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Experiencing food insecurity, or insufficient access to healthy foods, has been associated with negative health outcomes, including an increased vulnerability for vitamin and mineral deficiencies¹ and a higher probability of developing chronic diseases.^2-4 While both low income and food insecurity are related to chronic disease risk,⁵ studies suggest that food security status may be more strongly predictive of chronic illnesses.^3,6

Dietary change may be an essential part of combatting many chronic diseases, yet food insecurity and limited access to affordable, nutritious foods can make this more difficult. In functional medicine, a personalized, nutrition-based strategy to address chronic disease starts with a comprehensive nutrition evaluation and hearing the entirety of your story. Understanding the conditions in which you live and your potential social, economic, and personal barriers is a crucial component of developing treatment plans that are both sustainable and effective.

Food Insecurity and Chronic Disease

Food insecurity occurs when access to sufficient amounts of nutritious, affordable food is blocked or interrupted due to a lack of money or other resources, resulting in a disruption of eating patterns and nutrient intake.⁵ As part of the US government’s prevention agenda outlined in the Healthy People 2030 report, food insecurity is a key issue discussed,⁵ and USDA national statistics from 2021 indicate that:

• 10.2% of US households (approximately 33.8 million people) were food insecure at least some of the time during the year.^7,8
• Rates of food insecurity increased for some population subgroups, including households with no children (from 11% in 2020 to 13.2% in 2021) and for older adults living alone (from 8.3% in 2020 to 9.5% in 2021).⁷
• Rates of food insecurity decreased significantly for all households with children (from 14.8% in 2020 to 12.5% in 2021) and for other population subgroups such as single mothers with children (from 27.7% in 2020 to 24.3% in 2021).⁷
• For adults who lived in families experiencing food insecurity, those who self-reported as non-Hispanic other and multiple races (12.7%) and non-Hispanic Black (12.2%) experienced higher rates of food insecurity compared to those who self-reported as non-Hispanic white (4.1%) and non-Hispanic Asian (3.7%).⁸

Observational studies have associated food insecurity with increased odds of self-reported poor health and development of chronic diseases such as obesity, diabetes, and hypertension for young and older adults.^4,5 In addition, a 2022 cross-sectional analysis of data from the 2017-2018 National Health and Nutrition Examination Study (n=3,502 participants aged 20 years or older) indicated that food insecurity was associated with higher liver stiffness measurements for those adults over 50 years of age and may increase the risk of advanced fibrosis and cirrhosis in older adults.⁹ Further analysis of US statistics have also suggested that food insecurity is associated with greater all-cause mortality in adults with metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, and advanced fibrosis.¹⁰

Analysis from a USDA National Health Interview Survey indicated that the number of chronic conditions for adults in food-insecure households was, on average, 18% higher than for those in food-secure households.³ Further, the analysis found that food security status of adults was also strongly related to the number of chronic conditions reported, and lower food security was associated with a higher probability of all the chronic diseases examined in the report, including high blood pressure, heart disease, stroke, cancer, diabetes, and kidney disease.³

And children are not exempt from these negative health impacts. A 2020 review published in Pediatric Clinics of North America reported that children experiencing food insecurity with limited access to healthy foods demonstrate poorer eating behavior that may lead to the development of chronic disease.¹¹ Food-insecure children may manifest with many different ailments, including anxiety and depression, and have an increased prevalence of anemia, asthma, and hospitalization with diabetes.¹¹

Food Deserts

Living in a food desert directly impacts consistent and reliable physical access to healthy foods. According to the Office of Disease Prevention and Health Promotion, reports indicate that more than 23 million people are estimated to live in food deserts in the United States.¹² These food deserts are neighborhoods that have fewer full-service supermarkets, and food-desert residents may have to travel long distances to reach grocery stores while potentially having limited vehicular access or public transportation options.^5,12,13 Convenience stores and small independent stores that may lack adequate variety, quantity, and consistency of affordable, nutritious foods are more common in food deserts than full-service supermarkets, and national reports suggest that overall, predominantly Black and Hispanic neighborhoods have fewer grocery stores than predominantly white and non-Hispanic neighborhoods.⁵

Functional Medicine Framework

In functional medicine, a robust patient-practitioner relationship is not only important to empower you in your health journey but also to develop the most effective treatment plan to combat chronic illness and boost immunity and resilience. Functional medicine clinicians consider certain factors, such as potential food insecurity and the possible resulting impacts of micronutrient deficiencies, elevated stress levels, and food accessibility barriers, to inform the speed and breadth of treatment. Find a functional medicine practitioner near you by clicking the link below.

Related Articles and Podcasts

The Hidden Hunger: Micronutrient Deficiencies

Mental-Emotional-Spiritual Connections to Physiology: The Influences of Social Determinants of Health

Farmers Markets: Promoting Healthy Eating in All Communities

References

1. Drake VJ. Subpopulations at risk for micronutrient inadequacy or deficiency. Linus Pauling Institute, Oregon State University. Published March 2018. Accessed October 11, 2024. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/subpopulations-at-risk
2. Laraia BA. Food insecurity and chronic disease. Adv Nutr. 2013;4(2):203-212. doi:3945/an.112.003277
3. Gregory CA, Coleman-Jensen A. Food insecurity, chronic disease, and health among working-age adults (ERR-235). USDA Economic Research Service. Published July 2017. Accessed October 11, 2024. https://www.ers.usda.gov/publications/pub-details/?pubid=84466
4. Nagata JM, Palar K, Gooding HC, Garber AK, Bibbins-Domingo K, Weiser SD. Food insecurity and chronic disease in US young adults: findings from the National Longitudinal Study of Adolescent to Adult Health. J Gen Intern Med. 2019;34(12):2756-2762. doi:1007/s11606-019-05317-8
5. Office of Disease Prevention and Health Promotion. Healthy People 2030: food insecurity. US Department of Health and Human Services. Accessed October 11, 2024. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity
6. Cai J, Bidulescu A. The association between chronic conditions, COVID-19 infection, and food insecurity among the older US adults: findings from the 2020-2021 National Health Interview Survey. BMC Public Health. 2023;23(1):179. doi:1186/s12889-023-15061-8
7. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2021 (ERR-309). USDA Economic Research Service. Published September 2022. Accessed October 11, 2024. https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=4735
8. Weeks JD, Mykyta L, Madans JH. Adults living in families experiencing food insecurity in the past 30 days: United States, 2021. NCHS Data Brief. 2023;(465):1-8. https://www.cdc.gov/nchs//data/databriefs/db465.pdf
9. Tapper EB, Mehta M, Leung CW. Food insecurity is associated with chronic liver disease among US adults. J Clin Gastroenterol. 2022;10.1097/MCG.0000000000001741. doi:1097/MCG.0000000000001741
10.  Kardashian A, Dodge JL, Terrault NA. Food insecurity is associated with mortality among U.S. adults with nonalcoholic fatty liver disease and advanced fibrosis. Clin Gastroenterol Hepatol. 2022;20(12):2790-2799.e4. doi:1016/j.cgh.2021.11.029
11.  Pai S, Bahadur K. The impact of food insecurity on child health. Pediatr Clin North Am. 2020;67(2):387-396. doi:1016/j.pcl.2019.12.004
12.  Office of Disease Prevention and Health Promotion. Healthy People 2030: Access to foods that support healthy dietary patterns. US Department of Health and Human Services. Accessed October 11, 2024. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-foods-support-healthy-dietary-patterns
13.  Brandt EJ, Silvestri DM, Mande JR, Holland ML, Ross JS. Availability of grocery delivery to food deserts in states participating in the online purchase pilot. JAMA Netw Open. 2019;2(12):E1916444. doi:1001/jamanetworkopen.2019.16444