The food insecurity–obesity paradox: a comparison of three obesity measures and sociodemographic disparities in Korean adults

Objective

We explored the impact of food insecurity on three different measures of obesity, that is, estimated percentage body fat (PBF), BMI, and waist circumference (WC), and examined the presence of sociodemographic disparities.

Methods

This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey 2019–2021 (n = 12,447, aged ≥30 years). Food insecurity was evaluated using an 18-item modified version of the US Household Food Security Survey Module. Three obesity measures were defined: PBF ≥25% for men or ≥35% for women, BMI ≥25 kg/m², and WC ≥90 cm for men or ≥85 cm for women. Logistic regression models were employed to estimate odds ratio (OR) values with 95% CI.

Results

Of those measured, 4% of households experienced food insecurity (men 3.7%, women 4.6%). In women, food insecurity was positively associated with PBF-defined obesity (OR: 1.37, 95% CI: 1.03–1.81) but not with BMI- or WC-defined obesity. When analyzed by sociodemographic factors, positive associations between food insecurity and PBF-defined obesity were observed in older women and urban residents but not in their counterparts.

Conclusions

Food insecurity seems to have a stronger positive association with PBF than with BMI or WC among Korean women, especially those who are older and reside in urban areas.