Inside the CDC's latest dietary findings

It’s understandable for clinicians to attribute some illnesses to patients’ unhealthy dietary patterns. After all, diabetes, heart disease, and poor immune function are associated with low-quality food intake.

But patients living with food insecurity may not have a choice. Food-insecure patients are less likely to have access to high quality foods. When paired with other social determinants of health (SDOH), food-insecure patients may need their healthcare provider’s help to locate resources that address the root causes of unhealthy food intake.

Americans aren’t eating enough fruits and vegetables

Fruits and vegetables make up a vital part of an individual’s diet. According to a 2022 CDC report, adults should eat 2-3 cups of vegetables and 1.5-2 cups of fruit each day to reap the maximum nutritional benefits—including healthy immune function and decreased risk of heart disease, to name a couple.

Unfortunately, most American adults aren’t meeting the CDC’s produce intake standards. In 2019, nearly one in 10 people reported eating the optimal amount of fruits and veggies. 

The population that most frequently met the vegetable quota were participants aged 51 and older (12.5%). Those who lived close to or below the poverty level most often didn’t (6.8%). On the other hand, the population to most frequently meet the fruit quota were Hispanics (16.4%) and those who met it least were male (10.1%).

Consistent with previous reports, the 2019 findings showed that more Hispanic than non-Hispanic White adults met the fruit quota, and more White adults met the vegetable quota than non-Hispanic Black adults.

To contextualize these disparities, physicians must consider the role of SDOH in patients’ relationships to food—including food insecurity.

The prevalence and effect of food insecurity

Food insecurity is a common SDOH among Americans, affecting more than 11% of US households in 2018. A survey published by BMC Public Health details the effects of food insecurity: low food supply and variety of food, disrupted eating patterns, and reduced caloric intake, among others.

Food insecurity caused by financial and structural barriers leads to mental distress and functional limitations in patients who face them. Ethnicity, race, and age are a few demographic characteristics that have a hand in who experiences the brunt of food insecurity.

The survey looked at the food retail environment’s effect on the dietary patterns of 422 participants from Columbus, OH. Nearly 76% of participants were female. Of the total respondents, 67.5% were Black, and the average age of those surveyed was 51. Over 60% received less than or equivalent to a high school education.

The results found that 252 participants—over half—screened positive for food insecurity. Those who did were much less likely to view a fresh and healthy diet as convenient or affordable, largely because of the inability to use a car to frequently shop for food.  

A Family and Community Health article takes a closer look at structural racism and subsequent economic disadvantages as drivers of food insecurity in communities of color. For example, White households have 13 times the median wealth of Black households and 10 times the median of Hispanic households. This disparity may account for why the population to most often miss the recommended vegetable intake in 2019 was low-income, as well as why Black participants reported eating significantly fewer veggies than White participants.

Another factor that influenced the paucity of and financial access to fruits and vegetables is the COVID-19 pandemic, as noted by the CDC. The economic struggles posed by COVID, including supply chain disruptions, diminished access to healthy foods among populations who already struggled to meet their dietary needs.

How physicians can help food-insecure patients

Physicians who have food-insecure patients can intervene in several ways. American Family Physician suggests doctors routinely screen patients—especially those at-risk—for food insecurity.

The authors of an AFP article mention two statements that can help identify potential food insecurity in patients: 

• “Within the past 12 months we worried whether our food would run out before we got money to buy more.”

• “Within the past 12 months the food we bought just didn't last, and we didn't have money to get more.”

Patients who affirm these statements are likely food-insecure.

Once physicians identify and document food insecurity in patients, doctors can intervene by referring them to the Supplemental Nutrition Assistance Program (SNAP), according to BMC Public Health. While it’s not a universal solution, when paired with other nutrition incentive programs like Double Up Food Bucks, SNAP helps to reduce food insecurity among individuals.

Incentivizing the consumption of fruits and veggies is also helpful. Doctors can do this by implementing produce prescription programs in their practice. An article published by the Permanente Journal states that produce prescription programs help doctors supply patients with fruit and vegetable vouchers, redeemable at applicable grocery stores, farmers markets, and Community Supported Agriculture programs.

Sources

1. Banks AR, Bell BA, Ngendahimana D, Embaye M, Freedman DA, Chisolm DJ. Identification of factors related to food insecurity and the implications for social determinants of health screenings. BMC Public Health. 2021;21(1):1410.

2. Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2019. Center for Disease Control and Prevention. 2022;71:1–9.

3. Forbes JM, Forbes CR, George DR, Lehman E. “Prevention produce”: Integrating medical student mentorship into a fruit and vegetable prescription program for at-risk patients. Permanente Journal. 2019;23:18-238.

4. Odoms-Young AM. Examining the impact of structural racism on food insecurity: implications for addressing racial/ethnic disparities. Family & Community Health. 2018.

5. Patil SP, Craven K, Kolasa K. Food insecurity: how you can help your patients. American Family Physician. 2018;98(3):143-145.