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Self‐reported diabetes status moderates the association between food insecurity and body mass index

Food insecurity is associated with reduced consumption of fruits, vegetables, dairy, and lower levels of micronutrients. These dietary patterns are linked to the development of chronic diseases. Few studies have explored disease factors that impact the relationship of food insecurity with obesity. The purpose of this study was to investigate the role of self‐reported diabetes status in moderating the association between food insecurity and body mass index (BMI) among Indiana food pantry users aged 21 – 80 y (n = 285). Food pantry users that speak and read English were recruited from eight rural and low income counties in Indiana. Participants were interviewed for individual and household characteristics, household food security status (US Household Food Security Survey Module), and measured for height and weight to determine BMI. Results from adjusted multiple linear regression model showed that marginal food‐secure adults had an estimated 8.2 kg/m2 higher BMI (P = 0.03), low food‐secure adults had an estimated 9.3 kg/m2 higher BMI (P = 0.008), and very low food‐secure adults had an estimated 6.6 kg/m2 higher BMI (P = 0.06), compared with high food‐secure adult BMI. There was a significant interaction between food security status and self‐reported diabetes status. Among adults with self‐reported diabetes, BMI was significantly higher in marginal and low food‐secure groups (P = 0.03, P = 0.007), compared with the high food‐secure group. Among adults without diabetes, BMI in marginal, low, and very low food‐secure groups was not significantly different from the high food‐secure group (P = 0.59, P = 0.55, P = 0.42). Results of this study suggest that overweight and obesity are more prevalent among diabetic food pantry clients in marginal and low food‐secure groups. Food pantries may serve diabetic clients in marginal and low food secure groups by supporting provision of appropriate foods for these clients and allowing client choice along with offering nutrition education to improve self‐sufficiency and enable healthy, high‐quality, and appropriate food selection.