The term “food security” refers to the concept of people having access to enough food, including the ready availability of nutritionally adequate, safe foods for an active, healthy life and the ability to acquire these foods in socially acceptable ways.¹ When individuals and families have limited access to food or if their ability to obtain food is limited or uncertain (food insecurity), they often resort to the use of emergency food supplies, or they beg, steal, or scavenge for food.¹

Standardized measures of U.S. household food security status are included in the Census Bureau's Current Population Survey and other large national surveys.^2,3 In 2001, 10.7 percent of U.S. households were unable to secure adequate amounts of food; and in 2002, that number rose to 11.1 percent, representing 12.1 million households and 34.9 million people, including 13.1 million children.⁴

For the practicing physician, a thorough history is key to uncovering and then assisting patients experiencing food insecurity. Generally, households unable to secure adequate amounts of food have limited resources, and lack access (because of limited resources, lack of transportation, living in remote areas, or limited access to food stores). To cope, these people depend on food assistance programs, substitute less expensive alternatives for nutritious foods, seek assistance from emergency feeding programs (e.g., soup kitchens and food pantries), and skip meals.⁵ The households that are at higher risk of being unable to secure adequate amounts of food are those whose income falls below the official poverty line; those headed by a single woman with children; those with black or Hispanic members; those with children; and those located in central cities or rural areas, or in southern and western states.⁴

When persons lack access to proper food, physical impairment, psychologic suffering, and sociofamilial disturbance may result.⁶ In fact, having adequate food is vital to achieving the U.S. Healthy People 2010 objectives.⁷

Among adults, poor or fair self-rated health and physical limitations, poorer functional health status, and depression were associated with the inability to secure adequate amounts of food. An increase in disordered eating patterns and a decrease in consumption of fruit, vegetable, or dairy consumption was also noted. Food insecurity has been associated with decreased caloric intake, as well as decreased intake of nutrients, including antioxidants. Paradoxically, food insecurity has been associated with a greater body mass index and obesity among women.^8,9 It has been speculated that the relationship of obesity and food insecurity may be mediated by the low cost of energy-dense foods and reinforced by the pleasing taste of sugar and fat.¹⁰

Although inability to secure adequate amounts of food may not have immediate health effects, the risk of chronic disease appears to increase in patients experiencing food insecurity.^8,9

Family physicians should be aware that their patients may have difficulty complying with prescribed treatments simply because of issues related to food insecurity. Unfortunately, patients often are faced with difficult decisions. One report prepared for America's Second Harvest¹¹ revealed that 30 percent of emergency food clients were faced with the choice of paying either for food or for medicine or medical care. In addition, 45 percent were faced with choosing to pay for food or for utilities or heating fuel, and 36 percent had to choose between paying for food or rent or mortgage payments.¹¹

While family physicians face time constraints when interacting with patients, to improve patient access to food, physicians should inquire about weight loss and dietary habits resulting from having limited resources. Examples of dietary habits that may result include relying on only a few kinds of low-cost foods, not eating a variety of foods or “balanced” meals, eating less or cutting meal size, skipping meals, and not eating when hungry. Several other factors also should be considered during an office visit to facilitate food security (Table 1). Knowing and understanding the culture of the community will guide additional points to consider in the office visit. Some practices involve other health professionals, including registered dietitians and social workers, who can assist in helping patients to secure adequate amounts of food.

Ultimately, referrals may be necessary to assist the patient in securing adequate food. A variety of programs are available across the United States, and others are unique to particular communities (Table 2). An understanding of the household structure will assist physicians in making appropriate referrals. For example, a physician may see a young adult male whose spouse is pregnant and whose elderly father lives with the family. Using a current list of community programs, it would be appropriate to advise the patient that his wife may be eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children, and that his father may be eligible for service from Meals on Wheels.

Community involvement by family physicians also can benefit patients. Initiating the development of a food pantry within a medical clinic or personally assisting the local food bank with a food drive or food recovery project (http://www.usda.gov/news/pubs/gleaning/content.htm) can benefit patients and the community.

Finally, continuing to learn about food insecurity and how it negatively impacts patients is vital. In addition to participating in continuing medical education on the topic, practicing physicians can access information through several organizations (Table 3).