Association of Food Security, Emotional and Behavioral Disorders and Obesity Among U.S. Adolescents

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Background: Socioeconomic factors, including family income and education, have been shown to contribute to disparities in obesity rates among children. Food security is inconsistently associated with obesity in childhood. Little is known regarding the association of both emotional health and socioeconomic factors with childhood obesity.

Objective: To determine the association between obesity, food security, and emotional health among U.S. adolescents.

Design/Methods: The National Health Interview Survey (NHIS) combined years 2016-2018, a nationally representative sample, was used to analyze data of children aged 12-17 years. Caregiver reported height and weight were used to calculate BMI ?95%ile. Four levels of family food security were measured with a validated scale developed by the U.S. Department of Agriculture. Emotional and behavioral disorders (EBD) were measured with a validated short version of the Strengths and Difficulties Questionnaire (SDQ). Multiple logistic regression was used to determine adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the effects of food security and EBD on BMI, while controlling for child's race, sex, and age, poverty, parent education, and family structure. Chi-square tests were used to compare obesity prevalence between males and females. SPSS v25 complex sampling design module with weighting was used for analyses.

Results: 10,155 children representing a weighted sample of 73,601,202 children from the 2016-2018 NHIS survey were analyzed. Overall 20.5% (95% CI 19.4-21.6) of adolescents had BMI ?95%ile. Males had a significantly higher prevalence of obesity than females in all ages except 17-year-olds (Figure). Parent education
Conclusion(s): Multiple socioeconomic factors are associated with obesity in adolescents. This study adds that although moderate and low food security are associated with obesity in the U.S., very low food security is not. This may be due to decreased meal frequency and cutting portion size in those with very low food security. EBD such as peer problems and hyperactivity-inattention are also independently associated with obesity. This study strengthens the limited research which shows an increase in the prevalence of obesity in adolescent males and may reflect differences in behavior and puberty rates.