 2004). The severity of the issue has caused the Centers for

Disease Control and Prevention (CDC) to label the problem an “epidemic” (Brownell & Horgen,

2004). According to The Pediatric Nutrition Surveillance System, one in three low-income

adolescents are obese or overweight (Center for Disease Control, 2009). The impact of

childhood obesity among low-income children’s long-term health is so unprecedented, one study

proposes that this generation of American children may have a shorter life expectancy than their

parents (Brownell & Horgen, 2004).

A leading explanation for high obesity rates in low-income children is food insecurity.

Food insecurity is the cyclical pattern of eating highly caloric or fatty foods to compensate for an

anticipated lack of foods in the future (Daniels, Queen, & Schumacher, 2007). Several reports

indicate food insecurity can lead to obesity, specifically in children (Karnik, Foster, Mayer,

Pratomo, McKee, Maher, & Anderson, 2011; Franklin, Jones, Love, Puckett, Macklin, & White-

Means, 2012). A 2009 report stated as many as sixteen percent of American families are living

in a state of food insecurity (Nord, 2009).

The complexities of food insecurity in modern American reveal inter-related hardships

among low-income populations (Iceland & Bauman, 2007). Because food insecurity

predominantly impacts low-income populations, some reports have identified physical and

financial barriers to healthy food as a social injustice (Jernigan, Salvatore, Styne, & Winkleby,

2012). In this respect, obesity rates of low-income children and the lives of the food insecure is a

POOR & PUDGY 3

national concern. The problem of low-income child obesity is important because it exposes

systemic inequalities as to whom should be responsible for a child’s weight.

This report highlights research, which explains the various themes of food insecurity and

how this affects obesity rates in low-income children. Specifically, it will identify food

insecurity characteristics and mechanisms which influence weight, or Body Mass Index (BMI),

the calculation of weight divided by height (Ogden, Carroll, & Flegal, 2008 p. 2401).

It will also discuss the causal relationship between participants of Federal Food Assistance

Programs and food insecure populations by evaluating programs: Womens, Infants, Childrens

(WIC) and Supplementary Nutrition Assistance Program, popularly referred to as “food stamps.”

Finally, the report will identify Rational Choice Theory as a possible explanation for

understanding this complex problem.

Food Insecurity

Characteristics of Food Insecurity

The prevalence of food insecurity in American has developed a field of research which

identifies habits of the food-insecure population, associating environmental and systemic

influences to aid in childhood obesity rates (Smith, 2010). Adams, Grummer-Strawn and

Chavez (2003) divide food insecure associative behaviors into three mechanisms: “biological,

social, and behavioral” (p.1043). Because people living in food insecurity are not typically

isolated to this problem alone, this model helps explain why children living in food insecure

homes are influenced by several factors (Adams, et.al., 2003). The characteristics of the food

insecure explain why children in those environments have an increased body fat and are exposed

to highly caloric, low priced foods while under-consuming fresh produce (Daniels, Queen, &

Schumacher, 2007, p.45).

POOR & PUDGY 4

Stress & Food Insecurity

Food insecurity is rooted in a neurobiological response of uncertainty as to when food

will be available, a product of populations living in poverty (Dowler, & O’Connor, 2012).

Reports indicate a relationship between food insecurity, stress, and eating to fill an emotional

void, which collectively contribute to increasing obesity rates in children (Lofton, 2008). Lofton

(2008) also concludes the responses of those living in food insecurity cannot be isolated to one

causal indicator of obesity (pp. 5581). One report showed over sixty percent of obese food

insecure children under five-years-old were exposed to an interrelated social risk, including

domestic violence, unstable housing, and stress (Suglia, Duarte, Chambers, & Boynton-Jarrett,

2012, p. 1173).

The stress of how a family acquires and distributes food is found to be a connection of

“food insecurity and child overweight” (McCurdy, Gorman, & Metallinos, Katsaras, 2010, p.

144). The stress caused by low socio-economic households show a strong indicator for obesity

among mothers, causing higher obesity amongst their children (Franklin, et. al., 2012). One

study expressed a correlation which indicates the higher level of stress from a mother increased

the likelihood of children in food insecure homes to be obese (Lohman, Stewart, Gundersen,

Garasky, & Eisenmann, 2009).

Parental stress can facilitate the effects of food insecurity in children’s eating behavior

(Huang, Oshima, & Kim, 2010). Stresses from mothers are often realized in the inability to

provide attentive parenting and a prioritization of healthy food choices for their children

(Lohman, et. al., 2009). Over-feeding and giving unhealthy food to young children can be

gratifying to parents, out of a compensating behavior for parental inconsistencies (Kaufman &

Karpati, 2007).

POOR & PUDGY 5

Acculturation & Food Insecurity

Social indicators of food insecurity can be understood by cultural demographics of low-

income populations. Among low-income people, minority sub-groups, Hispanics are

documented at a significantly greater risk (Cutts, Darby, Boone, & Brewis, 2009). In Latino

immigrant populations, a lack of acculturation has caused a higher rate of food-insecurity

(Buscemi, Beech, & Relyea, 2011). As a result, these authors suggest acculturation for Latino

immigrants as a “significant moderating variable between food insecurity and [BMI] percentile

in children of Latino immigrants” (p. 149). Further, the lack of acculturation in Latino

immigrants in rural settings can be expressed in limited social networks or community support,

maintaining a cycle of food insecurity (Sano, Garasky, Greder, Cook, & Browder, 2011). For

these populations, small social networks and low levels of acculturation are risk factors for food

insecurity (Dhokarh, Himmelgreen, Peng, Segura-Pérez, Hromi-Fiedler, & Pérez-Escamilla,

2011).

Access & Food Insecurity

Unhealthy eating patterns of food-insecure children can be seen by the lack of healthy

food options available in schools (Rose, 2011). With a lack of healthy food choices, food

insecure children are more likely to eat foods that are more calorically dense (Drewnowski, &

Specter, 2004). School vending machines have been criticized to aid the problem of healthy

food access, contributing to a higher number of fatty foods and sweetened drink options for

students (Cullen, Watson, Zakeri, and Ralston, 2006). These authors confirmed a positive

correlation between healthier food vending machine choice with an increase of healthier food

consumption amongst children (Cullen et.al., p.814). However, current reappraisals of school

POOR & PUDGY 6

nutrition programs have shown limiting results to impacting the BMI of obese children (Jaime &

Lock, 2009).

Consuming calorically dense food habitually has accustomed children’s appetites to have

a high palatability of fat and sugar (Drewnowski, & Specter, 2004). These authors suggest the

routine pattern of eating foods with a high fat and sugar content at a young age impacts a lower

consumption of healthier foods over time (p. 8). As a result, there is a higher demand of highly

caloric foods in lower income neighborhoods (Jennings, Welch, Jones, Harrison, Bentham, Van

Sluijs, & Cassidy, 2011). One study defined food insecurity as a lack of access to nutritious food

a common trend in low-income neighborhoods (McIntyre, Glanville, Raine, Dayle, Anderson, &

Battaglia, 2003). To follow, researchers suggest low-income children are exposed to

neighborhood food environments which are often full of venders selling calorically dense,

nutritionally poor food (Tester, Yen, & Laraia, 2010). Convenience stores and low-income

neighborhood environments are contributors to the obesity problem (Koleilat, 2011). The

unhealthy food choices available in those low-income neighborhood food outlets have shown to

increase children’s weight (Jennings, et.al., 2011).

Federal Food Assistance Programs & Food Insecurity

The US Census suggested that the U.S. is currently poorer than it has been in fifty years

(CDC, 2009). Franklin and colleges (2012) claim federal “food stamp participation may

exacerbate obesity outcomes” (p.253). Over the last twenty years, obesity rates amongst

assistance program participants have caused government organizations to review program

practices (Lloyd, 2008). As more people seek food assistance, development and evaluation of

these programs is critical to reduce the number of food insecure homes (Frank, Chilton, Casey,

Black, Cook, Cutts, & Meyers, 2010).

POOR & PUDGY 7

In 1995, William Dietz explained a causal relationship between hunger and obesity

(p.766). In this report, Dietz identified the paradox of overeating behavior amongst populations

whom experience hunger (Dietz, 1995). This study introduces a platform to understanding

obesity rates amongst food insecure populations (Dinour, Bergen, & Yeh, 2007). Food insecure

homes result from by a lack of economic resources, creating a dependency to over-consume

when allotted food (Dinour, et.al., 2007). These authors speculate federal food assistance

programs “play a role in this obesity–food insecurity paradox” (Dinour, et. al., 2007, p. 1953).

 WIC has contributed to food insecurity and obesity rates among low-income children

(Sekhobo, Edmunds, Reynolds, Dalenius, & Sharma, 2010). WIC participants in New York City

have revealed a four percent increase in childhood obesity during the 1990s (Sekhobo, et.al.,

2010). Critics of the WIC program’s monthly distribution plan claim that the system has caused

an increase of food insecurity populations by causing fluctuating eating habits throughout the

month (Kaufman & Karparti, 2007). Dhokarh and colleagues (2011) claim “poor food stamps

management skills may influence household food insecurity” (p.288).

Conflicting Reports & Food Insecurity

Food insecurity and obesity rates in low-income children have an associated relationship,

yet, some suggests food insecurity is not a predictor of obesity in low-income children (Adams,

et.al. 2003). In fact, one report noted that food insecurity is not a clear indicator of childhood

obesity (Harris, 2009). Some reports are indicating outliners of food insecurity, such as stress,

access to calorically dense food, and children’s palate as more significant to childhood obesity

than food insecurity alone (Drewnowski, & Specter, 2004).

Some researchers claim a lower level of food insecurity in WIC participants (Lindsay,

Sussner, Greaney, & Peterson, 2009). Sekhobo and colleagues (2010) found a decline in

POOR & PUDGY 8

childhood obesity rates for New York City low-income WIC non-Hispanic children (p. 222).

Yet, these authors also note the Hispanic community reported higher rates of childhood obesity

in the same time period (Sekhobo, et.al., 2010, p. 222). One study found no correlations between

BMI and food insecurity in children (Karnik, Foster, Mayer, Pratomo, McKee, Maher, &

Anderson, 2011, p. 658).

Rational Choice Theory

It is helpful to understand behaviors of food insecure populations using Rational Choice

Theory. Rational Choice Theory explains how people make decisions on the basis of rational

which serves their self-interest (Hutchison, 2011). For populations living in food insecurity, the

uncertainty of their next meal creates a rational decision to choose higher calorically dense food,

despite its connection to childhood obesity. This suggests that people make decisions based on

the information they have which will serve their best interests (Maziak, & Ward 2009). Rational

Choice Theory would propose that people are motivated by rational choices and make decisions

based on that rational (Robinson, 2010).

The Rational Choice Theory guides decision making on the basis of economic principles

of the “expected-value maximization” (Bhaskar, Herstein, & Hayes, 1983, p. 267). The lower

costs of calorically dense food can help explain the obesity rates as a rational choice. Rose

(2011) noted “individuals will consume less of a food when the price is higher” (p. 3). Rational

Choice economics explains consumers make decisions based on price.

Posner (1998) writes, “Rational choice need not be conscious choice” (p. 1551). Critics

claim marketing and misleading nutrition labels make it difficult for consumers to make

rationally healthy food choices (Ollberding, 2010). For low-income populations, the rational to

purchase cheaper calorically dense food is more rational than buying healthy, more expensive

food. Because people living in food insecurity are often operating on an instant need rational,

POOR & PUDGY 9

Rational Choice Theory can help explain decision making which is influenced by immediate,

environmental or situational factors (Tillyer, 2011, p.143).

Children are consistently making irrational decisions, (Cristea, Benga, & Opre, 2006).

Studies of children’s decision-making suggest a higher correlation of obesity among children

who make their own decisions regarding food consumption (Murphy, Ice, McCartney, Leary, &

Cottrell, 2012). These authors suggest that lower parental involvement in food decisions for

children causes higher obesity rates in those children. Rational Choice Theory would suggest the

relationship between palatable desires of highly fat or sweetened food is considered more

desirable choice amongst children who have an option to choose (Drewnowski, & Specter,

2004).

Conclusion

Rates of childhood obesity are disproportionately prevalent in socio-economic

disadvantage homes (Burns, Jones, & Frongillo, 2010, p. 129). These reports find a connection

between food insecurity and obesity rates amongst low-income children (Karnik, et.al., 2011).

Identifying indicators of food insecurity and the outlining mechanisms in food insecure

populations helps explain why hungry populations who overeat can become obese (Dinour, et.al.,

2007).

If research assumes children cannot make best decisions regarding healthy eating choices

the accountability of those decisions are then on the caretaking adults. Immediately, parents

living in food insecurity have biological, social and behavioral responses which interfere with

sustainable healthy food choices for their children (Adams, et.al, 2003). Stress of the food

insecure has impacted parenting and food decisions to low-income children, effecting overweight

and obesity (McCurdy, et.al., 2010). In addition, schools and neighborhood environments have

POOR & PUDGY 10

been criticized for lacking affordable and accessible healthy food options for students (Tester,

et.al., 2010). Acculturation and social networks can contribute to a higher risk of food insecurity

and a child’s weight (Dhokarh, et.al., 2011). Finally, obesity rates among federal food assistance

program participants imply a critical review of program procedure as to reduce childhood obesity

rates and food insecure homes (Frank, et.al., 2010).

Rational Choice Theory aids in understanding the food insecure behaviors of obese, low-

income children. The relationship between palate, access to healthy food, and price deviation

between healthy and unhealthy foods creates a rationale to buy and consume calorically dense

foods (Tillyer, 2011). Further, when children are making decisions independently, they are less

likely to make healthier food choices (Murphy et.al., 2012). To intervene, Rational Choice

Theorists might suggest to food insecure stakeholders to reappraise decision-making behaviors

of the food insecure to pursue a solution to this complex problem.

POOR & PUDGY 11

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