Adults: Poor financial health correlates with insecurity
The correlation between food insecurity and income is strong—evidenced by the spike in the number of adults who reported food insecurity during the 2008-2011 recession in the United States, to a high of 14.9%.1 As noted, households with children are more likely to report food insecurity. In addition, studies show that limited resources, race and ethnicity, underemployment or unemployment, and high housing costs are also strongly associated with food insecurity.16 Even subtle economic fluctuations—for example, an increase in the price of gasoline, natural gas, or electricity—contribute to food insecurity.17 Debt and coping mechanisms influence whether a household living below the poverty line is food-secure or food-insecure. Additional factors contributing to food insecurity include participation in SNAP, education, and severe depression.
Food insecurity in adults reduces the quality of food and nutritional intake, and is associated with chronic morbidity, such as type 2 diabetes, hypertension, and obesity.5-7 Adults in food-insecure homes are more likely to purchase cheap, calorie-dense, nutritionally poor foods (or refrain from purchasing food altogether, to pay other debts).17,18 The literature further suggests that food insecurity is associated with diseases that limit function and lead to disability, such as arthritis, stroke, and coronary artery disease, in adults and older adults (> 65 years of age; see the next section).5,6,19 These studies are weak, however, in their ability to show directionality: Does food insecurity cause disability or does disability cause food insecurity?
Patchwork of programs. Programs such as WIC are available for women who are pregnant or have children < 5 years of age. Federal programs for adults who do not have children are scarce, however, and the burden of food insecurity for this population is typically addressed by local programs, such as food banks and food kitchens. Evidence shows that (1) combining the efforts of federal and local food programs is the most effective method of stymieing food insecurity in adults and (2) it would benefit food-insecure adults to have access to such programs. Regrettably, many food programs are underutilized because of barriers that include poor outreach, ineffectual application, and ineligibility.
What you can do. Although it might not be an official, professional society guideline to include questions about food security in a patient wellness survey, physicians should consider creating one for their practice that they (or the office staff) can administer. Furthermore, physicians (or, again, the office staff) should familiarize themselves with programs in the community, such as SNAP or a food bank, to which they can refer patients, as needed.
CASE You ask the nurse–care manager to consult with staff of the food bank and request that, based on your evaluation and recommendation, Ms. D be given more protein-based foods, including peanut butter and beans, when she visits the food bank. The nurse–care manager also makes arrangements to procure an insulin pump for Ms. D.
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