Applied Evidence

Food insecurity: How to recognize & address it

Author and Disclosure Information

Certain factors put different patient populations at risk. A 2-question survey can help identify families that are food insecure.


› Consistently use the American Academy of Pediatrics 2-question survey to screen for food insecurity (all populations). A

› Identify and treat maternal depression during pregnancy and the postpartum period, and beyond A and screen for depression in older adults A because depression can reduce motivation to ­accomplish daily activities, such as ­obtaining and preparing food.

› Ask older adults about ­declines in performing ­activities of daily ­living C and how food is eaten or prepared . C

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series



CASE Alice D is 20 years old and has type 1 diabetes, as well as retinopathy, hypertension, bipolar I disorder, and hyperlipidemia. She is a new patient at your clinic and reports that she is ­“occasionally homeless” and has difficulty affording food.

You renew Ms. D’s prescriptions during the visit, discuss nutrition with her, and order lab testing, including a test of hemoglobin A1C, a lipid panel, and a basic metabolic panel. You ask her to follow up in 1 week to discuss the test results and next steps in her care.

Eggs in empty refrigerator © Masterfile

According to a 2016 report from the US Department of Agriculture (USDA) Economic Research Service, an estimated 12.3% of households in the United States are “food insecure.”1 To ascertain what food security and insecurity are, the USDA measured numerous variables, including household structure, race and ethnicity, geography, and income. The report of the Economic Research Service stands as one of the largest domestic sources of information about food insecurity.

Food insecurity is defined as “food intake of household members [that is] reduced and normal eating patterns that are disrupted.”1 It is often measured “per household,” but those data must be interpreted carefully because food insecurity affects household members differently. Some members, such as children, might be affected only mildly; adults, on the other hand, might be more severely affected. (Adults may, for instance, disrupt or skip their meals to maintain normal diets and meal patterns for their children.) In some households, food insecurity affects only a single member—such as an older adult—because of conditions unique to the people living in the home.

Adults may disrupt or skip their meals to maintain normal diets and meal patterns for their children.

In this article, we review variables that can give rise to food insecurity in children, adults, and the elderly, and offer ­strategies to the family physician for identifying and alleviating the burden of food insecurity in these populations.

Food insecurity threatens children’s health, development

In 2016, households with children faced a higher level of food insecurity (16.5%) than the national average (12.3%).1 In a study of more than 280,000 households, food ­insecurity was sometimes so severe that children skipped meals or did not eat for the whole day.1 Although income strongly correlates with food insecurity, evidence shows that families above and below the poverty line suffer from food insecurity.2,3

According to the USDA, the rate of food insecurity is higher than the national average of 12.3% in several subgroups of ­children1:

  • households with children < 6 years of age (16.6%)
  • households with children headed by a single woman (31.6%) or single man (21.7%)
  • households headed by a black non-Hispanic (22.5%) or Hispanic (18.5%) person
  • low-income households in which the annual income is < 185% of the poverty threshold (31.6%).

Continue to: Evidence suggests that...


Next Article: