The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play


      During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states. Although this relationship has not been repeatedly seen in men, research suggests a correlation in women. Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex. Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults—especially women—but not in children. This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity–obesity relationship. This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention.
      To read this article in full you will need to make a payment


        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Johnson C.L.
        Prevalence and trends in obesity among US adults, 1999-2000.
        JAMA. 2002; 288: 1723-1727
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • McDowell M.A.
        • Tabak C.J.
        • Flegal K.M.
        Prevalence of overweight and obesity in the United States, 1999-2004.
        JAMA. 2006; 295: 1549-1555
        • Ogden C.L.
        • Flegal K.M.
        • Carroll M.D.
        • Johnson C.L.
        Prevalence and trends in overweight among US children and adolescents, 1999-2000.
        JAMA. 2002; 288: 1728-1732
      1. Nord M, Andrews M, Carlson S. Household food security in the United States, 2004. Economic Research Report 11. Available at: Accessed February 24, 2006.

        • Anderson S.A.
        Core indicators of nutritional state for difficult-to-sample populations.
        J Nutr. 1990; 120: 1559-1560
      2. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security, revised 2000. Available at: Accessed January 23, 2006.

        • Casey P.H.
        • Szeto K.
        • Lensing S.
        • Bogle M.
        • Weber J.
        Children in food-insufficient, low-income families.
        Arch Pediatr Adolesc Med. 2001; 155: 508-514
        • Dietz W.H.
        Does hunger cause obesity?.
        Pediatrics. 1995; 95: 766-767
        • Townsend M.S.
        • Peerson J.
        • Love B.
        • Achterberg C.
        • Murphy S.P.
        Food insecurity is positively related to overweight in women.
        J Nutr. 2001; 131: 1738-1745
        • Goodner C.H.
        • Wolman P.G.
        • Stallings S.F.
        • Meacham S.L.
        • Cason K.L.
        Do food stamps without nutrition education improve food intake patterns?.
        Top Clin Nutr. 2000; 15: 49-58
      3. Rosso R. Characteristics of food stamp households: Fiscal year 2001. Available at: Accessed February 15, 2006.

      4. Annual update of the HHS poverty guidelines-HHS. Notice. Available at: Accessed February 23, 2006.

        • Laraia B.A.
        • Siega-Riz A.M.
        • Evenson K.R.
        Self-reported overweight and obesity are not associated with concern about enough food among adults in New York and Louisiana.
        Prev Med. 2004; 38: 175-181
        • VanEenwyk J.
        • Sabel J.
        Self-reported concern about food security associated with obesity—Washington, 1995-1999.
        MMWR Morbid Mortal Wkly Rep. 2003; 52: 840-842
        • Basiotis P.
        • Lino M.
        Food insufficiency and prevalence of overweight among adult women.
        Fam Econ Nutr Rev. 2003; 15: 55-57
        • Bhattacharya J.
        • Currie J.
        • Haider S.
        Poverty, food insecurity, and nutritional outcomes in children and adults.
        J Health Econ. 2004; 23: 839-862
        • Olson C.M.
        Nutrition and health outcomes associated with food insecurity and hunger.
        J Nutr. 1999; 129: 521S-524S
        • Adams E.J.
        • Grummer-Strawn L.
        • Chavez G.
        Food insecurity is associated with increased risk of obesity in California women.
        J Nutr. 2003; 133: 1070-1074
        • Kaiser L.L.
        • Townsend M.S.
        • Melgar-Quinonez H.R.
        • Fujii M.L.
        • Crawford P.B.
        Choice of instrument influences relations between food insecurity and obesity in Latino women.
        Am J Clin Nutr. 2004; 80: 1372-1378
        • Kaiser L.L.
        • Melgar-Quinonez H.R.
        • Lamp C.L.
        • Johns M.C.
        • Sutherlin J.M.
        • Harwood J.O.
        Food security and nutritional outcomes of preschool-age Mexican-American children.
        J Am Diet Assoc. 2002; 102: 924-929
        • Rose D.
        • Bodor J.N.
        Household food insecurity and overweight status in young school children: Results from the Early Childhood Longitudinal Study.
        Pediatrics. 2006; 117: 464-473
        • Matheson D.M.
        • Varady J.
        • Varady A.
        • Killen J.D.
        Household food security and nutritional status of Hispanic children in the fifth grade.
        Am J Clin Nutr. 2002; 76: 210-217
        • Jyoti D.F.
        • Frongillo E.A.
        • Jones S.J.
        Food insecurity affects school children’s academic performance, weight gain, and social skills.
        J Nutr. 2005; 135: 2831-2839
        • Alaimo K.
        • Olson C.M.
        • Frongillo E.A.
        Low family income and food insufficiency in relation to overweight in US children.
        Arch Pediatr Adolesc Med. 2001; 155: 1161-1167
        • Kaiser L.L.
        • Townsend M.S.
        Food insecurity among US children.
        Top Clin Nutr. 2005; 20: 313-320
      5. Parker L. Obesity, food insecurity and the federal child nutrition programs: Understanding the linkages. Available at: Accessed August 13, 2007.

        • Drewnowski A.
        • Specter S.E.
        Poverty and obesity: The role of energy density and energy costs.
        Am J Clin Nutr. 2004; 79: 6-16
        • Kendall A.
        • Olson C.M.
        • Frongillo Jr, E.A.
        Relationship of hunger and food insecurity to food availability and consumption.
        J Am Diet Assoc. 1996; 96: 1019-1024
        • Frongillo E.A.
        Understanding obesity and program participation in the context of poverty and food insecurity.
        J Nutr. 2003; 133: 2117-2118
        • Rose D.
        Economic determinants and dietary consequences of food insecurity in the United States.
        J Nutr. 1999; 129: 517S-520S
        • Olson C.M.
        Food insecurity in women.
        Top Clin Nutr. 2005; 20: 321-328
        • Wilde P.E.
        • Ranney C.K.
        The monthly food stamp cycle: shopping frequency and food intake decisions in an endogenous switching regression framework.
        Am J Agr Econ. 2000; 82: 200-213
        • Taren D.L.
        • Clark W.
        • Chernesky M.
        • Quirk E.
        Weekly food servings and participation in social programs among low income families.
        Am J Public Health. 1990; 80: 1376-1378
        • Bhargava A.
        Socioeconomic and behavioural factors are predictors of food use in the National Food Stamp Program Survey.
        Br J Nutr. 2004; 92: 497-506
        • Alaimo K.
        • Briefel R.R.
        • Frongillo Jr, E.A.
        • Olson C.M.
        Food insufficiency exists in the United States: Results from the third National Health and Nutrition Examination Survey.
        Am J Public Health. 1998; 88: 419-426
        • Oberholser C.A.
        • Tuttle C.R.
        Assessment of household food security among food stamp recipient families in Maryland.
        Am J Public Health. 2004; 94: 790-795
        • Gundersen C.
        • Gruber J.
        The dynamic determinants of food insufficiency. In: Andrews MS, Prell MA, eds. Second Food Security Measurement and Research Conference. Volume II: Papers.
        Food and Rural Economics Division, Economic Research Center, US Department of Agriculture, Washington, DC2001
        • Alaimo K.
        • Olson C.M.
        • Frongillo Jr, E.A.
        • Briefel R.R.
        Food insufficiency, family income, and health in US preschool and school-aged children.
        Am J Public Health. 2001; 91: 781-786
        • Condrasky M.
        • Marsh J.G.H.
        Food stamps and dietary intake of low-income women in the rural South in the time of welfare reform.
        Top Clin Nutr. 2005; 20: 366-373
        • Gundersen C.
        • Oliveria V.
        The Food Stamp Program and food insufficiency.
        Am J Agr Econ. 2001; 83: 875-887
        • Perez-Escamilla R.
        • Ferris A.M.
        • Drake L.
        • Haldeman L.
        • Peranick J.
        • Campbell M.
        • Peng Y.-K.
        • Burke G.
        • Bernstein B.
        Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, Connecticut.
        J Nutr. 2000; 130: 2711-2717
        • Olson C.M.
        • Holben D.H.
        Position of The American Dietetic Association: Domestic food and nutrition security.
        J Am Diet Assoc. 2002; 102: 1840-1847
        • Keenan D.P.
        • Olson C.
        • Hersey J.C.
        • Parmer S.M.
        Measures of food insecurity/security.
        J Nutr Educ. 2001; 33: S49-S58
      6. US Department of Agriculture, Economic Research Service. Food and nutrition assistance programs: FANRP research funding opportunities. Available at: Accessed March 24, 2006.

        • Gibson D.
        Food stamp program participation is positively related to obesity in low income women.
        J Nutr. 2003; 133: 2225-2231
        • Townsend M.S.
        Obesity in low-income communities: Prevalence, effects, a place to begin.
        J Am Diet Assoc. 2006; 106: 34-37
      7. Nutrition and Your Health: Dietary Guidelines for Americans, 2005.
        6th ed. US Government Printing Office, Washington, DC2006 (Home and Garden Bulletin No. 232)


      L. M. Dinour is a doctoral student at the Graduate Center, City University of New York, New York, and an adjunct instructor at Hunter College, City University of New York, New York; at the time of the study, she was a graduate student, Urban Public Health Program, Hunter College, City University of New York, New York.


      D. Bergen is a nutrition counselor in New York, NY, and an adjunct instructor, Hunter College, City University of New York, New York.


      M.-C. Yeh is an assistant professor, Urban Public Health Program, Hunter College, City University of New York, New York.