For 25 Years, Food Security Has Included a Nutrition Domain: Is a New Measure of Nutrition Security Needed?
Originally Posted in the Journal of the Academy of Nutrition and Dietetics (JAND)
THE US HOUSEHOLD FOOD SECURITY SURVEY MODULE AND ITS RELATIONSHIP WITH NUTRITION
Access to adequate, nutritious food, particularly in early childhood, is essential for keeping current and future generations healthy across the life span. When families lack enough resources to afford competing basic necessities, such as housing, utilities, health care, medication, and child care, food is often where they economize. Coping strategies include reducing the quality of food purchased, decreasing the quantity of food eaten or served to family members, acquiring food from emergency private food assistance sources (eg, charities and food pantries), and other behaviors.
An oft-used abbreviated definition of food insecurity, “lack of consistent access to enough healthful food for an active healthy life,” is directly linked to inadequate availability of household-level financial resources, which in turn is a consequence of persistent societal inequities and systemic barriers. Food insecurity negatively influences cognitive function and the physical and mental health of children and adults. Food insecurity aggravates a wide variety of co- occurring adverse health conditions, disproportionately burdening families with low socioeconomic status, families of color, and immigrant families.
Preceding the development of a food security measure, food insecurity was indirectly assessed to inform mitigation of the social problem of hunger. Aggregate food availability indicators (eg, Food and Agriculture Organization of the United Nations [FAO] food balance sheets, and indicators of malnutrition prevalence), poverty indicators (eg, income and education), nutritional status indicators (eg, anthropometric, biochemical, and clinical indexes), and food intake indicators (eg, 24-hour recall and food frequency) all were used to infer food insecurity.
Nutrition, nutritional status, and nutritional state were all prominent features of the conceptualization and definition of food security by the Life Sciences Research Office of the Federation of American Societies for Experimental Biology. An expert panel of the Life Sciences Research Office, including highly regarded experts in nutrition from around the United States (eg, William H Dietz Jr, MD, PhD; Johanna Dwyer, DSc; and Jean-Pierre Habicht, MD, MPH, PhD) articulated a conceptual framework for nutritional state defined as “the assimilation and utilization of nutrients by the body plus interactions of environmental factors such as those that affect food consumption and food security. Thus, evaluation of nutritional state requires assessment of food consumption and food insecurity as well as biochemical, clinical, and anthropometric indices of nutritional status.”
Later, during development and validation of the US Household Food Security Survey Module (HFSSM), four dimensions were incorporated as its foundational basis: “quantity of food intake, quality of food intake, anxiety about the adequacy of food supply, and social acceptability of the sources of food.” Based on this construct, the expanded definition of food security was stated as “access by all people at all times to enough food for an active, healthy life. Food security includes at a minimum: (1) the ready availability of nutritionally adequate and safe foods, and (2) the assured ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies).” In turn, food insecurity was defined as “whenever the availability of nutritionally adequate and safe foods, or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.” In this sense, the core HFSSM dimensions and definitions of food security and food insecurity were understood as an outcome of systemic/societal factors influencing economic deprivation, which in turn affected people’s ability to be nourished.
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CONCLUSIONS
Replacing food security, the well-established and widely used HFSSM measure that is backed by 25 years of data and empirical research, with the new, ambiguous and poorly defined construct of nutrition security, for which there is no measure, has the potential to have detrimental effects on research, policy, and ultimately on the health and well-being of people. Although focusing on and emphasizing the necessity for all people to have a healthy nutritional state is essential and laudable, shifting focus from food security to nutrition security, or healthy nutritional state, is similarly risky because food security is a necessary condition for a healthy nutritional state, or nutrition security. Instead, focus should be given to action-oriented research examining the multiple systemic, political economic factors that perpetuate food insecurity and make a healthy nutritional state unachievable for a large proportion of the US population. Those factors include inequitable and exclusionary social policies, lack of jobs that pay living wages, food advertising to adults and children, inequitable education funding mechanisms and low education attainment, and trends in corporate food production and marketing that strongly influence nutritional state in all sociodemographic groups. Nutrition scientists and other leaders in the field can play important roles in mitigating the adverse influence of these factors; however, continued insistence on shifting attention, resources, and effort from reducing and eliminating food insecurity to nutrition security is certain to be damaging to those living with food insecurity and others in need of improvement in their nutritional state.
