Commentary: Assessing food insecurity in Trinidad and Tobago.

Journal of Epidemiology on a study in Trinidad and Tobago that investigated whether household food insecurity was associated with obesity in this middle-income country. 1 They found that food insecurity was associated with underweight but not with obesity. Food insecurity was also associated with decreased consumption of fruits and vegetables, a result previously reported in several studies, and with physical limitations, a result previously reported for elders in the US. 2 Prior studies of the association of food insecurity and obesity have been done in high-income countries and found that white women and adolescent girls in families that were food insecure were more likely to be obese. One study in New York State in 1993 found that, whereas mild or moderate food insecurity was associated with a higher risk of obesity, severe food insecurity was associated with a lower risk. 3,4 These prior results suggest a possible explanation for why Gulliford and colleagues observed that food insecurity was related to underweight and not obesity, if the severity of food insecurity in their sample was relatively high. To evaluate this possible explanation, we can compare the percentages of affirmative responses for the six items in the abbreviated food security measure with those reported from other samples. The percentages of affirmative responses in the Trinidad and Tobago sample for the six items were 21, 31, 18, 14, 13, and 6, listing the items in order of expected severity. The corresponding values for the same items in the US sample from 5.0, and 3.4. The percentages for these items in the Trinidad and Tobago sample were about two times higher than in the 1995 US sample, and were similar to those of the 1993 New York State sample. 6 Also, the second item listed (item 3 in Figure 1) that 516 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 34 Tarasuk VS. Household food insecurity with hunger is associated with women's food intakes, health and household circumstances. insecurity to food availability and consumption. body mass index and obesity with physical activity, food choices, Energy density of foods affects energy intake across multiple levels of fat content in lean and obese women. Figure 1 Comparison of percentages of affirmative responses to six food security measurement items in samples from Trinidad and Tobago and the US. Item numbers are from Blumberg et al. as cited in Gulliford et al. 1