Food Insecurity and Family-based Treatment for Pediatric Obesity

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Project Summary/Abstract Pediatric obesity puts children at risk for long-term, negative health outcomes including cardiovascular disease, high blood pressure, and stoke, and disproportionately impacts children from low-income families. Low-income families are also at increased risk for food insecurity. Consistent with the “scarcity mindset” theory of poverty, food insecurity is associated with increased discounting of delayed rewards and increased present bias. It is also associated with increased food reinforcement, and decreased likelihood of meal planning. These factors are in turn associated with increased risk for obesity. Despite the seriousness of this issue, little research has examined the role food insecurity and its psychological correlates play in behavioral treatments for pediatric obesity. Family-based treatment (FBT) for pediatric obesity is an effective treatment for childhood obesity that targets parent-child dyads and achieves long-lasting weight change in children through behavior change techniques such as reinforcement, stimulus control, preplanning, and parenting skills. However, low-income households have shown reduced treatment response in similar behavioral obesity treatments and are at elevated risk for treatment drop-out. The proposed study will examine food insecurity in 208 parent-child dyads enrolled in a CDC-funded pilot study seeking to adapt FBT for low-income families that will include a unique emphasis on budgeting and meal planning, which has been shown to predict greater weight loss in previous studies of obesity treatment, as well as a referral system to link families with social determinants of health (SDOH) needs, such as food insecurity, to resources. The proposed study will 1) characterize parents with and without food insecurity using baseline data based on weight and health status, demographics (SES, race, ethnicity), other social determinants of health needs (e.g. housing, utilities, transportation), scarcity mindset (delay discounting, relative reinforcing efficacy of food, financial planning horizon, perceived probability of living to age 75), family nutrition and physical activity, and meal planning behavior; 2) determine the degree to which food insecurity and scarcity mindset (in parents) moderate weight change after 3 and 6 months of treatment for parents and children enrolled in FBT; and 3) determine whether increased meal planning and SDOH service receipt moderate the relationship between food insecurity and/or scarcity mindset, and weight change. By characterizing the association between food insecurity and weight outcomes in FBT, this study will help guide the adaptation of FBT for low-income families and improve treatment for a subset of children at disproportionate risk for obesity.