Food insecurity in the United States affects 1 out of 8 people (12.3% or 42 million, including 13 million children), reflecting an often hidden public health challenge (https://hungerandhealth.feedingamerica.org/understand-food-insecurity/). Food insecurity is defined as not consistently being able to obtain adequate food due to a lack of financial resources (http://www.ers.usda.gov). Food insecurity can result in hunger or poor nutrition. According to a 2014 survey of people supported by the Feeding America organization, 69% of those surveyed had to choose between buying food or paying utilities, 67% had to choose between food and transportation, 66% had to choose between food and medical care, 57% had to choose between food and housing, and 31% had to choose between food and education (http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/).
Not surprisingly, food insecurity is strongly correlated with negative health outcomes. A recent report from the United States Department of Agriculture (USDA) Economic Research Service found a higher probability for 10 chronic diseases in the presence of lower food security when compared to adults in households with higher food security. The chronic conditions addressed included: (1) hypertension, (2) coronary heart disease, (3) hepatitis, (4) stroke, (5) cancer, (6) asthma, (7) diabetes, (8) arthritis, (9) chronic obstructive pulmonary disease, and (10) kidney disease (Gregory & Coleman-Jensen, 2017). In recognizing the impact of food insecurity on chronic diseases, it is important for gastroenterology nurses to assess for food insecurity as they encounter individuals and their families.
Statistics from the USDA show that households with children have a higher rate of food insecurity than households without children, particularly households for single mothers with children. Senior adults are also more at risk for food insecurities whether due to decreased income or increased medical expenses. Inability to travel outside their home to obtain food can also contribute to inadequate nutrition. Often, an economic hardship can trigger the downward trajectory for food insecurity. Food is watered-down, diluted, or downsized so that it will stretch. Additionally, since non-nutritious foods are typically cheaper, they are often substituted for more expensive nutritious foods, contributing to malnourishment. Over time, meals are missed or skipped, because there is not enough money for food or an inability to obtain food.
Gastroenterology nurses should make a concerted effort to recognize that food insecurity and malnutrition require a deliberate assessment during patient encounters. While many gastroenterology patients are instructed to go temporarily without food due to an impending procedure or acute management of gastrointestinal symptoms, it is important to assess the broader perspective of whether or not the individual/family typically has had to miss a meal due to lack of food. If affirmed, the patient can be referred to a social worker for assistance in locating a local food bank or accessing federal assistance through such programs as the supplemental nutrition assistance program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
With the acute care focus of many gastroenterology settings, the broader issues of public health are often underappreciated in our day-to-day delivery of nursing care. Assessment of patients in our care should not only be gastroenterology-focused, but also address broader issues of public health such as the issue of food insecurity highlighted here. Regardless of practice setting, nurses are always committed to maximizing public health. Let's do our part in assessing and intervening in the public health challenge of food insecurity. To find out more about food insecurity in your state or regional area, see the interactive charts and highlights provided by the USDA Economic Research Service available at https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u.
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