Association Between Food Insecurity and Obesity Among Indonesian

Adolescents

Hardi Firmansyah

, Rasita Purba

, Edy Marjuang Purba

and Risti Rosmiati

Nutrition Study Program, Faculty of Engineering, Universitas Negeri Medan, Jl. Willem Iskandar Psr V, Medan, Indonesia

Keywords: Adolescents, Food Composition Score, Food Insecurity, Obesity.

Abstract: The emergence of food insecurity and obesity as significant public health challenges, particularly concerning

Indonesian adolescents, has garnered global attention. In the face of distinctive socioeconomic complexities,

Indonesia is confronting a simultaneous surge in the prevalence of food insecurity and obesity. This study

examined the interrelation between food insecurity and obesity within the cohort of Indonesian adolescents.

Data were meticulously collected from participants within the 2014 Indonesia Family Life Survey (IFLS)

purview. A comprehensive evaluation of food insecurity based on the conceptual framework outlined by the

World Food Program (WFP) was conducted utilizing the 17-item Food Frequency Questionnaire (FFQ).

Furthermore, the assessment of Body Mass Index (BMI)-for-age z-scores was facilitated by the meticulous

height and weight measurements recording. A multinomial logistic regression model was subsequently

deployed to scrutinize the test hypothesis. The study encompassed a cohort of 4883 adolescents aged between

10 and 18 years old. Notably, an augmented proportion of overweight and obese individuals was recorded

among those grappling with food insecurity in comparison to their food-secure counterparts. The results

obtained from the multinomial logistic regression models unequivocally underscored the heightened

probability of being overweight and obese among those grappling with moderate and severe food insecurity.

Additionally, an explicit correlation between household food insecurity and an elevated predisposition to

obesity was conclusively established.

1 INTRODUCTION

In recent decades, the coexistence of food insecurity

and obesity has emerged as a consequential global

public health problem (Huizar et al., 2021). The

discernible convergence of these complex issues,

which has transpired amid the rapid socioeconomic

transformations and shifts in dietary norms within

societies, has evoked extensive research and policy

deliberations worldwide (Frongillo & Bernal, 2014).

Indonesia, characterized by a rich tapestry of cultural

diversity, intricate economic dynamics, and notable

demographic transformations, is an intriguing case

study within this multifaceted landscape. Within this

context, the exploration of the correlation between

food insecurity and obesity among the cohort of

Indonesian adolescents assumes profound

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significance, offering an invaluable vantage point to

comprehend the broader implications for local and

global health comprehensively (Carvajal-Aldaz et al.,

2022; Dewi et al., 2020).

Indonesia, an expansive archipelagic nation

characterized by its cultural diversity, has achieved

significant milestones in pursuing economic

advancement in recent years. Nevertheless, this

trajectory of progress has been concomitantly marred

by a host of intricate socioeconomic impediments,

notably encompassing disparities in equitable access

to adequate, uncontaminated, and nourishing

sustenance (Amrullah et al., 2019). Simultaneously,

the transformative shifts in dietary predilections and

consumption behaviors, fostered by the forces of

urbanization and globalization, have engendered a

novel spectrum of nutritional complexities, most

Firmansyah, H., Purba, R., Purba, E. M. and Rosmiati, R.

Association Between Food Insecurity and Obesity Among Indonesian Adolescents.

DOI: 10.5220/0012901000004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 82-86

ISBN: 978-989-758-727-6; ISSN: 2975-8297

notably evidenced by the surging prevalence of

obesity within the adolescent demographic

(Maruapula et al., 2011; Ogden et al., 2018; Pirgon &

Aslan, 2015). The coexistence of these intricate

predicaments, namely food insecurity and obesity,

incites an intriguing discourse surrounding the

intricate interplay between these phenomena,

shedding light on their potential shared determinants

and underlying drivers (Carvajal-Aldaz et al., 2022).

This comprehensive study rigorously investigates

the intricate correlation between food insecurity and

obesity within the demographic of Indonesian

adolescents. By meticulously examining diverse

factors encompassing both economic and behavioral

dimensions, this research unveils the nuanced

interconnections linking insufficient access to

essential food resources with the escalating incidence

of obesity. By delving into this complex

interrelationship, the study aspires to furnish

invaluable insights into the global discourse

surrounding mitigating the dual challenges posed by

the coexistence of malnutrition and overnutrition,

thereby deciphering the potential pathways at the

nexus of these multifaceted predicaments. This

study's focal point centers on analyzing the interplay

between food insecurity and obesity among

Indonesian adolescents.

2 METHODS

2.1 Data Source and Participants

The methodology employed in this study entailed

using secondary data sourced from the fifth wave

(2014) of the Indonesian Family Life Survey (IFLS).

The datasets incorporated within the ambit of the

IFLS were accessed in compliance with the

established RAND Corporation guidelines, ensuring

the anonymity and confidentiality of the data

accessible to researchers. The study specifically

focused on adolescent respondents within the age

bracket of 10 to 18 years old. Subsequently, a

comprehensive analysis was conducted solely on

those respondents who had provided substantive data

concerning their nutritional status, anthropometric

measurements, and pertinent sociodemographic

information. Upon applying the stipulated inclusion

criteria, a total of 4883 participants were deemed

eligible for incorporation within the scope of this

study.

2.2 Measurement of Food Insecurity,

Nutritional Status, and Covariates

The assessment of food insecurity in this study was

conducted in adherence to the conceptual framework

outlined by the World Food Program (WFP).

Analyzing food consumption patterns was

instrumental in deriving the Food Consumption

Scores (FCS). The computation of the FCS was

predicated upon the comprehensive evaluation of

dietary patterns using the 17 distinct items collated

from the Food Frequency Questionnaire (FFQ).

Precisely, the study ascertained the frequency of

consumption for each of the 17 food items over a

period of seven days immediately preceding the

interview. Subsequently, all food items were

categorized into nine distinct food groups, as

stipulated by the guidelines outlined by the United

Nations and the World Food Program (UN-WFP,

2015). Based on the cumulative scores derived from

each food group, the Food Consumption Scores

(FCS) were subsequently categorized into three

distinct Food Consumption Groups (FCGs) cut-offs.

Finally, within the purview of this study, the

classification of adolescents as severely food

insecure, moderately food insecure, or food secure

was contingent upon their respective placements

within the designated FCG categories. Specifically,

individuals falling within the "poor" (<21) group of

FCGs were classified as severely food insecure, and

those within the "borderline" (21 to 35) group were

identified as moderately food insecure. In

comparison, those within the "acceptable" (>35)

group were categorized as food secure, drawing from

the guidelines established by the United Nations and

the World Food Program (UN-WFP, 2015; WFP,

2008).

This study's categorization of nutritional status

encompassed distinct classifications, namely severely

underweight, underweight, normal, overweight, and

obese. The determination of these classifications was

predicated upon the computation of the BMI (Body

Mass Index) for age z-score (Kemenkes, 2020). The

analysis incorporated several covariates, including

age, sex, household income, and the parents'

nutritional status and educational attainment.

2.3 Statistical Analysis

The descriptive statistics were meticulously outlined,

featuring frequencies and means alongside their

corresponding standard deviations (SDs). A

multifaceted multinomial logistic regression

methodology was undertaken to comprehensively

Association Between Food Insecurity and Obesity Among Indonesian Adolescents

explore the correlation between food insecurity and

nutritional status. Notably, the analytical model

incorporated meticulous adjustments for various

covariates, including age, sex, household income, and

the parents' nutritional status and educational

attainment. The entire statistical analysis was carried

out using SPSS V.26.0.

3 RESULTS AND DISCUSSION

A total of 4883 adolescents, aged between 10 and 18

years old, actively participated in the study. The

demographic characteristic of the participants is

presented comprehensively in Table 1.

Table 1: Demographic characteristics of participants.

Characteristics n %

e, mean

(

±SD

)

13.4

(

2.5

)

Sex

Boys

Girls

2517

2366

51.5

48.5

Household income, mean

(

IDR

)

2,740,000

Parent's educational level

Unschooled

Primary school

Junior high school

Senior high school

Tertiar

education

1389

1042

1635

754

1.3

28.4

21.3

33.5

15.4

Parent's nutritional status

Severely underweight

Underweight

Normal

Overweight

Obese

1814

1003

2001

0.5

0.9

37.1

20.5

41.0

Food security

Severely food insecure

Moderately food insecure

Food secure

213

1428

3242

4.4

29.2

66.4

On average, the adolescents were 13.4 years old.

Most of the adolescent population consisted of boys.

Roughly 33.5% of the parents had attained education

up to the senior high school level, while more than

half were classified as overweight or obese.

Additionally, approximately 33.6% of the

adolescents lived in households characterized by food

insecurity.

As depicted in Table 2, the adjusted multinomial

logistic regression models distinctly revealed a

statistically significant correlation between severe

and moderate food insecurity and the prevalence of

adolescent overweight and obesity. Relative to the

group classified as food-secure, individuals classified

as severely food insecure exhibited a 2.94-fold and

5.11-fold heightened risk of being overweight and

obese, respectively. Similarly, a parallel association

was observed for individuals classified as moderately

food insecure, indicating elevated odds of

experiencing overweight and obesity within this

group.

Table 2: Multinomial logistic regression analysis on the

relationship between food insecurity and nutritional status.

Overweight

(95% CI)

Obese

(95% CI)

Severely food insecure 2.94**

(

1.76-4.94

)

5.11**

(

2.42-10.78

)

Moderately food

insecure

2.26**

(

1.77-2.90

)

3.94**

(

2.68-5.81

)

OR indicates odds ratio; CI, confidence interval; ** p <

0.001. Multinomial logistic included severely underweight,

underweight, overweight, and obese with reference to

normal-weight groups. Table only listed the results of

overweight and obesity group. All the regression analyses

were adjusted for age, sex, household income, parent's

educational level, and parent's nutritional status.

Food insecurity, characterized by the persistent

insufficiency in accessing an adequate, safe, and

nourishing food supply, can significantly influence

individuals' dietary choices and overall weight status.

Individuals grappling with food insecurity often

encounter obstacles in acquiring a well-rounded and

varied diet, thereby consuming energy-dense,

nutrient-depleted food items (Landry et al., 2019;

Leung et al., 2014). This prevalent phenomenon

contributes to developing detrimental dietary patterns

and amplifies the susceptibility to weight-related

complications, including the onset of overweight and

obesity (Dhurandhar, 2016).

Under circumstances of food insecurity,

individuals may be compelled to prioritize food

quantity over its nutritional quality. Resource

constraints often prompt individuals to opt for more

economical, high-calorie alternatives that frequently

exhibit high concentrations of detrimental fats and

added sugars while concurrently being deficient in

vital vitamins and minerals. Such dietary preferences

can yield an imbalanced nutritional intake lacking the

essential elements for fostering optimal health

(Bocquier et al., 2015).

"Junk foods" or "empty calories" often describe

energy-dense, nutrient-poor food items. These

products possess a high caloric value relative to their

nutritional composition and commonly encompass

sugary snacks, fast food, sugary beverages, and

heavily processed foodstuffs. Their consumption can

lead to excessive intake of calories devoid of essential

ICSDH 2023 - The International Conference on Social Determinants of Health

vitamins, minerals, and other vital nutrients,

consequently fostering weight gain and triggering

adverse health implications (Bhaskar, 2012; Payab et

al., 2015; Singh et al., 2021). The consumption of

energy-dense, nutrient-poor foods, arising from

circumstances of food insecurity, can significantly

contribute to the onset of weight gain and obesity.

These food items typically boast a high caloric

content and a low satiety quotient, prompting

individuals to consume bigger portions to attain

satiation. Over time, this consumption pattern can

culminate in an excessive calorie intake, thereby

fostering subsequent weight gain (Stelmach-Mardas

et al., 2016).

The issue of food insecurity is intricately

intertwined with various socioeconomic

determinants, notably income and educational

disparities. Due to financial constraints, individuals

of lower socioeconomic status frequently encounter

impediments in accessing wholesome food options.

The elevated costs associated with procuring fresh

fruits, vegetables, lean protein sources, and whole

grains can prove prohibitive for families grappling

with food insecurity, compelling them to resort to

comparatively more economical yet less nutrient-

dense alternatives (Bocquier et al., 2015).

The intricate interplay between food insecurity

and its profound impact on the development of

unhealthy dietary patterns can instigate a self-

perpetuating cycle. Diets lacking in essential

nutrients can foster weight gain and give rise to

interconnected health complications, thereby

exacerbating individuals' challenges in obtaining and

affording nutritious food options. Complications

arising from compromised nutrition may escalate

healthcare expenditures and curtail economic

prospects, thereby perpetuating the cycle of food

insecurity (Shinwell et al., 2022). The nexus between

food insecurity, detrimental dietary patterns, and

weight status represents a multifaceted and intricate

relationship. The persistent struggle to secure

sufficient and wholesome sustenance often

precipitates a reliance on energy-dense, yet nutrient-

sparse alternatives, contributing to the emergence of

weight gain and associated health adversities. This

underscores the critical imperative for comprehensive

interventions targeting the holistic spectrum of food

insecurity alongside the broader socioeconomic

determinants of health. By addressing challenges

pertinent to food accessibility, affordability, nutrition

education, and social support, we can strive to

interrupt the cycle of unhealthy dietary patterns and

enhance the overall welfare of populations grappling

with food insecurity (Dhurandhar, 2016).

4 CONCLUSIONS

In comparison to individuals with food security, a

notable proportion of those grappling with food

insecurity reported a higher incidence of being

overweight and obese. Notably, moderate and severe

food insecurity were significantly linked to

heightened odds of being overweight and obesity.

Furthermore, household food insecurity was

identified as a contributing factor amplifying the

likelihood of being overweight and obese.

ACKNOWLEDGEMENTS

We would like to thank the Research and Community

Service Institute of Universitas Negeri Medan (LPPM

UNIMED) for providing funding for our research.

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