Authors: Abhaya Dilip(1)*, Victoria G. Williamson(2)*, Jackson R. Dillard(1), Jane Morgan-Daniel(1), Alexandra M. Lee(1), and Michelle I. Cardel(1)
Faculty Mentor: Michelle I. Cardel
College: College of Medicine
Eating behaviors, including unhealthy snacking or excessive snacking leading to excess calorie consumption, may contribute to obesity among adolescents. Socioeconomic status (SES) also significantly influences eating behaviors, and low SES is associated with increased risk for obesity. However, little is known regarding the relationship between snacking behavior and SES among adolescents and how this may contribute to obesity-related outcomes. The primary objective of this scoping review was to review the literature to assess and characterize the relationship between SES and snacking in adolescents. The secondary objective was to assess weight-related outcomes and their relation to snacking habits. Included articles were published between January 2000 and May 2019; written in English, Portuguese, or Spanish; and focused on adolescents (13–17 years). In total, 14 bibliographic databases were searched, and seven studies met the inclusion criteria. Preliminary evidence from the seven included studies suggests a weak but potential link between SES and snacking. Additionally, these dietary patterns seemed to differ by sex and income type of country. Finally, only three of the included studies addressed weight-related outcomes, but the overall available evidence suggests that snacking does not significantly affect weight-related outcomes. Due to the small number of included studies, results should be interpreted with caution.
(1) – University of Florida, Gainesville, Florida; (2) University of Oregon, Eugene, Oregon
Great job Abby! So proud of you!
Thank you, Dr. Cardel, for your constant encouragement and kind words!
Were there any reasons cited in the papers for why snacking behaviors differ based on sex? If not, do you have any explanations as to why this trend exists?
Thats a great question. The two papers that found that snacking behaviors differed by sex were Hardy et al. and Pérez et al. In the Hardy et al. paper, they state that for males, lower household income was “less strongly associated with high snack intake” (p=0.045). For females, maternal educational attainment was associated with high snack intake (p=0.034). They don’t state why this may be the case. With that being said, the measure of socioeconomic status (SES), either household income or parental education, could be associated with these differences in snacking behaviors by sex.
In the Pérez et al. study, they report that for all of their participants aged 3-16 years, snacking significantly decreases in both males and females as their “family socioeconomic level” (FSEL) increased. However, for our study, which focused only on adolescents aged 13 through 17, there were sex-related differences in snacking outcomes where rates of snacking for males decrease as their FSEL increases, and for females, their rates of snacking increase as their FSEL levels increase. The authors discuss factors that influence dietary habits for both males and females collectively, but do not mention differences by sex and our particular age group.
Hope this helps!
Thank you for sharing your research. Your field of study is very interesting and has many implications to the design of future nutrition studies and nutritional guidelines.
I have a few questions:
Moving forward, what kind of research (prospective or retrospective) would help clear up the ambiguity in the results of your review?
Did you see any noticeable differences in snacking habits among countries or cultures? You did not include that information in your table?
Have you thought of modifying your research with some scrutiny into the relative standards of poverty/middle class between each study? It is well known that the economic state of a country (in addition to culture) changes what the standard of poverty is. This may have significantly changed availability of food among the different SES groups in the different studies you analyzed.
Thank you for your time.
Regarding your question on future studies clearing up ambiguity, I believe that there should be prospective studies purposefully designed to look at socioeconomic status (SES) and its impacts on snacking and weight-related outcomes in adolescents aged 13 through 17. Lots of the studies we looked at only happened to include this data, meaning that was not the primary aim of their papers. Additionally, intentionally conducting specific between group analyses of the various SES groups would be extremely beneficial.
We actually did observe a difference based on countries for the “High SES” category, which is a reason for why we had various results in that particular SES category. Interestingly, in the Maruapula et al. study conducted in Botswana, Africa, as the SES of adolescents aged 13 through 17 increased, so did their rates of snacking. This result was contrary to the Larson et al. study, conducted here in the United States in Minneapolis, Minnesota, that found that as SES does not have a statistically significant effect on snack intake and the Verstraeten et al. study conducted in Nabón, Ecuador, which found that SES had no effect on snacking. We believe that because Botswana is an upper middle-income economy, interactions with snacking function differently there due to its different economic state.
Although we did not modify our definitions of poverty/middle class between each study for this scoping review, I do think it is very important to pay attention to each country’s type of economy, because, like you mentioned, of the impact it can have on food availability. For the future, it would be interesting and beneficial to perhaps look at the influence of the type of economy each country has on snacking habits of that country’s people.
I hope that cleared up a few things! Thanks so much for your insightful questions.
Awesome job, Abby!
Thanks, Jackson! Thankful I get to do research with you!
Good Job! Did any of the papers mention anything about Healthy dieting being more expensive, and low-income families being more preoccupied with quantity rather than quality?
Thank you. Although it is not mentioned specifically by participants that healthy eating behaviors were more costly, it is known that the cost associated with healthy eating is a barrier for many. Additionally, since this paper did not look into the quality of snacking, I am uncertain if the participants in the lower SES groups mentioned quantity of snacks over quality of snacks as a concern. However, for future research, I am interested in investigating how snack quality rather than quantity is influenced by SES. Hope that helps!
Interesting study Abhaya! It was a pleasure to go through, especially since it is such a relevant topic to adolescents, especially college students. I look forward into hearing more regarding your research in this field!
Hi, Basil! Thanks for taking the time to listen to me. It’s great to hear that you found this research interesting and relevant!
I enjoyed watching your presentation and exploring your poster. I think your findings regarding snacking, SES, and sex are really interesting. I was wondering what you thought the future implications of this research might be? Could further research in this topic inform efforts to improve weight-based health outcomes in children and adolescents and, if yes, how so?
In regards to future implications of my research, information gathered through scoping review studies like these can be used by researchers when developing behavioral interventions or by clinicians when speaking to patients about their eating behaviors. Additionally, I think it is important for researchers to take the economic condition of the country in which research is being conducted into consideration as this can impact findings between differing countries, as seen by the Maruapula et al. study done in Botswana, Africa compared to the Larson et al. study done in the United Staes and the Verstraeten et al. study done in Ecuador.
Our findings on the relationship between snacking and weight-related outcomes were not significant when controlling for SES, so further research would need to be done to see if weight-related outcomes are influenced by snacking. Only then would it be possible to determine whether or not weight-based outcomes in children and adolescents could be improved.
Thanks so much for watching my presentation and taking your time to write these questions!