SummaryResearch has established a wide array of genetic and environmental factors that are associated with childhood obesity. The focus of this review is on recent work that has established the relationship between one set of environmental factors, stressors and childhood obesity. These stressors are particularly prevalent for low-income children, a demographic group that has high rates of obesity in the USA and other developed countries. In this review, we begin by summarizing the psychosocial stressors faced by children followed by health outcomes associated with exposure to these stressors documented in the literature. We then summarize 11 articles which examined the connection between psychosocial stressors in the household and obesity and eight articles which examined the connection between individual psychosocial stressors and obesity. Policy recommendations emerging from this research include recognizing reductions in childhood obesity as a potential added benefit of social safety net programmes that reduce financial stress among families. In addition, policies and programmes geared towards childhood obesity prevention should focus on helping children build resources and capacities to teach them how to cope effectively with stressor exposure. We conclude with suggestions for future research.

Younger children in food secure, low-income households in the United States who are experiencing higher levels of maternal stressors have a greater probability of being overweight than food insecure children. This finding was contrary to the hypothesis; 3 reasons for this are covered in the article. Those who create policies that address childhood obesity could consider the benefits to low-income children's well-being resulting from reducing their mothers' stressors. Because most children in the United States are food secure, these policies could have a profound impact on childhood overweight.

SummaryIn the USA, several nutrition-related issues confront the normal growth, maturation and development of children and adolescents including obesity and food insecurity. The purpose of this paper is to provide a review of the concept of food insecurity and a summary of studies that have examined the association between food insecurity and overweight/obesity in children and adolescents. Besides the initial case report, we review 21 studies (16 cross-sectional and five prospective studies) that have been published on this topic as of December 2009. As there is limited literature in this area, we review studies that sample children and adolescents in the USA. The results are mixed with positive, negative and null associations. The reasons for the mixed results are difficult to disentangle. Among earlier studies, small samples hampered definitive conclusions. More recent studies with larger samples have overcome these limitations and tend to find no associations between these constructs. Nonetheless, all of the studies to date have shown that food insecurity and overweight co-exist -that is, even though there may not be statistically significant differences in overweight between food-insecure and food-secure children, the prevalence of overweight remains relatively high in food-insecure children.

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There has been extensive previous research examining the connection between obesity and food insecurity, 2 serious nutrition challenges facing low-income children in the US. All of this work used BMI to categorize a child as obese. Although BMI is one way to categorize the obesity status of a child, other measures have not been used to understand the connection between food insecurity and obesity. In response, this study used multiple measures of obesity taken from the 2001 to 2004 NHANES. The sample included 2516 children between the ages of 8 and 17 y in households with annual incomes <200% of the poverty line. Within this sample, 36.6% of children were in food-insecure households. The prevalence of obesity depended on the measure employed (BMI, waist circumference, triceps skinfold thickness, trunk fat mass, body fat), with prevalence rates ranging from 15.4 to 44.8%. Logistic regression models estimated the probability of a child being obese using multiple measures of obesity conditional on food-insecurity status and other covariates. The results indicated that food-insecure children were no more likely to be obese than their food-secure counterparts across all measures of obesity. This relationship held after controlling for other factors and examining subpopulations based on race/ethnicity, gender, and race/ethnicity and gender. These results suggest that efforts to alleviate food insecurity and childhood obesity will work independently.

Food insecurity is one of the leading public health challenges facing children in the United States today. Reducing food insecurity and its attendant consequences requires an understanding of the determinants of food insecurity. Although previous work has greatly advanced our understanding of these determinants, the role of one of the oft-speculated important determinants of food insecurity, household financial management skills, has not been considered. To address this research lacuna, we use a recently conducted survey, the Survey of Household Finances and Childhood Obesity, that has information on specific financial management practices, impressions of financial management skills, and households' food insecurity. The sample included 904 households with children. Within this sample, 19.3% were food insecure and, for our central financial management skill variable, the mean value was 3.55 on a 5-point scale. Probit regression models estimated the probability of a household being food insecure as conditional on financial management skills and other covariates. We found a large and significant inverse relationship between a respondent's use of specific financial management practices and food insecurity and between a respondent's confidence in his or her financial management skills and food insecurity. That is, households with greater financial management abilities are less likely to be food insecure. This finding also holds when the sample is restricted to households with incomes <200% of the poverty line. These results suggest that improving households' financial management skills has the potential to reduce food insecurity in the United States.

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