Food Insecurity: Public Health Implications

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Food Insecurity Public Health Implications

• Wendy L. Johnson-Askew, Ph.D., MPH, RD
• NIH, Division of Nutrition Research Coordination

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Food Insecurity

• Having Limited or uncertain availability of
  nutritionally adequate and safe food or limited
  or uncertain ability to acquire acceptable foods
  in socially acceptable ways. (Life Sciences
  Research Office)

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Categories of Food Security

• High food securityHouseholds had no problems, or
  anxiety about, consistently accessing adequate
  food
• Marginal food securityHouseholds had problems at
  times, or anxiety about, accessing adequate food,
  but the quality, variety, and quantity of their
  food intake were not substantially reduced
• Low food securityHouseholds reduced the quality,
  variety, and desirability of their diets, but the
  quantity of food intake and normal eating
  patterns were not substantially disrupted
• Very low food securityAt times during the year,
  eating patterns of one or more household members
  were disrupted and food intake reduced because
  the household lacked money and other resources
  for food.

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Categories of Food Insecurity

• Least severeWas this statement often,
  sometimes, or never true for you in the last 12
  months? "We worried whether our food would run
  out before we got money to buy more."
• Somewhat more severe Was this statement often,
  sometimes, or never true for you in the last 12
  months? "We couldn't afford to eat balanced
  meals."
• Midrange severity In the last 12 months, did
  you ever cut the size of your meals or skip meals
  because there wasn't enough money for food?
• Most severe In the last 12 months, did you ever
  not eat for a whole day because there wasn't
  enough money for food?In the last 12 months,
  did any of the children ever not eat for a whole
  day because there wasn't enough money for food?

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Faces of the Food Insecure
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The face of food insecurity

• As of 2007, 37.3 million adults and 12.4 million
  children lived in food insecure households
• As of 2007, 1.7 million seniors lived in food
  insecure homes
• Current (2007) rate of food insecurity for
  children was 16
• In 2004, 24 million adults and 14 million
  children (13.5 million households)

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The face (contd)

• 39.8 non Hispanic White
• 37.9 non-Hispanic Black
• 4.5 American Indian or Alaskan native
• 17.4 Spanish, Latino or of Hispanic descent or
  origin
• 42.6 of those served live in rural/suburban
  areas
• 57.4 of those served live in urban areas

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Missouri Statistics

• 18 of children live in homes that have income
  100 below the poverty threshold
• 2001-2003 10.4 of households were food insecure
  
• 2004-2006 12.3 of households were food insecure
• 15.9 rate of food insecure children 2003-2005
• www.ers.usda.gov
• Listed by FRAC as one of the top 10 states in
  rates of food insecurity

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How do people cope?
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Hunger in America 2006(Americas 2nd Harvest)

• 1.2 million pantry household visits per week
• 21.7 to 24.7 million people served annually by
  the pantries
• 1.8-2.0 million people served annually by the
  kitchens
• 1.3 to 1.4 million served by shelters
• 12 of those served live in rural areas
• 9 of those served live in suburban areas

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PUBLIC HEALTH IMPLICATIONS
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Can those who are obese be hungry?
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Obesity in the US

• Nearly two thirds of US adults are overweight
  (BMI ? 25), and over 30 are obese (BMI ? 30)
• 18 of children 6-11 and 17 of adolescents 12-19
  are overweight
• 147 billion/year in economic costs (2000 data)

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Prevalence of Disease and Conditions Due to
Obesity
Sleep apnea5 Type 2 diabetes1 Gallbladder
disease1 Asthma4 Hypertension2 Coronary heart
disease (CHD)1 Osteoarthritis3 Breast
cancer1 Uterine cancer1 Colon cancer1
95 61 30 2540 25 17 14 11 11 11
1Wolf AM, Colditz GA. Obes Res. 1998697.
2American Health Foundation Roundtable on Healthy
Weight. Am J Clin Nutr. 199663(suppl)4095.
3Camargo CA Jr et al. Arch Intern Med.
19991592582. 4Gelber AC et al. Am J Med.
1999107542. 5Suratt PM, Findley LJ. N Engl
J Med. 1999340881.
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Calculating BMI

• Wt (lbs) X 703/ ht (in)/ ht (in)
• What does your BMI say about you

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Obesity Classificationfor Adults
Overweight BMI gt 25 kg/m2 Obesity
BMI gt 30 kg/m2

• Obesity
• BMI Class
• 25.0 29.9 Overweight
• 30.0 34.9 Obesity I
• 35.0 39.9 Obesity II
• gt 40.0 Extreme Obesity III

NHLBI Guidelines, June 1998
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Obesity Trends Among U.S. AdultsBRFSS, 2008
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
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Hunger and Obesity

• First highlighted in a case study by Dr. Bill
  Dietz, Director for the Division of Nutrition,
  Physical Activity and Obesity at the CDC
• Plethora of research

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Research Findings

• Women are more often affected and not men
• Relationship shows up in cross sectional studies
  only
• No clear relationship has emerged for children.
• Persons who are food insecure and receive food
  stamps are more likely to be obese than people
  who are food insecure and not receiving food
  stamps
• Variability in the findings also reflect
  measurement variability
• Level of poverty is predictive of this phenomena
• Is food insecurity a mediator of the poverty
  obesity relationship?

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Theories being Proposed

• Role of participation in food stamps programs etc
  (contribution to Feast or Famine Eating Pattern)
• Lower consumption of fruits and vegetables and
  higher consumption of fruits and vegetables
• Socioeconomic disadvantage in childhood
• Related stress
• Poverty

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Research Gaps

• Are there methodologies that allow us to have
  better understanding of the food environment and
  its impact on human behavior?
• Is there a need to restructure food assistance
  programs?
• Should we control for food assistance program
  participation in addition to poverty in obesity
  studies?
• How do we identify the socioeconomic phenotypes
  that are predisposed to this phenomena?
• Will newer approaches to research be helpful in
  explaining the phenomena?
• Are there ways to measure longitudinal stress?

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Other Adverse Health Outcomes

• Undernourished children have learning delays
• Undernourished pregnant women are more likely to
  have low birth weight infants or to have infants
  that do not survive
• Exacerbation of chronic diseases
• Increase in illness

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Suggestions for Intervention

• Recognize hunger as a public health problem
• Regularly screen for hunger
• Develop partnerships with social services and
  readily make referrals
• Work with faith based agencies to assist with the
  identification and appropriate treatment of
  hunger

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Federal Programs

• Supplemental Nutrition Assistance Program (SNAP)
• The Emergency Food Assistance Program (TEFAP)
• Commodity Supplemental Food Program (CSP)
• National School Lunch Program (NSLP)
• Commodity Assistance to Child Nutrition Programs
• School Breakfast Program
• Summer Food Service Program
• Special Supplemental Nutrition Programs for Women
  Infants and Children (WIC)
• Temporary Assistance to Needy Families
• Special Milk Program

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Local Faith-Based Organizations and Non-profit
are carrying the brunt of this problem and they
need help
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Want to know more?

• Food Research and Action Center
  (http//www.frac.org/)
• Feeding America (Americas Second Harvest,
  http//feedingamerica.org )

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Bottom Line

• Food security for all
• Improved food quality for all
• Greater appreciation for the role of stress
• Increase understanding of the roles of food and
  physical activity to a healthy life style

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Thank you

• Questions?