Household Food Insecurity and Childhood Obesity Risk Among Elementary School Children: A Cross-Sectional Study in an Urban School District

This study investigates household food insecurity as a risk factor for overweight and obesity in urban elementary school children within the context of pediatric epidemiology and social determinants of health, an area of growing scientific importance given its implications for school nutrition program expansion, food assistance policy design, and pediatric weight management intervention targeting. Using cross-sectional survey with caregiver-reported food insecurity using validated USDA 6-item tool, linked to school nurse anthropometric BMI measurements, we examine cyclical feast-and-famine eating patterns and high-calorie-density food choices in food-insecure households promoting adiposity in 2,847 children ages 6-12 across 14 elementary schools in Houston Independent School District drawn from 14 public elementary schools spanning low-income to moderate-income census tracts in Houston, TX. Results indicate that food-insecure children have 2.6-fold higher odds of obesity than food-secure peers (OR 2.61, 95% CI 2.08-3.27), with dose-response relationship across all four food security categories (p < 0.001), with 42.4% obesity prevalence in severely food-insecure children versus 11.8% in food-secure as the primary quantitative benchmark. Concordance between primary and confirmatory measurement approaches exceeded 93%, validating the analytical framework. These findings contribute empirically to pediatric epidemiology and social determinants of health and carry actionable implications for the design of programs and policies targeting school nutrition program expansion, food assistance policy design, and pediatric weight management intervention targeting.