Experts on Camera

Dr. Hilary Seligman: Food insecurity on the rise

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Food insecurity—lacking consistent access to enough nutritious food—was already on the rise in the U.S. when SNAP benefits (food stamps) were cut this spring for residents of 35 states.

On Tuesday, May 30, 2023, SciLine interviewed: Dr. Hilary Seligman, a professor of medicine and of epidemiology and biostatistics, at the University of California, San Francisco. She discussed topics including: trends in food insecurity rates among U.S. adults and children; factors that drive food insecurity, such as rising grocery prices; how food insecurity affects people’s health; how inconsistent access to food affects performance and success at work or school; common misperceptions about hunger; research-backed approaches to reduce or eliminate food insecurity; and “Food is medicine”—efforts to incorporate nutrition into healthcare, in recognition of nutrition’s importance to disease prevention and management.

Declared interests:

Dr. Seligman currently serves as the Senior Medical Advisor for Feeding America. She also receives funding from the USDA, NIH, and CDC, in addition to numerous private foundations.

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HILARY SELIGMAN: My name is Hilary Seligman. I’m professor of medicine at the University of California, San Francisco, where I study food insecurity and its impact on health across the life course.


Interview with SciLine

What is food insecurity?


HILARY SELIGMAN: Food insecurity is defined by the U.S. Department of Agriculture as the limited or uncertain access to enough food for a healthy life.

What are the recent data trends in food insecurity rates among U.S. adults and children?


HILARY SELIGMAN: The most recent data reported by the U.S. Department of Agriculture suggests that about one in ten households in the United States are food insecure, about 10.2% of all U.S. households. And this rate is even higher among certain groups, like black and brown households and households with children.

What factors cause food insecurity?


HILARY SELIGMAN: Well, at its root food insecurity is an inability to access enough resources for your basic needs. So, it’s not having sufficient money in the household to meet a food budget. And that may be because of disability, because of unemployment, because of inadequate educational opportunities, or all of these root causes that predispose people in the United States to low household incomes.

What do we know about how inflation is affecting food insecurity rates?


HILARY SELIGMAN: Food inflation has been a big issue this year. And it’s very clear that when the price of foods rise, it makes it more difficult for households to afford food because it makes them have to stretch their food budget even more. And so what typically happens in a food-insecure household is that people have to make difficult choices about the kind of food that they eat, and the amount of food that they eat. And in many cases, what happens when household budgets are stretched very thin is that people have to shift their food purchases towards foods that are cheaper. And in the United States, cheaper foods are almost always less healthy for you, more energy dense, more deficient in vitamins and nutrients.

How does food insecurity affect people’s health?


HILARY SELIGMAN: Well, over the last couple of decades, we’ve seen that food insecurity can have a profound impact on both people’s physical health and mental health, whether they are children, adults, older adults, or anywhere across the lifespan. And a lot of this is because of the shift in dietary intake towards less expensive foods that tend to be less healthy for you. And so these foods may predispose people to developing obesity or diabetes or other diseases that are really tightly intertwined with the types of foods that you eat. We also know that when you live in a food-insecure household, it makes it very difficult to afford other things that are good for your health. For example, it would make it more difficult to afford your copayment to see your primary care doctor or to afford the copayment on your medications. And when people have to make choices between food and these other decisions about their medical care, oftentimes their health can suffer.

How does food insecurity affect success at work or school?


HILARY SELIGMAN: We know that food insecurity is associated with poor academic performance among children. Parents are probably really familiar with the way that their children behave when they’re hungry. And those same things happen in school environments when kids show up to school having not had the opportunity to eat a healthy breakfast. So, the evidence is clear that food insecurity is associated with behavioral problems in school, with absenteeism from school, and with poor academic performance. And these can have lifelong consequences for children. A similar thing plays out with adults. Adults who are living in food insecure households are less likely to be able to hold down a sufficient number of hours to meet their household budget needs. They’re less likely to be able to devote a lot of hours to finding employment because finding food takes a lot of time and a lot of energy.

Are there any common misconceptions about hunger?


HILARY SELIGMAN: One of the misconceptions around hunger that’s really important for us to understand is that people who are experiencing food insecurity don’t want access to a healthier diet. In many, many cases, if not most cases, the evidence is clear that people at all income levels often want access to a healthier diet. But in a household experiencing food insecurity, a healthier diet is simply out of reach financially. And as an example, many people living in food insecure households will tell you that they perceive fruits and vegetables to be luxury items. They only splurge to afford fruits and vegetables when they have extra money in their budget. And so one of the things that we really have to guard against is an assumption that people with lower incomes don’t want to eat a healthy diet.

What is “Food is Medicine”? Can you describe some of these initiatives?


HILARY SELIGMAN: As it’s become clear that food insecurity has a really profound impact on people’s physical and mental health, the health care sector has become increasingly engaged in efforts to address food insecurity in their clinical or hospital settings. And the result has been this momentum towards what we call Food is Medicine approaches, and Food is Medicine approaches are bringing access to healthy food into the health care setting. So, you might, for example, offer clinicians the opportunity to write a prescription for healthy food to their patients in a very similar way that you might offer clinicians the opportunity to write a prescription for an antibiotic. Or you may, for example, bring a healthy food pantry onto the grounds of the hospital or the clinic and allow patients with certain diseases or high risk of certain diseases access to that on-site food pantry. Or for certain people, you may need to offer medically tailored meals that allow patients to access healthy meals at home when they can’t cook or shop for themselves. These would all be examples of Food is Medicine interventions that the health care system has become increasingly interested in using to help support the health of their patients.

What else works to reduce or eliminate food insecurity?


HILARY SELIGMAN: Well, the best solution for food insecurity is SNAP, which used to be called the food stamps program. It is very, very clear that SNAP is enormously effective at supporting food security in U.S. households. And anything that reduces access to SNAP or makes it more difficult to enroll in SNAP is going to have the effect of increasing food insecurity rates in the United States. An example of this would be the work requirements that are currently being discussed in Washington, D.C., that would push people out of the SNAP program that would likely increase food insecurity rates. Other things that increase household food budgets also protect families against food insecurity. So, things like earned income tax credits protect families against food insecurity. Emergency stimulus checks like we saw during the COVID pandemic, these also protected families against food insecurity.

What will be the effects of a new work requirement for SNAP benefits?


HILARY SELIGMAN: It’s really clear that if the federal government imposes new restrictions on SNAP eligibility, food insecurity rates in the United States will go up. And what that really means for people is that there is going to be a lot more stress around how to get enough food. There also are going to be a lot of difficult choices: whether to pay for food or medical care, whether to pay for food or put gas in the car to get to your job, whether to pay for food or buy things that your children need. And the other coping strategy that people are going to have to start engaging is shifting their food purchases towards cheaper foods. And one of the big problems in the U.S. is that those cheaper foods tend to be really highly processed, nutritionally poor, shelf stable foods. And we know these foods are really bad for people’s health in the long term. And they really predispose people towards weight gain, diabetes, cardiovascular disease, and even cancer. So, the new SNAP restrictions that are being talked about have the capacity to have a really, really negative impact on people with low incomes in the U.S.

How do SNAP benefits affect local economies?


HILARY SELIGMAN: SNAP benefits are very powerful at moving money into local economies. And so, particularly in a time when inflation is high, when local economies are often suffering, it’s really important that we continue to allow SNAP and access to money for food to help keep local food economies thriving.

How are reporters doing in covering food insecurity?

[Posted May 30, 2023 | Download video]