Abstract
Food security is an objective of Healthy People 2010 and an issue that affects dietetics practitioners. This article summarizes the self-identified food security (FS) knowledge and practices of licensed dietitians (LDs) in Ohio from a survey sent to 1599 LDs. Respondents' (n = 868/1599, 54.3%) FS practices were significantly related to (1) area of practice; community LDs considered FS to a greater degree than did clinical LDs; and (2) practice location; LDs practicing in urban areas considered FS to a greater degree than did suburban LDs. Almost 44% of LDs strongly agreed or agreed that they were knowledgeable about FS. Self-identified FS knowledge was related to the involvement of FS community service and research efforts by LDs. Practical suggestions are mentioned to incorporate FS into dietetics and nutrition practice.
AS part of achieving The Healthy People 2010 goals to increase quality and years of healthy life and eliminate health disparities, the health objectives identified increasing food security among United States (US) households to 94%. 1 Food security exists when all people at all times have access to sufficient food for active and healthy lives. 2 Food secure individuals and households are capable of sustaining an adequate supply of food without resorting to emergency food supplies or begging, stealing, or scavenging to obtain food. 2 Food insecure families or individuals, on the other hand, have limited resources and the ability to acquire food; therefore, they may resort to socially unacceptable ways to acquire food. 2,3 Kempson and others 4 identified novel food management practices used by people with limited resources. These practices included (1) strategizing food preparation (eg, making low-cost dishes; removing mold, insects and slim from cheese, grain, and meats); (2) rationing the household food supply; (3) conserving food; (4) inadequately preserving food; (5) restricting personal food intake; (6) overeating when food is available; (7) obtaining food opportunistically; (8) cycling monthly eating patterns; and (9) eating low-cost foods.
Although there has been much effort in the past few years to combat food insecurity and hunger, including Federal and non-Federal food and nutrition assistance programs, the prevalence is still unacceptable and does not meet the Healthy People 2010 goal. The most recent report 5 indicated that 89% of US households were food secure. Overall, Nord and others 5 reported that 11.5 million (10.7%) households in the United States were food insecure at some time in 2001, with 3.5 million (3.3%) US households experiencing hunger. Further, for about one fifth of households classified as food insecure and one quarter of those reporting hunger-related conditions, those behaviors or experiences occurred chronically. 6
The effects of food insecurity can have grave consequences on health. Hamelin and others 7 reported the consequences of food insecurity to include physical impairments, psychological suffering, and sociofamilial disturbances. Dietary quality can be negatively impacted by food insecurity or insufficiency, which includes lower dietary intakes of essential nutrients 8,9 and fruits and vegetables. 10 The negative effects of these intakes may not be apparent immediately, but over the long term, they could increase the risk of developing diet-related, chronic diseases. 9 In fact, overweight/obesity occurs more often for food insecure women compared to food secure ones. 11,12 Pheley et al 13 reported that food insecurity was significantly associated with poorer functional heath status. Recent evidence also links it with grave consequences in children: poor health status, 14 psychosocial problems, 15,16 lower cognitive and academic performance, 17 and "at risk" nutritional status. 18,19
It is the position of the American Dietetic Association (ADA) that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all citizens in the United States. 20 Dietetics and nutrition professionals, especially those providing medical nutrition therapy (MNT), are uniquely positioned to assist in the efforts to help reduce hunger. 21 Food insecurity can potentially impact compliance to MNT. Therefore, nutrition and dietetics professionals need to be aware of clients' potential inability to follow prescribed diets because of the lack of food and other resources, and consider this when carrying out the nutritional care process.
In a preliminary survey of licensed dietitians in Ohio (unpublished data), almost 60% indicated that they were not familiar with the topic of food security. Food security, however, should be considered during nutrition assessment and treatment and be familiar to practicing dietitians and dietetics students. The Commission on Accreditation for Dietetics Education requires that all dietetics programs include food-security and food-security-related objectives for students. 22 Also, the American Society for Nutritional Sciences includes food security as a component of nutritional assessment, and other food-security-related concepts in the core knowledge for the discipline of nutrition. 23 As health professionals, it is an essential responsibility for dietetics and nutrition professionals to understand and be aware of the prevalence and consequences of food insecurity. Gaining scientific and practical knowledge related to risky food management practices used by food insecure individuals and families is needed to provide effective education. 4
Aside from considering food insecurity among clients, dietetics and nutrition professionals can play other key roles to assist in the efforts to end food insecurity. 21 Dietetics and nutrition professionals can (1) help find solutions to reduce edible food loss, especially through food recovery, the collection (or recover) of wholesome food from farmers' fields, retail stores, or foodservice establishments for distribution to those in need; (2) learn about food security in the United States and get involved in helping to reduce food insecurity in their community; and (3) assist in the efforts to describe food security status and its relationship to nutritional status and health. 21
The objectives of this project were to (1) assess nutrition and dietetics professionals' self-identified knowledge and practices relating to food security; and (2) identify the ways that these professionals assist in the effort to reduce food insecurity in their community. This article also provides practical suggestions for incorporating food security into dietetics and clinical nutrition practice.