Ethical considerations for addressing the food insecurity and obesity paradox: Reconceptualizing "vulnerability," "resiliency," and "agency" and the importance of "place" in the praxis of public health interventions

Increasingly in the U.S. and globally, adults and children living in low-income households are at a high risk of experiencing both food insecurity and obesity. The obesity/hunger paradox that has emerged shares common structural determinants of health, including poverty, income inequality, unemployment, poor housing conditions, gender inequality, race/ethnicity status, lower education levels, and restricted access to healthcare and diverse dietary food systems.  Several studies propose hypotheses and conceptual frameworks describing this link and health consequences.  A growing body of research suggests that food insecurity and obesity experienced together can have a devastating impact on dietary habits and behaviors and, subsequently, on individual health and socioeconomic outcomes within households that are already functioning under multiple resource constraints.  However, there is very limited research to understand the dynamics by which food insecurity can lead to obesity and resulting health disparities. In this paper, we reflexively draw upon our primary fieldwork experiences with indigenous, rural, and urban populations in both domestic and global spheres to discuss key ethical obligations in public health research. Specifically, we underscore the importance of reframing the “vulnerability,” “resiliency,” and “agency” of, as well as the importance of “place” for, research participants by including their voices in defining what it means to be “vulnerable,” along with the self-recognition of coping strategies to address “vulnerability” as they experience it in their everday lives.  Do we as public health researchers have an ethical obligation to frame obesity and food insecurity paradox as an “everyday vulnerability” without medicalizing this biocultural condition?  We conclude with recommendations for designing, implementing, and evaluating public health interventions that address the food insecurity and obesity paradox and seek to transform the underlying structures that support it.