UniversityHonorsStudentAssociation

2016CaseCompetition

That food insecurity1 and obesity can coexist and are signicantly associated in some studies does
not necessarily mean they are causally linked to each other. Both food insecurity and obesity can be
independent consequences of low income and the resulng lack of access to enough nutriousfood
or stresses of poverty. More specically, obesity among food insecure people as well as among
lowincome people occurs in part because they are subject to the same,oenchallenging,cultural
changes as other Americans (e.g., more sedentary lifestyles, increased poron sizes), and also
because they face unique challenges in adopng and maintaining healthful behaviors, as described
below:

Limitedr esourcesa ndlacko

fa ccesst oh
ealthy,a ffordablef oods.
Lowincome neighborhoods frequently lack fullservice grocery stores and farmers markets
where residents can buy a variety of highquality fruits, vegetables, whole grains, and lowfat
dairy products (Beaulac et al., 2009; Larson et al., 2009; Bell et al.,2013).Instead,residents
especially those without reliable transportaon may be limited to shopping at small
neighborhood convenience and corner stores, where fresh produce and lowfat items are
limited, if available at all. Comprehensive literature reviews examining neighborhood
disparies in food access ndthatneighborhoodresidentswithbeeraccesstosupermarkets
and limited access to convenience stores tend to have healthier diets and reduced risk for
obesity( Larsone ta l.,2
009;B
elle ta l.,2
013).
According to USDA, vehicle access is perhaps the most importantdeterminantofwhetheror
not a family can access aordable and nutrious food (Ver Ploeg et al., 2009). Households
with fewer resources (e.g., SNAP households, WIC households, foodinsecurehouseholds)are
considerably less likely to have and use their own vehicle for their regular food shopping
than those households with more resources (Ver Ploeg et al., 2015). Food choices and
purchases may be constrained by limits on how much can be carried when walking or using
publictransit(e.g.,buyingfeweritemsinbulkorthatareheavy),orifconsumersarelimitedto
one large shopping trip a month with a friend or family member to buy the majority of their
1

ContentsofthisdocumentadaptedfromFoodandResearchActionCenter.

monthlyfoodpurchases(e.g.,buyingfewerperishableitemslikefreshproduce)(Wiig&Smith,
2009; Walker et al., 2012). Transportaon costs also cut into the already limited resources of
lowincome households, and these costs plus travel me canbesubstanal(Roseetal.,2009;
Evanse ta l.,2
015).
When available, healthy food may be more expensive in terms of the monetary cost as well
as (for perishable items) the potenal for waste, whereas rened grains, added sugars, and
fats are generally inexpensive, palatable, and readily available in lowincome communies
(Aggarwal et al.,2012;Darmon&Drewnowski,2015;DiSansetal.,2013;Drewnowski,2010).
Households with limited resources to buy enough food oen trytostretchtheirfoodbudgets
by purchasing cheap, energydense foods that are lling that is, they try to maximize their
caloriesperdollarinordertostaveohunger(DiSansetal.,2013;Drewnowski,2009;Edinet
al., 2013). While less expensive, energydense foods typically have lower nutrional quality
and, because of overconsumpon of calories, have been linked to obesity (Kant & Graubard,
2005;P
erezEscamillae ta l.,2
012).
When available, healthy food especially fresh produce isoftenofpoorerqualityinlower
income neighborhoods, which diminishes the appeal of these items to buyers (Andreyeva et
al.,2
008;E vanse ta l.,2
015).
Lowincome communies have greater availability of fast food restaurants, especially near
schools (Fleischhacker et al., 2011; Hilmers et al., 2012; Kestens & Daniels, 2010). These
restaurants serve many energydense, nutrientpoor foods at relavely low prices. Fast food
consumpon is associated with a diet high in calories and low in nutrients, and frequent
consumpon may lead to weight gain (Larson et al., 2011; Pereira et al., 2005; Powell &
Nguyen,2
013).

Cycleso
fF oodD
eprivationa ndO
vereating
Those who are eang less or skipping meals to stretch food budgets may overeat whenfood
does become available, resulng in chronic ups and downs in foodintakethatcancontribute
to weight gain (Bruening et al., 2012; Dammann & Smith, 2010; Olson et al., 2007). Cycles of
food restricon or deprivaon also can lead to disordered eang behaviors, an unhealthy
preoccupaon with food, and metabolic changes that promote fat storage all the worse
when combined with overeang (Bove & Olson, 2006; FinneyRuenetal.,2010;Laraiaetal.,
2015). Unfortunately, overconsumpon is even easier given the availability of cheap,
energydensef oodsinlowincomec ommunies( Drewnowski,2
009;H
ilmerse ta l.,2
012).
The feast or famine situaon is especially a problem for lowincome parents, parcularly
mothers, who oen restrict their food intake and sacrifice their own nutrition in order to
protect theirchildrenfromhunger(Dammann&Smith,2009;Edinetal.,2013).Suchacoping
mechanism putsthematriskforobesityandresearchshowsthatparentalobesity,especially
maternal obesity, is in turn a strong predictor of childhood obesity(Devetal.,2013;Janjuaet
al.,2
012;M
etallinosKatsarase ta l.,2
012).

HighL evelso
fS tress,A
nxiety,a ndD
epression
Members of lowincome families, including children, may face high levels of stress and poor
mental health (e.g., anxiety, depression) due to the nancialandemoonalpressuresoffood
insecurity, lowwage work, lack of access to health care, inadequate transportaon, poor
housing, neighborhood violence, and other factors. For instance, a number of recent studies
nd associaons between food insecurity and stress, depression, psychological distress, and

other mental disorders (Laraia et al., 2015; Leung et al., 2015; Liu et al., 2014; McLaughlin et
al.,2
012).
Research has linked stress and poor mental health to obesity in childrenandadults,including
(for adults) stress from jobrelated demands and diculty paying bills (Block et al., 2009;
Gundersen et al., 2011; Lohman et al., 2009; Moore & Cunningham, 2012). In addion, a
number of studies nd associaons between maternal stressordepressionandchildobesity
(Gross et al., 2013; Tate et al., 2015). Emerging evidence also suggests that maternalstressin
combinaon with food insecurity may negavely impact child weight status (Lohman et al.,
2009).
Stress and poor mental health may lead to weightgainthroughstressinducedhormonaland
metabolic changes as well as unhealthful eating behaviors and physical inactivity(Adam &
Epel,2007;StultsKolehmainen&Sinha,2014;Torres&Nowson,2007;Tomiyamaetal.,2011).
There also is growing evidence that lowincome mothers struggling with depression or food
insecurity ulize obesogenic child feeding pracces and unfavorable parenng pracces that
could inuence child weight status (BronteTinkew et al.,2007;Grossetal.,2012;Grossetal.,
2013;G
ouldinge ta l.,2
014).

FewerO
pportunitiesf orP
hysicalA
ctivity
Lower income neighborhoods have fewer physical activity resources than higher income
neighborhoods, including fewer parks, green spaces, and recreaonal facilies, making it
dicult to lead a physically acvelifestyle(Mowen,2010).Researchshowsthatlimitedaccess
to such resources is a risk factor for obesity (GordonLarsen et al., 2006; Sallis & Glanz,2009;
Singhe ta l.,2
010b).
There is emerging evidence that food insecurity is associated with less physical activity and
greater perceived barriers to physical activity (e.g., too red tobephysicallyacve)(Framet
al., 2015; To et al., 2014). In addion, many studies nd that lowincome populaons engage
in less physical acvity and are less physically t than their higher income peers (Centers for
Disease Control and Prevenon, 2014; Jin & JonesSmith, 2015). This is not surprising, given
thatm
anye nvironmentalb
arrierst op
hysicala cvitye xistinlowincomec ommunies.
When available, physical activity resources may not be attractive places to play or be
physically acve because lowincome neighborhoods oen have fewer natural features (e.g.,
trees), more visible signs of trash and disrepair, and more noise (Bruton & Floyd, 2014;
Neckermane ta l.,2
009).
Crime, traffic, and unsafe playground equipment are common barriers to physical acvity in
lowincome communies (Neckerman et al., 2009; Taylor & Lou, 2011). Because of theseand
other safety concerns, children and adults alike are more likely to stay indoors and engage in
sedentaryacvies,suchaswatchingtelevisionorplayingvideogames.Notsurprisingly,those
living in unsafe neighborhoods are at greater risk for obesity (Duncan et al., 2009; Lumenget
al.,2
006;S inghe ta l.,2
010b).
Lowincome children are less likely to participate in organized sports (C.S. Mo Childrens
Hospital, 2012; Duke et al., 2003). This is consistent with reports by lowincome parents that
expense and transportaon problems are barriers to their childrens parcipaon in physical
acvies( C.S.M
oC
hildrensH
ospital,2
012;D
ukee ta l.,2
003).
Students in lowincome schools spend less time being active during physical education
classes and are less likely to have recess, both of which are of parcular concern given the
already limited opportunies for physical acvity in their communies (Barros et al., 2009;

Milteer & Ginsburg, 2007; UCLA Center to Eliminate Health Disparies & Samuels and
Associates,2
007).

GreaterE xposuret oM
arketingo
fO
besityPromotingP
roducts
Lowincome youth and adults are exposed to disproportionately more marketing and
advertising for obesitypromoting products that encourage the consumpon of unhealthful
foods and discourage physical acvity (e.g., fast food, sugary beverages, television shows,
video games) (Powell et al., 2014; Yancey et al., 2009). Such adversing has a parcularly
strong inuence on the preferences, diets, and purchases of children, who are the targets of
manym
arkenge orts( Instuteo
fM
edicine,2
006;Instuteo
fM
edicine,2
013).

LimitedA
ccesst oH
ealthC
are
While the enactment of the Aordable Care Act of 2010 improved health insurancecoverage
rates in the naon, many lowincome people sll are uninsured and lack access to basic
health care, especially in states that have not taken the Medicaid opon (Smith & Medalia,
2015). This results in lack of screening for food insecurity and referrals for food assistance,as
wella slacko
fd
iagnosisa ndt reatmento
fe mergingc hronich
ealthp
roblemslikeo
besity.

Your mission: Develop a novel solution (program, policy, and/or product) which reduces obesityin
lowincomec ommunitieso
ft heU
nitedS tates.

You will have 10 minutes to present your recommendaon. Aer that, judges will have up to 5
minutest oa ska nyc larifyingq
uesons.

Pleasee
maily ours lided
eckt ou
hsa@umn.edub
y7
:30amo
nS aturday,N
ovember1
2.

The resources provided in this document are simply a starng point; we encourage you and your
teammatest oa ccessa ddionalr esourcesinc raingy ourr ecommendaons.

SampleR
ubric
TeamN
ame__________________________R
oom_______R
ound________________
JudgeN
ame__________________________
SpecialtyArea:Wheredoyouthinktheteamwouldbestt?(Pleasecheckallthatapply)

Product_____Program______Policy_______

Criteria
Notes
Theoverallrecommendaonor

soluon.
Soluoninsight&
praccality
Detailedaconplanor
productspecicaon
Nextstepsandmeline

SupportforRecommendaon

Financialfocus(cashow,
etc)
Designfeasibility(do
similarproducts/programs
currentlyexist?)
Strategicfocus(abilityto
execute?)

Note:Studentsareallowedtouse
externalinformaon,faculty
assistance,dataanalysis,etcto
supportrecommendaon.

PresentaonQuality

Isinformaonpresented
clearly?
Organizedand
appropriateforaudience
Slidedesign
Condentspeaking
QualityofQ /Asession

OverallRanking(comparedto
otherteamsintheroom;1
4)

Score(110)