Food Insecurity and Health Outcomes

Dr. Ankit Rohatgi

Dr. Ankit Rohatgi

Food Insecurity and Health Outcomes

Food is essential to human health and well-being. However, millions of people worldwide suffer from food insecurity, which means they do not have access to enough healthy food to maintain an active and healthy life. The concept of food as medicine recognizes that food can be used not only to satisfy hunger but also to promote health and prevent disease. Food insecurity and lack of access to affordable nutritious food are associated with adverse health outcomes and pose an enormous burden of diet-related chronic diseases such as Diabetes, Obesity, Cardiovascular diseases, Hypertension, and Hyperlipidaemia.

Food insecurity also appears to be strongly correlated with diabetes, which is highly sensitive to diet, whereas hypertension and hyperlipidaemia are highly sensitive to medication adherence. Diabetes increases the risk of food insecurity, often due to out-of-pocket healthcare expenditures associated with chronic diseases and their management. The co-existence of food insecurity and diabetes, therefore, has a major implication for the sustainability of healthcare systems. Food insecurity among children has adverse health effects, including a higher incidence of iron-deficiency anaemia, acute and chronic illnesses, and developmental and mental health conditions. 

Individuals from racial and ethnic minorities and financially burdened populations experience the ill effects of diet-related ongoing sicknesses and may have restricted assets to deal with their illnesses. In 2021, 10.2% (13.5 million) of households in the United States were food insecure, with children's families accounting for almost 12.5%. In 2021, 20% of Black/African American households, 16% of Hispanic/Latinos households, and 7% of White households experienced food insecurity.

Food insecurities are predominantly influenced by the local environment, including neighborhood infrastructure, accessibility, and affordability barriers. Geographical areas that lack access to affordable and healthy foods such as fruits and vegetables are known as a food desert.

Food deserts are typically found in:

Urban or suburban neighborhoods that lack grocery stores that offer healthy food options. In rural areas and neighborhoods, the nearest grocery stores are too far away to be convenient or accessible. Neighborhoods that have racial or ethnic minority residents, lower income residents, people with lower levels of education and higher rates of unemployment.

Roughly 30 million people in the United States live more than one mile away (10 miles in non-metropolitan areas) from large grocery stores.

Areas which are overwhelmed with stores that sell unhealthy and inexpensive foods, including snacks, junk food, canned food with a high level of preservatives, high fructose ingredients and foods are known as food swamps. These food swamps provide easier access to unhealthy foods, especially in communities where residents have limited access to their own or public transportation and experience the greatest income inequality.

Food as Medicine:

Food as medicine is a concept that recognizes the power of food to promote health and prevent disease. By choosing nutrient-dense foods and avoiding foods that are high in sugar, salt, and unhealthy fats, individuals can reduce their risk of developing chronic diseases and improve their overall health.

In the context of food insecurity, food as medicine can be an essential tool for improving health outcomes. By providing access to nutrient-dense foods, individuals who are food insecure can improve their health and reduce their risk of developing chronic diseases. This approach to addressing food insecurity focuses not only on providing enough food but also on providing the right types of food.

Nutrient-Dense Foods:

Foods that contain many essential nutrients, like vitamins, minerals, and fiber, per calorie are called "nutrient-dense." American Heart Association recommends nutrient-dense diet rich in fruits, vegetables, whole grains, legumes, low-fatty dairy, and plant based or lean animal protein.

By providing access to nutrient-dense foods, individuals who are food insecure can improve their health outcomes. Programs such as Supplemental Nutritional Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provide financial assistance to low-income families to help them access nutritious foods. Community-based programs such as food cooperatives and farmers' markets can also provide affordable access to nutrient-dense foods.

Although it’s well known that food insecurity is a strong predictor of high-cost healthcare use, healthcare providers often lack effective strategies to address it. Healthcare systems are increasingly implementing food insecurity screening as a part of standard care and utilizing clinic-linked resources and food prescription programs as potential ways to improve outcomes for patients identified by healthcare screening. 

These programs may reduce food insecurity, A1c, hypertension, and body mass index (BMI), as well as improve diet quality and self-reported health, according to preliminary research from a number of studies. According to a recent modelling study that was published in 2019, the National Healthy Food Prescription Incentive Program in the United States has the potential to significantly reduce healthcare costs by $100 billion if implemented over the beneficiaries' lifetimes.

Partnerships and Innovation:

Many healthcare systems are venturing new partnerships to expand ‘food as medicine’ services. e.g., Boston Children’s Hospital has recently launched a virtual pharmacy with help of Instacart Health, Care Carts. As a part of this program, Instacart will deliver provider-selected food to patients with certain dietary needs. Other partnerships include digital platform Good Measures with WellCare of Kentucky, About Fresh with Veterans Health, food solution and care management platform NourishedRx with health plans and digital nutrition services such as Foodsmart.

Major knowledge gaps remain in understanding the cost-effectiveness of these programs over longer-term as well as optimal implementation strategies. While access to a healthy diet and healthy dietary habits have been shown to improve health outcomes, equally important is the combination of diet with lifestyle changes, commitment and engagement to the treatment plan and medication compliance and adherence. 

At AssureCare, we make it our mission to provide a 360 view of a patient’s health and wellness journey. Equipping care providers with the population health management tools they need to address every aspect of a patient’s healthcare needs, including nutrition, can help to improve outcomes.

Dr. Ankit Rohatgi

Dr. Ankit Rohatgi

Chief Clinical Officer, MD

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