Student Submission – Food Insecurity and its Effects on Health

This paper is the second of two posts in a new biannual  series comprised of undergraduate student submissions. 

We received student submissions from Dr. Tiffany Linton Page’s sociology of race and ethnicity class at UC Berkeley. Each submission brought a unique perspective to hunger. As a result, Food First will open a special program featuring undergraduate student submissions, published biannually in September and March of each year. We are interested in publishing student pieces written in English or Spanish that rigorously investigate and research the facts of hunger and its underlying mechanisms, and especially those that provide original thought and new insight into hunger and the injustices which cause it. We encourage students to include their own experiences and identities in their writing. To submit for our upcoming March 2017 series, please email your .doc to Food First Publications and Communications Coordinator Ahna Kruzic at akruzic(at)foodfirst.org by December 31st, 2016. 

The 1996 World Food Summit summarized the importance of food security as “all people, at all times, [having] physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”.[1] However, since 2008, food insecurity has increased from previous years in the United States, especially in African American and Hispanic households.[2] As of 2014, 48 million Americans (14%) were living in food insecure households.[3] Further, in order for individuals to be recognized as food secure, they must not only meet the suggested 2,000 calorie intake, but must also consume a diverse and nutritious diet to support a healthy lifestyle.

Growing up as an Afghan American immigrant, I quickly realized that my upbringing and my background was surprisingly similar to those around me in the Bay Area. One would think that Afghanistan, an impoverished country, could not possibly resemble such a country like the US. However, I noticed that both in Afghanistan and in the Bay Area where I now reside, food scarcity was seemingly linked to illness. I hypothesized that food insecurity stems from poor socioeconomic conditions, ultimately resulting in health deficiencies in vitamins and minerals. This in turn produces chronic illnesses such as obesity, which can then cause diabetes and other physical and psychological distresses that can impact households and lifestyles.

In this brief, I will first explore the official definition of food insecurity, and then I will describe its implications on a whole host of illnesses – which can create a cycle of medical adversities. After, I will discuss the implications of food insecurity for lesser-researched demographics, such as various geographical, racial, gender, and age groups. By making observations as to what the underlying causes of food insecurity and its associated medical illnesses, we may become one step closer to resolving them.

The Food Security Summit categorizes food security in four distinct categories, creating checklists to help individuals address and assess their food security needs.[4] One factor of food security is the physical availability of food – whether there is enough food in the markets, and whether there is constantly a reliable and adequate amount. The next factor of food security focuses on the economic and physical access of nutritional food and whether individuals have sufficient resources, for instance, a car, to obtain food. Since the 1970s, supermarkets have followed wealthier Americans, away from rural and low income areas, and into more modern and middle class suburbia, making it less accessible for many Americans to find fresh and healthy foods.[5] Further, food utilization refers to whether individuals understand and have the basic knowledge of how to use the food they purchase, such as how to best retain the nutrients of the specific food. Lastly, the category of stability is whether an individual is able to consistently acquire healthy food for a long period of time.[6] Many people do not fulfill one or more of these categories and thus face outcomes and circumstances that affect their health and the health of their communities.

With different manifestations of food insecurity arise different health impacts that are directly or indirectly associated with lack of food. Hunger is a result of food insecurity; individuals use various compensatory alternatives to avoid this consequence of food insecurity. As a result of inadequate money, especially amongst large households, individuals obtain their caloric intake through low-cost, energy heavy and nutrient lacking foods.[7] These foods tend to be filled with added sugars, extraneous fats and sodium as well as refined carbs and are less costly per calorie than fresh fruits, vegetables and healthy and nutritious consumption.[8] For instance, $1 potato chips contain 1,200 kilocalories, whereas $1 yields only 250 calories for a small bag of carrots.[9] Thus, these low-cost, low-nutrient, and high-energy foods are a substitute for individuals’ and families’ intake of proper calories; however, it comes with chronic health costs. These health costs are related to obesity, a disease that can trigger other illnesses, which can stem from poor socioeconomic conditions as these individuals are more at risk and vulnerable to inadequate resources.[10]

When food becomes scarce, individuals often overeat when in the presence of food, which results in weight gain as eating habits and food intake fluctuates.[11] In a sample of 2,000 individuals in 36 counties in Mississippi, Arkansas and Louisiana, 22% were food insecure. 35% of the population was obese, half of the population was female, and black and between the ages 18 and 44 years of age.[12] Adult obesity was significantly higher among food insecure adults than among food secure adults with incomes of greater than $30,000 per year.[13] Therefore, in the presence of food insecurity, income became a predictor of obesity. This suggests that individuals resort to low cost foods which are heavy in fat but light on the wallet.

Further, in a study conducted in Californian women, it was discovered that Asians, Blacks and nonwhite Hispanics had the greatest risk of obesity, with nonwhite Hispanic women being 36% more likely to be obese than those who were food-secure.[14] This study indicates that low-income people of Color, whom are the most food insecure, also have high obesity rates. Therefore, the substitution of healthy foods to unhealthy food as a result of socioeconomic conditions correlates with obesity due to more vulnerability to unhealthy food options, as these foods are cheaper and easily obtainable.

Obesity can be a risk factor for other chronic illnesses such as diabetes, hypertension and coronary heart disease. Diabetes is one of the examples that can be illustrated with significant and abundant data, proving just how much food insecurity can impact its growing numbers. Overall, 29 million Americans are diabetic, an increase from 26 million in 2012, while another 86 million are pre-diabetic.[15] In California specifically, among adults ages 50 to 64, the prevalence of diabetes in Hispanics is 22%, 16% among African Americans, and 8% among Whites.[16] Further, out of a 711 Latinos, African Americans and white participants, and after controlling for demographics and other risk factors, a study reported 28% of the sampled population reported to have 1 or more severe hypoglycemic episode in the previous year, and 9.4% reported to have had 4 or more hypoglycemic episodes. These numbers remained significant even after adjusting demographics and other factors, illustrating the association between food insecurity and diabetes.[17]

Research suggests that food insecurity is correlated with developmental, psychological, and physical impairments of children. For example, a research study found homeless youth lacked Vitamin D, folate, and other significant requirements for a nutritious lifestyle.[18] Further, research suggests that infants developmental health is correlated with food security; malnourished 9-month-old infants had lower mental proficiency levels at 24 months of age, independent of all other factors.[19] Researchers believe this is due to insufficient micronutrients as well as anxiety and stress pertaining to socioeconomic conditions.[20] Therefore, food security is an important factor for developmental proficiency in infants and children.

Pregnant women and their fetuses are particularly vulnerable to the impacts of food insecurity. In a study following pregnant women, researchers discovered that women who lack important nutrients necessary for proper development of the fetus was associated with poor health outcomes.[21] The birth defects included neural deficiencies such as spina bifida as a result of insufficient folate acid during pregnancy, as well as other health issues such as anencephaly and cleft palate, and are hypothesized by researchers to be correlated with food insecurity.[22]

The elderly are also particularly impacted by food insecurity. There are 43 million adults over the age of 65 (14%) in the United States, and the numbers are predicted to double to 83 million by 2050.[23] Regardless of food security status, elderly persons already lack certain nutrients; however, those who are food insecure oftentimes also lack sufficient amounts of calories, protein, niacin, saturated fats, magnesium, iron, zinc, carbohydrates, as well as other components that are necessary for healthy functioning of the human body.[24] Further, independent of disease, age, ethnicity, and education, elderly individuals reported to be 2.3 times more likely to be in the fair to poor health range, thus increasing their nutritional risk.[25] Thus, a lack of important macro and micronutrients can be a product of long-term food insecurity but is correlated with increasing health risks as one grows older.

Food insecurity continues to be a pressing issue in the United States experienced by individuals of all ages, from infants to the elderly. Socioeconomic conditions place households in tight circumstances that force them to make decisions about quantity over quality of food. The substitution of fresh fruits and vegetables with calorically dense but largely unhealthy food thus reduces the availability of necessary nutrients. Therefore, increases in obesity, diabetes and lack of vital nutrients arise as a result of food insecurity.

[1] United States of America. Food and Agriculture Organization of the United Nations. Economic and Social Development Department. Chapter 2. Food Security: Concepts and Measurement.

[2] “Latinos and African Americans Are Most at Risk of Hunger, According To New USDA Report.” Feeding America, 10 Sept. 2011. Web. 29 Apr. 2016.

[3] “Hunger and Poverty Facts and Statistics.” Feeding America. Accessed April 14, 2016. http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html?referrer=https://www.google.com/.

[4] United States of America. Food and Agriculture Organization. Food Security Information for Action. EC – FAO Food Security Programme. 2008. Accessed April 14, 2016. http://www.fao.org/docrep/013/al936e/al936e00.pdf.

[5] Fleming, L. Food Insecurity in the Bay Area: An Analysis of Disparities of Food Access. PhD diss., University of California, Berkeley, 2010. Berkeley: College of Natural Resources, UC Berkeley, 2010.

[6] United States of America. Food and Agriculture Organization. Food Security Information for Action. EC – FAO Food Security Programme. 2008. Accessed April 14, 2016. http://www.fao.org/docrep/013/al936e/al936e00.pdf.

[7] Seligman, Hilary K., Davis, Terry C., Schillinger, Dean, Wolf, Michael S. “Food Insecurity is Associated with Hypoglycemia and Poor Diabetes Self-Management in a Low-Income Sample with Diabetes.” Journal of Health Care for the Poor and Underserved. 2010 Nov; 21(4): 1227-1233.

[8] Kursmark, Meredith, and Michael Weitzman. “Recent Findings concerning Childhood Food Insecurity.” Current Opinion in Clinical Nutrition and Metabolic Care 12, no. 3 (2009): 310-16. doi:10.1097/mco.0b013e3283298e37.

[9] Seligman, Hilary K., and Dean Schillinger. “Hunger and Socioeconomic Disparities in Chronic Disease.” New England Journal of Medicine 363, no. 1 (2010): 6-9. doi:10.1056/nejmp1000072.

[10] Hartline-Grafton, Heather. Understanding the Connections: Food Insecurity and Obesity. Food Research and Action Center. October 2015.

[11] Food Research and Action Center. “Why Low-Income and Food Insecure People are Vulnerable to Obesity.” 2015.

[12] Stuff, Janice E., et al. “Household Food Insecurity and Obesity, Chronic Disease, and Chronic Disease Risk Factors.” Journal of Hunger & Environmental Nutrition 1, no. 2 (2007): 43-62. doi:10.1300/j477v01n02_04.

[13] Stuff, Janice E., et al. “Household Food Insecurity and Obesity, Chronic Disease, and Chronic Disease Risk Factors.” Journal of Hunger & Environmental Nutrition 1, no. 2 (2007): 43-62. doi:10.1300/j477v01n02_04.

[14] Adams, Elizabeth J., Laurence Grummer-Straun, and Gilberto Chavez. “Food Insecurity Is Associated with Increased Risk of Obesity in California Women.” Journal of Nutrition 133, no. 4 (April 1, 2003): 1070-074.

[15] “Diabetes Latest.” Centers for Disease Control and Prevention. 2014. Accessed April 14, 2016. http://www.cdc.gov/features/diabetesfactsheet/.

[16] Seligman, Hilary K., and Dean Schillinger. “Hunger and Socioeconomic Disparities in Chronic Disease.” New England Journal of Medicine N Engl J Med 363, no. 1 (2010): 6-9. doi:10.1056/nejmp1000072.

[17] Seligman HK, Jacobs EA, Lopez A, Sarkar U, Tschann J, Fernandez A. Food Insecurity and Hypoglycemia Among Safety Net Patients With Diabetes. Arch Intern Med.2011;171(13):1204-1206. doi:10.1001/archinternmed.2011.287.

[18] Kursmark, Meredith, and Michael Weitzman. “Recent Findings concerning Childhood Food Insecurity.” Current Opinion in Clinical Nutrition and Metabolic Care 12, no. 3 (2009): 310-16. doi:10.1097/mco.0b013e3283298e37.

[19] Zaslow, Martha, et al. “Food Security During Infancy: Implications for Attachment and Mental Proficiency in Toddlerhood.” Maternal and Child Health Journal Matern Child Health J 13, no. 1 (2008): 66-80. doi:10.1007/s10995-008-0329-1.

[20] Zaslow, Martha, Jacinta Bronte-Tinkew, Randolph Capps, Allison Horowitz, Kristin A. Moore, and Debra Weinstein. “Food Security During Infancy: Implications for Attachment and Mental Proficiency in Toddlerhood.” Maternal and Child Health Journal Matern Child Health J 13, no. 1 (2008): 66-80. doi:10.1007/s10995-008-0329-1.

[21] Carmichael, Susan L. “Maternal Food Insecurity Is Associated with Increased Risk of Certain Birth Defects.” Journal of Nutrition 137, no. 9 (November 5, 2007): 2087-092.

[22] Carmichael, Susan L. “Maternal Food Insecurity Is Associated with Increased Risk of Certain Birth Defects.” Journal of Nutrition 137, no. 9 (November 5, 2007): 2087-092.

[23] Ortman, Jennifer M., and Victoria A. Velkoff. An Aging Nation: The Older Population in the United States. Report no. P25-1140. May 2014. https://www.census.gov/prod/2014pubs/p25-1140.pdf.

[24] Lee, J. S., and E. A. Frongillo. “Factors Associated With Food Insecurity Among U.S. Elderly Persons: Importance of Functional Impairments.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 56, no. 2 (2001). doi:10.1093/geronb/56.2.s94.

[25] Lee, J. S., and E. A. Frongillo. “Factors Associated With Food Insecurity Among U.S. Elderly Persons: Importance of Functional Impairments.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 56, no. 2 (2001). doi:10.1093/geronb/56.2.s94.