The Association between Food Security and Weight Satisfaction among US Children

Background: An estimated 13 million children in the United States live in food-insecure
households, which has been linked to greater symptoms of depression and anxiety, lower
self-esteem, and eating disorders. Weight dissatisfaction is another factor found to be associated
with those same outcomes, but to date, studies looking at the association between food security
(FS) and weight dissatisfaction has not been done using a national database. Understanding the
relationship between FS and weight dissatisfaction can help in developing early interventions for
at-risk groups.
Objective: To evaluate the association between a child's FS level and their self-perception with
and satisfaction of their weight status. Secondary outcomes include the association between sex
and race/ethnicity with weight self-perception and satisfaction among individuals with lower FS
levels.
Methods: This is a retrospective cohort study of the National Health and Nutrition Examination
Survey data from 2005-2016. Respondents were categorized under one of four FS categories:
full, marginal, low, and very low in the database. Answers to the survey questions "How do you
consider your weight?" and "What are you trying to do about your weight?" were used to
categorize weight self-perception and weight satisfaction. The chi-squared test of independence
was used to analyze weight survey data, with a significance set at p ≤ 0.05.
Results: A total of 8,717 children aged 8-15 were included in the study. Both weight
self-perception (p ≤ 0.05) and weight satisfaction (p ≤ 0.05) significantly differed by FS level.
With regards to weight self-perception, more of those endorsing full FS considered themselves to
be about the right weight (75.2%) compared to those with low (70.0%) and very low FS (69.7%)
(p ≤ 0.05). More respondents with low (21.5%) and very low FS (20.2%) considered themselves
to be fat compared to those with high FS (17.2%) (p ≤ 0.05). Weight dissatisfaction was more
common among those with low (54.12%) and very low (57.30%) FS compared to those
endorsing full FS (47.39%) (p ≤ 0.05). Among respondents with low and very low FS, sex
differences in both weight self-perception (p ≤ 0.05) and weight satisfaction (p ≤ 0.05) were
seen. Racial differences in weight satisfaction (p ≤ 0.05) were seen, but racial differences in
weight self-perception (p > 0.05) were not seen.
Conclusion: Lower FS levels may influence children's weight satisfaction and self-perception.
Sex may influence both weight satisfaction self-perception and race/ethnicity may influence
weight self-perception among children endorsing lower FS levels. Future studies should use
in-depth questionnaires and evaluate other variables such as overall self-esteem, mental health,
and eating behaviors to better understand this relationship.