The household food environment and overweight status of Mexican American children

Childhood obesity is a prevalent and growing health problem, particularly among Mexican American (henceforth referred to as "MA" for brevity) children: 28% of MA boys and 20% of MA girls between ages 6 and 11, and 22% of MA boys and 20% of MA girls aged 12-19 are overweight (Centers for Disease Control and Prevention, 2009). Although the relationship between poverty and obesity in the U.S. has been well documented (Skelton, Cook, Auinger, Klein,& Barlow,2009),we still know  relatively little about the household food environment and its relationship to childhood overweight status among poor and minority groups (where obesity  rates are the highest). The household is a social and economic unit that is critical to children's health, and the household food environment may be particularly relevant to children's health, since that is where they are given or make food choices most often, and is the basis for food assistance programs.

 

The objective of this proposed research is to study the associations among multiple indicators of the household food environment (food insecurity, food availability, food assistance, and location of meals), and overweight status among MA children in the U.S. Limited research in this area has focused on food insecurity, with contradictory findings. Research to date suggests that there may be positive, no, or negative associations between food insecurity and obesity among children in the U.S. (Kursmark & Weitzman, 2009). It may be that food insecurity works in conjuncture with other aspects of the household food environment to affect overweight status among children. In a study of Minnesota middle and high school students, food insecure youth reported eating more fast food meals, fewer family meals, and less breakfast than food-secure youth, and were more likely to be overweight (Widome, Neumark-Sztainer, Hannan, Haines, & Story, 2009). Other studies suggest that eating behaviors (particular overeating) may be related to overweight status among young children in the U.S. (Dubois, Farmer, Girard, Peterson,& Tatone-Tokuda,2007). Preliminary studies (by Melgar-Quinonez) have shown significant differences in the meal patterns among food insecure children when compared to food secure children. These findings suggest that snacking by food insecure children contributes more energy and saturated fat than other meals.

 

With respect to MA children, Hispanic children may suffer from hunger and lack of adequate food more often than children in other ethnic  groups, particularly less acculturated (Kaiser, Melgar-Quinonez, Lamp, Johns, Sutherlin, & Harwood, 2002) and undocumented families (Hadley, Galeal, Nandi, Nandi, Lopez, Strongarone et al.,2008). In terms of health outcomes, one study finds that children born to unmarried MA mothers have worse health at age 1 than those born to unmarried mothers in other racial groups, and that  those born to immigrant mothers are less likely to have received food stamps and other forms of social welfare when needed (Padilla, Radey, Hummer,& Kim,2006}. Another recent study found children born to immigrant mothers had higher levels of food insecurity and fair/poor health status (Chilton, Black, Berkowitz, Casey, Cook, Cutts et al.,2009) However, a study just published (June 2009) found  that among MA children (ages 8-17)  in poor households, there was no statistical association between food insecurity and overweight status, even though they were the most likely to be both food insecure and overweight compared with white and African American children (Gundersen, Garasky,& Lohman, 2009).There is also evidence of distinct dietary patterns among MA households, with some following more  "traditional" Mexican diets than others  (Carrera, Gao, & Tucker, 2007).

 

These studies provide an important foundation for considering the household food environment and obesity among MA children. However, no one study adequately assesses how various aspects of the household food environment may be linked with child overweight status.  This study aims to go beyond a single measure of the household food environment to consider how food insecurity, types of food available in the household, food assistance, and extent  of eating out relate  to overweight status among MA children, and whether the associations are additive or interactive. In addition, we will explore key moderating forces, such as poverty, stage of childhood, gender, and acculturation status, with each of the food environment measures.