Food insecurity and hunger

Definition

Food security means that people have access at all times to enough food for an active healthy life. It implies that people have nutritionally adequate and safe foods and sufficient household resources to ensure their ability to acquire adequate, acceptable foods in socially acceptable ways ¿ that is through regular marketplace sources and not through severe coping strategies like emergency food sources, scavenging, and stealing.

Hunger in this context refers to the uneasy or painful sensation caused by a lack of food.⁷

Healthy People 2010 Goal

Increase food security among U.S. households to 94% from 88% and in so doing reduce hunger.⁷

Extent of the Problem

Several studies have estimated the prevalence of food insecurity and hunger.

Results vary with sampling methodology and the questions used to assess food insecurity and hunger.

• The Current Population Survey Food Security Supplement, 1999:

12 million children live in households that are food insecure and an additional 2.7 million children live in households where someone in the household experienced hunger in the previous year due to inadequate resources.³⁰

• NHANES III, 1988-1994:

10,202,000 Americans or 4.1% of the population did not have enough food to eat. Of these individuals 68.6% lived in families that went one or more days with no food or money to buy food in the previous month with 4% reporting more than 14 such days. In 2.7% of the families surveyed, children younger than 17 had cut the size of or skipped meals in the previous month due to a lack of money.³¹

• CSFII, 1994-1996
:

2.2% of all households and 3% of all households with children reported food insufficiency. Food insufficient households with children experienced not having enough to eat an average of 5.5 days during the month prior to the interview.³²

In both the NHANES III and CSFII, nearly all families attributed their food insufficiency to a lack of money, food stamps or WIC vouchers.^31,32

The prevalence of food insecurity and hunger varies with sociodemographic characteristics.

Prevalence of Food Insufficiency Among U.S. Children by Income Category, Race and Age (NHANES III, 1988-1994).

(Alaimo K, Briefel RR, Frongillo EA, & Olson CM. (1998) Food insufficiency exists in the United States: results from the Third National Health and Nutrition Examination Survey (NHANES III). Am J Public Health. 88: 419-426.)

Prevalence of food security, food insecurity, and hunger by selected characteristics of households (Current Population Survey 1999)

(Source: Andrews M, Nord M, Bicker G, & Carlson S. (1999) Household Food Security in the United States, 1999. Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture. Food Assistance and Nutrition Research Report No. 8.)

Selected sociodemographic characteristics

The prevalence of food insecurity is

• higher for households in central cities (13.8%) and non metro areas (10.1%) compared to suburbs and other metropolitan areas outside central cities (7.7%)³¹
• above the national rate in the South (11.1%) and West (11.8%) and below the national rate in the Midwest (8.3%) and Northeast (8.3%)³³
• higher among households with children (14.8%) than those without children (7.4%)³⁰
• higher among families with incomes below the poverty line ^30,33,34 
• 5.5 times higher among single female headed families at 131-185% of poverty than other family types ^31,32
• Higher among families on welfare or food stamps ^32,33

Heads of food insufficient families are less likely than heads of food sufficient families to be high school graduates (42.7% vs. 75.7%) ^33,35 pand/or employed (53.5% vs. 75.1%).³⁵

The percentage of children in low income food insufficient households participating in school breakfast and school lunch was not significantly different from food sufficient families.³² 

Not all low income families are food insecure and not all families with incomes well above the poverty line are food secure. 

Almost 2/3 of households with incomes below the poverty line are food secure.³⁰  Additionally, a few families who have incomes well above the poverty line experience episodes of food insecurity. ^30,34  Income figures do not reflect unexpected events such as divorce or job loss which can affect food security.³⁰

Ethnic Disparities

Mexican Americans experience the highest prevalence of food insecurity followed by African Americans.  African Americans are three times more likely and Mexican Americans six times more likely than white Americans to be food insufficient.³¹

Impact of Food Insufficiency

Impact on Health

Children in food insufficient families when compared to children in food sufficient families were more likely to

• be in fair/poor health.³⁵
• experience more frequent headaches and stomachaches^.35
• have suffered more colds in the past year.³⁵

• increased susceptibility to infections 
• weight loss
• impaired growth

Food insufficiency may impact health through

• nutrient deficiencies
• stress, worry, or feelings of deprivation³⁵

Impact on Nutritional Status

Obesity

Recent research indicates that food insufficiency may be associated with obesity in women.^33,37 

Two studies comparing BMI of women from food insecure and food secure households found food insecure women were significantly heavier for their height. ^33,37 

In one study 37% of food insecure women were obese compared to 26% of women in the food secure group.³⁷  Analysis of the CSFII data revealed that 41% of the mildly food insecure women and 52% of the moderately food insecure women were overweight compared to 34% of food secure women and 20% of severely food insecure women. 

No relationship was observed for men.³³ 

Overweight in food insufficient women may be related to a cycle of food sufficiency (i.e. early in the month when food stamps are available) during which caloric intake may be excessive followed by a short period of time when resources for purchasing are limited (i.e. the last week of the month when food stamps have been used).³³

The percentage of children in the CSFII who were overweight among low-income food sufficient households and food insufficient households was similar.³²

Nutrient Intake

Preschoolers from food insufficient households in the CSFII had mean zinc intakes that were 61% of the RDA and vitamin E 71% of the RDA. 

Women in food insufficient households consumed less than two-thirds the RDA energy, calcium, iron, vitamin E, magnesium, and zinc.³⁸  Analysis of NHANES III data indicate that intakes of these nutrients in food insufficient adults aged 20-59 were greater than two-thirds the RDA.³⁹

Impact of Inadequate Nutrition on Cognitive and Social Development

Lack of food can lead to chronic mild malnutrition resulting in impaired growth. 

Cognitive and social development is associated with height and weight measurements ⁴⁰ although the quality of the child's physical and psychological environment also plays a significant role.⁴¹  Chronic malnutrition rarely occurs in isolation from other psychosocial, biological and environmental stressors.  However, even after controlling for known predictors of child development such as family socioeconomic status and caregiver educational level, indicators of suboptimal nutrition still contribute uniquely to developmental outcomes.⁴⁰

Inadequate nutrition impairs cognitive development by impairing brain growth and reducing interaction with other people.  This decreased interaction may reflect a lack of energy as well as the child's ability to elicit appropriate stimulation from the environment.^36,40  

Undernourished children are irritable, apathetic, explore their environment less, have shorter bouts of play, and are less attentive to novel and social stimuli than well-nourished children. 

Altered interactions with caregivers result in children who are more timid, reserved, and passive.^41,42 Caregiver anxiety or irritability due to insufficient food or worry about obtaining enough food can influence interactions with the child even if the child has sufficient food.^40,42

Deficiency of individual nutrients also can have a detrimental impact on child development, even when energy and protein intakes are adequate.⁴⁰  Iron deficiency anemia can impair mental and motor development.⁴¹ 

Zinc deficiency can have a negative impact on school performance; calcium and copper intakes are positively related to developmental measures such as activity level and attention seeking.⁴⁰  Additionally, adequate intake of specific nutrients can attenuate the known impact of an environmental risk factor.  Adequate intakes of iron and calcium inhibit absorption of lead, a heavy metal which at high levels can impair cognitive development.^40,41  Similarly, higher zinc levels protect against the negative effect on cognitive development associated with high body cadmium levels.

Children experiencing hunger are more likely to have delays in development of motor skills, behavioral, emotional and academic problems such as

• Receiving special education
• Repeating a grade in school
• Utilizing mental health counseling currently or in the past
• Exhibiting more anxious, irritable, aggressive and oppositional behaviors
• Lower arithmetic test scores
• Difficulty getting along with other children
• Suspension from school ^42,43,44

It is postulated that malnutrition exerts its effects through motivational and emotional behaviors rather than a direct impact on intelligence.⁴²

Conclusion

In summary, food insufficiency which disproportionately impacts minority children may impair cognitive and psychosocial development especially in conjunction with other risk factors.