Food insecurity associated with less weight loss, even with intense intervention

The findings of a recent randomized trial suggest that weight loss approaches need to address both obesity and food insecurity, both of which continue to increase in the U.S.


Food insecurity was associated with less weight loss over 24 months among people with obesity undergoing an intensive, lifestyle-based intervention, a study found.

Researchers in Louisiana performed a two-year, cluster-randomized, two-group pragmatic trial in 18 primary care clinics to test the effectiveness of a high-intensity lifestyle-based program for obesity treatment in an underserved population. Clinics were randomized to either an intensive lifestyle intervention, delivered by trained health coaches embedded in primary care clinics who conducted weekly in-person sessions for the first six months followed by monthly sessions, or usual care.

Food insecurity was assessed using a six-item questionnaire, with two or more affirmative responses considered as food insecure. Results were published March 9 by Annals of Internal Medicine.

At 24 months, participants randomly assigned to the intervention lost more weight than those in the usual care group regardless of food security status. The mean absolute weight difference between groups was 5.2 kg (95% CI, 3.7 to 6.8 kg; P<0.001) among food secure patients and 2.7 kg (95% CI, 0.7 to 4.8 kg; P=0.009) among food insecure patients.

The study authors suggested that clinicians may want to screen patients with obesity for food insecurity using two-item questionnaires. Patients can then be referred to support services such as food banks or federal nutrition assistance. Screening for food insecurity can also identify patients with barriers (such as poor nutrition and diet quality or reduced medication adherence) and medical complications that can compromise chronic disease management.

“Of note, both food insecurity and obesity continue to increase in the United States. To address effective and equitable obesity prevention and treatment, tailored weight loss approaches that simultaneously address food insecurity and obesity are needed,” the authors wrote.