How can people who are starving also be obese?

I’ve become increasingly captivated by the prospect of designing healthy eating campaigns aimed at communities that are food insecure while concurrently having high occurrences of overweight and obesity. To the untrained observer this may seems unnecessarily paradoxical - starving people are skinny and malnourished, right?

What we are seeing in middle-to-high income countries is that when there is food insecurity, there is also often a higher occurrence of overweight and obesity than is seen in the food-secure population. In other words, not having access to enough food means that adults (especially women) are very likely to be overweight. 

What isn’t clear, however, is the correlation between food insecurity and obesity in kids. Multiple studies exist that seek to establish how obesity in food-insecure adults and their kids are related, but thus far there hasn't been even minimal consistency across the research. This article by Dinour seeks to provide a survey of the research around obesity, food security, and various demographics, and then goes a step further in proposing causality between government assistance - mainly Food Stamps - and obesity in the economically disadvantaged. Here are its findings:

Hypotheses addressing obesity in food-insecure adults include the following:

• kids raised in poverty are either deprived of certain foods or don’t establish healthy eating habits and consequently have poor eating habits in adulthood. 
• high-calorie dense foods are cheaper (posited often in both academic and non-academic sources)
• food insecurity leads to unhealthy psychological and biological behaviors such as a preoccupation with food and other disordered eating

Hypotheses addressing varied findings in obesity in food-insecure kids include the following:

• parents give healthy foods to kids while keeping less healthy foods for themselves (maternal deprivation) leads to obese children if the foods are unhealthy, and [rarely] not-as-obese children if the foods are fruits and vegetables
• federally-funded programs such as school breakfast, lunch and other programs provide foods for kids than they can’t get at home; the relative “healthiness” of these foods can affect body size
• older children have increased ability to supplement food from home; this is often unhealthy food and can account for an increase of obesity in older children

The authors of this article specifically address the Food Stamp Program as a possible culprit in obesity in food insecure households because of the following:

• monthly distribution of food stamps is thought to create a cycle of binge eating/starvation in households using Food Stamps. Families utilize the monthly allotment in the first three weeks of the cycle, leaving no money for food in the fourth week. When they receive the next month’s allotment, they eat to compensate for the week of severe food insecurity
• unhealthy (high calorie density/low nutrient) foods are encouraged under the Food Stamp program because they are cheap and allowed per the program’s regulations
• parents feed children at will during the three-week period, allowing multiple snacks and treats; during the fourth week of severe food insecurity, parents restrict these foods, leading to binging on behalf of kids in the fourth week as well

While a majority of the studies surveyed in this article are US-based studies, many of the studies are focused on Latino and Mexican-American families. Mexico is another county in which we see high levels of obesity and high levels of food insecurity. These middle-income countries are interesting to me because of the implications for campaigns. How does one design a campaign that both addresses concerns around obesity and concerns around not having enough to eat? I believe the solution lies somewhere in messages about nutrition, but I’m unsure as of yet how a message would be structured in such a way that it addresses both concerns. I would love to hear from the class what they think about this.

Dinour, L., Bergen, D., & Yeh, M. (2007). The food insecurity–obesity paradox: A review of the literature and the role food stamps may play. Journal of the American Dietetic Association, 107(11), 1952-1961.