The Relationship between Food Insecurity and Risk of Overweight or Obesity in under 18 Years Individuals: A Systematic Review and Meta‑Analysis

Ali Pourmotabbed, Seyedeh Parisa Moosavian, Amir Hadi, Hamed Mohammadi, Alireza Dadfarma, Shahabeddin Rezaei, Atefeh Babaei, Sajjad Moradi, Khadijah Mirzaei


Objective: Food insecurit (FI) has been considered as reason for childhood and adolescent overweight/obesity (OW/OB). Hence, this study was undertaken to assess these relationships.

Design: Related articles were found by searching the Web of Science, Scopus, PubMed and Embase databases until October 2019. Odds ratio (OR) was analized by a random‑effects model. Standard methods were used for assessment of heterogeneity and publication bias. Data were available from 32 studies. The risk ratios of 139,762 participants were pooled from these articles for the meta‑analysis.

Results: This study domenstrated that children and adolescents in food‑insecure condition are not at risk of OW/OB (OR = 1.02 95% CI: 0.99, 1.05). However, subgroup analysis indicated that FI related with inhanced risk of OW/OB in adolescents living in developed countries (OR = 1.14; 95% CI: 1.02, 1.27). Other subgroup analysis indicated that severe FI increased the risk of OW/OB among adolescents (OR = 1.24 95% CI: 1.03‑1.49). In addition, we found that lower economic development significantly decreased risk of OW/OB among under 6 year children (OR = 0.88; 95% CI: 0.84, 0.93).

Conclusions: Our results showed that higher FI degrees were related with more risks of OW/OB among adolescents (12–18 years). Moreover, the country economic levels had effect on the association between FI and risk of OW/OB.


Adolescents; children; food insecurity; obesity risk; overweight risk

Full Text:



Dias KA, Green DJ, Ingul CB, Pavey TG, Coombes JS.

exercise and vascular function in child obesity: A meta‑analysis.

Pediatrics 2015;136:e648‑59.

Lindsay AC, Sitthisongkram S, Greaney ML, Wallington SF,

Ruengdej P. Non‑responsive feeding practices, unhealthy eating

behaviors, and risk of child overweight and obesity in Southeast

Asia: A systematic review. Int J Environ Res Public Health 2017;14.

Wang Y, Lim H. The global childhood obesity epidemic and the

association between socio‑economic status and childhood obesity.

Int Rev Psychiatry (Abingdon, England) 2012;24:176‑88.

Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ.

Tracking of childhood overweight into adulthood: A systematic

review of the literature. Obes Rev 2008;9:474‑88.

Kline AM. Pediatric obesity in acute and critical care. AACN

Adv Crit Care 2008;19:38‑46.

Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity:

Prevalence, consequences, and causes of a growing public health

problem. Am J Med Sci 2006;331:166‑74.

Sybilski AJ, Raciborski F, Lipiec A, Tomaszewska A, Lusawa A,

Furmanczyk K, et al. Obesity‑‑A risk factor for asthma, but not

for atopic dermatitis, allergic rhinitis and sensitization. Public

Health Nutr 2015;18:530‑6.

Bass R, Eneli I. Severe childhood obesity: An under‑recognised

and growing health problem. Postgrad Med J 2015;91:639‑45.

Gonzalez‑Muniesa P, Martinez‑Gonzalez MA, Hu FB,

Despres JP, Matsuzawa Y, Loos RJ, et al. Obesity. Nat Rev Dis

Primers 2017;3:17034.

Trandafir LM, Temneanu OR. Pre and post‑natal risk and

determination of factors for child obesity. J Med Life


Oken E, Levitan EB, Gillman MW. Maternal smoking during

pregnancy and child overweight: Systematic review and

meta‑analysis. Int J Obes 2008;32:201‑10.

Moradi S, Mirzaei K, Abdurahman AA, Keshavarz SA,

Hossein‑Nezhad A. Mediatory effect of circulating vaspin

on resting metabolic rate in obese individuals. Eur J Nutr


Moradi S, Mirzaei K, Abdurahman AA, Keshavarz SA.

Adipokines may mediate the relationship between resting

metabolic rates and bone mineral densities in obese women.

Osteoporos Int 2017;28:1619‑29.

Anderson SA. Core indicators of nutritional state for

difficult‑to‑sample populations. J Nutr (USA) 1990;120

(Suppl 11):1559‑600.

Shen X, Gao X, Tang W, Mao X, Huang J, Cai W. Food

insecurity and malnutrition in Chinese elementary school

students. Br J Nutr 2015;114:952‑8.

Moradi S, Mirzababaei A, Dadfarma A, Rezaei S,

Mohammadi H, Jannat B, et al. Food insecurity and adult weight

abnormality risk: A systematic review and meta‑analysis. Eur J

Nutr 2019;58:45‑61.

Moradi S, Arghavani H, Issah A, Mohammadi H, Mirzaei K.

Food insecurity and anaemia risk: A systematic review and

meta‑analysis. Public Health Nutr 2018;21:3067‑79.

Moradi S, Mirzababaei A, Mohammadi H, Moosavian SP,

Arab A, Jannat B, et al. Food insecurity and the risk of

undernutrition complications among children and adolescents:

A systematic review and meta‑analysis. Nutrition 2019;62:52‑60.

Melchior M, Chastang JF, Falissard B, Galéra C, Tremblay RE,

Côté SM, et al. Food insecurity and children’s mental health:

A prospective birth cohort study. PLoS One 2012;7:e52615.

Holben DH, Taylor CA. Food insecurity and its association

with central obesity and other markers of metabolic syndrome

among persons aged 12 to 18 years in the United States. J Am

Osteopath Assoc 2015;115:536‑43.

Casey PH, Simpson PM, Gossett JM, Bogle ML,

Champagne CM, Connell C, et al. The association of child and

household food insecurity with childhood overweight status.

Pediatrics 2006;118:e1406‑13.

Bhawra J, Cooke MJ, Guo Y, Wilk P. The association of

household food security, household characteristics and school

environment with obesity status among off‑reserve First Nations

and Metis children and youth in Canada: Results from the 2012

Aboriginal Peoples Survey. Health Promot Chronic Dis Prev Can


Franklin B, Jones A, Love D, Puckett S, Macklin J,

White‑Means S. Exploring mediators of food insecurity and

obesity: A review of recent literature. Journal of community

health 2012;37:253‑64.

Eisenmann JC, Gundersen C, Lohman BJ, Garasky S,

Stewart SD. Is food insecurity related to overweight and obesity

in children and adolescents? A summary of studies, 1995–2009.

Obes Rev 2011;12:e73‑83.

Dubois L, Farmer A, Girard M, Porcherie M. Family food

insufficiency is related to overweight among preschoolers. Social

Sci Med 2006;63:1503‑16.

Rosas LG, Guendelman S, Harley K, Fernald LC, Neufeld L,

Mejia F, et al. Factors associated with overweight and obesity

among children of Mexican descent: Results of a binational

study. J Immigr Minor Health 2011;13:169‑80.

Dubois L, Francis D, Burnier D, Tatone‑Tokuda F, Girard M,

Gordon‑Strachan G, et al. Household food insecurity and

childhood overweight in Jamaica and Quebec: A gender‑based

analysis. BMC Public Health 2011;11:199.

Metallinos‑Katsaras E, Must A, Gorman K. A longitudinal study

of food insecurity on obesity in preschool children. J Acad Nutr

Diet 2012;112:1949‑58.

Kaur J, Lamb MM, Ogden CL. The association between food

insecurity and obesity in children—The National Health and

Nutrition Examination Survey. J Acad Nutr Diet 2015;115:751‑8.

Papas MA, Trabulsi JC, Dahl A, Dominick G. Food insecurity

increases the odds of obesity among young Hispanic children.

J Immigr Minor Health 2016;18:1046‑52.

Jones AD, Mundo-Rosas V, Cantoral A, Levy TS. Household

food insecurity in Mexico is associated with the co-occurrence

of overweight and anemia among women of reproductive age,

but not female adolescents. Maternal and Child Nutrition


Alaimo K, Olson CM, Frongillo EA. Low family income and

food insufficiency in relation to overweight in US children: Is

there a paradox? Arch Pediatr Adolesc Med 2001;155:1161‑7.

Jones SJ, Jahns L, Laraia BA, Haughton B. Lower risk of

overweight in school‑aged food insecure girls who participate

in food assistance: Results from the panel study of income

dynamics child development supplement. Arch Pediatr Adolesc

Med 2003;157:780‑4.

Rose D, Bodor JN. Household food insecurity and overweight

status in young school children: Results from the Early

Childhood Longitudinal Study. Pediatrics 2006;117:464‑73.

Isanaka S, Mora‑Plazas M, Lopez‑Arana S, Baylin A, Villamor E.

Food insecurity is highly prevalent and predicts underweight

but not overweight in adults and school children from Bogota,

Colombia. J Nutr 2007;137:2747‑55.

Martin KS, Ferris AM. Food insecurity and gender are risk

factors for obesity. J Nutr Educ Behav 2007;39:31‑6.

Gundersen C, Lohman BJ, Eisenmann JC, Garasky S,

Stewart SD. Child‑specific food insecurity and overweight are

not associated in a sample of 10‑to 15‑year‑old low‑income

youth. J Nutr 2008;138:371‑8.

Gundersen C, Garasky S, Lohman BJ. Food insecurity is not

associated with childhood obesity as assessed using multiple

measures of obesity. J Nutr 2009;139:1173‑8.

Trappmann JL, Jimenez EY, Keane PC, Cohen DA, Davis SM.

Cross‑sectional relationships between household food insecurity

and child BMI, feeding behaviors, and public assistance

utilization among Head Start children from predominantly

Hispanic and American Indian communities in the CHILE study.

J Hunger Environ Nutr 2015;10:439‑55.

Hernandez DC. Latino mothers’ cumulative food insecurity

exposure and child body composition. Am J Health Behav


Gubert MB, Spaniol AM, Bortolini GA, Pérez‑Escamilla R.

Household food insecurity, nutritional status and morbidity in

Brazilian children. Public Health Nutr 2016;19:2240‑5.

Speirs KE, Fiese BH, Team SKR. The relationship between food

insecurity and BMI for preschool children. Matern Child Health

J 2016;20:925‑33.

Jafari F, Ehsani S, Nadjarzadeh A, Esmaillzadeh A,

Noori‑Shadkam M, Salehi‑Abargouei A. Household food

insecurity is associated with abdominal but not general obesity

among Iranian children. BMC Public Health 2017;17:350.

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD,

Rennie D, et al. Meta‑analysis of observational studies in

epidemiology: A proposal for reporting. Meta‑analysis of

observational studies in epidemiology (MOOSE) group. JAMA


Modesti PA, Reboldi G, Cappuccio FP, Agyemang C,

Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure

in Europe: A systematic review and meta‑analysis. PLoS One


Sun J, Wang J, Pan X, Yuan H. A New treatment strategy for

inactivating algae in ballast water based on multi‑trial injections

of chlorine. Int J Mol Sci 2015;16:13158‑71.

Coates J, Swindale A, Bilinsky P. Household Food Insecurity

Access Scale (HFIAS) for Measurement of Food Access: Indicator

Guide. Washington, DC: Food and Nutrition Technical Assistance

Project, Academy for Educational Development; 2007. p. 34.

Kac G, Velasquez‑Melendez G, Schlüssel MM,

Segall‑Côrrea AM, Silva AA, Pérez‑Escamilla R. Severe food

insecurity is associated with obesity among Brazilian adolescent

females. Public Health Nutr 2012;15:1854‑60.

Lohman BJ, Gillette MT, Neppl TK. Harsh parenting and food

insecurity in adolescence: The association with emerging adult

obesity. J Adolesc Health 2016;59:123‑7.

Metallinos‑Katsaras E, Sherry B, Kallio J. Food insecurity is

associated with overweight in children younger than 5 years of

age. J Am Diet Assoc 2009;109:1790‑4.

Shamah‑Levy T, Mundo‑Rosas V, Morales‑Ruan C,

Cuevas‑Nasu L, Méndez‑Gómez‑Humarán I, Pérez‑Escamilla R.

Food insecurity and maternal‑child nutritional status in Mexico:

Cross‑sectional analysis of the National Health and Nutrition

Survey 2012. BMJ Open 2017;7:e014371.

Whitaker RC, Orzol SM. Obesity among US urban preschool

children: Relationships to race, ethnicity, and socioeconomic

status. Arch Pediatr Adolesc Med 2006;160:578‑84.

Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC,

et al. Dietary behaviors mediate the association between food

insecurity and obesity among socioeconomically disadvantaged

youth. Appetite 2019;132:275‑81.

Yeganeh S, Motamed N, Najafpour Boushehri S, Ravanipour M.

Assessment of the knowledge and attitude of infants’ mothers

from Bushehr (Iran) on food security using anthropometric

indicators in 2016: A cross‑sectional study. BMC Public Health


Swindle T, Fitzgerald S, McKelvey LM, Whiteside‑Mansell L.

Application of noninferiority tests to examine the food

insecurity–obesity relationship in children. J Hunger Environ

Nutr 2018;13:228‑39.

Lee AM, Scharf RJ, Filipp SL, Gurka MJ, DeBoer MD. Food

insecurity is associated with prediabetes risk among US

adolescents, NHANES 2003–2014. Metab Syndr Relat Disord


Gipson‑Jones TL, O’Neal LJ, Sheats JL, Thorpe Jr RJ, Beech BM,

Bruce MA. Food security status and overweight/Obesity among

‑to 5‑year‑old boys and girls in a community‑based clinic. Fam

Community Health 2019;42:117‑22.

Au LE, Zhu SM, Nhan LA, Plank KR, Frongillo EA, Laraia BA,

et al. Household food insecurity is associated with higher

adiposity among US schoolchildren ages 10–15 years: The

healthy communities study. J Nutr 2019;149:1642‑50.

Cook JT, Frank DA, Casey PH, Rose‑Jacobs R, Black MM,

Chilton M, et al. A brief indicator of household energy

security: Associations with food security, child health, and

child development in US infants and toddlers. Pediatrics


Nettle D, Andrews C, Bateson M. Food insecurity as a driver of

obesity in humans: The insurance hypothesis. Behav Brain Sci


Dhurandhar EJ. The food‑insecurity obesity paradox: A resource

scarcity hypothesis. Physiol Behav 2016;162:88‑92.

Gross RS, Mendelsohn AL, Fierman AH, Racine AD,

Messito MJ. Food insecurity and obesogenic maternal infant

feeding styles and practices in low‑income families. Pediatrics


Cavagnini F, Croci M, Putignano P, Petroni M, Invitti C.

Glucocorticoids and neuroendocrine function. Int J Obesity


Dallman MF, la Fleur SE, Pecoraro NC, Gomez F, Houshyar H,

Akana SF. Minireview: Glucocorticoids—food intake,

abdominal obesity, and wealthy nations in 2004. Endocrinology


Björntorp P. Do stress reactions cause abdominal obesity and

comorbidities? Obes Rev 2001;2:73‑86.

Gruenewald TL, Kemeny ME, Aziz N. Subjective social status

moderates cortisol responses to social threat. Brain Behav

Immun 2006;20:410‑9.

Sim A, Lim E, Leow M, Cheon B. Low subjective socioeconomic

status stimulates orexigenic hormone ghrelin–A randomised trial.

Psychoneuroendocrinology 2018;89:103‑12.

Ryan‑Ibarra S, Sanchez‑Vaznaugh EV, Leung C, Induni M. The

relationship between food insecurity and overweight/obesity

differs by birthplace and length of US residence. Public Health

Nutr 2017;20:671‑7.

Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH,

Subramanian S. Anaemia in low‑income and middle‑income

countries. Lancet 2011;378:2123‑35.