Marginal Food Research Articles

Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

BackgroundLow food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood. ObjectiveThis study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina. DesignThis was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy. Participants and settingThis study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016. Main outcome measureDiet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well. Statistical analysis performedMultiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake. ResultsIn this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03). ConclusionsVery low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.

Association of loss of Supplemental Nutrition Assistance Program benefits with food insecurity and dietary intake of adults and children

Supplemental Nutrition Assistance Program (SNAP) disenrollment among income-eligible households could limit their ability to access food. To assess the association of loss of SNAP benefits on food security status and dietary intake of household members, using 2011-2016 NHANES data. SNAP participation status among those with a household income ≤130% of the federal poverty level was categorized as 1) current participants, 2) former participants with benefits cut off in the past year, and 3) former participants with benefits cut off for more than a year. Logistic regression examined associations of SNAP participation status with odds of household (n=7387), adult (n=7387), and child (n=5898) food security. Linear regression examined associations of participation status with Healthy Eating Index-2015 (HEI-2015) total and component scores in adults (n=2784) and children/adolescents (n=2553). Former SNAP participants with benefits cut off in the past year had greater odds of severe household (OR: 2.18; 95% CI: 1.25, 3.78) and adult (OR: 2.09; 95% CI: 1.24, 3.54) food insecurity compared with current participants. Benefit cutoff in the past year was significantly related to low child food security (OR: 1.80; 95% CI: 1.04, 3.11) and lower child/adolescent greens and beans score (estimate: -0.40; SE: 0.18). Loss of benefits for more than a year was significantly associated with increased marginal child food security odds (OR: 2.07; 95% CI: 1.23, 3.47), lower adult dairy score (estimate: -0.63; SE: 0.24), and lower child/adolescent greens and beans (estimate: -0.34; SE: 0.16), whole grains (estimate: -0.50; SE: 0.21), and dairy scores (estimate: -0.93; SE: 0.29). This study suggests that loss of benefits may increase household food insecurity. Although child/adolescent intakes of certain HEI-2015 adequacy components were lower among former SNAP participants, overall diet quality score did not differ. Findings collectively imply the need for policies that protect households from the adverse effects of benefits loss.

Food insecurity is associated with mental health problems among Canadian youth

BackgroundResearch has linked food insecurity to mental health problems, though little is known about this relationship among Canadian youth. We investigate the association between food insecurity severity and mental illnesses...

Food Insecurity, Dietary Quality, and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study

BackgroundFood insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities. ObjectiveOur aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults. DesignThis was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey. Participants/settingParticipants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States. Main outcome measuresSelf-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization. Statistical analysesMultiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality. ResultsIn a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44). ConclusionsAdults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.

College Students With Disabilities Report Higher Rates of Food Insecurity

Abstract Objectives To characterize the prevalence of food insecurity among college students with and without disabilities. Methods Cross-sectional data were collected between 2018–2020 at a mid-size, northeast public university as part of the ongoing College Health and Nutrition Assessment Survey. An online survey collected self-reported data, including food security and disability status. Food security status was measured via the U.S Household Food Security Survey Module 6-Item Short Form, and categorized into very low, low, marginal, and high food security. Disability status was categorized into yes or no via affirmative answers to either one of two items related to limitations or use of specialized equipment. Chi-square was used to assess the differences in food insecurity prevalence among students with and without disabilities. Results The sample (n = 880) was 60.6% female, predominately white (94.3%), and had a mean age of 19 ± 1.2 years. One out of seven students (14.6%) reported a disability; 18.6% reported low or very low food security (13.2% and 5.5% respectively) and 81.4% reported high or marginal food security (67.6% and 13.8%, respectively). Students with a disability reported higher rates of food insecurity vs. those without a disability (35.9% vs. 16.0%, P &amp;lt; 0.001). Among students with a disability, 12.8% reported very low food security and 23.1% reported low food security, compared to 4.3% and 11.7%, respectively, among those students without disabilities. Conclusions College students with disabilities experienced far greater rates of food insecurity than students without disabilities. Further research, including qualitative work, can help to understand and develop better supports for this underserved segment of the college population. Funding Sources The New Hampshire Agriculture Experiment Station and the USDA National Institute of Food and Agriculture Hatch Project 1010738.

Does Students’ Home Zip Code Relate to Food Insecurity on Campus? Implications of Home Demographics on Food Insecurity in College

Abstract Objectives To explore the relationship between students’ home zip code demographics and their food security status at a midsized, northeastern university. Methods Data were collected between 2018–2020 from the College Health and Nutrition Assessment Survey, an ongoing, cross sectional study at a midsized, public, northeastern university. As part of an online survey (Qualtrics) offered during the 3rd or 4th week of the semester, students completed the 6-item USDA Food Insecurity Questionnaire and provided the zip code associated with their primary residence prior to attending college. Students’ self-reported answers were used to categorize current food security status: food secure, low food secure, or very low food secure. A food security index was created from 13 unique sets of US Census data associated with zip codes. Each zip code was scored by sextiles for each census demographic and summed; final index values were assigned to each reported zip code and ranged from high to low risk of food insecurity (13–78). Results After exclusion of missing data, 687 students were included in the final analysis. The sample of predominantly female (62.0%), white (93.1%), first year (47.7%), and reported a zip code from the home state of the institution (39.9%). The mean food security index (±SD) of reported zip codes was 45.3 ± 8.9. In all, 18.8% reported food insecurity, (5.5% very low food security and 13.2% low food security), and 81.2% reported food security or marginal food security. Food insecurity was highest (21.8%) in students from zip codes most at risk for food insecurity based on the index, however, not significantly different from students from zip codes with the most food secure index score (18.8%). Conclusions Food insecurity among college students has been previously linked to poorer health, grades, and academic retention. More work is needed to elucidate the role of students’ prior place of residence to identify those at greatest risk of experiencing food insecurity on campus. Funding Sources The New Hampshire Agricultural Experiment Station and USDA National Institute of Food and Agricultural Hatch Project 1010738.

Association between Food Insecurity, Mental Health, and Intentions to Leave the US Army in a Cross-Sectional Sample of US Soldiers.

Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations. The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave"). A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n=5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator. The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave. The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.

534 Food Insecurity and Sleep Health by Race/Ethnicity and Age Group in the United States

Abstract Introduction Food insecurity may influence sleep through poor mental health (e.g., depression) and immune system suppression. Although prior studies have found food insecurity to be associated with poor sleep, few studies have investigated the food security-sleep association among racially/ethnically diverse participants and with multiple sleep dimensions. Methods Using National Health Interview Survey data, we examined overall, age-, sex/gender-, and racial/ethnic-specific associations between food insecurity and sleep health. Food security was categorized as very low, low, marginal, and high. Sleep duration was categorized as very short (&amp;lt;6 hours), short (&amp;lt;7 hours), recommended (7–9 hours), and long (≥9 hours). Sleep disturbances included trouble falling and staying asleep, insomnia symptoms, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CI) for sleep dimensions by very low, low, and marginal vs. high food security. Results The 177,435 participants’ mean age was 47.2±0.1 years, 52.0% were women, 68.4% were Non-Hispanic (NH)-White. Among individuals reporting very low food security, 75.4% had an annual income of &amp;lt;$35,000 and 60.3% were ≥50 years old. After adjustment, very low vs. high food security was associated with a higher prevalence of very short (PR=2.61 [95%CI: 2.44–2.80]) and short (PR=1.66 [95% CI: 1.60–1.72]) sleep duration. Very low vs. high food security was associated with both trouble falling asleep (PR=2.21 [95% CI: 2.12–2.30]) and trouble staying asleep (PR=1.98 [95% CI: 1.91–2.06]). Very low vs. high food security was associated with higher prevalence of very short sleep duration among Asians (PR=3.64 [95% CI: 2.67–4.97]), Whites (PR=2.73 [95% CI: 2.50–2.99]), Blacks (PR=2.03 [95% CI: 1.80–2.31]), and Hispanic/Latinxs (PR=2.65 [95% CI: 2.30–3.07]). Conclusion Food insecurity was associated with poor sleep in a diverse sample of the US population. Support (if any):

Screening for marginal food security in young children in primary care

BackgroundHousehold food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years.ResultsThe sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question “I have difficulty buying food I want to feed my child because food is expensive” had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™.ConclusionThe single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits.Trial registrationTARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov; NCT01869530); www.targetkids.ca

Marginal Food Security Predicts Earlier Age at Menarche Among Girls From the 2009-2014 National Health and Nutrition Examination Surveys.

This study analyzed the relationship between household food security and variation in age at menarche, as well as the connections between food insecurity, nutritional status, and allostatic load, among girls aged 12-15 years from the 2009-2014 United States National Health and Nutrition Examination Survey (NHANES). Data analysis included mean comparisons of age at menarche among household food security groups (high, marginal, low, and very low) as well as categorical variables known to associate with age at menarche (ethnicity, poverty status, body mass index [BMI], allostatic load, and milk consumption). χ2 Analyses were used to test the associations between household food security and additional categorical variables. Univariate and multivariate regression models were used to test the relationship between variation in age at menarche and household food security, ethnicity, BMI, and allostatic load categories while controlling for age. Non-Hispanic Black and Hispanic/Mexican American girls had earlier mean ages at menarche, higher mean BMIs, and disproportionately experienced household food insecurity when compared to non-Hispanic White-identifying girls. In the univariate analyses, marginal household food security, Hispanic/Mexican American and Black ethnicities, overweight and obese BMI categories, and marginal-high allostatic load were each associated with lower age at menarche compared to reference categories.These associations were maintained in the multivariate analysis, although only Hispanic/Mexican American ethnicity predicted earlier menarche when compared to that of non-Hispanic White girls. Marginal household food security, particularly for girls who identified as non-White, predicted earlier age at menarche independent of nutritional status and allostatic load. At the same time, having more energetic resources (ie, higher BMI) also significantly predicted earlier menarche.

'Spending all this time stressing and worrying and calculating': marginal food security and student life at a Diverse Urban University.

Food security status is a continuum ranging from high to very low food security. While marginal food security falls next to high food security on the spectrum, new quantitative research indicates marginal food security status is associated with negative health outcomes and poor academic performance among college students. Qualitative research focusing on college students experiencing marginal food security has not been conducted. The current study aims to qualitatively explore experiences of college students with marginal food security and to identify themes to better understand and provide context regarding how marginal food security impacts students. Students were recruited for semi-structured interviews with questions designed to study the challenges associated with students' food situations. All interviews were recorded and transcribed with themes identified via an inductive approach. A large public university on the US west coast. Thirty college students. Key themes that emerged: purchasing cheap unhealthy foods, insufficient time to prepare and eat meals on a regular basis, stress and anxiety around the inability to eat healthy food and future health issues, self-perception of health when eating poorly along with physical symptoms and low academic motivation by not fully participating in their courses due to few healthy food options or missing meals. Marginal food security can potentially diminish students' health and their capacity to learn and succeed in their coursework. The results emphasise that students experiencing marginal food security should not be grouped with students experiencing high food security.

Students with Food Insecurity Are More Likely to Screen Positive for an Eating Disorder at a Large, Public University in the Midwest

BackgroundCollege students experience a disproportionately high prevalence of both food insecurity and eating disorders. Food insecurity is associated with stress, irregular eating patterns, weight change, depression, and body dissatisfaction, making it a possible risk factor for the onset of eating disorders. However, the association between food insecurity and eating disorders among college students is not well understood. ObjectiveThis study explored the relation between food insecurity and screening positive for an eating disorder among students attending a large, public Midwestern university. DesignCross-sectional data were collected using an online survey administered from March through June 2018. Participants/settingParticipants were recruited from a random sample of 2,000 students, with oversampling from the following groups: racial/ethnic minorities, first-generation students, and students from lower-income households. Of those sampled, 851 students (43%) responded. The final analytic sample comprised 804 students after excluding those with missing data. Main outcome measureThe validated 5-item Sick, Control, One stone, Fat, Food (SCOFF) questionnaire was used to screen for the presence of an eating disorder. Statistical analyses performedPoisson regression was used to model prevalence ratios for positive SCOFF screens (≥2 affirmative responses) by levels of food security (ie, high, marginal, low, or very low). Models were adjusted for sex, age, race/ethnicity, degree type, financial aid, and first-generation student status. ResultsCompared to students with high food security, a higher prevalence of positive SCOFF screens was found among students with marginal food security (prevalence ratio [PR], 1.83, 95% CI 1.26 to 2.65; P = 0.001), low food security (PR 1.72, 95% CI 1.16 to 2.54; P = 0.007), and very low food security (PR 2.83, 95% CI 2.01 to 3.97; P < .0001). ConclusionsStudents with food insecurity at any level were more likely to screen positive for an eating disorder via the SCOFF questionnaire. Prospective studies are needed to determine whether food insecurity is a risk factor for the onset of eating disorders among college students.

Food Insecurity and Chronic Diseases among Native Hawaiians and Pacific Islanders in the US: Results of a Population-based Survey

ABSTRACT Data from the 2014 Native Hawaiian and Pacific Islander (NHPI) National Health Interview Survey were used to examine associations between food security and individual chronic diseases, total number of chronic diseases, and general health status among 637 NHPI adults with income below 200% federal poverty level. Very low food security was associated with hypertension, diabetes, and asthma. Very low food security and marginal food security were associated with having any chronic disease and with having a higher number of chronic diseases. Risk for food insecurity increased as health status decreased. These associations had not previously been documented for NHPI.

Changing from a highly food secure household to a marginal or food insecure household is associated with decreased weight and body mass index z-scores among Latino children from CHAMACOS.

Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration. Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12. We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood. Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households. Changes in food security status and duration of food insecurity were associated with changes in children's growth.

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

Food Security Status is not Associated with Increased Risk of Metabolic Syndrome in Korean Adults.

Background: It is still uncertain whether food insecurity increases the risk of metabolic syndrome. Recent reports from the United States and developing countries have shown conflicting results on this issue. This study aimed to investigate the association between food security status and metabolic syndrome in Korean adults. Methods: We performed a nationwide population study using data for 18,782 adults obtained from the 2012 to 2015 Korean National Health and Nutrition Examination Surveys. The 18-item Food Security Survey Module was utilized to assess household food security status. We used multiple logistic regression models to determine the association between food security status and metabolic syndrome. Results: The overall prevalence of food insecurity was 8.2% and that of metabolic syndrome was 27.3%. The prevalences of metabolic syndrome were 26.2%, 32.3%, 30.2%, and 28.8% in the high, marginal, low, and very low food security groups, respectively. Food-insecure participants (participants in the low food security and very low food security groups) were significantly more likely to be female, divorced/widowed/separated, and current smokers compared to food-secure participants. Food-insecure participants also had lower incomes, lower education attainments, and lower physical activities (P < 0.05). Compared with the high food security group, the marginal (odds ratio [OR]: 1.34, 95% confidence interval [95% CI]: 1.19-1.50, P < 0.001) and low food security groups (OR: 1.22, 95% CI: 1.04-1.42, P = 0.01) had increased odds of metabolic syndrome in the unadjusted models. However, after controlling for covariates, including age, sex, marital status, education attainment, household income, smoking, alcohol intake, and physical activity, neither marginal food security (adjusted odds ratio [aOR]: 1.02, 95% CI: 0.87-1.19, P = 0.86) nor low food security (aOR: 0.88, 95% CI: 0.71-1.08, P = 0.22) was significantly associated with an increased risk of metabolic syndrome. Conclusions: Contrary to a prior report from the United States, food security status was not significantly associated with the risk of metabolic syndrome in Korean adults.

The Need for Investment in Rigorous Interventions to Improve Child Food Security

The Need for Investment in Rigorous Interventions to Improve Child Food Security

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BackgroundSchool meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear. ObjectiveTo examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years). DesignCross-sectional analysis. Participants/settingSecondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project. Main outcome measuresConsumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener. Statistical analysisMultiple linear regression. ResultsFor the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI –0.93 to –0.53) to 0.99 (95% CI –1.59 to –0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI –0.65 to –0.34) to 0.68 (95% CI –1.07 to –0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security. ConclusionsLower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.

Sustainable health equity: achieving a net-zero UK

Sustainable health equity: achieving a net-zero UK

Food insecurity is linked to poorer dietary quality in prebariatric surgery patients.

Research exploring dietary quality patterns within bariatric populations is limited, despite the significance of eating behaviors for postoperative outcomes. Recent studies revealed associations between food insecurity and disordered eating behavior in bariatric patients; however, the relationship between food insecurity and dietary quality is not known. To examine the association between dietary quality and levels of food security within a sample of presurgical bariatric patients. One academic medical center in central Pennsylvania, United States of America. Patients completed three self-report measures as part of their presurgical psychological assessment process. Food security status was measured by the United States Department of Agriculture's Food Security Module, modified for self-reports. Participants also completed the Rapid Eating Assessment for Participants, short version, which is a measure of dietary quality with scores ranging from 13-39, and the Adult Eating Behavior Questionnaire. Hierarchical multiple regressions were used to assess relationships between dietary quality and food security levels, and mediation models were built to explore associations between variables. Of the 197 participants, 35.5% reported high food security, while 35.0% and 29.5% reported marginal food security and food insecurity, respectively. Compared with patients with high food security, the dietary quality scores of food-insecure patients were 1.3 points lower (95% confidence interval [CI], -3.3 to .7; P = .2) of and marginally food-secure patients were 1.2 points lower (95% CI, -2.9 to .5) than those reporting high food security (P = .2). Our findings indicate a need for further exploration into the barriers that prebariatric patients may face when attempting to adhere to pre- and postoperative dietary requirements, particularly for those reporting marginal food security and food insecurity. Future research should target postoperative outcomes, including weight gain, weight regain, and dietary adherence, among the most economically vulnerable bariatric patients.