The Paradox:Hunger and Obesity—

What Can We Do?

Susan B. Foerster, MPH, RD, ChiefPolicy, Planning and EvaluationNetwork for a Healthy California

Santa Clara County Hunger Issues Forum

September 10, 2010

The Reality, the Vision“16.7 million American children –nearly one in four – live in households thatdo not have access to enough nutritious food to lead active, healthy lives.

“No childhood hunger in Americaby the Year 2015”

Source: Roadmap to End Childhood Hunger in America by 2015, 16 National Anti-Hunger Organizations, 2009

Understanding action

• Research about the “paradox”

• Dynamics in California

• Promising actions and opportunities

The Paradox of Hunger and Obesity

• Obesity impacts all U.S. population segments

• Poverty increases vulnerability to obesity, as well as hunger.

• Risk factors associated with poverty make low-income and food insecure people especially vulnerable to obesity.

Source: Hunger and Obesity? Making the Connections – Food Research and Action Center Working Document, 2/1010.

U.S. Obesity Trends

Source: Behavior Risk Factor Surveillance System, United States.

10

15

20

25

30

35

40

1994 1996 1998 2000 2002 2004 2006 2008 2010

Year

Per

cent

Obe

se

African American

Less Than $15,000

$15,000-24,999

Latino

Total

U.S. Economic Costs of Obesity

• $147 Billion in attributable health care (2006)1

• 11% of Medicaid costs1

• $14 Billion for children2

1 Finkelstein et al, 2009. 2 Trasande Et al, 2009

U.S. Food Security Trends • About 1 in 6 U.S. households (15%)

experienced food insecurity in 2008

• 5.7% of households were food insecure with hunger in 2008, compared to 3.1% in 2000

• 2008 rates of food insecurity, announced 11/09, were the highest since reporting began in 1995

Risk Factors for obesity associated with poverty –

Cost of Healthy Foods• Cost of healthy foods – need to stretch food budget

• From 1985 to 2000, retail prices for1..– Soda – 20% – Sugar and Sweets – 46% – Fresh Fruits and Vegetables – 188%

• Study in 59 metropolitan areas - young children were more likely to gain excessive weight in areas where fruits and vegetables were more expensive.2

(1) Putnam, Allshouse and Kanater, 2002. (2) Sturm and Datar, 2005.

Cost of unhealthy foods• Low-cost, calorie-dense, high-fat and high-sugar

foods seem like a “good deal”.

• Low-income youth/adults are exposed to more advertising for obesity-promoting products.

Risk Factors associated with poverty – availability

• “Lower-income neighborhoods and communities of color have fewer grocery stores and an abundance of fast food restaurants and convenience stores compared to higher income and predominately Caucasian neighborhoods.”

• “Where there are high numbers of fast-food restaurants compared to grocery stores, there are also higher rates of diabetes, cardiovascular disease, and cancer.”

Designed for Disease. California Center for Public Health Advocacy, 2008.

Availability associated with consumption

• Multi-state study found African Americans’ fruit and vegetable intake increased 32% for each additional supermarket in the census tract.1

• Study of corner stores in New Orleans found every additional meter of shelf space for fresh fruits and vegetables was associated with residents’ eating 0.35 more servings of vegetables per day.2

1 Moreland, Wing, Roux, 2002. 2. Bodor, Rose, Farlet, Swalm, Scott, 2008.

Fewer Opportunities for Physical Activity

• Lower-income neighborhoods have fewer physical activity resources – parks, bike paths, recreational faculties – than higher-income neighborhoods.

Stress• Financial and emotional stress of food insecurity,

low-wage work, inadequate housing, transport, health care, neighborhood violence.

• Stress is linked to weight gain in adults and youth.

• 19-year study in UK with thousands of government workers – anxiety, depression were associated with weight gain and obesity.1

Source: Atlantis et al, 2009.

Disordered eating• Skipping meals, eating less may

lead to overeating when food is available.

• Cycles of food deprivation and overeating.

• Such cycles may be associated with an unhealthy preoccupation with food and even metabolic changes.

1 Moreland, Wing, Roux, 2002. 2. Bodor, Rose, Farlet, Swalm, Scott, 2008.

Is federal nutrition assistance a risk factor for obesity?

• For children and men, most studies found no direct relationship between participation and obesity

• Research does not suggest that SNAP promotes obesity in children, teens or men; long-term use may increase women’s risk.

• Few studies, little evidence that WIC, school lunch or school breakfast increase obesity risk.

Source: Healthy Eating Research, 2010

Food Insecurity, Obesity,

Healthy Eating and Physical Activity in California

Benchmarks, Trends

Food Insecurity in CaliforniaBefore the recession……• Over 1.5M, or 12%, of California households

were food insecure (2005-2008).

• Over half a million, or 4.3%, of California households had very low food security akafood insecurity with hunger (2005-2006).

• 1.6M, or 16.8%, of California children were food insecure (2005-2007)

1. Nord, et al. Nov. 2009 USDA. 2. Feeding America. Child Food Insecurity in the United States.

Low-income Adults at Greatest Risk for Food Insecurity

Source: California Health Interview Survey, 2005 Food Security Health Policy Research Brief

17.4% 20.0%

30.8%33.8%

39.8% 39.8%

4.2% 2.9%

11.0% 13.7%18.4%

9.3%

0%5%

10%15%20%25%30%35%40%45%

Old

er A

dults

(65+

)

Pre

gnan

t

HH

with

Chi

ldre

n

Sin

gle-

head

edH

H w

ithC

hild

ren

Une

mpl

oyed

Und

ocum

ente

dR

esid

ents

Food Insecure Very Low Food Security

Low-income Ethnicities at Greatest Risk for Food Insecurity

37.5%32.6%

28.6%24.1%

16.8%

9.0% 10.2%

4.4%

0%5%

10%15%20%25%30%35%40%

AfricanAmericans

Latinos Whites Asian

Food Insecure Very Low Food Security

Source: California Health Interview Survey, 2005 Food Security Health Policy Research Brief

Source: Behavior Risk Factor Surveillance System, California.

African Americans and Latinos Lead in Obesity1984-2009

0

5

10

15

20

25

30

35

40

45

1983 1988 1993 1998 2003 2008Year

Per

cent

Obe

se

AfricanAmericanLatino

Total

White

Asian/PacificIslander

Source: Behavior Risk Factor Surveillance System, California.FPL = Federal Poverty Level

Lower Income Adults Lead in Obesity1995-2009

10

15

20

25

30

35

40

1994 1996 1998 2000 2002 2004 2006 2008 2010

Year

Per

cent

Obe

se <100% FPL

101-200% FPL

Total

>200% FPL

***p<.001Trends were analyzed for 2001-2007 only; FSP data were not collected until 2003.Source: California Dietary Practices Survey, CDPH.

Obesity Increased in All Groups, but More Among Low Income

2001-2007

0

5

10

15

20

25

30

35

40

2001 2002 2003 2004 2005 2006 2007

Year

Per

cen

t O

bese

SNAP Participants

Less than $15,000***

$15,000 - 24,999***

$35,000 - 49,999

Total***

$25,000 - 34,999

$50,000+

Food insecurity and obesity among low-income Californians

35%

26% 27%

24%

18%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Food Insecure Obesity-Female Obesity-Male

Low-Income (<200%FPL)

Middle to High-Income(>200%FPL)

Source: California Health Interview Survey (2007)

Obesity Rates Among Adults, by Food Security Status, 2007

Source: California Health Interviews Survey, 2007

24.1%

31.5%

0%

5%

10%

15%

20%

25%

30%

35%

Able to Afford Enough Food - Food Secure

Unable to Afford Enough Food - Food Insecure

Economic Costs of Obesity, Overweight and

Physical Inactivity in California

• $26 Billion, half as obesity and overweight (2000)1

• $41 Billion (2006)2

• One-half borne by health care system

• Other half borne by employers as lost work productivity

1 Chenoweth et al, CDPH, 20052 Chenoweth et al, CPHA, 2009

Obesity among Low-Income Children 2 to 4 Years – CA 3rd

Highest State

Pediatric Nutrition Surveillance, 2008

17.3%

14.1%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

California National

Promising Actions and Opportunities

• Breakthrough vision about the causes and social determinants of food insecurity and obesity

• New organizational norms, higher expectations

• Action at all levels, in all sectors, with all policies and programs

National Drumbeat for Change

• Roadmap to End Childhood Hunger by 2015

• 7 Institute of Medicine Reports

• National Physical Activity Plan

• Multiple other organizations calling for, and funding, action

• 2010 Dietary Guidelines for Americans

• 2010 Child Nutrition/WIC Reauthorization (S 3307 and HR 5504)

• 2012 Farm Bill aka America’s Food Bill

I

Federal Task Force on Childhood Obesity (2010)

• 80 Recommendations for the Federal, State/Local, Private Sectors in:

– Early Childhood– Empowering Parents and Caregivers– Healthier Food in Schools– Access to Healthy, Affordable Food– Increasing Physical Activity

Let’s Move!The First Lady’s Initiative

• Help parents make healthier family choices

• Serve healthier food in schools

• Access healthy, affordable food

• Increase physical activity (just announced President’s Council on Physical Fitness, Sport and Nutrition)

• Partnership for a Healthier America—would help convene state, communities, non-profit and for-profit private sectors

CDC “Pillars” for Preventing Obesity (Plus One)

Fruits and Vegetables

Physical Activity

Breast Feeding

Sugar-Sweetened Beverages

Low-nutrient, Calorie-dense Foods

Screen Time

(Food Insecurity)

Community Strategies to Prevent Obesity

• 24 recommended obesity prevention strategies

• Focused on environmental and policy level change

• For local governments and school districts to promote healthy eating and active living

• Measurements, resources, examples

Nutrition Education Dollars, Compared to Total Program Dollars – National FFY/08

Source:1. FRAC National and State Program Data 2. FNS/USDA Nutrition Education and Promotion.. A Report to Congress. March, 2010.

Total Federal Funding

Nutrition Education Funding2

Nut Education Dollars, as % of Program

SNAP $34.6B $314.1M 0.9%Child Nutrition (SBP, NSLP, SNP)

$11.7B $13.3M(Team

Nutrition)

0.1%

WIC $6.2B $358.0M 5.8%

Selected California Initiatives

• Governor’s Obesity Prevention Plan

• Foundation, Health Plan initiatives

• Breastfeeding initiatives

• Child care, Healthier US Schools Challenge

• ARRA—SSB, Joint Use Agreements for PA, LA and San Diego Counties

• Re-naming, re-framing California’s Food Stamp Program

• State Nutrition Action Partnership

• Network for a Healthy California

CDC “Pillars” (Plus One) Addressed through the

Network Fruits and Vegetables

Physical Activity

Breast Feeding

Sugar-Sweetened Beverages

Low-nutrient, Calorie-dense Food

Screen Time

(Food Insecurity)

Network Stat’s • Audience is families with children, HH incomes <185% FPL

• Statewide ad campaign, Champion Moms, and 115+ projects planning to serve 10,000 sites via USDA matching funds

•• 11 Regional Networks with ‘signature’ FV, PA and ReThink

Your Drink campaigns and programs for children, Latino and African American families, worksites, and retail food stores

• 11 Regional Collaboratives with 1,000+ partners and custom “Nutrition Education Initiatives”

• Food Stamp Access Improvement Project conducts Outreach in 43 counties

Eligible Californians Participating in SNAP, WIC, and Free/Reduced Price (FRP) School Lunch and Breakfast Program

Sources: 1 Cunnyngham and Castner, USDA, 2009 2 California WIC Program, estimated. 3. CFPA 2010 California Nutrition and Food Insecurity Profile

48%

80%

67%

29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

SNAP (2007)1 WIC (2009) FRP School Lunch(2008)3

FRP School Breakfast(2008)3

**p<.01, ***p<.001Trends were analyzed for 1997-2007 only; Asian/PI data were not collected until 1999.Source: California Dietary Practices Survey, CDPH.

All Groups Made Gains in FV Consumption, African Americans Still Lag

1997-2007

20

25

30

35

40

45

50

55

60

65

1997 1999 2001 2003 2005 2007

Year

Per

cen

t R

epor

tin

g 5

+

Serv

ings

/Day

Asian/PacificIslanderWhite***

Total***

Latino***

AfricanAmerican**

**p<.01, ***p<.001Trends were analyzed for 1997-2007 only; SNAP data were not collected until 2003.Source: California Dietary Practices Survey, CDPH.

The Lowest-Income Adults Reported Eating More FV as the Network Grew from 4 to 135 Projects

1997-2007

2.5

3

3.5

4

4.5

5

5.5

6

1997 1999 2001 2003 2005 2007Year

Serv

ings

$50,000+***

Total***

$15,000-24,999***

<$15,000***

SNAP Participants

$35,000-49,999**

$25,000-34,999

The Vision“By the end of 2015, every child inthe United States will be food secure and

every family with children will have access to the nutritious food they need to thrive.”

“This will be the generation that breaks the hunger cycle in America.”

Source: Roadmap…, National Anti-Hunger Organizations 2009

For more information about …

• Food stamps in California1-877-847-3663

• Nutrition and physical activitywww.cachampionsforchange.net

• The Network for a Healthy Californiawww.networkforahealthycalifornia.net