Why physicians need to focus on food insecurity

Food insecurity leads to negative health outcomes: ©Zahar2000 - stock.adobe.com

Food insecurity, defined as the limited or uncertain availability of nutritionally adequate and safe food, is emerging as a critical factor shaping long-term health outcomes, especially for children. As physicians face rising rates of childhood obesity, two studies published in JAMA Pediatrics link food insecurity and adverse health effects in both community and hospital settings.

The impact of neighborhood food access on childhood obesity

The first study, conducted by researchers at the Harvard Pilgrim Health Care Institute, looked at how food insecurity and limited access to healthy food during pregnancy and early childhood can have profound effects on child health, specifically increasing the risk of obesity. This large-scale study analyzed data from more than 28,000 children enrolled in 55 birth cohorts across the United States, as part of the National Institutes of Health Environmental Influences on Child Health Outcomes program. The results confirmed that children who grew up in low-income, low-food-access neighborhoods—where supermarkets were more than 0.5 miles away in urban settings or 10 miles away in rural areas—were at a significantly higher risk of developing obesity and severe obesity from childhood into adolescence.

Izzuddin Aris, PhD, an assistant professor of population medicine at Harvard Medical School and the study’s lead author, said in a statement: “Our findings indicate that exposure to food insecurity in these formative years has a lasting impact on a child’s weight and health trajectory. The risk of obesity and severe obesity increased by more than 50% for children living in such neighborhoods during pregnancy or early childhood.”

The study further emphasizes that this increased risk persists even after adjusting for various sociodemographic factors such as parental income, education, and race. The researchers also noted that children in these food-insecure environments had consistently higher body mass index z-scores at ages 5, 10, and 15, reflecting ongoing and cumulative weight gain over time.

This research builds on existing evidence that links food insecurity to poor health outcomes, including cardiovascular disease, diabetes, and other chronic conditions. While previous studies have largely focused on adult populations, the new data underscores the critical need to address food access during pregnancy and early childhood—stages when interventions may be most impactful in shaping long-term health outcomes.

Rising food insecurity and obesity: A national concern

The study's findings are especially troubling in the context of broader national trends. According to recent data, food insecurity in U.S. households with children has risen sharply, from 12.5% in 2021 to 17.3% in 2022. This increase parallels a continued rise in childhood obesity rates, creating what public health experts are calling a “dual burden” on the nation’s health care system. The co-existence of food insecurity and obesity highlights the problem wherein families struggle to access nutritious food, yet rely on cheaper, calorie-dense, nutrient-poor options that contribute to weight gain.

Aris stated that addressing this dual challenge will require a multifaceted approach. “Investments in improving food access are urgently needed in low-income-low-food-access neighborhoods. These might include policies to incentivize the opening of supermarkets in underserved areas, the establishment of healthy-choice food pantries, and efforts to increase the availability of fresh produce in small corner stores or convenience stores,” he said. “Such measures could help prevent child obesity and promote healthier communities.”

Food insecurity during hospitalization: An overlooked facto

While the community setting plays a crucial role in childhood obesity, food insecurity also follows children into hospitals, potentially worsening health outcomes during and after hospitalization. A second study, led by researchers at Wake Forest University School of Medicine, explored how inpatient food insecurity—the lack of access to adequate nutrition during a child’s hospital stay—impacts hospital length of stay and readmission rates.

In this study, researchers collected data from 9,325 hospital encounters at Atrium Health Levine Children's Brenner Children’s Hospital between May 2022 and December 2023. Caregivers of hospitalized children were asked to complete a three-question survey to screen for inpatient food insecurity. Those who reported skipping meals, feeling hungry without eating, or eating less than they felt they should due to financial constraints during their child’s hospitalization were considered positive for food insecurity.

The results showed that 8% of caregivers reported inpatient food insecurity, with a notable portion—40%—screening negative for household food insecurity, indicating that even families who are generally food secure may face nutritional challenges during hospitalization. These caregivers experienced significantly worse hospital outcomes: their children had an average hospital stay that was 2.4 days longer, and they faced 1.8 times higher odds of being readmitted within 30 days of discharge compared to caregivers without inpatient food insecurity.

Leila H. DeWitt, D.O., assistant professor of pediatrics at Wake Forest University and the study’s lead author, said in a statement: “Hospitalization can be a financially and emotionally draining experience for families. Inpatient food insecurity adds another layer of stress, which may contribute to poorer health outcomes and longer recovery times. By identifying families who need nutritional support during hospitalization, we can reduce disparities in care and improve both immediate and long-term health outcomes for these children.”

The role of physicians: Addressing food insecurity in clinical practice

For physicians, these studies highlight the need for a proactive approach to addressing food insecurity both in the community and during hospital care. Screening for food insecurity, whether in outpatient or inpatient settings, should become a routine part of care for families with children. Evidence-based interventions—such as connecting families to nutrition assistance programs, advocating for policy changes to improve food access, and ensuring food support is available during hospital stays—are critical tools in combating the dual burden of food insecurity and childhood obesity, researchers say.

Physicians can play a key role in educating families about the health risks associated with poor nutrition and providing resources for healthier eating, even in challenging economic circumstances. Given the long-term health consequences of both food insecurity and obesity, early identification and intervention are essential to reducing the risks of chronic disease in children and fostering healthier communities.

“Understanding the complex relationship between food insecurity and obesity in early life gives us the opportunity to intervene at a time when it can make the biggest difference,” Aris said. “By ensuring that children have access to healthy food from pregnancy onwards, we can set them on a path to better lifelong health.”