Food Insecurity and Diabetes: How Sweet Foods Lead to a Not So Sweet Disease

Food insecurity, unfortunately, is a too-common dilemma affecting millions worldwide everyday. But what exactly is it, and who does it predominantly affect?

Food insecurity is defined into two categories by the United States Department of Agriculture (USDA). The first category of food insecurity involves “reduced quality, variety, or desirability of diet and little or no indication of reduced food intake” [1], whereas the second category more severely involves “multiple indications of disrupted eating patterns and reduced food intake” [1]. Food insecurity is a national issue, yet it seems to predominantly affect low-income and unemployed households. According to the Economic Research Service (ERS) branch of the USDA, while the national average of food-insecure households was 13.5% in 2023, 38.7% of households with incomes below the federal poverty line were food-insecure [6]. Food insecurity rates were also considerably higher for “single-parent households, women living alone, and Black and Hispanic households” [6].

Unfortunately, having a lower income also means having less access to healthier foods. A study conducted by the Harvard School of Public Health found that eating a healthy diet costs $1.50 more daily compared to eating an unhealthy diet, explaining why lower-income households opt for cheaper, albeit unhealthier, diet options [7]. As such, this limits access to healthy food for specific demographics and facilitates the consumption of more unhealthy, sugary food.

When considering the overconsumption of unhealthy food, diabetes is a disease that comes to mind, likely due to the fact that 11.6% of the U.S. population suffers from it [4]. Diabetes is essentially a “group of diseases that affect how the body uses glucose” [2] with two types: Type 1 and Type 2. Both types of diabetes can happen at any age, but Type 1 diabetes is an autoimmune condition and is more prevalent in children, while Type 2 diabetes usually develops in older people due to lifestyle and diet issues. Specific causes of diabetes are unknown, but environmental and genetic factors have proven influential [2]. Some ways diabetes can be prevented include a healthy diet, regular exercise, and maintaining a healthy weight. 

Now, you might be wondering: how exactly are food insecurity and diabetes connected? According to a study published by the Journal of Nutrition Education and Behavior, food insecurity increased the prevalence of maternal and infant consumption of sugary beverages in low-income households [3]. In other words, low-income families are consuming excess amounts of unhealthy foods as a result of food insecurity, potentially inciting a cycle of health deterioration and the development of Type 2 diabetes that could’ve been avoided with access to affordable nutritious options.

The interconnectedness of food insecurity and diabetes may have facilitated a cycle of health disparities, but studies have shown that programs such as “Food is Medicine” and federal nutrition assistance programs provide an outlet for addressing this food insecurity and reducing health disparities in low-income communities [5]. While there is still work to be done on the journey to food equality, such programs illuminate a path to a brighter future where millions worldwide can overcome food insecurity and improve their health.

Edited by: Sheldon Liu

Designed by: Eugene Cho

References

1. Office of Disease Prevention and Health Promotion (2020). Food insecurity. Food Insecurity - Healthy People 2030. (n.d.). https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity#:~:text=Food%20insecurity%20is%20defined%20as,possible%20outcome%20of%20food%20insecurity. 

2. Mayo Foundation for Medical Education and Research. (2024, March 27). Diabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444

3. Fernández, C. R., Chen, L., Cheng, E. R., Charles, N., Meyer, D., Monk, C., & Woo Baidal, J. (2020). Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days. Journal of nutrition education and behavior, 52(8), 796–800. https://doi.org/10.1016/j.jneb.2020.03.006 

4. American Diabetes Association. Statistics about diabetes. Statistics About Diabetes | ADA. (2023). https://diabetes.org/about-diabetes/statistics/about-diabetes. 

5. Levi, R., Bleich, S. N., & Seligman, H. K. (2023). Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes care, 46(9), 1599–1608. https://doi.org/10.2337/dci23-0002 

6. USDA. (2023). USDA ERS - Food Security and Nutrition Assistance. USDA.gov. https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/ 

Dwyer, M. (2013, December 5). Eating Healthy vs. Unhealthy Diet Costs about $1.50 More per Day. Harvard School of Public Health. https://www.hsph.harvard.edu/news/press-releases/healthy-vs-unhealthy-diet-costs-1-50-more/ 

Postpartum Diet Culture: How Ideals of Thinness Are Increasing Stress and Postpartum Weight Retention for Minority Birthing Populations

For the last century, global stigmatization of heavier body types has progressively worsened. As a result, women of all age, race, ethnicity, and religion continue to face unrelenting pressures to meet social ideals of thinness. This often leads them to adopt hurtful social messages that associate weight gain with “failure, weakness, gluttony, laziness and other moral failings” [1]. Internalization of these societal expectations for body type is linked to damaging psychological and physical health outcomes. 

Idolization of ultra thin body types poses a significant risk for pregnant women, who experience gestational weight gain. Despite the fact that pregnant women spend nine months eating for two, mothers are continuously told they aren’t dropping their postpartum weight fast enough. In addition to adjusting to life as a new mother, birthing women experience greater “depressive symptoms, daily stress, and maladaptive dieting behavior” as a result of these pressures [2]. In a survey of 501 pregnant and postpartum women in 2017, the number of sources of weight stigma endorsed was significantly associated with depressive symptoms and perceived stress. These stress-inducing stigmas were also shown to have a direct association with more emotional eating behavior, making it even more difficult for mothers to lose weight the year following delivery. This goes to show that postpartum diet culture may actually be the cause of higher rates of postpartum weight retention (PPWR) in our generation. 

However, stress regarding postpartum diet culture does not seem to be uniform across the diverse population of birthing women. In a study conducted by Jacqueline Kent-Marvick and her colleagues at the University of Utah, they found that race and education level were two of the most prominent structural determinants predicting postpartum weight retention [3]. Higher weight retention was specifically observed in African American populations and among individuals with lower levels of education. This can be attributed to a variety of factors, including access to healthy and nutritious food as well as access to outdoor spaces for physical fitness. Another contributing factor may be the deeply rooted medical distrust among African American patients, stemming from the historic mistreatment of minority women in obstetric care. This highlights the need to address racism as a chronic and persistent stressor linked to high PPWR [4].

The psychological risks driven by postpartum diet culture also impact hormone systems, which are closely associated with increased morbidity. Stress and glucocorticoids, for example, are directly linked to food consumption patterns, particularly choices high in fat and sugar content [5]. In turn, these stress-induced spikes in cortisol levels for postpartum women elevate the risk for obesity-related conditions such as high blood pressure, type 2 diabetes, and ischemic heart disease [6].

Pregnant women, who are already a vulnerable population, deserve support through societal efforts to confront demographic stressors that contribute to weight retention, rather than being burdened by unrealistic postpartum weight loss standards. This support can take many forms, including subsidized nutritious foods, greater access to postpartum psychiatric care, and the integration of telehealth nutritionists for both pre- and postpartum patients. By shifting the focus away from idealized standards of thinness, we can mitigate the negative effects of postpartum diet culture and reduce stress-related postpartum weight retention, ultimately promoting better mental and physical health outcomes for mothers worldwide.

Reviewed by Makalya Gorski

Graphic by Monic Rashkov

References

[1] Li, M., Yu, X., Zhang, W., Yin, J., Zhang, L., Luo, G., Liu, Y., & Yang, J. (2023). The association between weight-adjusted-waist index and depression: Results from NHANES 2005–2018. Journal of Affective Disorders, 347, 299–305. https://doi.org/10.1016/j.jad.2023.11.073

[2]  Rodriguez, A. C. I., Schetter, C. D., Brewis, A., & Tomiyama, A. J. (2019). The psychological burden of baby weight: Pregnancy, weight stigma, and maternal health. Social Science & Medicine, 235, 112401. https://doi.org/10.1016/j.socscimed.2019.112401. 

[3] Kent-Marvick, J., Cloyes, K. G., Meek, P., & Simonsen, S. (2023). Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework. Women's Health, 19, 17455057231166822. https://doi.org/10.1177/17455057231166822. 

[4] Chatlani, S. (2024). Focusing on maternity and postpartum care for Black mothers leads to better outcomes. Monitor on Psychology, 53(7). https://www.apa.org/monitor/2022/10/better-care-black-mothers.  

[5] Hewagalamulage, S. D., Lee, T. K., Clarke, I. J., & Henry, B. A. (2016). Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domestic animal endocrinology, 56 Suppl, S112–S120. https://doi.org/10.1016/j.domaniend.2016.03.004

[6] Vicennati, V., Pasqui, F., Cavazza, C., Pagotto, U., & Pasquali, R. (2009). Stress‐related development of obesity and cortisol in women. Obesity, 17(9), 1678–1683. https://doi.org/10.1038/oby.2009.76

Cereal Offenders: Exposing Gluten's Health and Societal Impact

Let's put a protein on the stand: gluten. This composite found in wheat, barley and rye, has become the topic of focus surrounding health and nutrition. With the rising cases of allergies and a third of Americans adopting less gluten in their lifestyle, we need to understand the implications of this abundant substance [3].

First, let's examine the different faces of gluten-intolerance:

Celiac Disease is an autoimmune disorder where ingestion of gluten leads to small intestinal damage. This damages nutrient absorption and leads to symptoms like weight loss, fatigue, and diarrhea. The only effective treatment is a strict, lifelong gluten-free diet [1].

Wheat Allergies involve an allergic reaction to proteins found in wheat. These symptoms can range from hives and nasal congestion to anaphylaxis [1].

Non-Celiac Gluten Sensitivity (NCGS) is described through gastrointestinal symptoms related to gluten ignition for individuals that don't have celiac disease or a wheat allergy. Symptoms may include abdominal pain, bloating, fatigue, and headache. NCGS doesn't cause intestinal damage and we don't quite understand its pathophysiology [2].

Recently, research has found the potential role of the nocebo effect — the phenomenon where negative expectations of a substance cause adverse effects — in NCGS. A Lancet study explored the influence of expected versus actual gluten intake on the symptoms of patients with NCGS and found that negative expectations of gluten can exacerbate symptoms leading to a nocebo effect. Yet, future studies are needed to determine the exact role of personal expectations in promoting NCGS prevalence [2].

The increase in allergies related to gluten sensitivity has left healthcare professionals stumped while simultaneously popularizing the gluten-free diet [5]. The significant rise in Americans adopting gluten-free diets has been driven more by misconceptions of health benefits than by medical necessity. While medical professionals and scientists continue to investigate the reasons behind the recent surge in gluten sensitivities, marketing and advertising have capitalized on the increase in gluten allergy symptoms by promoting gluten-free foods as healthier alternatives. This trend reflects societal diet culture dynamics, where products are marketed as healthy through word of mouth and advertising, often outpacing the scientific community and data-based evidence [3].

Though gluten-free foods are becoming popular, accessibility and availability has not been uniform across all communities. Areas with limited food access lack gluten-free options and often portray the gap in food inequities which make it challenging for individuals with celiac disease or gluten disorders in underrepresented regions to obtain their dietary needs. This coupled with the rising expenses of gluten-free products due to the demand, places a financial burden on those who medically require these alternatives [4].

While gluten is a harmless protein for the majority of people, it poses significant challenges for individuals with celiac disease, wheat allergy, or NCGS. The potential influence of the nocebo effect in NCGS individuals highlights the need for a greater understanding of the effects that gluten can have on the body, as well as the importance of studying cultural dietary choices  and their impact on human health. As gluten-free foods are becoming more prevalent, we must critically address existing food inequity issues to ensure all individuals have access to the dietary options needed for their well-being.

Reviewed by Nick Hoffmann

References

1. Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. https://doi.org/10.2147/CEG.S57816

2. de Graaf, M., et al. (2016). Gluten and non-coeliac gluten sensitivity: The nocebo effect and future avenues. The Lancet Gastroenterology & Hepatology, 1(2), 86–94. https://doi.org/10.1016/S2468-1253(16)30087-5

3. NYU Langone Health. (2015). One-third of Americans are trying to avoid gluten—but is it the villain we think it is? NYU Langone News. Retrieved from https://nyulangone.org/news/one-third-americans-are-trying-avoid-gluten-it-villain-we-think-it-is

4. The Sun. (2023). Aldi issues urgent 'do not eat' warning and urgently recalls hundreds of tins over dangerous health risks. The Scottish Sun. Retrieved from https://www.thescottishsun.co.uk/health/13693999/aldi-tuna-fish-recall-gluten-coeliac-disease/

5. Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3908912/#:~:text=The%20incidence%20of%20allergy%20and,related%20disorders%20are%20no%20exception