Members of rural Appalachian households who lack access to food or experience hunger are more likely to be obese and have diabetes, according to an Ohio University study.

Researcher David Holben found that subjects from households with greater levels of what medical, nutrition and dietetic professionals call “food insecurity” had a greater body mass index (BMI) than those with smaller levels of food insecurity (an average BMI of 30.3 vs. average BMI of 29). Those from food insecure households also were more likely to have diabetes (37.9 percent) and to be overweight (48.1 percent) than subjects from food secure households (25.8 percent and 35.1 percent, respectively). The study was published in the July 2006 issue of Preventing Chronic Disease, a publication of the Centers for Disease Control.

A total of 2,580 people participated in the Ohio University project, with 72.8 percent from food secure households and 27.2 percent from food insecure households that may or may not be experiencing hunger. That’s higher than the national average: In 1999, the year the Ohio University study was conducted, 10.1 percent of U.S. households were food insecure.

Food insecurity is associated health problems such as stress, obesity, diabetes and heart disease, as well as with poor management of chronic disease, said Holben, who recently wrote a major position paper about the problem for the American Dietetic Association.

The survey included residents of Athens, Hocking, Meigs, Perry, Pike and Vinton counties in Ohio. Researchers asked participants about food access of their households, as well as health care access and use. Those who agreed to an additional health exam were checked for weight, blood pressure, hemoglobin levels, total cholesterol and blood glucose control, said Holben, associate professor of human and consumer sciences and the director of the Didactic Program in Dietetics in Ohio University’s College of Health and Human Services.
Volunteers were recruited from community sites, such as fairs and festivals, food distribution programs, churches, senior centers, community centers, grocery stores and shopping malls. While the sample is not representative of the region in which it was collected, the study provides an impression of the problems faced by residents of rural Appalachia.

“This does have implications for policy, and it has implications for patient care,” Holben said about the study findings. “Physicians, nurses -  not just dietitians -  need to be aware that people may not have money to buy medicine, and that they have a harder time managing a chronic disease if they’re food insecure.”
While it might be surprising that someone can be overweight while experiencing hunger, Holben explained that low-cost foods such as fast food “are lower in cost, usually are high fat and high sugar and taste good,” which makes it easier for families to rely on these foods. He also pointed to preliminary studies conducted elsewhere that show that malnourishment at a young age can result in adults whose metabolism works more slowly, predisposing them for quick weight gain.
An irregular food supply, caused by monthly food allotments that may run out by the end of the month, also can set up periods of bingeing and fasting, which in turn prompt the body to store as much energy as possible for those times when food is in short supply, Holben said.

To address the food insecurity problem, Holben suggests educational programs on better managing food supply, nutrition education (such as recipe ideas for some of the foods provided by the food assistance programs) and proper interpretation of sell-by dates on food labels.

“(Those dates) don’t mean that magically on that date the food rots, but if we have people throwing away foods, and yet they don’t have resources to buy foods, that could be a problem,” said Holben, who is continuing to study issues of food security, obesity and diabetes in a national sample.

Co-author on the Preventing Chronic Disease paper is Alfred Pheley, a former Ohio University College of Osteopathic Medicine professor who is now on the faculty of the Virginia College of Osteopathic Medicine in Blacksburg, Va. The study was funded by a grant from the Ohio University College of Osteopathic Medicine.

Ohio University Office of Research Communications