Food Security and Nutrition in the U.S.

Across the United States in 2019, over 1 in 10 households were defined as being food-insecure. Food-insecure households are, according to U.S. Department of Agriculture (USDA), “uncertain of having, or unable to acquire, at some time during the year, enough food to meet the needs of all their members because they had insufficient money or other resources for food.” These food-insecure households include 5.3 million U.S. households with “very low food security,” which disrupts eating patterns and leads to food intake levels below those considered adequate.¹

While rates of food insecurity have significantly declined since they spiked to nearly 15 percent of households following the 2008 stock market crash,¹ preliminary data shows that the COVID-19 pandemic has dramatically worsened food insecurity, which was already considered one of “the nation’s leading health and nutrition issues.”² Feeding America, a national anti-hunger nonprofit, estimates that 1 in 8 people may experience food insecurity in 2021, with those most impacted by the pandemic at greater risk. Notably, racial disparities in food security that existed before the COVID-19 pandemic remain severe, with 1 in 5 Black individuals in the U.S. projected to experience food insecurity in 2021 (nearly double the rate among white individuals).³

The health complications associated with food insecurity are well-documented. Among children, these include anemia, key nutrient deficiencies, behavioral problems such as aggression, and mental health challenges such as depression and suicidal ideation.² Many of these issues persist for adults, who are also more likely to develop chronic conditions, like diabetes, chronic heart disease, chronic obstructive pulmonary disease (COPD), hypertension, and hyperlipidemia.^2,4 A study from the USDA on working-age U.S. adults found that food security status is more strongly correlated with chronic disease than income, which was only associated with hepatitis, arthritis, and COPD out of 10 chronic diseases significantly associated with food insecurity.⁵

How food insecurity may cause many chronic conditions remains under-researched. One exception is type 2 diabetes, which is reportedly twice as common in food-insecure individuals than others. Food scarcity may trigger peripheral insulin resistance, increases in cortisol, and accumulation of central adiposity (belly fat), which are all conditions associated with diabetes. Obesity, which some studies have found to be associated with food insecurity, may also play a role in making individuals vulnerable to diabetes and other chronic conditions.²

These findings are indicative of the essential tie between food insecurity and an inability to access nutritious food, which together impact overall health. In general, the cost of a diet rich in healthy foods — including fruits and vegetables, fish, and nuts — is greater than one reliant on highly processed foods, including meats and refined grains, according to a Harvard School of Public Health meta-analysis of 27 studies.⁶ A USDA study likewise found that foods high in saturated fat and/or added sugars are overall less expensive, per calorie.⁷ The authors of the Harvard study estimate that a “healthy” diet costs on average $1.50 more per day, which amounts to $550 per year and is an appreciable investment for low-income individuals.⁶

Making healthier foods more accessible, the authors write, would require a reversal of many decades of policies that have created “a complex network of farming, storage, transportation, processing, manufacturing and marketing capabilities” that have generated an economy for highly processed, low-priced foods.⁶ While the federal government has historically invested in food initiatives for low-income people, notably the Supplemental Nutrition Assistance Program (SNAP), there has been little innovation in these programs over the past four decades, in spite of a dramatic increase in diet-related illnesses such as obesity and type 2 diabetes.⁸ SNAP benefits are based on a 1970s metric that represents the minimal amount of money needed to purchase a nutritious diet, and therefore do not align with modern dietary recommendations and economic circumstances. Before the pandemic, SNAP benefits averaged less than $1.40 per meal.⁹

The need for improving nutritional health and equity across the country is clear. Greater government coordination across federal agencies and programs, especially within the National Institutes of Health, can strengthen government research and programs.⁸ Beyond taxation of less healthy foods and subsidies for more nutritious options, greater governmental coordination can fuel projects to revolutionize the production, transportation and marketing of healthier foods, increasing their availability while reducing their prices.⁶

References 

1. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2019. U.S. Department of Agriculture. Published 2020. https://www.ers.usda.gov/publications/pub-details/?pubid=99281 

2. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood). 2015;34(11):1830-1839. 

3. Hake M, Dewey A, Engelhard E, et al. The Impact of the Coronavirus on Food Insecurity. Feeding America. Published 2021. https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf 

4. Sun Y, Liu B, Rong S, et al. Food insecurity is associated with cardiovascular and all-cause mortality among adults in the United States. J Am Heart Assoc. 2020;9(19):e014629. 

5. Gregory CA, Coleman-Jensen A. Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. U.S. Department of Agriculture. Published 2017. https://www.ers.usda.gov/publications/pub-details/?pubid=84466 

6. Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013;3(12):e004277. 

7. Carlson A, Frazao E. Are healthy foods really more expensive? It depends on how you measure the price. SSRN Electron J. Published online 2012. doi:10.2139/ssrn.2199553 

8. Fleischhacker SE, Woteki CE, Coates PM, et al. Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority. Am J Clin Nutr. 2020;112(3):721-769. 

9. Carlson S, Keith-Jennings B, Llobrera J. Modernizing SNAP Benefits Would Help Millions Better Afford Healthy Food. Center on Budget and Policy Priorities. Published 2021. https://www.cbpp.org/research/food-assistance/modernizing-snap-benefits-would-help-millions-better-afford-healthy-food