Elsevier

Appetite

Volume 49, Issue 1, July 2007, Pages 198-207
Appetite

Research Report
Growing up poor: Long-term implications for eating patterns and body weight

https://doi.org/10.1016/j.appet.2007.01.012Get rights and content

Abstract

This study aimed to understand how poverty-associated food deprivation in childhood contributes to the well-known relationship between low socioeconomic status (SES) in childhood and obesity in the adult years. Thirty low-income, rural women with at least one child were followed for over three years with annual semi-structured interviews collecting quantitative and qualitative data. For the quantitative portion, the measures of interest were body mass index (BMI), food insecurity, eating patterns, and SES. For the qualitative portion, text from the interviews was analyzed using the constant comparative method. Growing up in a poor household was associated with increased risk of overweight and obesity in adulthood. Experiences of poverty-associated food deprivation in childhood appeared to super-motivate some women to actively avoid food insecurity in adulthood. It also influenced the women's current food preferences. Tremendous excitement accompanied the availability of food after periods of deprivation in both the women and their children. Some women had used food to meet emotional needs in childhood and overeating had become a generalized response to negative emotional states in the adult years. Food deprivation in childhood and associated attitudes and behaviors towards food are one possible mechanism for explaining the association between childhood poverty and adult obesity.

Introduction

Socioeconomic disadvantage in childhood is positively associated with increased risk of obesity in adulthood (Laaksonen, Sarlio-Lähteenkorva, & Lahelma, 2004; Langenberg, Hardy, Kuh, Brunner, & Wadsworth, 2003; Lissau & Sørensen, 1994; Parsons, Power, Logan, & Summerbell, 1999; Poulton et al., 2002; Power et al., 2005; Power, Manor, & Matthews, 2003). In the Dunedin Multidisciplinary Health and Development Study, Poulton et al. (2002) showed that as childhood socioeconomic status (SES) increased, body mass index (BMI) and waist:hip ratio at age 26 years decreased. These associations remained significant after controlling for infant health and after adding statistical controls for adult SES. Upward mobility did not eliminate the effect of low SES in childhood on adult BMI, but did modify its effect on waist:hip ratio.

Power et al. (2003) utilized data from a 1958 birth cohort that included all persons born in England, Wales, and Scotland during 3–9 March 1958. Social class in early life, at birth for men and at age 7 years for women, showed a persisting effect on obesity at age 33 years, with those from unskilled manual origins having the highest risk of obesity in adulthood. Power et al. (2003) conclude that “inequalities in obesity will not be explained by adult life factors alone.”

These studies support the earlier finding of Lissau and Sørensen (1994) that 9–10-year-old children in Copenhagen rated as dirty and neglected by school personnel were 9.8 times more likely to be obese 10 years later compared to children rated as averagely groomed. Neglected children were not more likely to be obese in childhood.

Poulton et al. (2002) state, “Research now needs to identify the key mechanisms that bring about this longitudinal association” between low SES in childhood and adult obesity. They suggest three potential candidate mechanisms: class-biased health care delivery during the early years that set up long-standing health inequalities; social class-related differences in parenting practices; and social class-related stressors in early life that alter biological systems to produce long-lasting health differences.

Our group has conducted research on food insecurity as it is experienced in food-rich countries such as the US and its relation to obesity in adult women (Frongillo, Olson, Rauschenbach, & Kendall, 1997; Olson, 1999). Food insecurity is defined as occurring “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain” (Anderson, 1990). Several teams of investigators have found a significant association between food insecurity and increased risk of overweight and obesity in women in cross-sectional studies (Adams, Grummer-Strawn, & Chavez, 2003; Basiotis & Lino, 2003; Frongillo et al., 1997; Olson, 1999; Townsend, Peerson, Love, Achterberg, & Murphy, 2001). In the one longitudinal study covering the time period from early pregnancy until 2 years postpartum, food insecurity at the beginning of pregnancy was positively associated with major weight gain at 2 years postpartum but only in the women who were initially obese (p=0.007) (Olson & Strawderman, 2004). This finding could be interpreted as suggesting that both food insecurity and obesity are influenced by a common factor. We speculated that this common factor was the experience of poverty-associated food insecurity in early childhood and the eating practices and attitudes resulting from food insecurity. In a recent study of 25 overweight and obese poor white women, eating in childhood as a way to keep your mind off of your problems was mentioned as a factor contributing to weight problems in the adult years (Parker & Keim, 2004).

The objective of the research reported here was to gain an understanding of how poverty-associated food deprivation in childhood might influence attitudes toward and the use of food in later life. This study used a triangulation mixed-methods design, collecting both quantitative and qualitative data, analyzing them separately, and then comparing and combining results to address the research objective (Creswell, 2003). The qualitative portion of the research was completed first as part of a broader investigation seeking insights on how social, environmental, and economic factors contribute to obesity in low-income women (Bove & Olson, 2006). The quantitative portion was then undertaken to determine whether the previously demonstrated association between low SES in childhood and adult obesity was present in this sample of women. In addition for this portion of the study, we hypothesized that low SES in childhood was associated with two correlates of overweight and obesity: binge-like patterns of eating and food insecurity in adulthood.

Section snippets

Sample and recruitment

This investigation used the New York State data from a large longitudinal multi-state research project, “Rural Low-Income Families: Tracking Their Well-Being and Functioning in the Context of Welfare Reform” (Rural Families Speak, 2002). The research protocols for the multi-state study dictated the characteristics of the sample and the basic questionnaires used for data collection. These are described in detail on the Rural Families Speak (2002) web site and will be briefly described here. For

Socio-demographic characteristics of the women

At the time of first wave of interviews, the mothers in the 30 families were 19–48 years old, and most (77%) were in their 20s or 30s; three women (10%) were 19 years old and four (13.3%) were age 40 years and older. Eighty percent had attained a high school diploma, and nearly one-third had received some education beyond high school, typically technical training. Only one woman had completed a 4-year-college degree. Twenty-five (83.3%) women resided with a male partner, and of these, 16 (64%)

Discussion

In this section, the quantitative and qualitative findings are interpreted to address the objective of the study: to understand the potential mechanisms by which low SES, particularly poverty-associated food deprivation in early life, could lead to increased risk of obesity in the adult years. First, the sample is appropriate for addressing the research objective because the association between growing up in a poor household and increased likelihood of being overweight or obese in adulthood

Acknowledgments

This research was supported in part by USDA/CSREES/NRICGP Grants (NRICGP2000-0159, NRICGP2001-35401-10215, and NRICGP2002-35401-11591), the Hazel E. Reed Human Ecology Extension Chair in Family Policy at Cornell University, and the Cornell University Agricultural Experiment Station (Project NYC-399401).

Data were collected in conjunction with the Multi-State Hatch project, NC-223, Rural Low-Income Families: Monitoring Their Well-being and Functioning in the Context of Welfare Reform. Cooperating

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