Obesity, Poverty, and Hunger Heather Hartline-Grafton, DrPH, RD Senior Nutrition Policy Analyst Anti-Hunger Policy Confere...
U.S. Prevalence of Overweight & Obesity 31.3 31.6 28.8 63.2
<ul><li>Physiological </li></ul><ul><li>Diabetes </li></ul><ul><li>Atherosclerosis </li></ul><ul><li>Hypertension </li></u...
Overweight & Obesity | Adult Disparities <ul><li>In general, rates are: </li></ul><ul><li>Higher for African-American and ...
<ul><li>In general, rates are: </li></ul><ul><li>Higher (and have increased more rapidly over time) among African-American...
<ul><li>Greater obesity risk if low-income, especially among low-income women and children </li></ul><ul><li>Source: McLar...
<ul><li>But risk varies depending on gender and race-ethnicity </li></ul><ul><ul><li>Higher risk for females </li></ul></u...
Overweight & Obesity | Food Insecurity <ul><li>Research is mixed  </li></ul><ul><ul><li>Greater risk of obesity with food ...
Overweight & Obesity | Causes Environment Culture Socioeconomic Status Behavior Metabolism Genetics Intake > Expenditure (...
What contributes to the high rates of overweight and obesity in the U.S.?
Why are low-income and  food insecure people  vulnerable to obesity?  What are their unique challenges?
<ul><li>Limited resources </li></ul><ul><li>Lack of access to healthy, affordable foods </li></ul><ul><li>Fewer opportunit...
<ul><li>Limited resources and lack of access to healthy, affordable foods </li></ul><ul><ul><li>Lack full-service grocery ...
 
 
 
<ul><li>Fewer opportunities for physical activity </li></ul><ul><ul><li>Fewer physical activity resources  </li></ul></ul>...
 
<ul><li>Cycles of food deprivation and overeating </li></ul><ul><ul><li>Chronic ups and downs in food intake </li></ul></u...
<ul><li>High levels of stress </li></ul><ul><ul><li>Sources of stress: food insecurity, low-wage work, lack of access to h...
<ul><li>Greater exposure to obesity-related marketing </li></ul><ul><ul><li>Fast food </li></ul></ul><ul><ul><li>Sugar-swe...
<ul><li>Limited access to health care </li></ul><ul><ul><li>Lack of diagnosis </li></ul></ul><ul><ul><li>Lack of treatment...
What Can We Do?
Role of the Federal Nutrition Programs  in Obesity Prevention Reduce Overweight & Obesity Federal Nutrition  Programs Impr...
 
“ We also find that subsidized meals at school or day care are beneficial for children’s weight status, and we argue that ...
Increase participation in the federal nutrition programs
President Obama’s Goal
Ending Childhood Hunger by 2015: The Essential Strategies for Achieving the President's Goal  <ul><li>Restore  economic gr...
 
 
Healthy Food Financing Initiative <ul><li>Obama administration goal: eliminate food deserts within 7 years </li></ul><ul><...
What is FRAC doing? <ul><li>Advocacy, advocacy, advocacy </li></ul><ul><li>Creating publications </li></ul><ul><ul><li>Hun...
For more information, contact: <ul><li>Heather Hartline-Grafton, DrPH, RD </li></ul><ul><li>Senior Nutrition Policy Analys...
References <ul><li>Adam, T. C. & Epel, E. S. (2007). Stress, eating and the reward system.  Physiology and Behavior , 91(4...
References <ul><li>Gregg, E. W., Kirtland, K. A., Cadwell, B. L., Rios Burrows, N., Barker, L. E., Thompson, T. J., Geiss,...
References <ul><li>McLaren, L. (2007). Socioeconomic status and obesity.  Epidemiologic Reviews , 29, 29-48. </li></ul><ul...
References <ul><li>Rodbard, H. W., Fox, K. M., Grandy, S., & Shield Study Group. (2009). Impact of obesity on work product...
References <ul><li>Wilde, P. E. & Peterman, J. N. (2006). Individual weight change is associated with household food secur...
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AHPC2010 - Community initiatives to increase food access

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2010 National Anti-Hunger Policy Conference
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  1. 1. Obesity, Poverty, and Hunger Heather Hartline-Grafton, DrPH, RD Senior Nutrition Policy Analyst Anti-Hunger Policy Conference Community Initiatives to Address Food Access and Healthy Eating Washington, DC | March 7, 2010
  2. 2. U.S. Prevalence of Overweight & Obesity 31.3 31.6 28.8 63.2
  3. 3. <ul><li>Physiological </li></ul><ul><li>Diabetes </li></ul><ul><li>Atherosclerosis </li></ul><ul><li>Hypertension </li></ul><ul><li>Some types of cancer </li></ul><ul><li>Mobility limitations </li></ul><ul><li>Earlier onset of puberty </li></ul>Overweight & Obesity | Consequences Sources: Finkelstein et al., 2009; Guh et al., 2009; Hesketh et al., 2004; Houston et al., 2009; Kaplowitz, 2008; Krukowski et al., 2009; Nguygen et al., 2008; Petry et al., 2008; Puhl et al., 2008; Rodbard et al., 2009 <ul><li>Psychological & Social </li></ul><ul><li>Depression </li></ul><ul><li>Anxiety </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Discrimination </li></ul><ul><li>Work impairment </li></ul><ul><li>Poor academic performance </li></ul>$147 billion in annual medical costs
  4. 4. Overweight & Obesity | Adult Disparities <ul><li>In general, rates are: </li></ul><ul><li>Higher for African-American and Hispanic women than White women </li></ul><ul><li>Fairly similar for men across racial-ethnic groups </li></ul><ul><li>Higher in the South </li></ul><ul><li>Higher with increased age </li></ul>Sources: Flegal et al., 2010; Gregg et al., 2009
  5. 5. <ul><li>In general, rates are: </li></ul><ul><li>Higher (and have increased more rapidly over time) among African-American and Hispanic children than White children </li></ul><ul><li>Higher in the South </li></ul>Overweight & Obesity | Child Disparities Sources: Freedman et al., 2006; Ogden et al., 2010; Singh et al., 2008
  6. 6. <ul><li>Greater obesity risk if low-income, especially among low-income women and children </li></ul><ul><li>Source: McLaren, 2007; Miech et al., 2006; Skelton et al., 2009 </li></ul><ul><li>Between 1986 and 2002, BMI was higher every year for adults in the lowest income and education groups </li></ul><ul><li>Source: Truong & Sturm, 2005 </li></ul><ul><li>Obesity rates increased by 10% for all U.S. children between 2003 and 2007, but by 23% for low-income children </li></ul><ul><li>Source: Singh et al., 2010 </li></ul>Overweight & Obesity | Low-Income
  7. 7. <ul><li>But risk varies depending on gender and race-ethnicity </li></ul><ul><ul><li>Higher risk for females </li></ul></ul><ul><ul><li>Less consistent relationship among males </li></ul></ul><ul><ul><li>Sources: McLaren, 2007; Ogden et al., 2007 </li></ul></ul><ul><ul><li>Seems to be a greater risk for White females, but lower risk for African-American females </li></ul></ul><ul><ul><li>Sources: Ogden et al., 2007; Wang & Zhang, 2006; Zhang & Wang, 2004 </li></ul></ul>Overweight & Obesity | Low-Income
  8. 8. Overweight & Obesity | Food Insecurity <ul><li>Research is mixed </li></ul><ul><ul><li>Greater risk of obesity with food insecurity </li></ul></ul><ul><ul><li>Sources: Basiotis & Lino, 2002; Casey et al., 2006; Townsend et al., 2001; </li></ul></ul><ul><ul><li>Townsend & Melgar-Quinonez, 2003; Wilde & Peterman, 2006 </li></ul></ul><ul><ul><li>No relationship or lower risk of obesity with food insecurity </li></ul></ul><ul><ul><li>Sources: Jones & Frongillo, 2007; Rose & Bodor, 2006 </li></ul></ul><ul><li>The strongest and most consistent evidence is for a </li></ul><ul><li>higher risk among food insecure women. </li></ul>
  9. 9. Overweight & Obesity | Causes Environment Culture Socioeconomic Status Behavior Metabolism Genetics Intake > Expenditure (chronic)  Overweight & Obesity <ul><ul><li>Source: USDHHS, 2001 </li></ul></ul>
  10. 10. What contributes to the high rates of overweight and obesity in the U.S.?
  11. 11. Why are low-income and food insecure people vulnerable to obesity? What are their unique challenges?
  12. 12. <ul><li>Limited resources </li></ul><ul><li>Lack of access to healthy, affordable foods </li></ul><ul><li>Fewer opportunities for physical activity </li></ul><ul><li>Cycles of food deprivation and overeating </li></ul><ul><li>High levels of stress </li></ul><ul><li>Greater exposure to obesity-related marketing </li></ul><ul><li>Limited access to health care </li></ul>Overweight & Obesity | Challenges Associated with Poverty
  13. 13. <ul><li>Limited resources and lack of access to healthy, affordable foods </li></ul><ul><ul><li>Lack full-service grocery stores and farmers’ markets </li></ul></ul><ul><ul><li>Healthy food is often more expensive </li></ul></ul><ul><ul><li>Healthy food – especially fresh produce – is often of poorer quality </li></ul></ul><ul><ul><li>Greater availability of fast food restaurants </li></ul></ul>Challenges Associated with Poverty Sources: Andreyeva et al., 2008; Drewnowski et al., 2007; Larson et al., 2009; Simon et al., 2008
  14. 17. <ul><li>Fewer opportunities for physical activity </li></ul><ul><ul><li>Fewer physical activity resources </li></ul></ul><ul><ul><li>Physical activity resources may not be attractive </li></ul></ul><ul><ul><li>Crime, traffic, and unsafe playground equipment are barriers </li></ul></ul><ul><ul><li>Less time being active during PE classes </li></ul></ul><ul><ul><li>Less likely to have recess </li></ul></ul>Challenges Associated with Poverty Sources: Barros et al., 2009; Neckerman et al., 2009; Powell et al., 2004; UCLA Center to Eliminate Health Disparities, 2009
  15. 19. <ul><li>Cycles of food deprivation and overeating </li></ul><ul><ul><li>Chronic ups and downs in food intake </li></ul></ul><ul><ul><li>Unhealthy preoccupation with food </li></ul></ul><ul><ul><li>Metabolic changes that promote fat storage </li></ul></ul>Challenges Associated with Poverty Sources: Alaimo et al., 2001; Basiotis & Lino, 2002; Dammann & Smith, 2009; Dietz, 1995; Olson et al., 2007; Polivy, 1996 Parents – primarily mothers – may restrict their food intake and sacrifice their own nutrition to protect their children from hunger.
  16. 20. <ul><li>High levels of stress </li></ul><ul><ul><li>Sources of stress: food insecurity, low-wage work, lack of access to health care, inadequate transportation, poor housing, violence </li></ul></ul><ul><ul><li>Hormonal and metabolic changes </li></ul></ul><ul><ul><li>Unhealthy eating behaviors </li></ul></ul><ul><ul><li>Anxiety and depression </li></ul></ul>Challenges Associated with Poverty Sources: Adam & Epel, 2007; Torres & Nowson, 2007
  17. 21. <ul><li>Greater exposure to obesity-related marketing </li></ul><ul><ul><li>Fast food </li></ul></ul><ul><ul><li>Sugar-sweetened beverages </li></ul></ul><ul><ul><li>Video games </li></ul></ul><ul><ul><li>Television shows </li></ul></ul>Challenges Associated with Poverty Sources: Kumanyika & Grier, 2006; Lewis et al., 2005; Yancey et al., 2009
  18. 22. <ul><li>Limited access to health care </li></ul><ul><ul><li>Lack of diagnosis </li></ul></ul><ul><ul><li>Lack of treatment </li></ul></ul>Challenges Associated with Poverty
  19. 23. What Can We Do?
  20. 24. Role of the Federal Nutrition Programs in Obesity Prevention Reduce Overweight & Obesity Federal Nutrition Programs Improve Dietary Intake Reduce Food Insecurity
  21. 26. “ We also find that subsidized meals at school or day care are beneficial for children’s weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children .” Source: Kimbro & Rigby, 2010
  22. 27. Increase participation in the federal nutrition programs
  23. 28. President Obama’s Goal
  24. 29. Ending Childhood Hunger by 2015: The Essential Strategies for Achieving the President's Goal <ul><li>Restore economic growth and create jobs with better wages for lower-income workers </li></ul><ul><li>Raise the incomes of the lowest-income families </li></ul><ul><li>Strengthen the SNAP/Food Stamp Program </li></ul><ul><li>Strengthen the Child Nutrition Programs </li></ul><ul><li>Engage the entire federal government in ending childhood hunger </li></ul><ul><li>Work with states, localities and nonprofits to expand and improve participation in federal nutrition programs </li></ul><ul><li>Make sure all families have convenient access to reasonably priced, healthy food </li></ul>
  25. 32. Healthy Food Financing Initiative <ul><li>Obama administration goal: eliminate food deserts within 7 years </li></ul><ul><li>$400 million in President’s FY2011 budget </li></ul><ul><li>Develop or equip grocery stores and other healthy food retailers in underserved areas </li></ul><ul><li>Departments of Treasury, Agriculture, and Health & Human Services to provide financial and technical assistance </li></ul>
  26. 33. What is FRAC doing? <ul><li>Advocacy, advocacy, advocacy </li></ul><ul><li>Creating publications </li></ul><ul><ul><li>Hunger and Obesity? Making the Connections </li></ul></ul><ul><ul><li>FRAC Focuses: Obesity and Poverty </li></ul></ul><ul><li>Developing comprehensive Web site content </li></ul><ul><li>Providing technical assistance </li></ul>
  27. 34. For more information, contact: <ul><li>Heather Hartline-Grafton, DrPH, RD </li></ul><ul><li>Senior Nutrition Policy Analyst </li></ul><ul><li>Food Research and Action Center (FRAC) </li></ul><ul><li>1875 Connecticut Avenue, NW, Suite 540 </li></ul><ul><li>Washington, DC 20009  </li></ul><ul><li>202-986-2200 x3017 (t) </li></ul><ul><li>202-986-2525 (f) </li></ul><ul><li>[email_address] </li></ul><ul><li>www.frac.org </li></ul>
  28. 35. References <ul><li>Adam, T. C. & Epel, E. S. (2007). Stress, eating and the reward system. Physiology and Behavior , 91(4), 449-458. </li></ul><ul><li>Alaimo, K., Olson, C. M., & Frongillo, E. A., Jr. (2001). Low family income and food insufficiency in relation to overweight in U.S. children: is there a paradox? Archives of Pediatrics and Adolescent Medicine , 155(10), 1161-1167. </li></ul><ul><li>Andreyeva, T., Blumenthal, D. M., Schwartz, M. B., Long, M. W., & Brownell, K. D. (2008). Availability and prices of foods across stores and neighborhoods: the case of New Haven, Connecticut. Health Affairs , 27(5), 1381-1388. </li></ul><ul><li>Barros, R. M., Silver, E. J., & Stein, R. E. (2009). School recess and group classroom behavior. Pediatrics , 123(2), 431-436. </li></ul><ul><li>Basiotis, P. P. & Lino, M. (2002). Food insufficiency and prevalence of overweight among adult women . Nutrition Insight , 26. Alexandria, VA: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. </li></ul><ul><li>Casey, P. H., Simpson, P. M., Gossett, J. M., Bogle, M. L., Champagne, C. M., Connell, C., Harsha, D., McCabe-Sellers, B., Robbins, J. M., Stuff, J. E., & Weber, J. (2006). The association of child and household food insecurity with childhood overweight status. Pediatrics , 118(5), e1406-e1413. </li></ul><ul><li>Dammann, K. W. & Smith, C. (2009). Factors affecting low-income women’s food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight. Journal of Nutrition Education and Behavior , 41(4), 242-253. </li></ul><ul><li>Dietz, W. H. (1995). Does hunger cause obesity? Pediatrics , 95(5), 766-767. </li></ul><ul><li>Drewnowski, A., Monsivais, P., Maillot, M., & Darmon, N. (2007). Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults. Journal of the American Dietetic Association , 107, 1028-1032. </li></ul><ul><li>Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs , 28(5), W822-W831. </li></ul><ul><li>Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association , 303(3), 235-241. </li></ul><ul><li>Freedman, D. S., Khan, L. K., Serdula, M. K., Ogden, C. L., & Dietz, W. H. (2006). Racial and ethnic differences in secular trends for childhood BMI, weight, and height. Obesity , 14(2), 301-308. </li></ul>
  29. 36. References <ul><li>Gregg, E. W., Kirtland, K. A., Cadwell, B. L., Rios Burrows, N., Barker, L. E., Thompson, T. J., Geiss, L., & Pan, L. (2009). Estimated county-level prevalence of diabetes and obesity - United States, 2007. Morbidity and Mortality Weekly Report , 58(45), 1259-1263. </li></ul><ul><li>Guh, D. P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C. L., & Anis, A. H. (2009). The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BioMed Central Public Health , 9, 88. </li></ul><ul><li>Hesketh, K., Wake, M., & Waters, E. (2004). Body mass index and parent-reported self-esteem in elementary school children: evidence for a causal relationship. International Journal of Obesity and Related Metabolic Disorders , 28(10), 1233-1237. </li></ul><ul><li>Houston, D. K., Ding, J., Nicklas, B. J., Harris, T. B., Lee, J. S., Nevitt, M. C., Rubin, S. M., Tylavsky, F. A., Kritchevsky, S. B; Health ABC Study. (2009). Overweight and obesity over the adult life course and incident mobility limitation in older adults: the health, aging and body composition study. American Journal of Epidemiology , 169(8), 927-936. </li></ul><ul><li>Jones, S. J., Jahns, L., Laraia, B. A., & Haughton, B. (2003). Lower risk of overweight in school-aged food insecure girls who participate in food assistance: results from the Panel Study of Income Dynamics Child Development Supplement. Archives of Pediatric and Adolescent Medicine , 157(8), 780-784. </li></ul><ul><li>Larson, N. I., Story, M. T., & Nelson, M. C. (2009). Neighborhood environments: disparities in access to healthy foods in the U.S. American Journal of Preventive Medicine , 36(1), 74-81. </li></ul><ul><li>Kaplowitz, P. B. (2008). Link between body fat and the timing of puberty. Pediatrics , 121(Supplement 3), S208-S217. </li></ul><ul><li>Kimbro, R. T. & Rigby, E. (2010). Federal food policy and childhood obesity: a solution or part of the problem? Health Affairs , 29(3), 411-418. </li></ul><ul><li>Krukowski, R. A., Smith West, D., Philyaw Perez, A., Bursac, Z., Phillips, M. M., & Raczynski, J. M. (2009). Overweight children, weight-based teasing and academic performance. International Journal of Pediatric Obesity , 4(4), 274-280. </li></ul><ul><li>Kumanyika, S. & Grier, S. (2006). Targeting interventions for ethnic minority and low-income populations. Future of Children , 16(1), 187-207. </li></ul><ul><li>Lewis, L. B., Sloane, D. C., Nascimento, L. M., Diamant, A. L., Guinyard, J. J., Yancey, A. K., & Flynn, G for the REACH Coalition of the African Americans Building a Legacy of Health Project. (2005). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health , 95(4), 668-673. </li></ul>
  30. 37. References <ul><li>McLaren, L. (2007). Socioeconomic status and obesity. Epidemiologic Reviews , 29, 29-48. </li></ul><ul><li>Miech, R. A., Kumanyika, S. K., Stettler, N., Link, B. G., Phelan, J. C., & Chang, V. W. (2006). Trends in the association of poverty with overweight among U.S. adolescents, 1971-2004. Journal of the American Medical Association , 295(20), 2385-2393. </li></ul><ul><li>Neckerman, K. M., Lovasi, G. S., Davies, S., Purciel, M., Quinn, J., Feder, E., Raghunath, N., Wasserman, B., & Rundle, A. (2009). Disparities in urban neighborhood conditions: evidence from GIS measures and field observation in New York City. Journal of Public Health Policy , 30(Supplement 1), S264-S285. </li></ul><ul><li>Nguyen, N. T., Magno, C. P., Lane, K. T., Hinojosa, M. W., & Lane, J. S. (2008). Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. Journal of the American College of Surgeons, 207(6), 928-934. </li></ul><ul><li>Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association , 91(3), 519-527. </li></ul><ul><li>Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association , 295(13), 1549-1555. </li></ul><ul><li>Ogden, C. L., Yanovski, S. Z., Carroll, M. D., & Flegal, K. M. (2007). The epidemiology of obesity. Gastroenterology , 132, 2087-2102. </li></ul><ul><li>Olson, C. M., Bove, C. F., & Miller, E. O. (2007). Growing up poor: long-term implications for eating patterns and body weight. Appetite , 49(1), 198-207. </li></ul><ul><li>Petry, N. M., Barry, D., Pietrzak, R. H., & Wagner, J. A. (2008). Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine , 70(3), 288-297. </li></ul><ul><li>Polivy, J. (1996). Psychological consequences of food restriction. Journal of the American Dietetic Association , 96, 589-592. </li></ul><ul><li>Powell, L. M., Slater, S., & Chaloupka, F. J. (2004). The relationship between community physical activity settings and race, ethnicity, and socioeconomic status. Evidence-Based Preventive Medicine , 1(2), 135-144. </li></ul><ul><li>Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., & Brownell, K. D. (2008). Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Education Research , 23(2), 347-358. </li></ul>
  31. 38. References <ul><li>Rodbard, H. W., Fox, K. M., Grandy, S., & Shield Study Group. (2009). Impact of obesity on work productivity and role disability in individuals with and at risk for diabetes mellitus. American Journal of Health Promotion , 23(5), 353-360. </li></ul><ul><li>Rose, D. & Bodor, J. N. (2006). Household food insecurity and overweight status in young school children: results from the Early Childhood Longitudinal Study. Pediatrics , 117(2), 464-473. </li></ul><ul><li>Simon, P. A., Kwan, D., Angelescu, A., Shih, M., & Fielding, J. E. (2008). Proximity of fast food restaurants to schools: do neighborhood income and type of school matter? Preventive Medicine , 47, 284-288. </li></ul><ul><li>Singh, G. K., Kogan, M. D., & van Dyck, P. C. (2008). A multilevel analysis of state and regional disparities in childhood and adolescent obesity in the United States. Journal of Community Health , 33(2), 90-102. </li></ul><ul><li>Singh, G. K., Siahpush, M., & Kogan, M. D. (2010). Rising social inequalities in US childhood obesity, 2003-2007. Annals of Epidemiology , 20(1), 40-52. </li></ul><ul><li>Skelton, J. A., Cook, S. R., Auinger, P., Klein, J. D., & Barlow, S. E. (2009). Prevalence and trends of severe obesity among U.S. children and adolescents. Academic Pediatrics , 9(5), 322-329. </li></ul><ul><li>Torres, S. J. & Nowson, C. A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition , 23(11-12), 887-894. </li></ul><ul><li>Townsend, M. & Melgar-Quinonez, H. (2003). Hunger, food insecurity, and child obesity. Food Assistance and Nutrition Research Report , 38. Washington, DC: U.S. Department of Agriculture, Economic Research Service. </li></ul><ul><li>Townsend, M. S., Peerson, J., Love, B., Achterberg, C., & Murphy, S. P. (2001). Food insecurity is positively related to overweight in women. Journal of Nutrition , 131, 1738–1745. </li></ul><ul><li>Truong, K. D. & Sturm, R. (2005). Weight gain trends across sociodemographic groups in the United States. American Journal of Public Health , 95(9), 1602-1606. </li></ul><ul><li>UCLA Center to Eliminate Health Disparities & Samuels and Associates. (2007). Failing Fitness: Physical Activity and Physical Education in Schools . Available at: http://www.calendow.org/uploadedFiles/failing_fitness.pdf. Accessed September 22, 2009. </li></ul><ul><li>U.S. Department of Health and Human Services. (2001). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity . Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. </li></ul><ul><li>Wang, Y. & Zhang, Q. (2006). Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. American Journal of Clinical Nutrition , 84, 707-716. </li></ul>
  32. 39. References <ul><li>Wilde, P. E. & Peterman, J. N. (2006). Individual weight change is associated with household food security status. Journal of Nutrition , 136, 1395-1400. </li></ul><ul><li>Yancey, A. K., Cole, B. L., Brown, R., Williams, J. D., Hillier, A., Kline, R. S., Ashe, M., Grier, S. A., Backman, D., & McCarthy, W. J. (2009). A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising. Milbank Quarterly , 87(1), 155-184. </li></ul><ul><li>Zhang, Q. & Wang, Y. (2004). Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000. Obesity Research , 12(10), 1622-1632. </li></ul>

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