Abstract
In the United States, approximately 12.5 million children are obese and at subsequent risk for persistent, worsening obesity into adulthood and numerous negative health consequences. Childhood obesity rates are highest among racial/ethnic minority children, a worrisome problem given the association with the substantial number of poor health outcomes. Meanwhile, more than 16 million American children are impacted by food insecurity, a public health issue presumed to be the opposite of obesity. Food insecurity also disproportionately impacts racial/ethnic minority children. As a nutrition-related disorder, food insecurity confers significant risks to child health and well-being, one of which, paradoxically may be obesity. Some studies have shown childhood obesity to be among the consequences of food insecurity, however other studies have had contradictory results and clarity in the relationship remains elusive. Assessing two chief components of food security separately, dietary quality and dietary quantity, is one possible way to illuminate obesity risk more clearly than the traditional measurement approach of grouping nutritional quality and quantity together. The purpose of this study was to explore the relationship between food insecurity and childhood obesity by investigating food quality as a mechanism through which the relationship may exist. A secondary data analysis of the National Health and Nutrition Examination Survey 2007-2008 cycle was conducted employing SEM methodology to compare two models of food insecurity for goodness-of-fit: (1) a combined 5-item food insecurity factor model, and (2) a 3-item food insecurity by quality factor model. Measurement invariance tests were conducted with the model of best fit to assess how the model relationship may differ by race/ethnicity and sex. The model using the three quality-related food insecurity items and BMI z-score achieved goodness of fit, however food quality did not predict BMI z-score. In the test of equivalence between minorities and non-minorities, the model fit the data, but food insecurity was not a predictor of BMI z-score and measurement invariance could not be established. Nevertheless, the factor loadings on the quality-related food insecurity items were stronger among minorities compared to non-minorities, indicating a statistically significant difference in response patterns. Measurement invariance between boys and girls also could not be established. While the results of this study did not support the approach undertaken, food quality remains a factor of interest in the relationship between food insecurity and childhood obesity given that the proposed model fit the data, and diminished food quality is associated with both food insecurity and obesity. Nurses are uniquely positioned to address the problems of food insecurity and childhood obesity through clinical, educational, political advocacy, and research-related work. The results of this study provide both a rationale and a springboard for future study.