Applying family stress theory to the food insecurity childhood obesity paradox: path model results from a rural pediatric obesity intervention study

Abstract Objective Food insecurity impacts mental and physical health for individuals of all ages. This study evaluates associations between food insecurity and weight status, diet, and mental health, as well as tests a path model to evaluate proposed patterns (i.e., parent BMI, parent distress, and child diet) of food insecurity’s relationship with child obesity. Methods This study includes a cross-sectional analysis of baseline data from parent–child dyads enrolled in rural, family-based obesity intervention. Dyads in rural Kansas (N = 148; 25% food insecure; child age 6–10 years) were recruited based on child weight status (i.e., above 85th percentile). Families completed measures pertaining to household food insecurity, mental health, child diet, and standardized height/weight measurement. Results Correlational analyses indicated significant positive associations between food insecurity, parent/child BMI(z), and parent anxious, depressive, and somatic symptoms (ps < .05). Additionally, path models indicated the strongest significant indirect effect on the relationship between food insecurity and child BMIz was via parent BMI (βs = 0.10–0.13, ps < .001), such that greater parent BMI partially explained the food insecurity child obesity paradox exhibited in previous literature, while parent distress (βs = −0.06, p < .001), and child diet (β = 0.02, ps < .001), demonstrated smaller mediation effects. Conclusions Findings highlight negative associations of food insecurity with physical and mental health of parents, which may then indirectly correspond to child weight status. Results emphasize the need to assess and address food insecurity in family-focused obesity intervention, especially for families living in rural areas.