Featured article in the Spring 2016 Issue of Nutrition Close-Up; written by Clancy Cash Harrison, MS, RD, LDN
Nearly 50 million people in the United States can be classified as food insecure.1 This staggering number supports the need for healthcare professionals to actively fight against hunger. Healthcare professionals can improve their patients’ outcomes by working with community organizations to increase access to food.
The common visualization of hunger features children with bloated bellies, crying eyes, and skinny limbs. In the United States, food insecurity has a different face. Food-insecure patients can have normal growth patterns, and often have an overweight diagnosis. It is a face that hides an invisible epidemic. While some people with food insecurity lose weight due to malnutrition, many others are at risk for obesity because they consume high quantities of food that are low-cost, high-calorie, and nutrient deficient.2
Food is a fundamental requirement for survival. If the basic need for food is not met, a patient is unlikely to comply with medical advice or nutritional counseling. In most cases, patients believe it is more important for them to feed their family than pay for their own medication. To compensate for a food shortage, families reduce the size of their meals, and frequently go without food. They often prioritize food over electricity, rent, transportation, and medical expenses.3 If a diabetic patient chooses food over medication, or is skipping meals frequently, their blood sugar can be difficult to regulate.4
Food insecurity has been shown to affect many dimensions of people’s lives. Food insecurity with malnutrition places a patient at risk for poor health, which makes them more susceptible to disease and less able to fight it. Malnutrition also increases the risk for acute infections, stress, poor health, nutrient deficiencies, developmental delays, and mental health problems.5
While hunger impacts everyone’s health negatively, it crushes children. Nourishing food is critical to a child’s emotional health, mental development, and physical growth. Children facing hunger struggle with social and behavioral problems, impacting their ability to learn in school. They often have lower academic achievement, resulting in lower paying jobs as an adult. They are more likely to be hospitalized, and they have a higher risk for chronic health conditions such as obesity and anemia. These children also have an increased risk of depression and suicide.6
Healthcare professionals can fight hunger and improve their patients’ outcomes by screening for food insecurity using a validated 2-statement tool, The Hunger Vital SignTM. The prevalence of food insecurity necessitates that healthcare professionals in clinical settings, especially those in low-income communities, use this tool. The Hunger Vital SignTM uses statements about food insecurity to measure a family’s concern regarding their access to food. Patients answer by choosing “often true,” “sometimes true,” or “never true.” The two statements are:
- “Within the past 12 months we worried whether our food would run out before we got money to buy more.”
- “Within the past 12 months the food we bought just didn’t last and we didn’t have the money to get more.”
The screening questions should be discussed during each routine office visit. If a patient answers “often true” or “sometimes true” to one or both statements, the family is at risk for food insecurity.
Early identification, assessment, and nutrition intervention of malnourished individuals or individuals at risk for malnutrition are critical to improve patients’ medical outcomes. After a positive screening, a healthcare professional refers the patient to local public health professionals and community resources who can help with food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), school nutrition programs, and emergency food resources.
Curbing our nation’s food insecurity epidemic requires a multidisciplinary approach that involves collaboration between healthcare professionals and public health educators. Healthcare professionals empower patients to improve their health by teaching them the skills needed to gain access to food. Patients trust healthcare professionals, so it is up to these professionals to leverage this relationship in order to screen, diagnose, and discuss food insecurity with patients.
Clancy Cash Harrison, MS, RD, LDN is a food security advocate and the award-winning author of the “Feeding Baby” cookbook. Clancy provides parents with logical and affordable approaches for healthy eating and believes food should be fun, not stressful or complicated.
- United States Department of Agriculture, Economic Research Report 194. Household Food Security in the United States in 2014. Version current September 2015. Internet: http://www.ers.usda.gov/media/1896841/err194.pdf (accessed January 14, 2016) (Website)
- Food Research and Action Center. Connections: Food Insecurity and Obesity. Version current October 2015. Internet: http://frac.org/pdf/frac_brief_understanding_the_connections.pdf (accessed 11 January 2016). (Website)
- O’Malley JA, Beck AF, Peltier CB, et al. Revealing hidden hunger. Contemporary Pediatrics. 2013 Internet: http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/modernmedicine/welcome-modernmedicine/revealing-hidden-hunger (accessed 11 January 2016). (Website)
- Seligman HK, Jacobs EA, Lopez A, et al. Food insecurity and glycemic control among low-income patients with Type 2 Diabetes. Diabetes Care. 2013;35:233-238. (Journal article)
- Seligman HK, Laraia BA, Kushel MB, et al. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010; 140:304-310. (Journal article)
- No Kid Hungry. Child Food Insecurity: The Economic Impact on our Nation. Internet: https://www.nokidhungry.org/sites/default/files/child-economy-study.pdf (accessed 11 January 2016). (Website)