Unpacking the paradox: testing for mechanisms in the food insecurity and BMI association

Objective: Using data from the 2007-2008 continuous National Health Nutrition Examination Survey NHANES, this study conducted gender-specific analyses to examine the influence of food insecurity on individual Body Mass Index (BMI). The recent literature has identified the existence of the food insecurity-obesity paradox such that individuals who are food insecure are more likely to have higher BMI, and this association is especially prevalent among women. Various mechanisms have been proposed as having the potential for explaining this paradox. Design Cross-sectional: The relationship between food insecurity and women was assessed. Potential mediating risk factors were tested using multiple regression techniques. Setting: The 2007-2008 National Health and Nutrition Examination Survey, USA Subjects: Women 24-64 years of age Results: Food insecurity is associated with greater body mass index among women. Potential mechanisms such as availability of health foods, time to grocery store, stress, and health insurance access had independent associations with BMI but did not mediate the relationship between food insecurity and BMI. Conclusion: Results confirm the positive association between food insecurity and elevated BMI among women. However, these analyses do not provide evidence for a mediating role of mechanisms described in the research literature. Future research should strive to identify and test for other potential pathways of influence that might explain this food insecurity-obesity paradox.