A Clinician's Guide to Food Security

Food Security and Health
How to Screen for Food Insecurity
How to Help Patients with Food Insecurity
About the Author
References

I.Food Security and Health

Links between food security and health are well-established both for children and adults. Though there is overlap with other social factors like poverty, not all poor people are food insecure, and some people above the poverty line are food insecure. As of 2007, over 36 million people in the US were food insecure, and about a third of those were children.

(Graphic from USDA: http://www.ers.usda.gov/briefing/foodsecurity/stats_graphs.htm#geographic)

     A. How does food insecurity affect children?

  • Food insecurity has been tied to low-birthweight[1] and iron deficiency;[2]
  • Food insecurity has been associated with lower parent or self-reported health;[3]
  • Food insecurity has been associated with increased hospitalizations and higher costs of care for children;[4]
  • Food insecurity (without hunger) has been linked with childhood overweight and obesity, though studies are controversial;[5]
  • Food insufficiency has been linked to cognitive, socio-emotional and behavioral problems in school-aged children.[6]

     B. How does food insecurity affect adults?

  • Hunger and malnutrition exacerbate chronic and acute diseases in the elderly, and worsen ability to meet ADLs;[7]
  • Hunger has been found to contribute to increases in the cost of health care for adults;[8]
  • Food insecurity has been linked to overweight, particularly in women;[9]
  • Food insecurity has been linked to poor adult health status.[10]

II.How to screen for food security?

There are multiple formats for food security screening, whether on paper, computer or in person. And the range of questions/screening forms can sometimes be overwhelming. A few ways to assess for food security are listed below. Don’t let perfect be the enemy of good. A study conducted in Boston showed that families are open to discussing social needs in clinical health settings.[11] Asking about food security with even one question about food security can help a family receive resources that they really need. The question can be as simple as “In the past month, was there any day when you or anyone in your family went hungry because you did not have enough money for food?” [12] But there are ways to collect more nuanced information about food security.[13]

The table included below was retrieved from the report by John Cook and Karen Jeng, Child Food Insecurity: The Economic Impact on our Nation,[14] and is also available through the USDA.

III.How do I help a patient who is food insecure?

This is ultimately the point of screening for food security. The answer to this question depends on what your clinical resources are, and actions can range in time and resource intensity according to your clinic’s capacity.

Consider making referrals to:

  • Local food pantries;
  • Senior meals programs;
  • Social work or case management staff;
  • WIC office;
  • Human Services Agency for School Meals, Food Stamps or Emergency Food Programs

Also consider an evaluation for how this food insecurity may affect the patient’s physical and mental health or the health of family members.

For more information, check out the Massachusetts-based Project Bread’s report at:

http://www.projectbread.org/site/DocServer/09_81_Hosp_Handbk_Rev2_FNL.pdf?docID=5401

Other resources include those from the footnotes below, and:

http://mchb.hrsa.gov/whusa09/popchar/pages/105fs.html

IV. About the Author

Laura Gottlieb, MD MPH is Asst. Professor of Family and Community Medicine at the University of California, San Francisco and co-founder of HealthBegins. She completed fellowship training in the social determinants of health with the RWJ Foundation's Health and Society Scholars Program at UCSF and UC Berkeley.


References

[1] Borders AEB, Grobman WA, Amsden LB, Holl JL. Chronic Stress and Low Birth Weight Neonates in a Low-Income Population of Women. Obstetrics & Gynecology, 2007; 109: 331-338.

[2] Skalicky A, Meyers, AF, Adams WG, Yang Z, Cook JT, Frank DA. Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States. Maternal and Child Health Journal, 2006 Mar; 10(2): 177-184.

[3] Cook JT et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr, 2004 Jun; 134(6):1432-8.; Casey PH et al. J Nutr. 2004;134[6]:1432-1438)

[4] Casey PH et al. J Nutr. 2004;134[6]:1432-1438

[8] Hadley C et al. Hunger and Health Among Undocumented Mexican Migrants in a US Urban Area, Public Health Nutrition, 2007; Lee JS and Frongillo EA. Nutritional and Health Consequences Are Associated with Food Insecurity among US Elderly Persons.The Journal of Nutrition, 2001; Nelson K, Cunningham W, Andersen R, Harrison G, and Gleberg L. Is Food Insufficiency Associated with Health Status and Health Care Utilization Among Adults with Diabetes? Journal of General Internal Medicine, 2001.

[9] Townsend MS, Peerson J, Love B, Achterberg C, Murphy SP. Food Insecurity is Positively Related to Overweight in Women. J Nutr, 2001; 131: 1738-1745.

[10] Stuff JE et al. Household Food Insecurity is Associated with Adult Health Status. J Nutr, 2004; 134: 2330-2335.

[11] Lawton E, Leiter K, Todd J, Smith L. Welfare reform: advocacy and intervention in the health care setting. Public Health Rep. 1999 Nov-Dec;114(6):540-9.

[12] Kleinman et al. Use of a single-question screening tool to detect hunger in families attending a neighborhood health center. Ambul Pediatr. 2007 Jul-Aug;7(4):278-84.

[13] Tscholl E and Holben DH. J Am Acad Nurse Pract. 2006;18[7]:335-342; Holben DH and Myles W. Am Fam Physician. 2004;69[5]:1058-1060.

[14] Cook J and Jeng K. Child food insecurity: the economic impact on our nation. A report on research on the impact of food insecurity and hunger on child health, growth and development commissioned by Feeding America and The ConAgra Foods Foundation. Feeding America 2009. http://feedingamerica.org/SiteFiles/child-economy-study.pdf

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Comment by Muntu Davis on July 28, 2013 at 4:33pm

This is great. Doctors do not have to know where all of the resources to help with food security are. Local public health and social services departments can and do make these connections daily. understanding how your local county and city departments help residents would help. 

Comment by Rishi Manchanda on January 30, 2012 at 8:31pm

awesome!

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