Although food insecurity is a major public health problem, research suggests that food security may be a better goal of disease prevention strategies. The American Heart Association (AHA) released a policy statement on recommendations for expanding and improving nutrition support policies and programs with a broader focus on food security, providing food availability, access, availability, and equitable and stable use of adequate food quality. pay more attention to food safety than to eating foods that are high in calories.1
The focus of food security is on the prevention of chronic diet-related diseases such as cardiovascular disease, diabetes, obesity and cancer. Color communities, families with children, and people in rural areas are severely affected by chronic diet-related illnesses.2
“Healthy eating quality is an important part of cardiometabolic health, but we need to recognize that achieving a healthy diet is not fair to all people in the U.S.,” said Anne Thorndike, MD, MPH, president and chair of the policy writing group. AHA nutrition committee. “If we are advising our patients on diet and lacking information about their ability to buy or acquire food, we cannot provide effective counseling,” said Dr. Thorndike, an associate professor of medicine at Harvard Medical School. Physician at Massachusetts General Hospital, Boston.
The USDA also supported the focus on food security in its recently published USDA Nutrition Security Act.2 The average American diet does not meet the American Dietary Guidelines (ADI), and the overall Health Nutrition Index score is 59 out of 100, according to the USDA.
The COVID-19 pandemic highlighted the problem of food insecurity in this country in two ways, Dr. Thorndike said. First, there was a sharp rise in food security rates at the beginning of the pandemic; these rates were flattened after programs were adapted to help meet this need. Second, two-thirds of patients hospitalized with COVID-19 in the U.S. had diet-related illnesses. Thus, health care providers knew that malnutrition is not only a risk factor for chronic cardiometabolic diseases, but also for an acute infectious disease.
How is Food Security Assessed?
There are currently no standard nutritional safety measures. Traditional dietary quality measures, such as 24-hour diet recall and food frequency questionnaires, can be burdensome to use in daily practice, as noted in the AHA statement. Shorter tools are less accurate and their validity and reliability may be questionable. The association requested research to develop validated questions for use in daily practice and surveys to assess food safety.
While waiting for improved assessment tools, Dr. Thorndike suggested using a two-question vital sign of hunger and asking patients what they had eaten in the last 24 hours as a way to facilitate the conversation (Table).3
Table. An intense sign of hunger
|1. For the past 12 months, we have been worrying before we get the money to buy more food||2. For the last 12 months, the food we bought didn’t last and we didn’t have any more money|
This information gives clinicians the ability to improve their diet in a cost-neutral way, from sweet drinks to water, low-fat whole-milk dairy products, white potatoes or chips to sweet potatoes, and salt. To low-cost spices like garlic, cumin, and black pepper, Dr. Thorndike said.
“Clinicians can’t do this alone, they need to collaborate with their health systems or their practices, and they need a structure around the study of food safety,” Dr. Thorndike said.
Clinicians should partner with health systems to develop strategies for connecting patients with community resources. In Massachusetts, the Medicaid program is conducting a pilot study called the Flexible Service Program, which provides responsible care organizations with money to connect people with food resources, including medical meals, healthy food vouchers, or fruits and vegetables, Dr. Thorndike said.
Use and stability of nutritious foods
The use and stability of nutritious foods are newer elements to consider in food-related policies and programs over time. Proper food preparation tools, kitchen equipment, or Americans who don’t have time to cook can rely on ultra-processed foods that provide little food, as stated in the AHA statement. Proper food storage is also a problem, as many healthy foods are perishable and need to be refrigerated; others need dry spaces and containers to prevent damage from moisture, pests, and other contaminants.
In terms of stability, access to federal nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) may vary over time and eligibility criteria, creating gaps in access to nutrition assistance programs.
The AHA set out recommendations to increase the impact of current US food policies and programs on food security and to help reduce socioeconomic and racial / ethnic inequalities in chronic disease rates. The AHA praised the evaluation of the USDA Thrifty Food Plan, which serves as a basis for calculating SNAP benefits, and the fact that in October 2021 SNAP recipients launched a 20% increase in benefit levels to more accurately reflect the cost of nutritious meals.
Principles of Food Aid Programs to Achieve Food Security
“We need to put programs and policies in place to ensure that we are equitable in our ability to achieve healthy eating quality for all,” Dr. Thorndike said. Coordination of all programs and policies to address food security is needed from the federal level to the community level and within the health care system, Dr. Thorndike explained.
The AHA recommended the following principles to emphasize food quality, improve accessibility and optimal use, and improve coordination between U.S. food aid policies and programs:
- Emphasize nutrition rules
- Increase outreach and simplify enrollment and certification procedures
- Ensure optimal use of participants
- Improve coordination between programs
- Avoid coverage gaps for age groups
- Ensure equity for stable accessibility, accessibility, availability, and use (e.g., provide foods that meet cultural, social, and dietary priorities).
- Reducing stigma associated with participation
“As a physician, I hope that health care providers will increasingly recognize the importance of dietary consumption in our health and that we should give priority to ourselves and our patients,” Dr. Thorndike said.
1. Thorndike AN, Gardner CD, Kendrick KB, et al. Strengthening U.S. Food Policies and Programs to Promote Equity in Food Security: A Policy Statement from the American Heart Association. Traffic. May 10, 2022: 101161CIR0000000000001072. doi: 10.1161 / CIR.0000000000001072
2. U.S. Department of Agriculture. USDA Food Security Actions. March 17, 2022. Accessed May 9, 2022.
3. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-element screen to identify families at risk of food insecurity. Pediatrics. 2010; 126 (1): e26-32. doi: 10.1542 / peds.2009-3146