Canadian Journal of Public Health

, Volume 107, Issue 4–5, pp e447–e452 | Cite as

Hunger and overweight in Canadian school-aged children: A propensity score matching analysis

  • Mariane SentenacEmail author
  • Geneviève Gariepy
  • Britt McKinnon
  • Frank J. Elgar
Quantitative Research


OBJECTIVE: The last decade saw a higher prevalence of overweight reported among food-insecure families in Canada, but no robust evidence exists on the covariate-adjusted association in children. In this study, we examined the association between hunger and overweight in Canadian students, using a propensity score matching analysis to reduce confounding.

METHODS: This research used data from the 2009/2010 Canadian Health Behaviour in School-aged Children study on a representative national sample of students in Grades 6 through 10. Students self-reported their height and weight and how often they have gone to school or to bed hungry due to a lack of food at home. Multivariate logistic regression modeling was conducted on the total sample (N = 17,694) and on the sample matched on propensity scores (n = 7,788).

RESULTS: The overall prevalence of overweight among students was 20.2% with a significant difference between students who reported hunger (24.0%; 95% CI: 22.1–26.0) and students who did not (19.0%; 95% CI: 17.9–20.2). Analysis on the matched sample revealed a significant association between hunger and overweight in children (adjusted odds ratio: 1.30; 95% CI: 1.12–1.50).

CONCLUSIONS: A substantial number of Canadian students have reported being hungry because of a lack of food at home. These students are at increased risk of overweight, regardless of their social class. Child hunger and household food insecurity exist in Canada and constitute a call for policy action at a national level.

Key words

Overweight child adolescent hunger propensity score food 


OBJECTIF: Au cours des 10 dernières années, la prévalence du surpoids déclarée chez les familles aux prises avec l’insécurité alimentaire au Canada a augmenté, mais il n’existe aucune donnée probante solide sur une association pondérée en fonction des covariables chez les enfants. Dans notre étude, nous avons examiné l’association entre la faim et le surpoids chez les élèves canadiens à l’aide d’une analyse d’appariement sur le score de propension pour réduire la confusion.

MÉTHODE: Nous avons appliqué les données du cycle 2009–2010 de l’Étude canadienne « Health Behaviour School-aged Children » (HBSC) à un échantillon national représentatif d’élèves de la 6e à la 10e année. Les élèves ont rapporté leur taille et leurs poids et si ils sont souvent allés à l’école ou au lit en ayant faim par manque de nourriture à la maison. Nous avons appliqué un modèle de régression logistique multivariée à l’échantillon total (N = 17 694) et à l’échantillon apparié sur le score de propension (n = 7 788).

RÉSULTATS: La prévalence globale du surpoids chez les élèves était de 20,2 %, avec un écart significatif entre les élèves ayant connu la faim (24,0 %; IC de 95 %: 22,1–26,0) et les autres élèves (19,0 %; IC de 95 %: 17,9–20,2). L’analyse de l’échantillon apparié a révélé une association significative entre la faim et le surpoids chez les enfants (rapport de cotes ajusté: 1,30; IC de 95 %: 1,12–1,50).

CONCLUSIONS: Un nombre considérable d’élèves canadiens a déclaré avoir connu la faim en raison du manque de nourriture à la maison. Ces élèves présentent un risque accru de surpoids, peu importe leur classe sociale. La faim des enfants et l’insécurité alimentaire des ménages existent au Canada et constituent un appel à l’action des pouvoirs publics à l’échelle nationale.

Mots clés

surpoids enfant adolescent faim score de propension nourriture 


  1. 1.
    Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377(9765):557–67. PMID: 21295846. doi: 10.1016/s0140-6736(10)62037-5.CrossRefGoogle Scholar
  2. 2.
    Roberts KC, Shields M, de Groh M, Aziz A, Gilbert JA. Overweight and obesity in children and adolescents: Results from the 2009 to 2011 Canadian Health Measures Survey. Health Rep 2012;23(3):37–41. PMID: 23061263.Google Scholar
  3. 3.
    Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, et al. Health consequences of obesity. Arch Dis Child 2003;88(9):748–52. doi: 10. 1136/adc.88.9.748.CrossRefGoogle Scholar
  4. 4.
    Wang Y, Beydoun MA. The obesity epidemic in the United States - Gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis. Epidemiol Rev 2007;29:6–28. PMID: 17510091. doi: 10.1093/epirev/mxm007.CrossRefGoogle Scholar
  5. 5.
    Davis B, Tarasuk V. Hunger in Canada. Agric Hum Values 1994;11(4):50–57. doi: 10.1007/BF01530416.CrossRefGoogle Scholar
  6. 6.
    Franklin B, Jones A, Love D, Puckett S, Macklin J, White-Means S. Exploring mediators of food insecurity and obesity: A review of recent literature. J Community Health 2012;37(1):253–64. PMID: 21644024. doi: 10.1007/ s10900-011-9420-4.CrossRefGoogle Scholar
  7. 7.
    Dietz WH. Does hunger cause obesity. Pediatrics 1995;95(5):766–67. PMID: 7724321.PubMedGoogle Scholar
  8. 8.
    Alaimo K, Olson CM, Frongillo EA. Low family income and food insufficiency in relation to overweight in US children - Is there a paradox? Arch Pediatr Adolesc Med 2001;155(10):1161–67. PMID: 11576013.CrossRefGoogle Scholar
  9. 9.
    Casey PH, Simpson PM, Gossett JM, Bogle ML, Champagne CM, Connell C, et al. The association of child and household food insecurity with childhood overweight status. Pediatrics 2006;118(5):E1406–13. PMID: 17079542. doi: 10. 1542/peds.2006-0097.CrossRefGoogle Scholar
  10. 10.
    Rose D, Bodor JN. Household food insecurity and overweight status in young school children: Results from the Early Childhood Longitudinal Study. Pediatrics 2006;117(2):464–73. PMID: 16452367. doi: 10.1542/peds.2005-0582.CrossRefGoogle Scholar
  11. 11.
    Bauer KW, MacLehose R, Loth KA, Fisher JO, Larson NI, Neumark-Sztainer D. Eating- and weight-related parenting of adolescents in the context of food insecurity. J Acad Nutr Diet 2015;115(9):1408–16. PMID: 25824114. doi: 10. 1016/j.jand.2015.01.011.CrossRefGoogle Scholar
  12. 12.
    Gundersen C, Lohman BJ, Eisenmann JC, Garasky S, Stewart SD. Child-specific food insecurity and overweight are not associated in a sample of 10- to 15-year-old low-income youth. J Nutr 2008;138(2):371–78. PMID: 18203906.CrossRefGoogle Scholar
  13. 13.
    Kaur J, Lamb MM, Ogden CL. The Association between food insecurity and obesity in children-The National Health and Nutrition Examination Survey. J Acad Nutr Diet 2015;115(5):751–58. PMID: 25737437. doi: 10.1016/j.jand. 2015.01.003.CrossRefGoogle Scholar
  14. 14.
    Freeman JG, King M, Pickett W. The Health of Canada’s Young People: A Mental Health Focus. Ottawa, ON: Public Health Agency of Canada, 2011; 194 pp.Google Scholar
  15. 15.
    Currie C, Zanotti C, Morgan A, Currie D, de Looze M, Roberts C, et al. (Eds.). Social Determinants of Health and Well-Being Among Young People. Health Behaviour in School-Aged Children (HBSC) Study: International Report from the 2009/2010 Survey. Copenhagen, Denmark: WHO Regional Office for Europe, 2012.Google Scholar
  16. 16.
    Vidmar SI, Cole TJ, Pan H. Standardizing anthropometric measures in children and adolescents with functions for egen: Update. Stata J 2013; 13(2):366–78.CrossRefGoogle Scholar
  17. 17.
    Pickett W, Michaelson V, Davison C. Beyond nutrition: Hunger and its impact on the health of young Canadians. Int J Public Health 2015;60(5): 527–38. PMID: 25929577. doi: 10.1007/s00038-015-0673-z.CrossRefGoogle Scholar
  18. 18.
    Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M. Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale. Soc Sci Med 2008;66(6):1429–36. PMID: 18179852. doi: 10.1016/j.socscimed. 2007.11.024.CrossRefGoogle Scholar
  19. 19.
    StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP, 2013.Google Scholar
  20. 20.
    Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70(1):41–55. doi: 10. 1093/biomet/70.1.41.CrossRefGoogle Scholar
  21. 21.
    DuGoff EH, Schuler M, Stuart EA. Generalizing observational study results: Applying propensity score methods to complex surveys. Health Serv Res 2014; 49(1):284–303. PMID: 23855598. doi: 10.1111/1475-6773.12090.CrossRefGoogle Scholar
  22. 22.
    Dubois L, Francis D, Burnier D, Tatone-Tokuda F, Girard M, Gordon-Strachan G, et al. Household food insecurity and childhood overweight in Jamaica and Quebec: A gender-based analysis. BMC Public Health 2011;11:199. PMID: 21453491. doi: 10.1186/1471-2458-11-199.CrossRefGoogle Scholar
  23. 23.
    Pryor LE, Brendgen M, Tremblay RE, Pingault JB, Liu X, Dubois L, et al. Early risk factors of overweight developmental trajectories during middle childhood. PLoS ONE 2015;10(6):e0131231. PMID: 26121682. doi: 10.1371/ journal.pone.0131231.CrossRefGoogle Scholar
  24. 24.
    Bhawra J, Cooke MJ, Hanning R, Wilk P, Gonneville SLH. Community perspectives on food insecurity and obesity: Focus groups with caregivers of Métis and Off-reserve First Nations children. Int J Equity Health 2015;14(1):1–10. PMID: 26475264. doi: 10.1186/s12939-015-0232-5.CrossRefGoogle Scholar
  25. 25.
    Kirk S, Kuhle S, McIsaac J, Williams PL, Rossiter M, Ohinmaa A, et al. Food security status among grade 5 students in Nova Scotia, Canada and its associations with health outcomes. Public Health Nutr 2014;18(16):2943–51. PMID: 25075606. doi: 10.1017/S1368980014001414.CrossRefGoogle Scholar
  26. 26.
    Mark S, Lambert M, O’Loughlin J, Gray-Donald K. Household income, food insecurity and nutrition in Canadian youth. Can J Public Health 2012;103: 94–99. PMID: 22530529.Google Scholar
  27. 27.
    Chandler-Laney PC, Morrison SA, Goree LL, Ellis AC, Casazza K, Desmond R, et al. Return of hunger following a relatively high carbohydrate breakfast is associated with earlier recorded glucose peak and nadir. Appetite 2014;80:236–41. PMID: 24819342. doi: 10.1016/j.appet.2014.04.031.CrossRefGoogle Scholar
  28. 28.
    Schulte EM, Avena NM, Gearhardt AN. Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS ONE 2015;10(2): e0117959. PMID: 25692302. doi: 10.1371/journal.pone.0117959.CrossRefGoogle Scholar
  29. 29.
    Jääskeläinen A, Nevanperä N, Remes J, Rahkonen F, Järvelin MR, Laitinen J. Stress-related eating, obesity and associated behavioural traits in adolescents: A prospective population-based cohort study. BMC Public Health 2014; 14(1):1–14. PMID: 24708823. doi: 10.1186/1471-2458-14-321.CrossRefGoogle Scholar
  30. 30.
    McCurdy K, Gorman KS, Metallinos-Katsaras E. From poverty to food insecurity and child overweight: A family stress approach. Child Dev Perspect 2010;4(2):144–51. doi: 10.1111/j.1750-8606.2010.00133.x.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2016

Authors and Affiliations

  • Mariane Sentenac
    • 1
    Email author
  • Geneviève Gariepy
    • 1
  • Britt McKinnon
    • 1
  • Frank J. Elgar
    • 1
    • 2
  1. 1.Institute for Health and Social PolicyMcGill UniversityMontrealCanada
  2. 2.Douglas Mental Health Research InstituteMcGill UniversityMontrealCanada

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