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OBJECTIVES

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  • Contrast food insecurity and hunger.

  • Discuss coping strategies associated with food insecurity that complicate disease management.

  • Identify risk factors for food insecurity and describe its epidemiology.

  • Discuss the nutritional, behavioral, and mental health impacts of food insecurity.

  • Identify challenges to providing care to food insecure patients and strategies that can help address these challenges in the clinical setting.

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Ms. Walker is a 48-year-old woman with a history of diabetes, hypertension, obesity, and depression. Her last hemoglobin A1c was 9.0%. She seems poorly engaged with her diabetes care, taking her medications intermittently, and infrequently adhering to a diabetic diet. She tells you that she frequently has difficulty making ends meet. Sometimes, rice is the only food she can afford to eat. You suspect her food insecurity is complicating her diabetes management.

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INTRODUCTION

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Food insecurity, or the inability to reliably access safe and nutritious food, has important health consequences. Food insecurity has an impact on health through nutritional, behavioral, and mental health pathways. Food insecure children and adults have higher rates of acute and chronic illness and higher health-care utilization. Management of chronic, diet-sensitive diseases, such as obesity, diabetes, and congestive heart failure, is particularly challenging in the context of food insecurity. This chapter explores the complicated relationships between food insecurity and illness with a focus on the issue in the United States and presents strategies to improve the care of food insecure patients.

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DEFINITION AND PATTERNS OF FOOD INSECURITY

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The most commonly accepted definition of food security and food insecurity comes from a 1990 report by the Life Sciences Research Office (LSRO)1:

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Food security was defined … as access by all people at all times to enough food for an active, healthy life and includes at a minimum: a) the ready availability of nutritionally adequate and safe foods, and b) the assured ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, and other coping strategies). Food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.

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In the United States, food insecurity generally implies that access to adequate food is limited by a lack of money and other resources. Globally, food insecurity may be due to other factors such as political unrest. The United Nations’ Food and Agriculture Organization defines food security as existing “when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.” Food must be consistently available, accessible, and useable.2

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DISTINGUISHING FOOD INSECURITY AND HUNGER

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Food insecurity is a concept distinct from the physical sensation of hunger. According to the LSRO,1...

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