Psychological Mechanisms Linking Food Insecurity and Obesity (Food Mind Pilot Study)
Conditions: Obesity, Psychological
Sponsor: Pennington Biomedical Research Center

Food Mind Pilot I Protocol v2 
March 5, 2018 1
Protocol Title:
Psychological Mechanisms Linking Food Insecurity and Obesity: A 
Quantitative Pilot Study (Food Mind Pilot I)
Principal Investigator: 
Candice A. Myers, Ph.D.
Co-Investigators:
Peter T. Katzmarzyk, Ph.D.
Corby K. Martin, Ph.D.
Stephanie T. Broyles, Ph.D.
Summary:
This pilot study will investigate an emergent risk factor for obesity: food insecurity, which 
is defined as the limited or uncertain availability of nutritionally adequate and safe foods. While 
paradoxically linked, numerous studies have shown a significant association between food 
insecurity and obesity. Moreover, recent narrative works have developed new, untested 
hypotheses linking food insecurity and obesity positing the causal role of psychological 
mechanisms. Given this, this quantitative pilot study will collect new psychological data in a 
sample of food secure and food insecure adults with and without obesity to examine the 
connections between food insecurity, body weight, and psychological constructs. The 
overarching objective of the study is to gather pilot data to identify potentially new intervention 
targets that will be used in future studies to more rigorously investigate the relationship between 
food insecurity and obesity. 
Background:
Food insecurity is defined as a lack of “nutritionally adequate and safe foods” or the 
limited or uncertain ability “to acquire acceptable foods in socially acceptable ways”1 and is most 
often determined by household income, or restricted monetary resources.2 In 2015, 12.7 percent 
of U.S. households were food insecure at some point during the year,3 with the prevalence 
being even greater in Louisiana at 25.7%.4 Food insecurity is now recognized as a pressing 
health issue in the United States given its linkage to greater body weight.5-8 The relationship 
between food insecurity and obesity has been labeled a paradox given that food insecurity 
potentially causes reduced food availability and obesity is often related to increased food 
intake.5,9,10 However, nationally representative data indicate that on average women who report 
being food insecure weigh 5.2 kilograms more than those who are food secure.11 
Food insecurity has also been shown to impede intervention response and 
effectiveness.12,13 Evidence from intervention-based studies demonstrates that food insecure 
participants often do not experience equivalent response in intervention targets. For example, 
studies have found that food insecure individuals did not see equivalent decreases in blood 
pressure compared to food secure participants.12 Similarly, food insecurity has been shown to 
be a barrier to diabetes self-management13,14 and antiretroviral therapy adherence.15
Most research evidence has largely implicated diet and eating behaviors in the linkage 
between food insecurity and obesity, which includes maladaptive dietary behaviors and poor 
diet quality,16,17 and physiological adaptations to episodes of food insecurity, or ‘feast-famine’ 
cycles associated with an abundance of food followed by food shortage.9,16,18,19 While this 
evidence demonstrates that food insecurity is a risk factor for obesity and related comorbidities 
(e.g., metabolic syndrome, poor cardiovascular health),20,21 more research is needed to better 
elucidate the key mechanisms that work in this pathway. 
Recently, a body of narrative literature has been published that develops new 
conceptual frameworks and hypotheses that posit causal explanations in the relationship 
between food insecurity and increased body weight.7,22,23 The common theme shared among 
these reviews is the explicit designation of the role of decision-making psychological 
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mechanisms in the relationship between food insecurity and obesity. While there is empirical 
evidence linking psychological constructs, such as delay discounting, less grit (perseverance), 
and lack of future time orientation, to greater body weight,24-26 there is a dearth of studies taking 
similar approaches in samples that explicitly include food insecure individuals. Only a single 
study has demonstrated the association of delay discounting and poor future time orientation 
with food insecurity, yet this study did not triangulate these associations with body weight.27 
Further, theoretical and empirical evidence also points to the importance of perceived social 
status in the association between food insecurity and weight status.22,28 
Specific Aim:
Food insecurity may play a significant role in the etiology of obesity, as well as the 
treatment and prevention of weight gain and concomitant adverse health outcomes. The current 
pilot study will examine emergent hypotheses by investigating the role of psychological 
mechanisms in the relationship between food insecurity and obesity. We will be the first to 
assess four key psychological constructs (delay discounting, grit, future time perspective, and 
subjective social status) in a sample of food secure and food insecure adults with and without 
obesity. This objective will be achieved via a cross-sectional, observational pilot study collecting 
quantitative data. The following specific aim will be addressed:  
Aim 1. Examine associations among psychological mechanisms, food security status, 
and body mass index (BMI). 
We will measure and evaluate four key psychological constructs via direct assessment in 
normal weight and overweight/obese adults. Participants will be categorized as food secure or 
food insecure. From these data, we will examine associations between food security status, 
weight status, and each of the following potential psychological mechanisms drawn from the 
extant literature: 
1) delay discounting
2) grit
3) future time perspective
4) subjective social status
Study Overview/Design: 
This is a cross-sectional, observational pilot study to collect quantitative data. Key 
independent variables are food security status and BMI. Primary endpoints are four 
psychological constructs: 1) delay discounting, grit, future time perspective, and 4) subjective 
social status. We will also assess a number of key measures, including health literacy, 
sociodemographics, food assistance use, and dietary quality. This study is community-based, 
with all screening and study assessments conducted in designated community locations, 
including partnering food pantries, local YMCAs, and other community centers.
 
Study Participants: 
The target study sample will be no more than 60 food secure and food insecure women 
and men aged 18 to 49 years with a BMI of 20.0 kg/m2 or greater. Food security status will be 
determined by the 6-item Food Security Scale. Participants will be matched on race for each of 
the four participant categories with approximately 14 subjects in each category (see Table 1). 
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Table 1. Sample size
Food security status
Food secure
Food insecure
BMI
< 25 (Normal)
~14
~14
≥ 25 (Overweight/Obese)
~14
~14
Recruitment: 
Participants will be recruited in designated community locations by trained study staff 
who will assess each potential participant’s interest in participating in the study and screen for 
eligibility. Our community outreach efforts may include, but are not limited to, flyers, 
presentations, health fairs, and attendance at site-specific community events. Additional 
recruitment efforts may include email blasts, social media posts, newsletters, etc.   
Eligibility Criteria:
We will perform a screening assessment to determine initial eligibility. Eligibility will be 
assessed with the following criteria (see below). If deemed eligible, participants will be enrolled 
into the study. 
Eligibility criteria include:

Age 18-49 years 

BMI ≥ 20.0 kg/m2 

Able to read and write using the English language

Willing to provide written informed consent
Exclusion criteria include:

Pregnancy 
Study Timeline:
Screening and study assessments will comprise a single study visit (see Table 2). 
However, if a participant is unable to complete all study assessments in a single visit, they will 
be allowed to schedule an additional study visit. Participants will be screened on-site at 
designated community locations to assess eligibility. Informed consent will be obtained during 
the screening assessment. Participants will be formally oriented to the study by receiving 
information on the purposes and goals of the study, as well as study measures and procedures. 
Eligible participants who provide informed consent will complete all study assessments.
Table 2. Schedule of study procedures
Screening Assessments
   Informed consent
   Anthropometrics (height and weight; BMI)
   Health literacy assessment
   Food security questionnaire
   Sociodemographic questionnaire
Study Assessments
   Food assistance question
   Dietary quality
   Psychological questionnaires
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Measures and Procedures:
Anthropometrics. Height and weight will be measured using a portable stadiometer and digital 
scale, respectively. Measurements will be taken without shoes and recorded to the nearest 0.1 
cm and 0.1 kg, respectively. Body Mass Index (BMI; weight in kilograms/height in meters2) will 
be calculated and used to categorize an adult participant as normal weight, overweight/obese. 
Health literacy. The REALM short form (SF) will be used to measure health literacy in 
participants. This assessment is a standardized series of seven words. The score (0-7) provides 
an assessment of how well the participant will be able to understand the additional 
questionnaires. Participants scoring 0-3 on the REALM SF will be provided assistance by study 
staff in completing the other questionnaires. Patients scoring 4-7 on the REALM SF will be 
allowed to complete the other questionnaires on their own, but will be offered assistance as 
needed.  
Food security. Self-reported food security status over the previous 12 months will be measured 
using the 6-item Food Security Scale.29,30 This scale is a well-validated measure of food security 
developed by researchers at the National Center for Health Statistics. Two or more affirmative 
answers (>2) indicate food insecurity. Participants can also be categorized by levels of food 
security: 1) high or marginal (0-1), 2) low (2-4), and 3) very low (5-6).12,27 
Sociodemographics. Participants will be asked to complete a questionnaire that will assess age 
(date of birth), race/ethnicity, sex, marital status, highest level of education completed, annual 
household income, number of people in the household, occupation, employment status, and 
home street address.
Food assistance. Participants will be asked about their use of Federal food assistance, e.g., 
SNAP (food stamps), WIC, and other forms of non-Federal food assistance (e.g., food pantries, 
soup kitchens).
Dietary quality. A questionnaire that assesses dietary fat, fruit, vegetable, and alcohol intake will 
be completed by participants. The questionnaire contains scales from several sources. The 
National Cancer Institute (NCI) fat screener estimates the percentage of energy from fat by 
asking participants to report the frequency of consuming specific foods over the past 12 
months.31,32 A standard 7-item fruit and vegetable screener developed by the NCI and National 
5 a Day Program asks how often fruit and vegetables were consumed in the past month.33,34 
Three questions related to the frequency of alcohol intake (beer, wine, hard liquor) were 
adapted from the Brief Questionnaire to Assess Habitual Beverage Intake (BEVQ-15).35
Psychological questionnaires. A series of psychological questionnaires will be administered to 
measure the primary endpoints of interest, which include: 1) delay discounting; 2) grit, 3) future 
time perspective, and 4) subjective social status.
Delay Discounting is a bias toward smaller, immediate rewards versus larger, delayed rewards36 
and will be assessed via the 27-item monetary choice questionnaire.37 This questionnaire 
presents participants with a set of choices between smaller, immediate monetary rewards and 
larger, delayed monetary rewards. Participants who discount the value of the delayed rewards 
more steeply are considered to be more impulsive.37 
Grit is a measure of trait-level perseverance and passion for long-terms goals and will be 
assessed using the 8-item Short Grit Scale (Grit-S).38 Scores range from 1 (not at all gritty) to 5 
(extremely gritty).
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Future Time Perspective is a comprehensive assessment of one’s orientation toward the 
future.25,27 We will assess future time perspective using 4 instruments. 
The future scale of the Zimbardo Time Perspective Inventory (ZTPI) measures 
psychological orientation toward the future.39 This scale is comprised of 13 statements 
with Likert-type responses. Higher scores indicate greater future time perspective.
The Consideration of Future Consequences Scale (CFCS) assesses how individuals 
consider future outcomes in choosing current behavior.40,41 This scale contains 14 
statements for which individuals indicate whether or not the statement is characteristic of 
them on a scale of 1-7. Higher scores indicate greater consideration of future 
consequences, respectively. 
Participants will be asked a single question to assess the time period considered for 
financial planning: “In planning your, or your family’s, saving and spending, which of the 
following time periods is more important to you and your partner, if you have one?” with 
the following response options: no planning, day to day, the next few weeks, next few 
months, next year, next few years, next 5-10 years, longer than 10 years.42,43 Higher 
values indicate greater future time perspective.
Last, participants’ subjective appraisal of longevity will also be assessed via a single 
question: “What do you think are the chances you will live to age 75 or more (where 0 
means there is not a chance you will live to 75 or more, and 100 means you will 
definitely live to 75 or more)?”.42,43 Higher values indicate greater future time 
perspective. 
Subjective Social Status is one’s self-perceived social position in U.S. society and will be 
measured using the MacArthur Scale of Subjective Social Status.44 This scale presents a 
‘ladder’ and asks participants to select a rung on which they feel they stand relative to other 
people in the U.S. Scores range from 1-10, with higher scores representing higher subjective 
social status.
Power Analysis and Sample Size:
Given that this is a pilot and feasibility study, power analysis and sample size 
calculations were not performed. It is anticipated that this study will provide variance estimates 
to inform power and sample size calculations for future grant applications and studies.
Statistical Analysis:
Descriptive statistics will be computed for all variables. Bivariate associations (chi-
square tests and Pearson/Spearman correlations) will be assessed between food security 
status, BMI, and psychological assessment scores. Linear and logistic regression will be used to 
estimate associations between food security status, BMI, and psychological outcomes. 
Regression models will include key demographic covariates.
Data Management:
All data will be collected and managed electronically via the Research Electronic Data 
Capture (REDCap) system. When necessary, data may be collected via paper forms and then 
entered by study staff into the REDCap system.45 REDCap is a secure, HIPAA-compliant, web-
based application that can be utilized for electronic collection and management of research and 
clinical trial data. Study data and electronic data capture tools are housed in a secure data 
center at Pennington Biomedical, and all web-based information transmission is encrypted. The 
server is backed up nightly and is protected by an enterprise network security firewall. REDCap 
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will be accessed through the Pennington Biomedical secure website, https://redcap.pbrc.edu, 
where research personnel are required to enter user ids and passwords previously approved 
and set up by the Pennington Biomedical REDCap Administrator. 
Risks to Subjects and Potential Benefits:
This study does not pose more than minimal risk to participants. This study will be 
required to have approval from the PBRC Institutional Review Board. PBRC has full 
accreditation by the Association for the Accreditation of Human Research Protection Programs 
(AAHRPP). All participants will be given time to read the consent form and ask questions with 
study staff. To continue, the participant must read and sign an informed consent to participate in 
further assessments. All volunteers are assured of their confidentiality both verbally and in the 
informed consent form. Efforts to minimize the potential risks of the assessment methods 
include frequent monitoring by the investigators to assure no participant suffers any adverse 
effects from participating in the research study. Potential risks associated with study procedures 
include:

Height and weight. There is a minimal risk to participants from these measurements.

Self-report questionnaires. There are no anticipated risks from completing self-report 
questionnaires. Due to the potentially sensitive nature of the questionnaires, participants 
may choose to not answer questions.
There are no direct benefits for participation in this study.  
Confidentiality:
All attempts will be made to maintain a subject’s privacy.  Safeguards such as password 
protected computer and networks have been put in place in order to limit access to subject data.  
Subjects will be given ample time to read over the consent, ask questions, and agree to 
participate in the research study.  Subjects may decline answering questions they are not 
comfortable with.  Each procedure will be explained to the subject before it is performed.  We 
will always ensure the privacy of the subjects.  However, someone from the Pennington 
Biomedical Research Center may inspect and/or copy the medical records related to the study.  
Results of the study may be published; however, we will keep participants’ names and other 
identifying information private.  Other than as set forth above, participants’ identities will remain 
confidential unless disclosure is required by law.
Sharing of Results with Study Participant:
Participants will be provided a summary results card at the completion of their study visit 
that will include body composition results.  
Data Safety Monitoring Plan:
Food Mind Pilot I is a study with a minimal level of risk to study participants and does not 
warrant the establishment of an independent Data and Safety Monitoring Board. This plan 
describes the safety monitoring procedures for the proposed study. The plan will help ensure 
the safety of all participants. The PI will communicate via electronic submission to the IRB all 
unanticipated problems as defined by the IRB. 
The study investigators will monitor conduct of Food Mind Pilot I. The PI will schedule 
monthly meetings with study staff to review data on eligibility and recruitment problems. Any 
significant health problems coming to our attention during the study will be referred to the 
participant’s usual source of medical care, with his/her permission. We will cooperate fully with 
his/her physician by providing relevant medical records.
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Setting:
This study, including screening and assessments, will take place in designated 
community locations across Baton Rouge. 
Compensation:
Participants in this study will receive $25 compensation for participation. 
Compensation for Research-Related Injury:
No compensation will be provided for research-related injury. 
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