Abstract Body: Background: Food insecurity has been consistently linked with obesity in adults, but research findings have been less conclusive among adolescents. Previous studies have suggested that food insecurity places adolescents at a higher risk for adverse health outcomes, with obesity being a significant concern.

Objective: To examine the relationship between baseline household food insecurity and adiposity changes over two years among Louisiana adolescents aged 10 to 16 in the Baton Rouge, Louisiana metropolitan area.

Methods. Multilevel longitudinal data were collected from June 2016 to August 2018 during baseline and follow-up assessments conducted within the Translational Investigation of Growth and Everyday Routines in Kids study. Adolescent adiposity and body composition data were obtained using body imaging (i.e., dual-energy X-ray absorptiometry and abdominal magnetic resonance imaging) and anthropometric measures at baseline and follow-up. Multivariable multilevel linear regression models, adjusted for demographic and physiological variables, assessed the relationship between baseline household food security status and changes in adiposity outcomes.

Results. The analytic sample consisted of 216 adolescents with a mean age of 12.9±1.9; 47.7% were male, 40.7% identified as African American or Hispanic, and 38.4% had obesity at baseline. Twenty-two percent of the sample reported food insecurity at baseline. Compared to food-secure adolescents, food-insecure adolescents experienced significantly larger increases in all adiposity measures between baseline and follow-up (percentage of the 95th BMI percentile: b=7.3, p<0.01; waist circumference: b=3.9, p<0.05; total body fat percentage: b=3.2, p<0.01; and abdominal visceral adipose tissue: b=0.2, p<0.01). Similar results were found among girls; however, among boys, only change in abdominal visceral adipose tissue was higher in food insecure vs food secure boys (b=0.2, p<0.05).

Conclusion. This study provides support for the longitudinal association between household food insecurity and increased adiposity in adolescents, with notable gender differences. The main findings show household food insecurity is associated with greater changes in adiposity among girls than boys. These findings underscore the importance of addressing food insecurity as part of comprehensive obesity prevention strategies. Moreover, they highlight the need for gender-specific approaches in tackling this complex public health issue.