Nutrition, Hunger, and Public Health

Most of us who work daily in public health think about public health as not just the elimination of certain diseases, but more about the entire spectrum of health and wellbeing.

On that spectrum is:

• Nutrition and diet
• Food insecurity and access to healthy food
• The role that fast food and processed foods plays in the rise of chronic diseases

Heavily processed foods are often high in sugar, fat, and empty calories. Consuming lots of these foods has long been linked to an increased risk of a wide variety of health problems that can lead to heart disease, or to other conditions like obesity, high blood pressure, elevated cholesterol, cancer, and mental health concerns like depression. It comes as no surprise that there’s a direct relationship between a poor diet and the growing epidemic of chronic diseases.

Another school of thought on the impact of ultra-processed foods is how the lack of micronutrients in those foods influences mental health symptoms like irritability, explosive rage, and unstable mood. There’s evidence in multiple studies that individuals who eat a healthy, whole food diet actually have less symptoms of depressive disorder and anxiety than those who eat processed foods.

·Considering that we are living in a more explosive society overall with increased rates of gun sales, social media pressures, 24/7 news, and bullying becoming mainstream and even seen within the chambers of government, the affect of what goes into our bodies is exacerbating this troublesome trend of a distressed and angry society. Consider that in the United States 67% of what children aged 2 to 19 years consumed and 57% of what adults consumed in 2018 were ultra-processed foods.

Also consider that Black Americans are more likely to be obese in the United States than white Americans. That’s also true for Latin Americans. The rise in obesity in the U.S. is an epidemic and much of the root causes can be found in poverty, a condition that is more prevalent in communities of color. Why is that? Accessibility and marketing are huge factors.

A study several years ago found that fast food chains in predominantly Black neighborhoods were more than 60% more likely to advertise to children than in predominantly white neighborhoods. Fast food locations in fact are strategically placed more prominently in neighborhoods with larger populations of non-white residents.

As expected, children who eat fast foods tend to eat more calories. That means more fat, sodium, and sugars, and less of the good stuff like fruits, vegetables, and dairy. Eating fast food has also been found to cause higher body fat and insulin levels in adolescence, and an increased risk of obesity in adulthood.

Another public health risk related to diet and poverty is rising rates of hunger and food insecurity. In 2020 over 38 million Americans lived in households that struggled against food insecurity, or lack of access to an affordable, nutritious diet. That is nearly a 10% increase from 2019. In terms of race and ethnicity, nearly 22% of Black households and 17% of Latinx households were impacted by food insecurity. These rates tripled in 2020.

In terms of geography, the food insecurity rate is highest in the South (12.3%), followed by the Midwest, then the West, and then Northeast. What can those of us who serve our patients do to help slow or reverse this trend?

For one, consider how important it is to get behind income support as a health intervention. We all agree that household food insufficiency is not only a material hardship but it is associated with adverse health outcomes. A study found that the recent Child Tax Credit (CTC), which ranged from $250 to many times that depending on the number and ages of children, was associated with a 26% reduction in food insufficiency nationally among households with children.

The Child Tax Credit which was precipitated by the COVID-19 pandemic as part of the $1.9 trillion American Rescue Plan Act passed in March 2021, and it has created a form of income support that is having positive public health outcomes of less hunger. That’s a great result of this troublesome time.

What else can we do? Well, as physicians, we can play a critical role in identifying and addressing our patients’ food insecurity by screening for social determinants of health and adding food insecurity to the discussion we have with patients. We can make referrals to community resources as needed in addition to the tips found in the Food Insecurity toolkit published online and found in the link below.

The food insecurity screening and referral process consists of five steps: 1.) Identifying patients living in food insecure households 2.) Connecting patients with proper resources 3.) Considering clinical needs that result from food insecurity 4.) Following up with patients at their next office visit 5.) Measuring the impact of food insecurity intervention(s) on patients’ food insecurity status and health.

Remember, to add food insecurity to the patient’s problem list, use ICD-10 diagnosis code Z59.4: Lack of adequate food and safe drinking water. We can help patients connect the dots that access to the role healthy food plays in managing their health, and to encourage them to let us help them. Again for more information and a food insecurity toolkit for physicians, refer to the sources below.

Sources:

• Food Insecurity Toolkit
• Fast Food Firms Target Low Income Minorities
• Fast Food, race/ethnicity, and income: a geographic analysis
• Fast Food Accessibility is a Public Health Issue
• How Fast Food Chains Supersized Inequality
• The disturbing ways that fast food chains disproportionately target black kids
• Junk Food and the Brain: How modern diets lacking in micronutrients may contribute to angry rhetoric
• Income Support as a Health Intervention
• Hunger & Poverty in America