Food insecurity and overweight/obesity associated with poor diet quality during COVID- 19 pandemic

Background: Food insecurity is associated with poor diet quality and an increased risk for obesity. In this study, we tested the following hypotheses: 1) college students who are overweight/obese (BMI ≥ 25 kg/m2) are more likely to be food insecure than students who are normal weight (BMI < 25 kg/m2), 2) college students who are food insecure and overweight/obese have lower diet quality than food-secure students who are normal weight during the COVID-19 pandemic.

Methods: We administered an online survey to 651 college students in Texas, US in May 2020. Food security was assessed using validated surveys. BMI was calculated from self-reported height and weight. Healthy Eating Index (HEI) scores (measure of diet quality) were derived from 24-h dietary recalls (ASA24 Dietary Assessment Tool). Prevalence of food insecurity by BMI was assessed by Chi-squared test. Two-way ANOVA assessed the impact of food security, BMI, and food security x BMI on HEI.

Results: In 332 students (94% female, 52% white) who completed the food security survey and dietary recall, 28.9% were food insecure. Students who were overweight/obese were more likely to be food insecure compared to students who were normal weight (35.7% vs. 24.8%, p=0.03). Food-secure students had higher HEI scores than students who were food insecure (55.0±14.2 vs. 51.5±14.5, p=0.04). Students who were normal weight had higher HEI scores than students who were overweight/obese (56.0±15.0 vs. 50.6±12.7, p=0.001). While the interaction between food security and BMI was not significant (p=0.31), students who were food secure and normal weight had higher HEI scores than students who were food insecure and overweight/obese (Mean difference.: +7.7, 95% CI: 1.9, 13.4; p<0.001).

Conclusion: College students with overweight/obesity were more likely to be food insecure during the COVID-19 pandemic. In addition, students who were food insecure and overweight/obese had lower HEI scores than students who were food secure and normal weight.