title: Food Security and Weight Status in Children: Interactions With Food Assistance Programs.
abstract: BACKGROUND
  It is unclear whether Supplemental Nutrition Assistance Program (SNAP) or National School Lunch Program (NSLP) participation modifies the relationship between food insecurity and obesity in children.
  
  
  METHODS
  Data were included for 4,719 children aged 9-17 years who participated in the National Health and Nutrition Survey between 2003-2004 and 2011-2012. Linear regression was used to examine the relationship between household food security (full, marginal, low, and very low) and BMI percentile. Adjusted models were also stratified by SNAP and NSLP participation.
  
  
  RESULTS
  There was no significant overall relationship between household food security and BMI percentile. In SNAP non-participants, there was no apparent overall relationship between BMI percentile and household food security. However, BMI percentile in children from households with low food security was significantly higher than that of children from fully food-secure households (risk difference [RD]=5.95, 95% CI=1.11, 10.80). Among SNAP participants, there was no significant relationship between household food security and BMI percentile. By NSLP participation category, there was a non-significant trend toward increasing BMI percentile with decreasing household food security in those reporting two or fewer (RD=1.75, 95% CI= -0.79, 4.29) and two to three (RD=1.07; 95% CI= -1.74, 3.89) lunches/week. There was no apparent relationship between household food security and BMI percentile in those reporting four or more lunches/week.
  
  
  CONCLUSIONS
  Although the overall relationship between household food security and weight status in school-aged children was not statistically significant, there was some evidence that the relationship may differ by SNAP or NSLP participation, suggesting the need for more research.
authors.affiliation: Independent Research Consultant, Mountain View, California.
authors.forename: Binh T
authors.initials: BT
authors.lastname: Nguyen
authors.affiliation: Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Ford
authors.affiliation: The Gretchen Swanson Center for Nutrition, Omaha, Nebraska.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Yaroch
authors.affiliation: Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.affiliation: Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia. Electronic address: jeffrey.drope@cancer.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Drope
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D005260:Female; D063105:Food Assistance; D005523:Food Supply / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D009749:Nutrition Surveys; D063766:Pediatric Obesity / Q000191:economics / Q000453:epidemiology*; D011203:Poverty