A Food Security Primer for the Primary Care Provider

Patient encounters with the health care system provide an opportunity for both assessment and for interventions focused on food security. A systematic review of the scientific literature on food insecurity reveals predictors of food insecurity for individuals and families, including poverty, households with children headed by single women, unemployment, elderly patients who have chronic, food-related diseases (diabetes, stroke, or cardiovascular disease) or the presence of functional impairment, ethnic or racial minority, energy insecurity, homelessness, and low education attainment. For pediatric patients, food insecurity may lead to impairment in psychosocial functioning, greater number of absences from school, lower arithmetic and reading skills, lower overall health status, and developmental risks. For adults, food insecurity is associated with lower ratings of health status, lower levels of fruit and vegetable consumption, diabetes, depression and anxiety. For mothers, the consequences of food insecurity also include maternal depression and an increased likelihood of provision of high-energy boosters and perceived appetite stimulants to their children. Elder patients experiencing food insecurity are more likely to have lower skin fold thickness than their food secure counterparts. Food security instruments in primary care settings have limitations, but the answer to a single question may give the primary care provider reason for referral. Providers should formulate plans for referral of potentially food insecure patients; a list of programs, organizations and resources is readily available. Primary health care should be considered a natural setting for working at the interface between health care and food insecurity.