Food Fight

Evaluating Nutrition Security to Promote Health and Achieve Equity

In the ongoing battle for nutrition security, stakeholders are diligently working on developing and testing new screening tools and interventions. It is important to note that nutrition insecurity is distinct from food insecurity, and efforts to combat it must be prioritized by health care systems, government programs, and community initiatives. Poor nutrition has emerged as a leading cause of various illnesses, increased healthcare spending, and reduced productivity in the United States and abroad. Cardiometabolic diseases, cancers, chronic conditions, and undernutrition are predominantly associated with these health burdens. These challenges disproportionately affect lower-income individuals, those with limited education, and minority racial and ethnic groups. The foundation for achieving overall health and well-being for all individuals lies in nourishing foods throughout their lifespan, beginning from the prenatal stage.

Over the past two decades, food security has played a pivotal role in the development of screening tools, surveillance systems, research initiatives, referral networks, and policies. Understanding the connections between food insecurity, health outcomes, and health disparities has been prioritized in healthcare systems and public health departments. Consequently, these stakeholders are now actively measuring food security and collaborating with federal and community-based food programs to address the issue. The recently launched National Strategy on Hunger, Nutrition, and Health aims to implement universal food security screening in both government and private healthcare settings.

While food-insecure individuals generally experience poorer nutrition and increased risk of diet-related diseases, it is worth noting that current major clinical and public health tools for assessing and mitigating food security do not adequately address nutritional quality. The widely used eighteen-question US Household Food Security Survey Module developed by the Department of Agriculture does not include any inquiries about nutritional quality, except for the mention of a “balanced meal”. Similarly, shorter food security screening tools commonly employed in public health and clinical practice also lack information on nutritional quality. The focus on stable access to sufficient calories in these measurement tools has led to a similar emphasis on calorie-centric interventions in public health, policy, and clinical practice.

Recognizing the fundamental difference between access to calories and access to nourishing foods, healthcare, public health, and policy sectors have shifted to a complementary concept called nutrition security. This new construct aims to ensure consistent access, availability, and affordability of foods and beverages that promote well-being, prevent diseases, and facilitate treatment when necessary. Rather than replacing measures of food security, nutrition security is designed to complement them. The USDA now emphasizes nutrition security across its programs, and Centers for Disease Control and Prevention (CDC) also includes and emphasizes nutrition security in its programming. National organizations, such as the American Heart Association, the American College of Physicians, and the Academy of Nutrition and Dietetics, have also voiced their support for national policies that address nutrition security, health equity, and the prevention of diet-related diseases.

Individuals experiencing food insecurity face a higher risk of poor nutrition and diet-related conditions, including obesity, diabetes, hypertension, coronary disease, stroke, and cancer, even after accounting for other demographic and socioeconomic factors. To effectively tackle nutrition-related disparities, nutrition security programs should be designed, implemented, and evaluated with a focus on equity.

It is important to note that nutrition insecurity and poor diet quality are not exclusive to those experiencing food insecurity. Tens of millions of Americans who do not face food insecurity still face nutrition challenges.

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