Food Insecurity Is Associated with an Increased Prevalence of Comorbid Medical Conditions in Obese Adults: NHANES 2007-2014

J Gen Intern Med. 2019 Aug;34(8):1486-1493. doi: 10.1007/s11606-019-05081-9. Epub 2019 Jun 3.


Background: Numerous studies have examined if food insecurity (FI) leads to increased weight gain, but little is known about how FI affects obese participants.

Objective: Our objective was to determine if obese, food-insecure adults are more likely to have medical comorbidities than obese, food-secure adults.

Design: We conducted a cross-sectional study using the 2007-2014 National Health and Nutrition Examination Survey (NHANES).

Participants: All obese participants (≥ 20 years) in NHANES were eligible. Participants who were pregnant or missing FI data were excluded.

Main measures: The primary exposure was household FI, and the primary outcome was the total number of obesity-related comorbidities. Secondary outcomes evaluated the association between FI and individual comorbidities. Propensity score weighting was used to improve covariate balance. We used negative binomial regression to test the association between FI and the total number of comorbidities. We used logistic regression to test the association between FI and individual comorbidities.

Key results: Of the 9203 obese participants, 15.6% were food insecure. FI (β = 0.09, 95% CI: 0.02, 0.15; p = 0.01) and very low food security (β = 0.17, 95% CI: 0.07, 0.28; p = 0.003) were associated with an increased number of comorbidities. In secondary analyses, FI was associated with increased odds of coronary artery disease (OR: 1.5, 95% CI: 1.1, 2.0) and asthma (OR: 1.3, 95% CI: 1.1, 1.6). Very low food security was associated with increased odds of coronary artery disease, diabetes, and asthma.

Conclusion: Obese adults living in food-insecure households were more likely to have an increased number of comorbid conditions than obese adults living in food-secure households. Clinicians should be aware of the association between FI and comorbid medical conditions when treating patients with obesity.

Keywords: cardiovascular disease; chronic conditions; food insecurity; obesity; social determinants of health.

MeSH terms

  • Adult
  • Chronic Disease / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Food Supply / classification
  • Food Supply / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Obesity / epidemiology*
  • Obesity / psychology
  • Prevalence
  • Social Determinants of Health / statistics & numerical data*
  • United States / epidemiology