• Elizabeth C Koller, Leonard E Egede, Emma Garacci, and Joni S Williams.
• School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
• J Gen Intern Med. 2022 Dec 1; 37 (16): 420242084202-4208.

BackgroundIn the USA, nearly 40% of adults ≥ 20 years have a body mass index (BMI) ≥ 30, and 11% of households are reported as food insecure. In adults, evidence shows women are more likely than men to be food insecure. Among adults with food insecurity, differences in BMI exist between men and women with women reporting higher BMI. Factors associated with this difference in BMI between genders are less understood.ObjectiveThe aim of this study was to assess gender differences in the relationship between food insecurity and BMI.DesignHierarchical models were analyzed using a general linear model by entering covariates sequentially in blocks (demographics, lifestyle behaviors, comorbidities, and dietary variables) and stratified by gender.ParticipantsThe sample included 25,567 adults in the USA from the National Health and Nutrition Examination Survey (NHANES), 2005-2014.Main MeasuresThe dependent variable was BMI, and food insecurity was the primary predictor.Key ResultsApproximately 51% of the sample was women. Food insecure women were significantly more likely to have higher BMI compared to food secure women in the fully adjusted model after controlling for demographics (β = 1.79; 95% CI 1.17, 2.41); demographic and lifestyle factors (β = 1.79; 95% CI 1.19, 2.38); demographic, lifestyle, and comorbidities (β = 1.21; 95% CI 0.65, 1.77); and demographic, lifestyle, comorbidities, and dietary variables (β = 1.23; 95% CI 0.67, 1.79). There were no significant associations between food insecure and food secure men in the fully adjusted model variables (β = 0.36; 95% CI - 0.26, 0.98).ConclusionIn this sample of adults, food insecurity was significantly associated with higher BMI among women after adjusting for demographics, lifestyle factors, comorbidities, and dietary variables. This difference was not observed among men. More research is necessary to understand this relationship among women.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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