Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth

Across many Asian countries, the prevalence of obesity is increasing and is increasingly recognized as an emerging public health issue. Food insecurity, defined as the limited or uncertain availability of nutritionally adequate and safe foods, is major difficulty faced by many poor subpopulations despite national economic growth. Previous research has yielded inconsistent results about the association between food insecurity and obesity, with positive associations more consistently observed among women than men. This study aims to elucidate relationships between food insecurity, dietary behaviors, and weight status, stratified by gender. Data come from the Taiwan Database of Children and Youth in Poverty. Participants (n = 1326) aged 10-18 years (2009-2013), which included measures of food security and dietary behaviors in three survey waves. Weight status was determined using self-reported body mass index (BMI; kg/m(2)) with the category "overweight/obesity" defined as a BMI above the 85th percentile within a representative population. Logistic regression analyses indicated a significant association between food insecurity and obesity/overweight with an odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.25-1.70. Food insecurity was associated with a select number of unhealthy dietary behaviors. Skipping breakfast in females (OR = 1.63, 95% CI 1.20-2.22) and consuming snacks and sugared drinks in males (OR = 1.51, 95% CI 1.15-1.98) were associated with obesity/overweight. Food insecurity remained significantly associated with obesity/overweight after adjusting for dietary behaviors. In addition, there was some evidence that dietary behaviors mediated the association between food security and obesity/overweight. In conclusion, economically disadvantaged youth are vulnerable to food insecurity and obesity, and food insecurity may increase the likelihood of obesity due to its association with dietary behaviors. Understanding the mediating factors between food insecurity and obesity may help to amend weight-related health problems in poverty-affected populations.