Childhood obesity and food insecurity coexist, largely because both are conditions disproportionately affecting families living in poverty. I am a pediatrician who works in a population with many socioeconomically disadvantaged children, and a researcher who has for years had a strong focused on food access in low- income communities. I am seeking a mentored career award to further develop my skills as a clinical researcher in order to achieve my goal of becoming an independently-funded investigator conducting research on policy-relevant strategies and interventions that improve the metabolic risk and long-term health of obese children who live in poverty. Preliminary studies with my patients exploring how our food-insecure patients differ from their food-secure peers have informed this proposal. Qualitative work has led to my hypothesis that food-insecure obese patients have a higher propensity towards disordered eating, and preliminary analysis with NHANES suggests that they have greater metabolic dysregulation than their food-secure peers. I am now broadening my investigations about the potential metabolic impact of food insecurity to include other more upstream markers of insulin resistance and metabolic risk. Key elements of my proposed research activities include the following: A. In order to refine understanding of the impact of food-insecurity on diet in food-insecure children, I will recruit 80 patients in order t conduct a more detailed investigation of their dietary intake and eating behaviors than is typically feasible in the context of routine clinic. B. These same 80 obese patients (8-14 yrs.) wil have laboratory testing done to assess how overall cardio-metabolic risk (evidenced by insulin resistance or the presence of more atherogenic lipoprotein profile) compares between food-insecure children and their low-income peers. C. Conduct a randomized intervention using physician-delivered supermarket vouchers for fruits, vegetables, and whole fiber foods among 60 low-income, obese children (8 to 14 years) who are in a household that uses SNAP (food stamps). Determine impact on behavior, BMI, and biomarkers of metabolic risk. In order to solidify my knowledge base regarding nutrition measurement, consolidate statistical analysis skills, and conduct a well-executed randomized intervention, I will take relevant coursework available to me on two University of California campuses. My mentorship team is well qualified to assist me not only with completing these proposed research activities, but also with launching my career as an independent clinical scientist.

Public Health Relevance

Childhood obesity and food insecurity are each associated with their own negative consequences, and are also known to coexist in low-income children. This proposed research is significant because it addresses a gap in knowledge about children who are both obese and food-insecure by evaluating early indicators of metabolic risk. It is already known that obese children face a higher risk of future chronic disease. This proposed research would supply the first investigation of whether the experience of food insecurity potentiates this risk. The proposed research is relevant to the NIH's mission to extend healthy life and reduce the burdens of illness.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Biobehavioral and Behavioral Sciences Subcommittee (CHHD)
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Grave, Gilman D
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Children's Hospital & Res Ctr at Oakland
United States
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Tester, June M; Phan, Thao-Ly T; Tucker, Jared M et al. (2018) Characteristics of Children 2 to 5 Years of Age With Severe Obesity. Pediatrics 141:
Leung, Cindy W; Tester, June M (2018) The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results. J Acad Nutr Diet :
Leung, Cindy; Tester, June; Laraia, Barbara (2017) Household Food Insecurity and Ideal Cardiovascular Health Factors in US Adults. JAMA Intern Med 177:730-732
Tester, June M; Leung, Cindy W; Leak, Tashara M et al. (2017) Recent Uptrend in Whole-Grain Intake Is Absent for Low-Income Adolescents, National Health and Nutrition Examination Survey, 2005-2012. Prev Chronic Dis 14:E55
Leung, Cindy W; Tester, June M; Rimm, Eric B et al. (2017) SNAP Participation and Diet-Sensitive Cardiometabolic Risk Factors in Adolescents. Am J Prev Med 52:S127-S137
Tester, June M; Laraia, Barbara A; Leung, Cindy W et al. (2016) Dyslipidemia and Food Security in Low-Income US Adolescents: National Health and Nutrition Examination Survey, 2003-2010. Prev Chronic Dis 13:E22
Tester, June M; Lang, Tess C; Laraia, Barbara A (2016) Disordered eating behaviours and food insecurity: A qualitative study about children with obesity in low-income households. Obes Res Clin Pract 10:544-552
Tester, June M; Leung, Cindy W; Crawford, Patricia B (2016) Revised WIC Food Package and Children's Diet Quality. Pediatrics 137: