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Food Insecurity and Body Mass Index: A Longitudinal Mixed Methods Study, Chelsea, Massachusetts, 2009–2013

Food Insecurity and Body Mass Index: A Longitudinal Mixed Methods Study, Chelsea, Massachusetts, 2009–2013

ORIGINAL RESEARCH — Volume 12 — August 6, 2015

Hong Chen Cheung, MD, MPH; Aileen Shen, MPH; Sarah Oo, MSW; Hailu Tilahun, MD, MPH; Marya J. Cohen, MD, MPH; Seth A. Berkowitz, MD, MPH

Suggested citation for this article: Chen Cheung H, Shen A, Oo S, Tilahun H, Cohen MJ, Berkowitz SA. Food Insecurity and Body Mass Index: A Longitudinal Mixed Methods Study, Chelsea, Massachusetts, 2009–2013. Prev Chronic Dis 2015;12:150001. DOI: http://dx.doi.org/10.5888/pcd12.150001.

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On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables
• Appendix

Abstract

Introduction

Cross-sectional studies show an association between food insecurity and higher body mass index (BMI), but this finding has not been evaluated longitudinally. Patient perspectives on food choice in resource-constrained environments are not well understood. The objective of this study was to evaluate the longitudinal association between food insecurity and BMI.

Methods

This mixed methods study used both a retrospective matched cohort and focus groups. For the quantitative analysis, all patients in a community health center who reported food insecurity from October 2009 through March 2010 (n = 457) were followed through August 2013 and compared with controls matched by age, sex, and race/ethnicity (n = 1,974). We evaluated the association between food insecurity and change in BMI by using linear, mixed effects longitudinal models. The qualitative analysis included patients with food insecurity, stratified by BMI. Qualitative data were analyzed by using open coding and grounded theory.

Results

The mean age of participants was 51 years; 61% were women, and 73% were Hispanic. Baseline BMI was similar in food insecure participants and matched controls. After adjustment in longitudinal analyses, food insecurity was associated with greater increase in BMI (0.15 kg/m2 per year more than controls, P < .001). Themes identified in 4 focus groups included attitudes and knowledge about food, food access, and food practices. Participants with BMI of 30 kg/m2 or less highlighted skills such as budgeting and portion control.

Conclusion

Food insecurity is associated with increase in BMI. The skills of food insecure participants who were not obese, such as portion control and budgeting, may be useful in weight management interventions for vulnerable patients.

Acknowledgments

We thank Christopher Freeman for hosting one focus group and helping with coding. We also thank Clinician LLC for the donation of grocery coupons. All authors affirm that they have no conflicts of interest to report.

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Author Information

Corresponding Author: Hong Chen Cheung, MD, MPH, Adult Medicine, Chelsea Health Care Center, 151 Everett Ave, Chelsea, MA 02150. Telephone: 617-889-8580. Email:Chencheung.hong@mgh.harvard.edu.

Author Affiliations: Aileen Shen, Injury Prevention at Boston Public Health Commission, Boston, Massachusetts; Sarah Oo, Community Health Department, Massachusetts General Hospital, Boston, Massachusetts; Hailu Tilahun, Department of Internal Medicine, Beth Israel Deaconess Hospital, Boston, Massachusetts; Marya J. Cohen, Adult Medicine, Massachusetts General Hospital, Chelsea Health Care Center, Chelsea, Massachusetts, Harvard Medical School, Boston, Massachusetts, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Seth A. Berkowitz, Harvard Medical School, Boston, Massachusetts, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts. Dr Chen is also affiliated with the Harvard Medical School, Boston, Massachusetts.

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