Food insecurity, obesity, and lifestyle in Spanish food aid recipients

Background: Food insecurity (FI) is increasingly recognized in high-income countries and is associated with poor diet quality and non-communicable diseases. However, limited data exist on the health profiles of individuals receiving food aid in Spain. Objectives: To examine the relationship between FI, obesity, and hypertension in food bank users, and to assess the associations of FI with adherence to the Mediterranean Diet (MedDiet) and physical activity (PA). Methods: A cross-sectional study involving 115 adults receiving food assistance in Lleida, Spain. Data were collected through validated questionnaires (HFIAS, MEDAS-14, IPAQ) and direct anthropometric and blood pressure measurements. Multivariable logistic regression identified factors associated with FI. Results: FI affected 81.7% of participants. Compared to food-secure individuals, those with FI had a higher prevalence of hypertension (28.7% vs. 4.8%, p = 0.021), lower adherence to the MedDiet, and low PA levels. Obesity prevalence was higher than 30% and similar across groups. In multivariable analysis, FI was independently associated with low physical inactivity (Odds ratio = 5.310, 95% Confidence Interval 1.561–18.064) and lower MEDAS score (OR = 0.666, 95%CI 0.453–0.979). However, no consistent association between FI and obesity, whether assessed by BMI or by estimated body fat percentage, was observed. Conclusions: In a context of socioeconomic vulnerability, participants with FI exhibited lower levels of physical activity and poorer adherence to MedDiet. This coexistence of FI with unfavourable lifestyle indicators highlights the complexity of health determinants among food aid recipients.