Food insecurity: How to recognize &amp; address it

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Applied Evidence

Food insecurity: How to recognize & address it

J Fam Pract. 2020 March;69(2):74-78,80-81

By

Lillian Amèzquita, BS

Paul George, MD, MHPE

Certain factors put different patient populations at risk. A 2-question survey can help identify families that are food insecure.

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PRACTICE RECOMMENDATIONS

› Consistently use the American Academy of Pediatrics 2-question survey to screen for food insecurity (all populations). A

› Identify and treat maternal depression during pregnancy and the postpartum period, and beyond A and screen for depression in older adults A because depression can reduce motivation to accomplish daily activities, such as obtaining and preparing food.

› Ask older adults about declines in performing activities of daily living C and how food is eaten or prepared . C

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

References

1. Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household Food Security in the United States in 2016, ERR-237. Washington, DC: US Department of Agriculture, Economic Research Service; September 2017. www.ers.usda.gov/webdocs/publications/84973/err-237.pdf?v=0. Accessed January 10, 2019.

2. Rose D. Economic determinants and dietary consequences of food insecurity in the United States. J Nutr. 1999;129:517S-520S.

3. Gundersen C. Dynamic determinants of food insecurity. In: Andrews MS, Prell MA, eds. Second Food Security Measurement and Research Conference, Volume II: Papers. [Food Assistance and Nutrition Research Report 11-2.] Washington, DC: US Department of Agriculture, Economic Research Service; August 24, 2001:92-110.

4. Kaiser LL, Townsend MS. Food insecurity among US children: implications for nutrition and health. Top Clin Nutr. 2005;20:313-320.

5. Nguyen BT, Shuval K, Bertmann F, et al. The Supplemental Nutrition Assistance Program, food insecurity, dietary quality, and obesity among US adults. Am J Public Health. 2015;105:1453-1459.

6. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140:304-310.

7. Laraia BA. Food insecurity and chronic disease. Adv Nutr. 2013;4:203-212.

8. Nackers LM, Appelhans BM. Food insecurity is linked to a food environment promoting obesity in households with children. J Nutr Educ Behav. 2013;45:780-784.

9. Ralston K, Treen K, Coleman-Jensen A, et al. Children’s food security and USDA child nutrition programs. Economic Information Bulletin 174. US Department of Agriculture, Economic Research Service. June 2017. www.ers.usda.gov/webdocs/publications/84003/eib-174.pdf?v=0. Accessed January 10, 2020.

10. US Department of Agriculture, Food and Nutrition Service. National School Lunch Program: community eligibility provision. April 19, 2019. www.fns.usda.gov/school-meals/community-eligibility-provision. Accessed January 10, 2020.

11. Kreider B, Pepper JV, Roy M. Identifying the effects of WIC on food insecurity among infants and children. South Econ J. 2016;82:1106-1122.

12. Garg A, Toy S, Tripodis Y, et al. Influence of maternal depression on household food insecurity for low-income families. Acad Pediatr. 2015;15:305-310.

13. Noonan K, Corman H, Reichman NE. Effects of maternal depression on family food insecurity. Econ Hum Biol. 2016;22:201-215.

14. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26-e32.

15. American Academy of Pediatrics Council on Community Pediatrics and Committee on Nutrition. Promoting food security for all children. Pediatrics. 2015;136:e1431-e1438.

16. Hamelin AM, Habicht JP, Beaudry M. Food insecurity: consequences for the household and broader social implications. J Nutr. 1999;129:525S-528S.

17. Gundersen C, Engelhard E, Hake M. The determinants of food insecurity among food bank clients in the United States. J Consum Aff. 2017;51:501-518.

18. Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. N Engl J Med. 2010;363:6-9.

19. Venci BJ, Lee S-Y. Functional limitation and chronic diseases are associated with food insecurity among U.S. adults. Ann Epidemiol. 2018;28:182-188.

20. Goldberg S, Mawn B. Predictors of food insecurity among older adults in the United States. Public Health Nurs. 2015;32:397-407.

21. Lee JS, Frongillo EA. Factors associated with food insecurity among U.S. elderly persons: importance of functional impairments. J Gerontol. 2001;56B:S94-S99.

22. Chang Y, Hickman H. Food insecurity and perceived diet quality among low-income older Americans with functional limitations. J Nutr Educ Behav. 2018;50:476-484.

23. Kamp B, Wellman N, Russell C. Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: Food and nutrition programs for community-residing older adults. J Nutr Educ Behav. 2010;42:72-82.

24. Cody S, Ohls JC. Evaluation of the US Department of Agriculture Elderly Nutrition Demonstration: Volume I, Evaluation Findings. Contractor and Cooperator Report No. 9-1. Washington, DC: US Department of Agriculture; July 2005.

25. US Department of Agriculture, Food and Nutrition Service; Office of Analysis, Nutrition, and Evaluation. Food stamp participation rates and benefits: an analysis of variation within demographic groups. May 2003. https://fns-prod.azureedge.net/sites/default/files/PartDemoGroup.pdf. Accessed January 10, 2020.

26. Russell JC, Flood VM, Yeatman H, et al. Food insecurity and poor diet quality are associated with reduced quality of life in older adults. Nutr Diet. 2016;73:50-58.

27. Pooler J, Levin M, Hoffman V, et al; AARP Foundation and IMPAQ International. Implementing food security screening and referral for older patients in primary care: a resource guide and toolkit. November 2016. www.aarp.org/content/dam/aarp/aarp_foundation/2016-pdfs/FoodSecurityScreening.pdf. Accessed January 10, 2020.

CASE Alice D is 20 years old and has type 1 diabetes, as well as retinopathy, hypertension, bipolar I disorder, and hyperlipidemia. She is a new patient at your clinic and reports that she is “occasionally homeless” and has difficulty affording food.

You renew Ms. D’s prescriptions during the visit, discuss nutrition with her, and order lab testing, including a test of hemoglobin A1C, a lipid panel, and a basic metabolic panel. You ask her to follow up in 1 week to discuss the test results and next steps in her care.

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According to a 2016 report from the US Department of Agriculture (USDA) Economic Research Service, an estimated 12.3% of households in the United States are “food insecure.”¹ To ascertain what food security and insecurity are, the USDA measured numerous variables, including household structure, race and ethnicity, geography, and income. The report of the Economic Research Service stands as one of the largest domestic sources of information about food insecurity.

Food insecurity is defined as “food intake of household members [that is] reduced and normal eating patterns that are disrupted.”¹It is often measured “per household,” but those data must be interpreted carefully because food insecurity affects household members differently. Some members, such as children, might be affected only mildly; adults, on the other hand, might be more severely affected. (Adults may, for instance, disrupt or skip their meals to maintain normal diets and meal patterns for their children.) In some households, food insecurity affects only a single member—such as an older adult—because of conditions unique to the people living in the home.

Adults may disrupt or skip their meals to maintain normal diets and meal patterns for their children.

In this article, we review variables that can give rise to food insecurity in children, adults, and the elderly, and offer strategies to the family physician for identifying and alleviating the burden of food insecurity in these populations.

Food insecurity threatens children’s health, development

In 2016, households with children faced a higher level of food insecurity (16.5%) than the national average (12.3%).¹ In a study of more than 280,000 households, food insecurity was sometimes so severe that children skipped meals or did not eat for the whole day.¹ Although income strongly correlates with food insecurity, evidence shows that families above and below the poverty line suffer from food insecurity.^2,3

According to the USDA, the rate of food insecurity is higher than the national average of 12.3% in several subgroups of children¹:

households with children < 6 years of age (16.6%)
households with children headed by a single woman (31.6%) or single man (21.7%)
households headed by a black non-Hispanic (22.5%) or Hispanic (18.5%) person
low-income households in which the annual income is < 185% of the poverty threshold (31.6%).

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