Food Insecurity Screening
There is a common condition that affects 1 in 7 people in the United States, with even higher rates among children. It is food insecurity—the limited or uncertain access to enough food.
It hinders normal development, is associated with decreased access to medical care, and has been proven to have a negative effect on overall health. While it certainly harms people who are otherwise healthy, it is especially dangerous for those with underlying chronic disease. Doctors or other healthcare providers cannot identify this condition by simply looking at a patient. There is no characteristic physical exam finding, lab test, or imaging study that can be used to make the diagnosis.
As a physician, my first thought after reading this description would naturally be "what can I do about it?” I am not alone. As we continue to learn about the many ways food insecurity affects health, more and more members of the healthcare community are taking notice and taking action.
While best practices for addressing food insecurity in the healthcare setting are still being established, understanding which patients are affected is generally considered to be a good first step. There is a validated screening tool known as the Hunger Vital SignTM that can be used to assess for food insecurity. Patients or their caretakers are presented with the following two statements and asked whether they are always, sometimes, or never true:
In the last 12 months we worried whether our food would run out before we got money to buy more.
In the last 12 months the food we bought just didn’t last and we didn’t have money to get more.
The screen is considered to be positive if the patient answers “always true” or “sometimes true” to one or both questions. Before using the Hunger Vital SignTM to screen for food insecurity, it is important to consider how the tool can be best incorporated into existing work flow and how it can be administered in a sensitive way that respects patients. There also must be a plan in place for responding to positive screens. Options range from making referrals to government nutrition programs or community agencies all the way up to providing patients with emergency food assistance on the spot.
Ultimately, the goal of healthcare is to promote optimum health and well-being for individuals and their communities. For many, being able to have an open conversation about food insecurity with their doctor or other healthcare provider is a necessary first step on the road to achieving that goal.
If you are a healthcare provider who is interested in learning more about how to incorporate food insecurity screening into your clinical practice, the American Academy of Pediatrics (AAP) and the Food Research and Action Center (FRAC) have published a toolkit with practical tips. While geared specifically towards pediatricians, it includes common themes that can be applied in any practice setting.