Food Insecurity and Overweight in WIC Clients

1. Food Insecurity and Overweight in WIC Clients A Community Nutrition Project by University of Washington Students Winter 2005

2. The purpose of this project is to examine the relationships between food insecurity and overweight in English speaking WIC clients so that food assistance programs can be optimally designed to reduce prevalence of obesity while encouraging food security.

3. Groundwork: • Lynne Smith Human subjects approval Consent form development Recruitment protocol IBB forms and IRB questions • Lisa DiGeorgio and Donna Oberg Location of WIC sites Interactions with WIC staff Initial presentation to this class • Donna Johnson Development of class project

4. Where we started: • Providing background information on food insecurity and obesity • Writing a plan for focus groups on food insecurity and obesity • Preparing a focus group procedure manual • Conducting a pilot focus group

5. What is Food Insecurity? • Food insecurity exists when the availability of nutritionally adequate food, or the ability to acquire nutritionally adequate food in socially acceptable ways, is limited or uncertain. • Prevalence: 11% of all US households (2003) 12% of Washington State households (2002) 54% of King County WIC households (prelim)

6. Who is at risk for food insecurity? • Households with incomes at or below 185% of the poverty line • Households with children under 18, headed by a single woman • Hispanic or African-American households

7. Who is obese? • Low income to poor adults tend to be more obese than higher income adults • Obesity more prevalent in women than men • Percentage of obesity higher in Hispanic and African-American populations

8. Possible mechanisms for a food insecurity – obesity link: • Physiological factors • Psycho-social factors • Socio-economic factors

9. Thoughts about a food insecurity-overweight relationship among Seattle-King County WIC population • Plan for focus groups • Protocol for focus groups

10. “Before” Plan Determine GOALS Designate ROLES Decide WHO should be invited Think about INCENTIVES RECRUIT participants CONTACTING participants

11. “Day of ” Plan Setting up Meeting and Greeting Signing Consent Forms Taking Notes Wrapping-Up Debriefing

12. “AFTER THE FOCUS GROUP” Plan TRANSCRIBE Focus Group READ Transcript Select ANALYSIS Method WRITE UP Report PRESENT Findings

13. PilotWhat we learned… • Recruitment process • Conducting focus groups • Transcription

14. In Summary: • Background research, focus group procedures, and conducted a pilot at the Eastgate WIC clinic • Shared our knowledge and trained ourselves to conduct the research • Got started…

15. Recruiting for focus groups • Each group toured the facilities, taught the staff how to recruit and determined specific logistics for each site -Eastgate -Renton -Kent Recruited English speaking WIC clients who were over 18. -Used a $25 Safeway gift card as an incentive for our clients.

17. Conducting the focus groups • Two sessions at each clinic on February 18th, 2005 • Moderator conducted with at 1-2 note-takers in the room • Worked thru the assigned questions in discussion format with 2-8 participants • Also collected demographic data from a questionnaire

19. A note about the questions • The questions were designed to address the issues without making the participants feel uncomfortable about their personal situation. The purpose of the questions were to get information on the following:

20. Participant’s knowledge of health effects of both food insecurity and weight status • Reasons for food insecurity • Coping strategies • WIC’s role • General experiences, observations and ideas

21. After the focus groups • Demographic data compiled • Transcription of the raw data and note-takers notes on non-verbal communication incorporated into the raw transcripts • Analysis team

22. Demographics

23. Analysis A subset of the class did the analysis: • Looked for major themes over all of the transcriptions from each site • Summarized them in a document

24. Results of Analysis of transcripts • Main findings- 4 major themes Participants indicated that they know the differences between healthy and unhealthy foods – it is other factors that are leading to becoming overweight • Lack of time and financial resources • Stress and fear of hunger • Poor quality of food in emergency food programs • Lack of exercise resources

25. Lack of financial and time resources • Participants identify cheaper foods as “bad” foods and “healthy” foods as expensive foods • “Bad” foods are also more convenient and easy to prepare • “Sometimes when people don’t have enough money to buy food, then that makes them prone to go get whatever is cheaper...” • “People are so pressed for time, they have to fit so many things into the day, you have all these dollar menus and everything and you don’t want to get out of the car so you are looking for things that are only drive-thru.”

26. Stress and fear of hunger • Participants identified a relationship between stress, hunger, and overweight • A fear of future hunger can lead to overbuying and over-eating food now • “Food hording; oh yes!!! Because when you don’t think you’re going to have enough you buy too much, and you will end up eating it.” • “Sometimes you just eat because you’re stressed out, so you get ice cream...you keep eating and eating ‘cause you don’t have enough food, you don’t have any food so you just want to eat. That makes you feel better.”

27. Poor quality of food in emergency food programs • Participants look to food assistance programs to get enough food to feed their families • They often perceive food from these programs to be junk food, the consumption of which leads to becoming overweight • “When you run out of food and go down to the food banks they load you up with donuts and bread and it’s hard to balance your diet that way.”

28. Lack of exercise resources • Participants recognize exercise as being part of a way to address the problem of overweight • They would like more information and resources for themselves and for their children, and some would like a health professional to give the information • “I didn’t know that there were certain things I could do with him when he was 3 months old, like swimming or whatever or like that, that could have stopped him from being in the 97th percentile.”

29. WIC focus group findings compared to the existing literature • New relationships identified: • Use of emergency food programs by the food insecure may contribute to overweight because of the poor food quality in these programs • Exercise is recognized as a way to prevent over-weight, but resources to being able to exercise are limited • In addition to a lack of financial resources, leading to the purchase of cheaper, “bad” foods, people lack the time to prepare healthier meals and find it more efficient to purchase these foods

30. Targeted Interventions

31. Potential Types of Interventions Four main categories: • Improve Access to healthy foods • Improve Access to physical activity • Provide Education about how to eat healthy on a budget • Provide Education about physical activity

32. Potential Types of Interventions Four main categories: • Improve Access to healthy foods • Improve Access to physical activity • Provide Education about how to eat healthy on a budget • Provide Education about physical activity

33. Improving Access to Healthy Foods(Potential partners) • Farmer’s Market Coalitions • Transportation services • Community Centers • Community gardens • Food banks, churches, community centers, and other emergency food assistance programs • Storage facilities • Worksites

34. Improving Access to Healthy Foods(WIC) • Increase flexibility in WIC food package • Continue to advocate for implementation of EBT card system • Expand WIC Farmer’s Market Program • Provide information about emergency food services • Continue to offer emergency food vouchers

35. Potential Types of Interventions Four main categories: • Improve Access to healthy foods • Improve Access to physical activity • Provide Education about how to eat healthy on a budget • Provide Education about physical activity

36. Improving Access to Physical Activity (Potential Partners) • Physical activity programs/Exercise facilities • Transportation services • Community Centers • Community Gardens • Worksites • Parks and Recreational Services

37. Improving Access to Physical Activity(WIC) • Provide classes, referrals to classes, scholarships, and activities that a mother and/or her child can do together • Increase the availability of physical activity groups that parents and children can do together • Provide information on low-cost physical activity resources available in the community

38. Potential Types of Interventions Four main categories: • Improve Access to healthy foods • Improve Access to physical activity • Provide Education about how to eat healthy on a budget • Provide Education about physical activity

39. Nutrition Education(Potential Partners) • Farmer’s Markets • Food assistance programs/Food banks • Community Gardens • Worksites • Policy makers

40. Nutrition Education(WIC) • Distribute meal planning and budgeting info booklets • Offer workshops- portion size, reading food labels, food variety • Utilize group classes to engage low-income families in discussions about healthy eating • Employ social marketing activities • Establish Mother support groups

41. Potential Types of Interventions Four main categories: • Improve Access to healthy foods • Improve Access to physical activity • Provide Education about how to eat healthy on a budget • Provide Education about physical activity

42. Physical Activity Education(Potential Partners) • Community centers, health centers, and schools • Physical activity programs/Exercise facilities

43. Physical Activity Education(WIC) • Provide more information about exercise resources for WIC mothers: • age-appropriate information about exercise for their children • low-cost physical activity resources available in the community • walking/biking route maps, neighborhood recreational parks • Increase availability of physical activity groups that parents and children can do together • Offer post-partum workout videos

44. Summary Recommendations for WIC are focused on a need for access and education regarding food and physical activity. We have few truly evidence-based interventions in this area which is why we need more studies that look for the real physiological, psycho-social, and socio-economic determinants of food insecurity and obesity. It is our hope that the results of this study can be used to improve the services that WIC offers to program participants. -Nutrition 531 class voice

45. Special love goes to… The “Donnas”, Lisa DiGiorgio, Lynne Smith, Michele Rimmer & Renton WIC staff, Ewa Baldyze & Kent WIC staff, Saskia Schaeffer, Katie Imberg, & Eastgate WIC staff

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