Addressing Food Insecurity to Improve Physical, Mental Health Outcomes

Food insecurity is a significant public health concern that disproportionately affects marginalized communities, contributing to a range of health disparities. | Image Credit: dizain - stock.adobe.com

Food insecurity, rooted in socioeconomic disparities, compromises health through chronic diseases, mental health issues, and obesity, while existing support systems often prove inadequate, necessitating a multifaceted approach involving policy, community engagement, and improved food distribution to foster healthier communities.¹

Food insecurity is the household-level economic and social condition of limited or uncertain access to adequate quality of food. The United States Department of Agriculture (USDA) divides food insecurity between 2 categories, low food security and very low food security.

Various factors like income, employment status, race/ethnicity, and disabilities can influence food security and determine whether it is long-term or temporary. By 2020, 28.6% of low-income households were food insecure compared with the 10.5% national average. The same year, food insecurity prevalence was an estimated 21.7% among Black American households and an estimated 17.2% in Latino/Hispanic households.² Both of these percentages were higher than the estimated 13.5% prevalence.

Food insecurity is largely uncontrollable by the affected individuals, often determined by geographical location, income and assets, food prices, and directly limited access to healthy food choices.¹ Food insecurity is a national public health crisis because inadequate access to nutritious food can harm the health of many Americans and worsen existing food and nutritional insecurity, as well as other social factors affecting health.³

Food Banks and Supplemental Nutrition Assistance Programs (SNAPs) are proposed support systems for food insecure families but are not tailored to target the complex factors of everyone. Various supplemental support systems will be analyzed and propose approaches that will target more specific populations while offering healthier, nutritional options.

A Public Health Concern

Food insecurity is considered a public health issue for a multitude of reasons, especially because it directly correlates to a range of health problems.³ Individuals who experience food insecurity have increased risks of birth defects, anemia, lower nutrient intake, cognitive problems, asthma, and worse oral health.

Adults living in the US participated in a National Health and Nutrition Examination Survey between 1999 to 2014 and found food insecurity was linked to higher risk of all-cause and cardiovascular disease mortality.⁴ The survey results determined food insecurity as a factor that leads to higher prevalence of coronary heart disease.

While low income is only associated with hepatitis, arthritis, and chronic obstructive pulmonary disease, the CDC reported a total of 10 chronic diseases linked to food insecure individuals.⁵ In addition to the 3 conditions previously mentioned, hypertension/high blood pressure, coronary heart disease, stroke, cancer, asthma, diabetes, and chronic kidney disease are also linked to food insecurity.

Individuals who are food insecure are often impacted by more than 1 health comorbidity which exacerbates since these patients are likely underusing their prescription medication due to high costs. Reports of individuals who are food insecure have found they are unable to afford prescription medications based on costs and skip doses/take less doses to save money. A study of older adults living in Georgia who were food insecure found they were 3 times as more likely to engage in cost-related medication budgeting than those who were food secure.

Food insecurity can also negatively impact mental health and is linked to child behavioral issues.³ Children who lived in food insecure households were more likely to react aggressively as well as struggle with anxiety or depression.⁵ A longitudinal study on childhood health and food insecurity found episodes of food insecurity in kindergarten were linked to reports of compromised health in eighth grade.

Adequate access to safe and nutritious food enhances mental wellbeing by relieving stress and anxiety associated with food insecurity.⁶ Notably, older adult populations with both economic food insecurity and physical difficulties accessing food had lower quality diets and higher depression levels compared with those in economically secure houses. Socioeconomic factors play a significant role in food insecurity as well. For instance, unhoused individuals are at greater risk of poor mental health, further exacerbated by the challenges of accessing or affording nutritious food.

Speculation between the relationship of food insecurity and obesity was considered a counterintuitive paradox prior to research.⁷ Extensive frameworks have displayed the coexistence of food insecurity and obesity that are both impacted by social disadvantages and economic consequences. A study of an estimated 7930 US adults reported household food insecurity that linked them to being overweight or obese, primarily among mothers.

Another study included 66,553 adults across 12 states who found food insecure individuals had 32% greater chances of being obese compared with food secure individuals. Food insecurity and obesity exhibit a strong correlation, stemming from low income, limited access to nutritious food, and the stressors associated with poverty. Individuals who are food insecure are disproportionately impacted by cultural factors that impede the adoption and maintenance of healthful behaviors.

Support Systems and Solutions

Food assistance programs were created to reduce food insecurity while targeting populations with intersecting vulnerabilities.¹ The USDA provides funding for the National School Lunch Program (NSLP); Women, Infants, and Children (WIC) program; and SNAP. During the pandemic, SNAP benefits were increased but ended this year in 32 states. Over 30 million people have become more vulnerable to food insecurity due to this.⁸

Policymakers should also be required to update SNAP benefits to better serve the needs and health of food insecure individuals and households.³ Medical professionals should partake in screening patients for food insecurity, incorporate food insecurity education within appointments, and establish strategies for referring patients in need of community and government resources. Additional research should focus on better understanding prevalence, severity, and cost of food and nutrition insecurity as well as the impact this has on health care.

More densely populated regions usually have food banks, crucial for addressing food insecurity challenges.⁹ Food banks are responsible for collecting, storing, and distributing food through partnerships with grocery stores, farms, and other suppliers. Nutritional options in food banks range by the donors, with some aiming to include fresh fruits and vegetables. Food banks play a vital role in addressing food insecurity; however, pre-prepared food parcels often fall short of meeting nutritional needs.¹⁰ The adoption of adequate nutrition practices can improve food banks by increasing food variety, choice, and safety.

Food deserts, often located in geographically rural communities, lack sufficient grocery stores, healthier options are usually far distances, and oftentimes exist in areas with higher poverty rates populated with minority residents.¹¹ Stores primarily selling unhealthy, calorie-dense junk food are called "food swamps" due to limited access to nutritious options and are linked to obesity, particularly in areas with limited transportation and income inequality.

A multifaceted approach is required when addressing food insecurity and nutrition security. Recruiting community partners to address knowledge gaps between food access and intake is a potential local strategy to engage community members. Interventions among retail stores to promote healthy food placements while decreasing health food prices and applying junk food taxes could balance the food insecurity issues.

The USDA reported an average of 30% to 40% of our entire food supply is wasted despite millions of Americans struggling to provide food for their households.¹² Roughly 1 pound of food is wasted everyday by every individual living in the US, enough to feed about 2 billion people each year. In a highly developed country like the US, food insecurity has the potential to be fixed throughout society based on the abundance of resources.⁸

The consequences of food insecurity extend far beyond hunger, impacting physical and mental health, and contributing to a range of chronic diseases. Addressing this complex issue requires policy changes, improved access to nutritious food, and community-based interventions. By working together, we can create a future where everyone has the opportunity to live a healthy and fulfilling life, free from the burden of food insecurity.

References

1. Food insecurity. Office of Disease Prevention and Health Promotion. 2020. Accessed November 25, 2024. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity

2. Zenk SN, Tabak LA, Pérez-Stable EJ. Research opportunities to address nutrition insecurity and disparities. JAMA. 2022;327(20):1953-1954. doi:10.1001/jama.2022.7159

3. ACP says food insecurity is a threat to public health in the United States. American College of Physicians. June 27, 2022. Accessed November 25, 2024. https://www.acponline.org/acp-newsroom/acp-says-food-insecurity-is-a-threat-to-public-health-in-the-united-states

4. Sun Y, Liu B, Rong S, et al. Food insecurity is associated with cardiovascular and all-cause mortality among adults in the United States. J Am Heart Assoc. 2020;9(19):e014629. doi:10.1161/JAHA.119.014629

5. Gregory CA and Coleman-Jensen A. Food insecurity, chronic disease, and health among working-age adults. USDA. July 31, 2017. Accessed November 26, 2024. https://www.ers.usda.gov/publications/pub-details/?pubid=84466

6. Ejiohuo O, Onyeaka H, Unegbu KC, et al. Nourishing the mind: how food security influences mental wellbeing. Nutrients. 2024;16(4):501. doi:10.3390/nu16040501

7. Understanding the connections: food insecurity and obesity. Food Research & Action Center. October 2015. Accessed November 25, 2024. https://frac.org/research/resource-library/understanding-connections-food-insecurity-obesity

8. Food insecurity: a neglected public health issue requiring multisectoral action. BMC Med. 2023;21(130)1-2. doi:10.1186/s12916-023-02845-3

9. Food for people: how to combat food insecurity. Convoy of Hope. January 31, 2024. Accessed November 26, 2024. https://convoyofhope.org/articles/food-for-people/

10. Oldroyd L, Eskandari F, Pratt C, Lake AA. The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review. J Hum Nutr Diet. 2022;35(6):1202-1229. doi:10.1111/jhn.12994

11. Food accessibility, insecurity and health outcomes. NIMHD. July 3, 2024. Accessed November 26, 2024. https://www.nimhd.nih.gov/resources/understanding-health-disparities/food-accessibility-insecurity-and-health-outcomes.html

12. Phillips J. Reducing food waste can help address food insecurity. US News & World Report. October 22, 2019. Accessed November 26, 2024. https://www.usnews.com/news/healthiest-communities/articles/2019-10-22/commentary-the-link-between-food-waste-and-food-insecurity