A Nutritional Emergency: the food insecurity-obesity paradox

Key points

  • Children lacking access to enough nutritious food remains a problem in the UK, despite government intervention

  • This results in malnutrition and contributes to the obesity epidemic

  • Measures to tackle the obesity epidemic have so far failed to address the underlying poverty

Nearly one in three children in the UK live in poverty, despite it being one of the largest economies in the world. Childhood poverty has severe negative consequences on social and physical development. Too many low-income families live in food insecure households, which means they lack reliable access to sufficient, nutritious food. Food insecurity can range from worrying about having enough money to go to the supermarket (mild), to skipping meals and experiencing hunger (severe). A recent Unicef report estimate that 19% children in the UK do not have reliable access to food, 50% of which go through severe food insecurity.

To help tackle this issue, in 2014 the coalition government implemented a policy to ensure that all infants in state-funded schools have a free, nutritious meal a day. This policy helped families with living costs and parents felt it improved children’s health, food education and school performance (as reported by the Educational Policy Institute in January 2018). Unfortunately, despite this reported improvement in helping families save money, the policy seems to have fallen short of preventing increasing food insecurity. Whilst other measures have been taken, such as free school meals available specifically for low-income families, the issue is still not fully resolved.

At the same time, we are seeing a sharp rise in childhood obesity, particularly in poorer households. A recent government report has found, when compared to children from higher income families, children from lower income families are more likely to be obese. The trend starts from age 5 when they are twice as likely to be obese and it continues: 11 year-olds from lower income households are three times more likely.

The obesity epidemic seems counterintuitive with the statistics on food insecurity, but in reality, the two can co-exist, in a phenomenon known as the Food Insecurity-Obesity Paradox. There are two main hypotheses about the mechanisms that drive low-income, food-insecure populations to become overweight and obese. Firstly, there is higher consumption of energy-dense “junk food” and a lack of education on healthy nutrition. Secondly, periods of food restriction can have negative consequences on metabolism, leading to overeating and decreased energy expenditure (resting metabolic rate), hence promoting fat storage.


The cost of healthy eating further contributes to the paradox. High-calorie, palatable foods are generally less expensive; one strawberry jam doughnut contains 250 calories and costs about 13 pence, whereas an apple has about 95 calories and costs twice as much. To counter this, Mexico and Hungary have introduced a “junk food” tax, which has been successful in driving consumers to buy healthier foods. In Hungary, this tax was accompanied by educational campaigns, tackling the knowledge aspect of food consumption too.

However efficient in improving consumers’ choices, an increase in taxes hits poorest people the hardest. It does not address poverty as the driving force behind food insecurity. Other measures proposed by a recent government report, such as restricting “junk food” advertising and regulating food types that can go on promotion in supermarkets, also ignores the root cause of food insecurity.

Obesity is an incredibly complex, multifactorial disease highly influenced by environmental factors. Its association with food insecurity warrants further sociological research into the potential causes, alongside medical research, and integrated, comprehensive public policies. Implementation of programmes that teach children to grow their vegetables, cooking lessons, as well as subsidisation of healthy, nutritious foods, and market regulation are measures that could be part of this strategy, starting from childhood. This is essential to improve the health of the population.

Additional reading

https://foodfoundation.org.uk/new-evidence-of-child-food-insecurity-in-the-uk/

http://researchonline.lshtm.ac.uk/2145730/1/bmj.h1775.full.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735508/

https://www.theguardian.com/commentisfree/2017/mar/31/food-poverty-crisis-government-cost-of-living

https://www.independent.co.uk/life-style/health-and-families/poverty-individual-choice-driving-obesity-health-a8219831.html

https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/882/88202.htm, Published 30/05/2018

https://epi.org.uk/publications-and-research/evaluation-universal-infant-free-school-meals/

About the author

Maria Paiva Pessoa is a 3rd year PhD student at Imperial College London, and her research focuses on the role of genes associated with obesity on energy homeostasis and behaviour. Her interest in healthcare policy made her look beyond the lab and join Polygeia, where her team is developing a project on micronutrient deficiencies in pregnant women in developing countries.

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