According to the United States Department of Agriculture (USDA), more than 35 million Americans faced food insecurity and hunger in 2019.
Defined as “a lack of consistent access to enough food for every person to live an active and healthy life” by the organization Feeding America, food insecurity can affect people from any demographic; however, vulnerable populations, including indigenous and people of color, seniors, and children experience hunger at higher rates.
Job loss, medical emergencies, or a missed paycheck can all contribute to a higher risk of food insecurity — conditions made even more prevalent by the COVID-19 pandemic. It is estimated that more than 42 million people, including 13 million children, may experience food insecurity in 2021 as a result of the pandemic.
Food waste in America
According to Feeding America, the world wastes roughly 108 billion pounds of food per year, with nearly 40% of that waste coming from the United States.
The physical leftovers are not the only things wasted. Decomposing food generates greenhouse gasses, which contribute to climate change. Water and energy used to grow food that is ultimately thrown out also goes down the proverbial drain.
Food waste drains the economy, too. Consumer preferences for unblemished food often lead many farmers to simply discard ugly or imperfect produce before they even make it to the shelves. Due to school closures amidst the pandemic, farmers lost a large share of their business, with decreasing demand forcing them to plow over edible crops and dump millions of gallons of milk every day.
The causes of food insecurity
With so much food wasted, what causes food insecurity? For families living paycheck to paycheck, a single unexpected expense (from unplanned car maintenance to illness or injury) can force them to choose between paying bills or purchasing food.
Many working families don’t qualify for federal food assistance, necessitating the use of food banks, but even those options may be limited by location. “Food deserts” are geographical areas where residents’ access to fresh, affordable, healthy foods is limited or unavailable due to the absence of grocery stores within convenient traveling distances.
According to the USDA, approximately 2.3 million people live more than one mile away from a grocery store and do not own a car. Due to limited or unavailable public transportation, this makes food shopping incredibly difficult. Often, there are fewer grocery stores in neighborhoods where people of color live, and in those food deserts, healthier foods are more expensive.
Demographically, food insecurity rates are higher among less educated people, those with lower incomes, people of color, unmarried, separated, or divorced people, renters, unemployed individuals, or those living with a disability.
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The health effects of food insecurity and hunger
Lack of access to healthy options can lead to an increased prevalence of diabetes, obesity, cardiovascular disease, and other diet-related conditions. In children, it can be related to congenital disabilities, inadequate nutrition, cognitive problems, anemia, aggression, and anger.
Food insecurity is associated with higher hospitalizations, increased stress, lower academic performance, a decline in health, asthma, behavioral issues, depression, suicide ideation, and poor oral health. The effects are also long lasting. Studies on the effect of food insecurity on children found that children who went hungry at least once in their lives were 2.5 times more likely to have poor overall health 10 to 15 years later than children who never experienced hunger (Second Harvest, 2021).
Food insecurity takes a psychological toll on children as well, with instances of anxiety notedly higher among children experiencing food insecurity. Caregivers who cannot provide adequate nutrition for themselves and their families experience higher rates of stress and depression, further impacting their children’s mental health.
A harmful cycle
While chronic conditions like high blood pressure, congestive heart failure, diabetes, etc., can be a consequence of food insecurity among older adults, it is also true that older adults with existing chronic conditions or functional limitations are also at greater risk for food insecurity, contributing to a harmful cycle.
For older adults suffering from food insecurity, unhealthy coping strategies may include cutting back on medication, not taking medication with food, postponing preventative or necessary medical care, consuming diets with low nutrient value, or making trade-offs between food and other necessities.
Food insecurity and the pandemic
Virtually no one has been untouched by the pandemic, but lower income households often experienced greater vulnerability compared to their higher income neighbors. Disruptions in public transport closed off grocery options for many families, widening the food desert. Closed schools, loss of employment, or the stress of working an essential job — with the risk of infection that accompanied it — all contributed to the mounting burden on low-income families.
Other stressors came in the form of alienation, worry, guilt, and irritability stemming from food insecurity. An unfortunate and undeserved stigma pervades much of American culture, tying food assistance from food banks or other charitable organizations to feelings of shame. A survey conducted with 2,417 low-income respondents found that food insecurity is strongly associated with depression and anxiety (Fang et al., 2021).
Occupational therapy’s unique role in addressing food insecurity
Occupational therapy practitioners evaluate the physical, cognitive, psychological, emotional, cultural, environmental, and social aspects of an individual’s ability to participate and engage in occupations through a holistic lens. OTs are therefore in a unique position to acknowledge and understand the complexity of food insecurity while addressing its many dimensions in a client-centered context.
Older adults may encounter numerous natural and built barriers, including home accessibility, inclement weather, and neighborhood accessibility affecting their ability to leave home. Individuals who live alone and lack the social support to leave their homes are at the most significant risk for food insecurity and malnutrition.
Disabled adults may encounter barriers to shopping due to limited accessibility at grocery stores, retrieving items on shelves of inconvenient heights, and difficulty transporting groceries from the car to the kitchen.
Tools and resources
An assessment such as the U.S. Household Food Security Survey Module (HFSSM): Six Item Short Form is a reliable tool used to screen food insecurity on a spectrum ranging from low to high. The Occupational Performance Measure of Food Activities (OPMF) is a 15-item scale designed to obtain information about perceived importance, performance level, and satisfaction related to shopping, cooking, eating, eating out, and eating healthily.
The Individual Food Resource Profile (IFRP), a novel food instrument for those living in poverty, addresses current or past use of community resources, food habits and routines, food resource management, dietary preferences and restrictions, and availability of everyday kitchen objects.
OTs can address other food-related activities, including food safety practices, self-feeding, oral-motor skills (chewing, swallowing, dysphagia), kitchen adaptations, simplifying meal preparation, and budgeting strategies to afford nutritious meals with a fixed income.
OTs can also collaborate with social workers to ensure those vulnerable clients access community resources such as Meals On Wheels, alternative transportation services for shopping, food banks, and meals at senior centers. Community and neighborhood gardens offer opportunities to grow fresh vegetables and engage in social interaction.
Additionally, OTs may play a role in schools and early intervention services to address food insecurity for students with specific food preferences such as texture, smell, and taste through individualizing school lunches and diets. OTs can help manage environmental distractions through adaptations in the school cafeteria to reduce noise and visual stimulation.
Red flags indicating food insecurity include poor attention span, obesity and low weight gain, developmental delays, behavioral issues, self-dysregulation, poor socialization, and academic performance. However, recognizing the health effects of food insecurity and the connection to academic performance and other behaviors is crucial.
Food insecurity and hunger are complex and multifaceted issues with multiple causes and even more layered consequences.
Occupational therapy practitioners play an essential role in mitigating the epidemic of food insecurity and hunger among those they serve — a role made even more vital as the COVID-19 pandemic continues to exacerbate food insecurity throughout the nation and the world.
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- Fang, D., Thomsen, M.R. & Nayga, R.M. The association between food insecurity and mental health during the COVID-19 pandemic. BMC Public Health 21, 607 (2021). https://doi.org/10.1186/s12889-021-10631-0
- Feeding America (2021). What is Food Insecurity? Retrieved from https://www.feedingamerica.org/hunger-in-america/food-insecurity
- Feeding America (2021). Hunger in America. Retrieved from https://www.feedingamerica.org/hunger-in-america
- Food Empowerment Project (2021). Food Deserts. Retrieved from https://foodispower.org/access-health/food-deserts/
- Food Action and Research Center (2019). Hunger is a Health Iss for Older Adults: Food Security, Health, and the Federal Nutrition Programs. Retrieved from https://frac.org/wp-content/uploads/hunger-is-a-health-issue-for-older-adults-1.pdf
- Gundersen, C.& Ziliak, (2015). Food Insecurity and Health Outcomes. Health Affairs, 34(11), 1830-1839. doi: 10.1377/hlthaff.2015.0645
- Juckett LA, Robinson ML. The Occupational Therapy Approach to Addressing Food Insecurity among Older Adults with Chronic Disease. Geriatrics (Basel). 2019 Feb 15;4(1):22. doi: 10.3390/geriatrics4010022. PMID: 31023990; PMCID: PMC6473539.
- RTS (2021). Food Waste in America. Retrieved from https://www.rts.com/resources/guides/food-waste-america/
- Second Harvest (2021). New study outlines long-term effects of food insecurity on children. Retrieved from https://www.shfb.org/impact/blog/new-study-food-insecurity-effects/
- Thomas, M., Miller, D.P. & Morrissey, T.W. (2019). Food Insecurity and Child Health. Pediatrics, 144 (4), e20190397.doi: 10.1542/peds.2019-0397
- U.S. Household Food Security Survey Module: Six-Item Short Form Economic Research Service, USDA (2012). Retrieved from https://www.ers.usda.gov/media/8282/short2012.pdf