Social Science & Medicine 74 (2012) 1754e1764
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Social Science & Medicine
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Feeding her children, but risking her health: The intersection of gender, household food insecurity and obesity
Molly A. Martin*, Adam M. Lippert Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802, United States
a r t i c l e i n f o
Article history: Available online 20 December 2011
Keywords: Overweight Obesity Gender Food insecurity Parenting Income USA
* Corresponding author. Tel.: þ1 814 863 5508. E-mail address: email@example.com (M.A. Mart
0277-9536/$ e see front matter � 2012 Elsevier Ltd. doi:10.1016/j.socscimed.2011.11.013
a b s t r a c t
This paper investigates one explanation for the consistent observation of a strong, negative correlation in the United States between income and obesity among women, but not men. We argue that a key factor is the gendered expectation that mothers are responsible for feeding their children. When income is limited and households face food shortages, we predict that an enactment of these gendered norms places mothers at greater risk for obesity relative to child-free women and all men. We adopt an indirect approach to study these complex dynamics using data on men and women of childrearing age and who are household heads or partners in the 1999e2003 waves of the Panel Study of Income Dynamics (PSID). We find support for our prediction: Food insecure mothers are more likely than child-free men and women and food insecure fathers to be overweight or obese and to gain more weight over four years. The risks are greater for single mothers relative to mothers in married or cohabiting relationships. Supplemental models demonstrate that this pattern cannot be attributed topost-pregnancy biological changes thatpredispose mothers toweight gain or an evolutionary bias toward biological children. Further, results are unchanged with the inclusion of physical activity, smoking, drinking, receipt of food stamps, or Women, Infants and Children (WIC) nutritional program participation. Obesity, thus, offers a physical expression of the vulnerabilities that arise from the intersection of gendered childcare expectations and poverty.
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Scholars argue that it takes money to maintain a healthy weight in America’s obesogenic environment (Poston & Foreyt, 1999) because healthy food is relatively expensive and calorie-dense, nutrient-poor food is cheap (Drewnowski & Specter, 2004). Although weight is a function of both caloric intake and expendi- ture, materialist arguments focus on the costs of food and predict greater caloric intake and consequent body fat among low versus high income people (Glass & McAtee, 2006). In the U.S., there is a strong, negative correlation between income and the likelihood of being overweight or obese, but only among women; this is not observed among men (for reviews, see McLaren, 2007; Sobal & Stunkard, 1989). This sex difference is puzzling, particularly to scholars who look beyond individual explanations to consider the role of shared environments for health because the majority of men and women live together (Casper & Bianchi, 2002) and share socioeconomic resources and weight-related behaviors (French, Story, & Jeffery, 2001; Mitchell et al., 2003). Given these common- alities, one would expect greater similarity between the sexes.
We hypothesize that the key distinction is not between all women and all men, but between mothers and non-mothers. We
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argue that the confluence of two factors e the experience of food insecurity and the gendered nature of childcare e intersect and contribute to the observed sex differences in the association of income and body weight. Food insecurity is highly correlated with poverty (Sarlio-Lähteenkorva & Lahelma, 2001) and occurs when a household faces budgetary constraints that limit the quantity or quality of food they can purchase (Wunderlich & Norwood, 2006). Yet food insecurity is a “managed process” (Radimer, 1990), meaning that families strategize and diligently work to avoid hunger. That responsibility, however, falls more heavily on women given traditional discourses about family life and “women’s work” that place greater expectations on women for feeding and nurturing their family, especially when children are present (DeVault, 1991). Given that food insecurity is correlated with poor dietary behavior and obesity (for a review, see Institute of Medicine, 2011), we assert that food insecurity mediates the association between income and weight, but that the management of food insecurity intersects with gender to create differential risks for obesity between mothers and non-mothers.
To investigate these dynamics, we study men and women of childrearing ages (i.e., 18e55) who are heads or partners of U.S. households in the 1999, 2001 and 2003 waves of the Panel Study of Income Dynamics (PSID). We test whether the association between
M.A. Martin, A.M. Lippert / Social Science & Medicine 74 (2012) 1754e1764 1755
household food insecurity and the likelihood of being overweight or obese differs across groups defined by sex and parenthood in cross-sectional models of weight status and longitudinal models of weight change. We also examine how partner co-residence further moderates these processes due to the gendered norms about parental custody (Coltrane & Adams, 2003) and the greater prev- alence of food insecurity among single parents (Rose, Gundersen, & Oliveira, 1998).
Food insecurity and weight
Household food security exists along a continuum but can be categorized into a four-point ordered scale: food secure, food insufficiency, low food security, and very low food security (Bickel, Nord, Price, Hamilton, & Cook, 2000; Wunderlich & Norwood, 2006). Most Americans are food secure, but some face food insuf- ficiency, meaning, they worry about having enough money to buy food for the month, but actually make no or few changes to their diet (Wunderlich & Norwood, 2006). Food insecurity occurs when those fears become a reality. Low food security, or not having the means to buy the kinds of food desired, reduces the quality and variety of people’s diets (Wunderlich & Norwood, 2006). Very low food security occurs when people do not have the means to buy the quantity of food needed and leads people to skip meals and reduce their food intake (Wunderlich & Norwood, 2006). Those with either “low food security” or “very low food security” are considered “food insecure” (Wunderlich & Norwood, 2006). In 2009, 14.7% of U.S. households were food insecure (Nord, Coleman-Jensen, Andrews, & Carlson, 2010), while in 2003, the year corresponding to our study, the prevalence was 11.2% (Nord, Andrews, & Carlson, 2004).
Because poverty predicts food insecurity (Sarlio-Lähteenkorva & Lahelma, 2001), there are several parallels found in research on the roleof food security for body weight. Keyamong them are consistent sex differences, such that low food security is linked to being over- weight (Adams, Grummer-Strawn, & Chavez, 2003; Dinour, Bergen, & Yeh, 2007; Lyons, Park, & Nelson, 2008; Townsend, Peerson, Love, Achterberg, & Murphy, 2001) and gaining 5 pounds or more in one year (Wilde & Peterman, 2006), but only among women. Very low food security is associated with being underweight, but again only for women (Wilde & Peterman, 2006).
Several studies suggest that food insecurity is linked to over- weight and obesity due to management strategies people adopt in the face of economic constraints. Food insecure individuals are more likely to consume high-calorie but nutritionally-poor food to avoid feelings of hunger (Dixon, Winkleby, & Radimer, 2001; Drewnowski & Specter, 2004; Kirkpatrick & Tarasuk, 2008), eat irregular meals or skip breakfast (Kempson, Keenan, Sadani, Ridlen, & Rosato, 2002; Ma et al., 2003), and consume less milk, fruit and vegetables, especially later in the month (Tarasuk, McIntyre, & Li, 2007). According to public health and nutrition research, these dietary practices are associated with being overweight (Ledikwe et al., 2006; Ma et al., 2003) and weight gain (Berkey, Rockett, Gillman, Field, & Colditz, 2003). In the next section, we detail how the management of food insecurity is gendered.
Gender, childcare, and food insecurity management
Traditional discourses about “family” life and “women’s work” since the industrial revolution include expectations that women are responsible for caring for their family members and managing household tasks (Rothman, 1978; Sokoloff, 1980). When children are present in the home, those responsibilities multiply (Hays, 1998) and the gendered division of household labor becomes more unequal (Coltrane, 2000). For example, there is greater gender equity in the total number of hours spent on housework in
child-free cohabiting and married couples than among similar couples with children (Sanchez & Thomson, 1997; South & Spitze, 1994). Therefore, mothers are more likely to be subjected to, internalize, and reflect traditional gender expectations about their roles and responsibilities than child-free women.
A key feminine responsibility is “feeding the family,” which requires a series of tasks: meal planning, monitoring the supply of household provisions, shopping, cooking, and cleaning (DeVault, 1991). Beyond the practical goals, “feeding the family” also sustains children’s emotional needs for love, support and security (DeVault, 1991).
In food insecure homes, mothers work hard to prevent hunger amongst their children. In a qualitative study with frequently food insecure young mothers, all insisted that their children only expe- rienced food insufficiency because they adopted several strategies to protect them (Stevens, 2010), including prioritizing their chil- dren’s needs over their own (McIntyre et al., 2003; Stevens, 2010). As DeVault notes “[t]hese women seem to be expressing a heightened sense of the more widespread notion that’s women’s own food is less important than that prepared for others” (1991, p.199). As one woman in a cash-strapped household noted: “If it gets down to it, we buy to feed the kids” (DeVault, 1991, p.191).