Household Food Insecurity Risk and Weight Status Outcomes in Early Childhood: A Public Health Perspective

Background: Household food insecurity (HFI), defined as the lack of reliable access to adequate food because of limited money or resources, may influence children’s nutritional status. This study aimed to examine the association between HFI risk, based on a single screening item, and underweight and obesity among kindergarten children in Nevada. Methods: Cross-sectional data from the Kindergarten Health Survey (KHS) collected across three school years (2022–2023, 2023–2024, and 2024–2025) were analyzed using a pooled sample of 7267 children. HFI risk was assessed using one item from the Hunger Vital Sign. Weight status was determined using Body Mass Index (BMI) guidelines from the Centers for Disease Control and Prevention (CDC). Descriptive statistics and multinomial logistic regression examined associations between HFI risk and underweight and obesity, adjusting for confounders. Results: Across the pooled sample, 16.3% were at risk for HFI, 16.0% were underweight, and 21.9% had obesity. In pooled analysis, HFI risk was associated with higher odds of obesity (Adjusted Odds Ratio [AOR] 1.29; 95% Confidence Interval [CI]: 1.05–1.59), but not underweight, compared with food-secure children. In year-specific analyses, higher odds of underweight were observed in 2023–2024 (AOR 1.74; 95% CI: 1.14–2.66) and 2024–2025 (AOR 1.58; 95% CI: 1.04–2.38). Conclusions: HFI risk was associated with obesity among kindergarten children in Nevada, while associations with underweight were observed only in certain school years and should be interpreted cautiously. These findings suggest HFI risk as an important early childhood health concern and support the need for nutrition support, family assistance, and longitudinal research.