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Food Insecurity in Obese Adolescent Females in Tehran Schools: An Examination of Anthropometric and Socio-Economic Factors

Ahmad Reza Dorosti Motlagh1, Leila Azadbakht2, Nayere Esmaeil Kaboli3*

1Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2Department of Community Nutrition, School of Nutritional Science and
Dietetics, Tehran University of Medical Sciences, Tehran, Iran
3PHD student of Nutrition Sciences, Tehran University of Medical Sciences,
Tehran, Iran

Corresponding Author Email: nekaboli@yahoo.com

DOI : https://dx.doi.org/10.12944/CRNFSJ.7.1.28

Article Publishing History

Received: 03-09-2018

Accepted: 15-04-2019

Published Online: 18-04-2019

Plagiarism Check: Yes

Reviewed by: Dr. Bekir DEMİRTAS Turkey

Second Review by: Dr. SHIPRA GUPTA India

Final Approval by: Dr. Victor J. Temple

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Abstract:

Background: Obesity and its complications affect much of the population of the world today. In addition to physical complications, psychological complications also increase with increasing obesity. It has always been important to pay attention to the growing trend of childhood obesity, which is a factor in adulthood obesity and future chronic illnesses. Today, one of the factors that have been identified as effective in weight gain and obesity in urban communities is food insecurity, which is not merely a lack of food but also includes related factors such as upbringing, behaviour, psychosocial adaptation, and physical activity. Therefore, the purpose of this study was to investigate the effects of food insecurity on anthropometric indicators and other relevant factors in obese girls aged 11 to 14 years. Method: In this study, 452 obese female students aged 11 to 14 years, who had BMI more than 2SD above the WHO 2007 reference point, were randomly selected from several schools in three areas of Tehran. After obtaining written consent, demographic information and food security information was collected using a General and the United States Department of Agriculture (USDA) questionnaire. Anthropometric indices and fat percentage were also measured, based on skinfold and by callipers. Finally, the data were analyzed using SPSS software. Results: There were significant differences between the level of father's education (p=0.004), mother's education (p<0.001), family economic status (p<0.001), and home ownership (p<0.001) in the two groups, food secure and insecure. There were also significant differences between height (p=0.02) and weight (p=0.03) in both groups. Also, according to an alternative 4-group food security categorization (secure, insecure without hunger, insecure with mild hunger, and severe hunger), significant differences were observed only in terms of father's job (p=0.004), father's education (p=0.001), mother's education (p<0.001), family economic status (p<0.001) and home ownership (p<0.001). Conclusion: There were significant associations between parents' occupation and education status, home ownership, household economic status, height and weight of children, and household food security status.

Keywords:

Anthropometric Indices; Female Students; Food Insecurity; Obesity

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Motlagh A. R. D, Azadbakht L, Kaboli N. E. Food Insecurity in Obese Adolescent Females in Tehran Schools: An Examination of Anthropometric and Socio-Economic Factors. Curr Res Nutr Food Sci 2019; 7(1). doi : http://dx.doi.org/10.12944/CRNFSJ.7.1.28


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Motlagh A. R. D, Azadbakht L, Kaboli N. E. Food Insecurity in Obese Adolescent Females in Tehran Schools: An Examination of Anthropometric and Socio-Economic Factors. Curr Res Nutr Food Sci 2019; 7(1). https://bit.ly/2UJBhVN


Introduction

According to current statistics, the prevalence of obesity (BMI > 2SD) in children is increasing. In Iran, which, like other developing countries, faces the phenomena of urbanization and industrialization, the prevalence of obesity and overweight is increasing. According to statistics, at least 10 per cent of the world’s children are overweight or obese.1 The prevalence of obesity in Iranian children aged 7 to 12 has been reported at 5-10%.2 Additionally, obesity increases the risk of chronic diseases such as type 2 diabetes, insulin resistance, increased blood pressure, increased cardiovascular disease, some cancers, and even premature death. It also causes psychosocial problems.3 Childhood obesity not only causes obesity in adulthood but also causes physical and psychological problems at an early age.4 Therefore, the prevention of obesity is a vital World Health Organization (WHO) goal.5

One of the factors that are known today to be an effective factor in weight gain and obesity in urban communities is food insecurity.6 According to the United Nations in 1986, food security exists when all members, at all times, have access to enough food for an active, healthy life. According to this definition, the availability of food, access to food and the stability of food intake are the three most important elements. The final report of 1996 states that food security “exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”.7

Food insecurity has drawn the attention of many health professionals and politicians as one of the most serious problems facing the international community over the past two decades. More than 852 million people globally suffer from food insecurity, of whom a large part live in developing countries.8 The prevalence of food insecurity in Iran in 2016 was reported as 49%, with the highest prevalence rate being among preschool children (67%), then the elderly (67%), mothers (61%), and adolescents 11-16 years old (49%).9

Given this general view, food insecurity is assumed to lead to lower food intake and changes in the type of food consumed, due to underlying reasons such as low economic status. Therefore, food diversity is reduced and the consumption of high-caloric and poor quality nutritional foods is increased. These dietary patterns are the basis for the development of obesity and overweight and associated risks. In general, food insecurity is associated not only with food deficiency, but also with various factors such as child education, behaviour, and the psychosocial, physical and motor factors,10-12 which overall form the lifestyle of the child and the household.

Materials and Methods

In this study, 452 obese female students aged 11 to 14 years with similar general characteristics who had BMI greater than 2SD above the defined WHO level were randomly selected from several schools in three areas of Tehran (south, south-east, south-west). After obtaining written consent, a general information questionnaire was completed. Students’ height and weight information were accurately recorded by trained experts. Body weight was measured to the nearest 0.1 kg using a Seca scale with subjects wearing light clothing (i.e. no sweaters, jackets, or belts) and no shoes. Height was measured to the nearest 0.1 centimetres using a Seca stadiometer, in a standing position and with shoes removed. Body mass index (BMI) was calculated from the height and weight data; BMI=kg/m2.

Obese people with z score> 2 were selected using standard BMI curves determined by the WHO. To determine the percentage of body fat, the skin fold was measured by callipers in the triceps of the arm. Skinfold callipers are used in the measurement of skinfold thickness and the estimation of total body fat. Skinfold measurements are generally taken at specific sites on the right side of the body. The tester pinches the skin at the location site and pulls the fold of skin away from the underlying muscle so only the skin and fat tissue are being held. Special skinfold callipers are then used to measure the skinfold thickness in millimetres.

To determine the household food score, the USDA Food Security Questionnaire (18 items) was used, which was carried out by trained experts who obtained the data from the students’ mothers. The USDA household food security questionnaire, which was used in this study, has been evaluated and validated in a study on households in Isfahan13 and, in another study on households in Shiraz, has been moderated.14 This questionnaire examines household food security over the past 12 months. The questionnaire has two parts: the first part is for all households, and the second part is for families with children under the age of 18. The scoring of this questionnaire, according to Bickel et al.,15 is that for options of “often correct”, “sometimes correct”, “almost every month”, “some months,” and “yes”, a score of 1 is awarded, whereas the answers “not true,” “only 1 or 2 months,” and “no” are awarded a score of 0. The maximum score of this questionnaire, when completed in both parts, is 18. To determine the state of food security, households are ranked into food secure, food insecure without hunger, food insecure with moderate hunger, and severe starvation.

Statistical Analysis

After data collection, data were analyzed using SPSS 17 software. Comparison within groups was done using an independent t-test. By using a covariance test, confounders effects were examined and eliminated as far as possible. Before performing the above analyses, the normal distribution of variables was examined. If variables were non-normal, a nonparametric test was used. Results with p-value <0.05 were considered significant.

Results

Based on the findings of this study, the samples were divided into two groups of food secure and food insecure. As shown in Table 1, there was a significant correlation between father’s level of education (p=0.004), mother’s level of education (p<0.001), household economic status (p<0.001) and house ownership (p<0.001) between the two groups, based on the chi-square test. In another analysis conducted within the context of food security, samples were divided into four categories: secure food group, insecure food group without hunger, insecure food group with mild hunger, and severe hunger. The association of these four groups with all quantitative and qualitative features was analyzed statistically. According to the independent t-test, there was a significant difference in height (p=0.02) and weight (p=0.03) between the two groups. According to Table 2, the only significant differences were observed in the father’s job (p=0.004), father’s education (p=0.001), mother’s education (p<0.001), family economic status (p<0.001) and home ownership (p<0.001) between all four groups, based on the chi-square test. However, no significant difference was observed between anthropometric indices and the 4 groups of food security, according to the ANOVA test.

Table 1: Quantitative and Qualitative Characteristics of Participants Based on Food Insecurity.

Secure Insecure without Hunger Insecure with Mild Hunger Insecure with Severe Hunger P-Value**
Mean or N % or SD Mean or N % or SD Mean or N % or SD Mean or N % or SD
School Grade 7th 94 17.9 36 6.9 20 3.8 14 2.7 0.118
8th 116 22.1 42 8.0 27 5.2 13 2.5
9th 108 20.6 29 5.5 14 2.7 11 2.1
Head of the Family Father 300 57.3 98 18.7 57 10.9 33 6.3 0.124
Mother or other 18 3.4 9 1.7 4 0.8 5 1.0
Father’s Occupation Unemployed 2 0.4 2 0.4 9 1.7 5 1.0 0.004
Self-employed 207 39.9 59 11.4 37 7.1 21 4.0
Retired or workman 23 4.4 17 3.3 7 1.3 3 0.6
Clerk or manager 85 16.4 28 5.4 8 1.5 6 1.2
Mother’s Occupation Housekeeper 253 48.4 91 17.4 52 9.9 33 6.3 0.128
Employed 64 12.2 16 3.1 9 1.7 5 1.0
Father’s Education Illiterate or primary school 44 8.5 14 2.7 12 2.3 11 2.1 0.001
High school or diploma 201 38.7 81 15.6 40 7.7 21 4.0
Academic education 72 13.8 11 2.1 9 1.7 4 0.8
Mother’s Education Illiterate or primary school 35 6.7 21 4.0 14 2.7 13 2.5 <0.001
High school or diploma 230 43.9 72 13.7 40 7.6 23 4.4
Academic education 53 10.1 14 2.7 7 1.3 2 0.4
Residential Region Region 9 42 8.0 21 4.0 9 1.7 8 1.5 0.336
Region 14 107 20.4 26 5.0 16 3.1 8 1.5
Region 16 76 14.5 18 3.4 13 2.5 9 1.7
Region 17 30 5.7 18 3.4 9 1.7 1 0.2
Region 18 63 12.0 24 4.6 14 2.7 12 2.3
Economic Status Weak 5 1.0 20 3.8 31 5.9 30 5.7 <0.001
Mild 264 50.4 85 16.2 30 5.7 8 1.5
Good 49 9.4 2 0.4 0 0.0 0 0.0
House Ownership Owner 157 30.0 45 8.6 15 2.9 4 0.8 <0.001
Tenant, organizational or other 161 30.7 62 11.8 46 8.8 34 6.5
House Type Apartment 291 55.5 92 17.6 53 10.1 35 6.7 0.417
Villa 27 5.2 15 2.9 8 1.5 3 0.6
Age (years) 13.863 0.865 13.776 0.877 13.843 0.810 13.821 0.896 0.84
Weight (kg) 82.011 10.055 80.200 8.706 81.343 9.421 78.913 7.732 0.13
Height (cm) 159.422 6.016 158.496 5.999 158.515 5.013 157.092 6.053 0.08
Body Mass Index (kg/m2) 32.168 2.406 31.858 2.131 32.361 3.438 31.946 2.156 0.55
Thickness of Skinfold (mm) 44.241 5.788 43.028 5.745 43.869 6.616 43.982 6.108 0.33
Number of Sisters andBrother 1.20 0.864 1.38 1.271 1.13 0.763 1.37 0.883 0.21
Number of People Living in Household 4.04 0.880 4.22 1.127 3.97 0.632 4.18 0.926 0.19

** presented as Mean (SD) for quantitative variables and frequency (%) for qualitative variables
** calculated by Chi-Square or one-way ANOVA test; Significant at the 0.05 level

Table 2: Quantitative and Qualitative Characteristics of Participants Based on Food Insecurity.

Secure Insecure P-Value**
N % N %
School Grade 7th 94 17.9 70 13.3 0.085
8th 116 22.1 83 15.8
9th 108 20.6 54 10.3
Head of the Family Father 300 57.1 189 36.0 0.216
Mother or other 18 3.4 18 3.4
Father’s Occupation Unemployed 2 0.4 16 3.1 0.108
Self-employed 207 39.8 117 22.5
Retired or workman 23 4.4 28 5.4
Clerk or manager 85 16.3 42 8.1
Mother’s Occupation Housekeeper 253 48.3 177 33.8 0.104
Employee 64 12.2 30 5.7
Father’s Education Illiterate or primary school 44 8.4 37 7.1 0.004
High school or diploma 201 38.6 143 27.4
Academic education 72 13.8 24 4.6
Mother’s Education Illiterate or primary school 35 6.7 48 9.1 <0.001
High school or diploma 230 43.8 136 25.9
Academic education 53 10.1 23 4.4
Residential Region Region 9 42 8.0 39 7.4 0.370
Region 14 107 20.4 50 9.5
Region 16 76 14.5 40 7.6
Region 17 30 5.7 28 5.3
Region 18 63 12.0 50 9.5
Economic Status Weak 5 1.0 81 15.4 <0.001
Mild 264 50.3 124 23.6
Good 49 9.3 2 0.4
House Ownership Owner 157 29.9 65 12.4 <0.001
Tenant, organizational or other 161 30.7 142 27.0
House Type Apartment 291 55.4 181 34.5 0.14
Villa 27 5.1 26 5.0
Age (years) 13.86 0.86 13.80 0.85 0.43
Weight (kg) 82.01 10.05 80.27 8.74 0.03
Height (cm) 159.42 6.01 158.25 5.72 0.02
Body Mass Index (kg/m2) 32.16 2.40 32.01 2.58 0.47
Thickness of Skinfold (mm) 44.24 5.78 43.44 6.05 0.13
Number of Sisters and Brother 1.20 0.86 1.31 1.07 0.21
Number of People Living in Household 4.04 0.88 4.14 0.97 0.20

** presented as Mean (SD) for quantitative variables and frequency (%) for qualitative variables
** calculated by Chi-Square or independent sample t-test; Significant at the 0.05 level

Discussion

According to the results of this study, there was a significant relationship between food insecurity and the employment status of the participant’s father. In the studies of Mohammad Zadeh et al., and Dastgiri et al.,17 there was a meaningful relationship between employment status and food insecurity. Food insecurity has shown a significant relationship with employment status in other studies on Canadian households, low-income households in Los Angeles, rural households in Malaysia, and women in California.18 These studies are consistent with the present results.

Significant relationships can be attributed to the fact that higher education increases the chances of earning more paid jobs and improving the nutritional attitude of parents in relation to food needs and, as a result, reducing the level of household insecurity.

In this study, there was also a significant relationship between household economic status and food insecurity. Other studies have similarly shown that food insecurity has a meaningful relationship with economic status.19 In the studies by Ghasemi et al.,20 and Dastgiri et al.,17 food insecurity showed an inversely significant relation with income. The prevalence of food insecurity in the US, Canadian, Malaysian, Mongolian and Georgian households had an inversely significant relationship with high-income levels.18 The results of these studies are consistent with the present study. Income is a crucial determinant of food security and is a critical factor in access to food in the community. Higher-income households and better economic conditions have wider food choices and can spend more on their food.

In a study by Andy Bukasa et al., there was a significant relationship between “overweight” children, based on “weight for height” in terms of the Household Food Insecurity Access Scale (HFIAS). Also, in this study, there was a significant relationship between “height ” and “mild family food insecurity”. On the other hand, “weight for age” and “weight for height” were not statistically related to HFIAS categories. The relationship between anthropometric indices, in particular, “overweight”, “height for age” and “weight for height” on the one hand, and poverty and HFIAS indicators on the other, shows that anthropometric indices of children can be good indicators of household food security. However, their measurements should be combined with other indicators. In the present study, a significant relationship was only observed in the weight and height of children with food security.

Conclusion

Today, food insecurity is a major public health problem, and food security is considered as a household and individual health indicator. Food insecurity and hunger can have adverse social and psychological effects in addition to their health effects. In this study, factors such as father’s occupation and education, mother’s education, and household economic status had a significant relationship with the level of food security. Also, from anthropometric indices in this study, only the height and weight of children showed a relationship with household food security.

Acknowledgements

This study was supported by Tehran University of Medical Sciences (TUMS). The authors are grateful to the Ministry of Education of Tehran Province for its collaboration. We also thank all students, who participated in this study.

References

  1. Wang, Y. and Lobstein, T. 2006. Worldwide trends in childhood overweight and obesity. Int Pediatr Obes. 1 (1): 11-25.
    CrossRef
  2. Hajiyan, K. Sajadi, P. and Rezvani, A. 2009. Prevalence of overweight and underweight among primary school children aged 7-12 years. Journal of Babol University of Medical Sciences. 10: 81-93. (in Persian).
  3. Veldhuis, L. Struijk, M.K. Kroeze, W. and Oenema, A. 2009. Be active, eat right. BMC Public Health. 9: 177-88.
    CrossRef
  4. Hering, E. Pritsker, I. Gonchar, L. and Pillar, G. 2009. Obesity in children is associated with increased health care use. Clin pediatr (phila). 48 (8): 812-8.
    CrossRef
  5. Hardy, L.R. Harrell, J.S. and Bell, R.A.2004. Overweight in children: definition, measurements, confounding factors and health consequences. J Pediatr Nurs. 19 (6):376-8.
    CrossRef
  6. Eisenmann, J.C. Gundersen, C. Lohman, B.J. Garasky, S. and Stewart S.D. 2011. Is food insecurity related to overweight and obesity in children and adolescents? A summary of studies,1995–2009. Obesity Reviews. 12: e73–e83.
    CrossRef
  7. 1996. Rome Declaration on World Food Security and World Food Summit Plan of Action. World Food Summit 13-17 November, Rome.
  8. 2007. The State of Food Insecurity in the World. Food and Agriculture Organization of the United Nations. Rome, 47.
  9. Behzadifar, M. Abdi, S. Malekzadeh, R. Arab Salmani, M. Ghoreishinia, G. Falahi, E. Mirzaei M. Shams Biranvand, N. and Sayehmiri, K. 2016. Prevalence of food insecurity in Iran: A systematic review and meta-analysis. Arch Iran Med. Apr, 19 (4):288-294.
  10. To, Q.G. Frongillo, E.A. Gallegos, D. and Moore, J.B. 2014. Association of food insecurity and physical activity in U.S. children and adults. J Nutr. 144: 1797–802.
    CrossRef
  11. 2006. Food insecurity and hunger in the United States: an assessment of the measure. Washington. The National Academies Press.
  12. Slack, K.S. and Yoo, J. 2005. Food hardship and child behaviour problems among low-income children. Soc Serv Rev. 79: 511–36.
    CrossRef
  13. Rafiei, M. Nord, M. Sadeghizadeh, A. and Entezari, M. 2009. Assessing the internal validity of a household survey based food security measure adapted for use in Iran. Nutr J. 8 (28): 1186-1197.
    CrossRef
  14. Ramesh, T. 2009. The Prevalence of food insecurity and some associated factors among Shirazian households in 2009. (dissertation), Tehran. Shahid Beheshti University, M.C. (in Persian).
  15. Bickel, G. Nord, M. Price, C. Hamilton, W.L. and Cook, J. 2000. Guide to measuring household food security, Revised 2000. USDA, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation, Alexandria Alexandria VA.
  16. Dorosty, A. and Naeini, A.M.A. Correlation of elderly nutritional status with cardiovascular disease and diabetes. IC Journal Master List. Tehran University Medical Journal (TUMJ). 2007; 65 (3): 68-71.
  17. Dastgiri, Soltanali, Totonchi, Ostadrahimi. Influencing factors on food insecurity: a cross-sectional study in Tabriz years 2004-2005. Journal of Ardabil University of Medical Sciences.
  18. Azizi S., Sadrzadeh, Hosseini S., Ahmadi A., Daneshi Maskooni M, Safarpour et al., Food insecurity and some socioeconomic factors affecting women with metabolic syndrome. Armaghane Danesh. 2013; 18(2): 95-106.
    CrossRef
  19. Payab M., Dorosty Motlagh, A.R. Eshraghian, M.R. Siassi, F. and Karimi, T. 2012. The association between food insecurity, socio-economic factors and dietary intake in mothers having primary school children living in Ray 2010. Iranian Journal of Nutrition and Food Technology. 7 (1): 0-0.
    CrossRef
  20. Ghasemi H. 2004. Food Security & Nutrition & Future Challenges of Country. The Articles Collection of the First Seminar of Agriculture & National Development Planning Surveys. Agricultural Economics Institution Publication.


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