Patterns of Obesity and Cutting Meals in Philadelphia, 2008-2012

Data Brief
May 2018

View the brief: Patterns of Obesity and Cutting Meals in Philadelphia [PDF]

While individual diet and physical activity behaviors impact obesity, community and institutional settings may shape behaviors and precursors of obesity. Food insecurity, the uncertain ability to acquire sufficient and nutritious foods in socially acceptable ways, may at first seem counter to obesity — a disease often characterized by an excess of food. However, these two issues often coexist. Most importantly, food insecurity disproportionately affects those at the highest risk for obesity, including low-income households, women, and members of racial and ethnic minority groups.

Regardless of mechanisms, epidemic levels of obesity and the harmful impacts of both obesity and food insecurity prompt action to identify and explore burden in populations. This brief explores spatial, temporal, and population patterns of cutting meals among those who are obese, using data from 2008-2012. We hope this work enables the recognition of these coexisting problems and facilitates discussions of opportunities for intervention. 

Complex Pathways Linking Obesity and Food Insecurity

Figure 1 in the brief illustrates complex pathways linking obesity and food insecurity. Being food insecure can negatively impact mental health, creating stress, anxiety and depression. Pathways that link obesity and food insecurity exist at multiple levels:

• Economic position can influence level of food insecurity through financial constraints.
• Social and economic policies impact food pricing, availability and social acceptability.
• Healthy food environments provide access to healthy choices at home, school, work sites, and restaurants, influencing food insecurity.
• Food environments are linked to economic food choices – unhealthy foods are less expensive compared with healthy foods.
• Financial and emotional pressures of food insecurity increase chronic stress, subsequently promoting obesity through changes in appetite, dietary preference and stress-induced metabolic hormones.

Figure 2: Pie chart depicts the burden of obesity and meal cutting in Philadelphia between 2008 - 2012. Six percent reported obesity + cutting meals. Eleven percent reported not obese + cutting meals. Twenty-five percent reported obesity + did not cut meals. The largest group reported 59% not obese + did not cut meals.

Measurement of Food Insecurity

The Core Food Security questions include, among others, questions about food running out, and questions about cutting or skipping meals because there was not enough money for food. Screening in a clinical setting can be done by asking patients to what extent they agree with two statements:

1. “We worried whether our food would run out before we got money to buy more.”

2. “The food that we bought just didn’t last, and we didn’t have money to get more.”

Data in this brief are from the Southeastern Pennsylvania Household Health Survey (SPHHS) administered by the Public Health Management Corporation (PHMC). This brief uses the question on cutting the size of or skipping a meal because it was the sole measure included in the SPHHS across multiple years.

Read the full brief, which charts data on characteristics, neighborhoods, access to healthy foods, and health care utilization.

Citation:

Hirsch A, Adams, M, Lucente A, Zhao Y, Moore K, Livengood K, Auchincloss A. Patterns of Obesity and Cutting Meals in Philadelphia. Philadelphia, PA: Drexel University Urban Health Collaborative; May 2018