Western New York women who are food insecure, overweight and want to eat healthy are being recruited for UB clinical trial

BUFFALO, N.Y. — Women who can’t regularly access the food they need are at a 50% greater risk of becoming obese, even though they don’t consume more calories.

The phenomenon is called the food insecurity-obesity paradox.

“People with food insecurity are more likely to be obese,” says Leonard H. Epstein, PhD, SUNY Distinguished Professor, chief of the Division of Behavioral Medicine in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

It’s a kind of “double whammy,” he says, because not only is the individual not getting the food they need, but the body is storing more calories as fat, a protective biological mechanism against food scarcity in the future.

Now, Epstein, principal investigator, and his colleagues are launching a novel clinical trial that aims to overcome the food insecurity-obesity paradox. The strategy is to provide participants with personalized diets, regular access to premade, healthy meals and plenty of education about healthy eating while also changing the way they metabolize food.

Improving health and weight

The goal of the small trial is to improve the health and weight of food-insecure participants by personalizing diets matched to each participant’s metabolism. The researchers are seeking a dozen women to participate. Interested individuals can get more information at the clinical trial’s website.

Epstein says they are especially interested in women, since many food-insecure people are single women with children. “Parents will go out of their way to make sure their kids have enough to eat but they may not be eating enough themselves,” he says.

The study, titled “Effect of Meal Timing and Dietary Changes on Metabolic and Behavioral Factors Involved in the Food Insecurity-Obesity Paradox,” is one of the first to attempt to change how participants metabolize food.

“Your body’s metabolism changes based on how predictable your food intake is,” Epstein explains. “And nobody knows how long it takes to change someone’s metabolism. We are the first to study this.”

Changing metabolism

Changing how they metabolize food is crucial in order for these individuals to achieve a healthy weight. That’s because, Epstein explains, their respiratory quotient, the ratio between the amount of carbon dioxide the body produces and the amount of oxygen consumed, operates differently for people who don’t eat on a predictable schedule. The respiratory quotient reveals what type of fuel an individual is burning: fats, carbohydrates or a combination of both.

“Most people burn fat and store glucose to use during exercise,” says Epstein. “But women with unpredictable access to food will preferentially burn carbohydrates and store fat. We call that the insurance hypothesis because storing fat is insurance against the future when you might not have food.”

Because their bodies don’t know when they can expect their next meal, the body holds onto fat — a more valuable fuel — and burns carbohydrates instead.

To determine how they metabolize food, participants will come to the UB clinic and briefly wear a calorimetry device to determine their respiratory quotient. The device is a mask outfitted with sensors that measure the concentration of carbon dioxide they exhale and the amount of oxygen they inhale, which corresponds to whether they are burning primarily fats or carbohydrates.

“Based on those data and additional information provided by the patients, we will develop a diet personalized to each participant’s metabolism,” Epstein says. “We will provide, for free, one month of three, premade meals per day tailored to their metabolism on a predictable schedule, along with plenty of education about healthy eating, behavioral factors and meal planning. We hope to be able to shift them from storing fat to burning fat.”

The study will last for six months, during which time participants will work closely with a counselor to develop health skills and strategies to support meaningful and lasting change. 

The trial is being funded as a translational pilot study by UB’s Clinical and Translational Science Institute. The CTSI Translational Pilot Studies Program, with local institutional support and an award from the National Institutes of Health’s National Center for the Advancement of Translational Sciences, provides seed money to advance promising new technologies and therapeutics from the conceptual stage to clinical trials.