Lack of access to nutritious food is negatively impacting the health of children and adults in the United States, and both healthcare providers and lawmakers need to step up to solve the problem, according to a position paper from the American College of Physicians (ACP), published on June 28 in the Annals of Internal Medicine.
“Strengthening access to good nutrition is a public health imperative, as we know that food insecurity is associated with worse mental and physical health, worse health outcomes, and an increased risk of diet-related illnesses and health conditions,” said the ACP’s president, Ryan Mire, MD, a practicing physician and an assistant professor of clinical medicine education at the University of Tennessee in Nashville, in a video statement accompanying the paper.
According to the paper, making sure that everyone is able to feed themselves a healthy diet, with dignity, is an important component of a just society, and the United States has a moral and public health imperative to address food insecurity.
What Is Food Insecurity?
In a food insecure household, members are uncertain of having enough food to meet their needs because there isn’t enough money or other resources necessary to acquire food. It’s estimated that about 1 in 10 households — 13.8 million — were food insecure at some point during 2020, according to the U.S. Department of Agriculture (USDA).
Food Insecurity Is Linked to Poor Health in Both Adults and Children
Diet-related conditions, such as diabetes, obesity, coronary artery disease, certain types of cancer, and nonalcoholic steatohepatitis have become some of the leading causes of morbidity, mortality, and healthcare expenditure in the United States, according to the Centers for Disease Control and Prevention (CDC).
Older people with food insecurity are at risk of lower nutrient intake, increased risk of depression, increased risk of chronic disease, such as diabetes, hypertension, and high cholesterol, and limitations on activities of daily living, the authors wrote. Nearly two out of three food assistance recipients have had to choose between paying for food and paying medical bills or medications within the past year.
Pregnant women are especially vulnerable to poor health outcomes due to food insecurity, an issue that has grown even more dire during the pandemic, according to a study published in April 2021 in the American Journal of Obstetrics & Gynecology. Increased risk of birth defects, poor birth outcomes, weight gain, gestational diabetes, and mental health problems are all associated with lack of access to healthy food during pregnancy.
In children, food insecurity is associated with a variety of health conditions, such as birth defects and anemia, and poor oral health and mental health, according to the paper. Lack of access to food is also linked to developmental delays, poor social skills, and poor academic performance, which can have downstream effects later in life.
Everyone Should Have Access to Healthy Foods
The ACP is a national organization of internal medicine doctors (primary care doctors), the second-largest physician group in the country, and the paper was written by the group’s Health and Public Policy Committee.
Before drafting the statement, the committee reviewed available studies, reports, and surveys related to food and nutrition insecurity from PubMed and Google Scholar between 1990 and 2022, as well as relevant news articles, policy documents, websites, and other sources.
The group affirmed “the need for all persons to have adequate access to healthful foods,” and urged policy makers to prioritize food insecurity and nutritional factors that influence health in future policies and budgets.
Improving Food Insecurity Means Removing Barriers to Food Assistance Programs
According to the authors, federal food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are falling short in many ways. The organization made specific recommendations, including the following:
- Congress should make sure nutrition assistance programs don’t have interruptions and do have consistent funding.
- The nutrition assistance program enrollment processes should be simplified, streamlined, and free of barriers, and greater efforts should be made to ensure that people who are eligible for these programs know about what’s available and how to get help.
These programs should encourage a healthy diet based on the latest science — that means a focus on nutrient-dense foods rather than highly processed calorie-dense foods. Because healthy foods such as whole grains, lean meats, and fresh fruits and vegetables are often more expensive, SNAP benefit levels should be increased and the benefit calculation formula regularly adjusted so that families can afford them, the authors wrote.
Food assistance should be able to be accessed by everyone, and that should include people who have mobility issues, disabilities, limited transportation options, or who live in “food deserts” with no good sources of affordable and healthy food, according to the recommendations.
Healthcare Providers Should Screen for Food Insecurity
Physicians and other medical professionals should make an effort to better understand and reduce the food insecurity experienced by their patients, the authors wrote.
To achieve that goal, validated screening tools for food insecurity need to be developed and should be a routine part of office and hospital visits. When a case of food insecurity is identified, healthcare providers should be able to refer patients to community and government resources.
Physicians cannot eliminate food insecurity on their own, said Dr. Mire. “These efforts need to be supported by governments, payers, and other stakeholders,” he said. In addition to the committee’s recommendations, there also need to be “big picture” changes to the food system that will require innovative and sustainable approaches, said Mire.