research topics on food insecurity

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• Published: 31 October 2022

Food insecurity

Nature Climate Change volume  12 ,  page 963 ( 2022 ) Cite this article

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• Climate-change impacts

Climate change is a confounding factor that can affect agriculture and food security in many different ways. Climate-resilient food systems are needed to ensure food security and to support mitigation efforts.

World Food Day — 16 October, with the theme this year of ‘leave no one behind’ — is an appropriate time to reflect on global progress toward Sustainable Development Goal 2: Zero Hunger. The 2022 Global Hunger Index, released October 2022 ( https://www.globalhungerindex.org/ ), highlights that progress has stagnated, with the war in Ukraine, climate change and related extreme events, and the related increased price of food, fuel and fertilizer all contributing. The 2022 Global Hunger Index report 1 highlights that 44 countries are currently suffering serious or alarming levels of hunger, although there is large within-country variability. The report estimates that 828 million people are currently undernourished, with parts of Africa south of the Sahara and South Asia having the highest hunger levels, and being the most vulnerable to future shocks.

Climate change can affect crops in different ways and the impacts of climate change due to higher levels of atmospheric CO 2 are often deleterious. While higher levels of atmospheric CO 2 may enhance photosynthesis and growth in some crops 2 , there isn’t a clear picture on the overall effects on crops. Further, it has been reported that plants grown under higher CO 2 levels have changed nutritional value 3 .

Warming temperatures due to climate change also impact crop productivity, with an example discussed in this issue of Nature Climate Change . In an Article , Peng Zhu and colleagues consider how warming temperatures affect cropping frequency and yields. They find that warmer temperatures are increasing productivity and the possibility of multiple cropping seasons in cold regions, but increased temperatures in warm regions are causing decreases that outweigh the cold-region increases for an overall loss in crop productivity. The authors note that irrigation can offset the losses in warm regions, but water availability and the infrastructure needed suggest that the required 5% expansion of irrigation areas would be difficult to achieve.

Research has highlighted the risks of concurrent regional droughts; for example, work looking at 26 main crop-producing countries that found the probability under a high-emissions scenario to be at least 5% compared with 0% in the historical period 4 , as well as work showing increases by 40–60% for 10 global regions, with disproportionate risk increase across North America and the Amazon region 5 . With many regions relying on rain-fed agriculture, drought is a major risk to crop failure.

The shifting of seasons, in particular wet periods, can also affect planting. The northern USA had heavy spring rains this year that limited corn planting. This reduced planting led the US Department of Agriculture to lower the predicted yield per acre by 4 bushels, which equals more than 9 million tonnes less corn crop across the country. This lower yield, alongside lower-than-expected grain harvests in China, India, South America and part of Europe, reduced the available produce, not only for consumption but also for stock feed.

As well as their impact on production, extreme events can be a major disruption of supply chains. Yet, international trade has been highlighted as a possible way to mitigate climate change impacts on food security. It has been shown that high-emissions climate scenarios lead to increased hunger risk of 33–47% when trade is restricted, but decreases to 11–64% when trade is open 6 . However, production for export does need to be carefully considered to minimize negative effects in the producing region 7 .

The need to transform food systems to ensure resilience to climate change and other external pressures is well recognized, yet in climate change discussions it has not always been at the fore; at COP27, there will be a Food Systems Pavilion for the first time. How to achieve food systems transformation needs careful consideration and discussion, but work needs to begin now to push past the current stagnation and to ensure that no one is left behind.

von Grebmer, K. et al. 2022 Global Hunger Index: Food Systems Transformation and Local Governance (Welthungerhilfe, Concern Worldwide, 2022).

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Food insecurity. Nat. Clim. Chang. 12 , 963 (2022). https://doi.org/10.1038/s41558-022-01530-2

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Published : 31 October 2022

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Food Insecurity

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In 2015, at least 795 million people worldwide, some 12.9% of world population, lacked enough food to lead a healthy and active life. The majority lived in developing countries in Asia (512 million) and Sub-Saharan Africa (220 million) and these figures are only increasing. Food insecurity (FI) has ...

Keywords : Food systems, nutrition, hunger, right to food, food insecurity

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Food Insecurity

Economic Stability

About This Literature Summary

This summary of the literature on Food Insecurity as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Access to Foods that Support Healthy Dietary Patterns literature summary.

Related Objectives (4)

Here's a snapshot of the objectives related to topics covered in this literature summary. Browse all objectives .

• Reduce household food insecurity and hunger  — NWS‑01
• Eliminate very low food security in children — NWS‑02
• Increase fruit consumption by people aged 2 years and over — NWS‑06
• Increase vegetable consumption by people aged 2 years and older — NWS‑07

Related Evidence-Based Resources (1)

Here's a snapshot of the evidence-based resources related to topics covered in this literature summary. Browse all evidence-based resources .

• The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States

Literature Summary

Food insecurity is defined as a household-level economic and social condition of limited or uncertain access to adequate food. 1  In 2020, 13.8 million households were food insecure at some time during the year. 2 Food insecurity does not necessarily cause hunger, i but hunger is a possible outcome of food insecurity. 3

The United States Department of Agriculture (USDA) divides food insecurity into the following 2 categories: 1

• Low food security : “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
• Very low food security : “Reports of multiple indications of disrupted eating patterns and reduced food intake.”

Food insecurity may be long term or temporary. 4 , 5 , 6  It may be influenced by a number of factors, including income, employment, race/ethnicity, and disability. The risk for food insecurity increases when money to buy food is limited or not available. 7 , 8 , 9 , 10 , 11  In 2020, 28.6 percent of low-income households were food insecure, compared to the national average of 10.5 percent. 2  Unemployment can also negatively affect a household’s food security status. 10  High unemployment rates among low-income populations make it more difficult to meet basic household food needs. 10  In addition, children with unemployed parents have higher rates of food insecurity than children with employed parents. 12  Disabled adults may be at a higher risk for food insecurity due to limited employment opportunities and health care-related expenses that reduce the income available to buy food. 13 , 14  Racial and ethnic disparities exist related to food insecurity. In 2020, Black non-Hispanic households were over 2 times more likely to be food insecure than the national average (21.7 percent versus 10.5 percent, respectively). Among Hispanic households, the prevalence of food insecurity was 17.2 percent compared to the national average of 10.5 percent. 2 Potential factors influencing these disparities may include neighborhood conditions, physical access to food, and lack of transportation.

Neighborhood conditions may affect physical access to food. 15  For example, people living in some urban areas, rural areas, and low-income neighborhoods may have limited access to full-service supermarkets or grocery stores. 16  Predominantly Black and Hispanic neighborhoods may have fewer full-service supermarkets than predominantly White and non-Hispanic neighborhoods. 17  Convenience stores may have higher food prices, lower-quality foods, and less variety of foods than supermarkets or grocery stores. 16 , 18  Access to healthy foods is also affected by lack of transportation and long distances between residences and supermarkets or grocery stores. 16

Residents are at risk for food insecurity in neighborhoods where transportation options are limited, the travel distance to stores is greater, and there are fewer supermarkets. 16  Lack of access to public transportation or a personal vehicle limits access to food. 16  Groups who may lack transportation to healthy food sources include those with chronic diseases or disabilities, residents of rural areas, and some racial/ethnicity groups. 15 , 16 , 19  A study in Detroit found that people living in low-income, predominantly Black neighborhoods travel an average of 1.1 miles farther to the closest supermarket than people living in low-income predominantly White neighborhoods. 20

Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. For example, a study found that food-insecure adults may be at an increased risk for obesity. 21  Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 years and 65 years. 22  Food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity. 23 , 24 , 25 They also face a higher risk of developmental problems compared with food-secure children. 12 , 25 , 26  In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on children’s mental health. 27

Food assistance programs, such as the National School Lunch Program (NSLP); the Women, Infants, and Children (WIC) program; and the Supplemental Nutrition Assistance Program (SNAP), address barriers to accessing healthy food. 28 , 29 , 30 , 31 Studies show these programs may reduce food insecurity. 29 , 30 , 31  More research is needed to understand food insecurity and its influence on health outcomes and disparities. Future studies should consider characteristics of communities and households that influence food insecurity. 32  This additional evidence will facilitate public health efforts to address food insecurity as a social determinant of health.

i  The term hunger refers to a potential consequence of food insecurity. Hunger is discomfort, illness, weakness, or pain caused by prolonged, involuntary lack of food.

U.S. Department of Agriculture, Economic Research Service. (n.d.). Definitions of food security . Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/

U.S. Department of Agriculture, Economic Research Service. (n.d.). Key statistics & graphics. Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx

Carlson, S. J., Andrews, M. S., & Bickel, G. W. (1999). Measuring food insecurity and hunger in the United States: Development of a national benchmark measure and prevalence estimates. Journal of Nutrition, 129 (2S Suppl), 510S–516S. doi:  10.1093/jn/129.2.510S

Jones, A. D., Ngure, F. M., Pelto, G., & Young, S. L. (2013). What are we assessing when we measure food security? A compendium and review of current metrics. Advances in Nutrition, 4(5), 481–505.

Food and Agriculture Organization. (2008). An introduction to the basic concepts of food security . Food Security Information for Action Practical Guides. EC–FAO Food Security Programme.

Nord, M., Andrews, M., & Winicki, J. (2002). Frequency and duration of food insecurity and hunger in U.S. households. Journal of Nutrition Education and Behavior, 34 (4), 194–201.

Sharkey, J. R., Johnson, C. M., & Dean, W. R. (2011). Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women. Women & Health, 51 (5), 442–460.

Seefeldt, K. S., & Castelli, T. (2009). Low-income women’s experiences with food programs, food spending, and food-related hardships (no. 57) . USDA Economic Research Service. https://www.ers.usda.gov/publications/pub-details/?pubid=84306

Nord, M., Andrews, M., & Carlson, S. (2007). Measuring food security in the United States: household food security in the United States, 2001. Economic Research Report (29).

Nord, M. (2007). Characteristics of low-income households with very low food security: An analysis of the USDA GPRA food security indicator. USDA-ERS Economic Information Bulletin (25).

Klesges, L. M., Pahor, M., Shorr, R. I., Wan, J. Y., Williamson, J. D., & Guralnik, J. M. (2001). Financial difficulty in acquiring food among elderly disabled women: Results from the Women’s Health and Aging Study. American Journal of Public Health, 91 (1), 68.

Nord, M. (2009). Food insecurity in households with children: Prevalence, severity, and household characteristics. USDA-ERS Economic Information Bulletin (56).

Coleman-Jensen, A., & Nord, M. (2013). Food insecurity among households with working-age adults with disabilities. USDA-ERS Economic Research Report (144).

Huang, J., Guo, B., & Kim, Y. (2010). Food insecurity and disability: Do economic resources matter? Social Science Research, 39 (1), 111–124.

Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health, 95 (4), 660–667.

Ploeg, M. V., Breneman, V., Farrigan, T., Hamrick, K., Hopkins, D., Kaufman, P., Lin, B.-H., Nord, M., Smith, T. A., Williams, R., Kinnison, K., Olander, C., Singh, A., & Tuckermanty, E. (n.d.). Access to affordable and nutritious food-measuring and understanding food deserts and their consequences: Report to congress. Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=42729

Powell, L. M., Slater, S., Mirtcheva, D., Bao, Y., & Chaloupka, F. J. (2007). Food store availability and neighborhood characteristics in the United States. Preventive Medicine, 44 (3), 189–195.

Crockett, E. G., Clancy, K. L., & Bowering, J. (1992). Comparing the cost of a thrifty food plan market basket in three areas of New York State. Journal of Nutrition Education, 24 (1), 71S–78S.

Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010). Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition, 140 (2), 304–310.

Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health , 95(4), 660–667.

Hernandez, D. C., Reesor, L. M., & Murillo, R. (2017). Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities. Appetite, 117, 373–378.

Gregory, C. A., & Coleman-Jensen, A. (n.d.). Food insecurity, chronic disease, and health among working-age adults . Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=84466

Gundersen, C., & Kreider, B. (2009). Bounding the effects of food insecurity on children’s health outcomes. Journal of Health Economics , 28 (5), 971–983.

Metallinos-Katsaras, E., Must, A., & Gorman, K. (2012). A longitudinal study of food insecurity on obesity in preschool children. Journal of the Academy of Nutrition and Dietetics, 112 (12), 1949–1958.

Cook, J. T., & Frank, D. A. (2008). Food security, poverty, and human development in the United States. Annals of the New York Academy of Sciences, 1136 (1), 193–209.

Cook, J. T. (2013, April). Impacts of child food insecurity and hunger on health and development in children: Implications of measurement approach. In Paper commissioned for the Workshop on Research Gaps and Opportunities on the Causes and Consequences of Child Hunger.

Burke, M. P., Martini, L. H., Çayır, E., Hartline-Grafton, H. L., & Meade, R. L. (2016). Severity of household food insecurity is positively associated with mental disorders among children and adolescents in the United States. Journal of Nutrition , 146(10), 2019–2026.

Bhattarai, G. R., Duffy, P. A., & Raymond, J. (2005). Use of food pantries and food stamps in low‐income households in the United States. Journal of Consumer Affairs , 39(2), 276–298.

Huang, J., & Barnidge, E. (2016). Low-income children's participation in the National School Lunch Program and household food insufficiency. Social Science & Medicine, 150 , 8–14.

Kreider, B., Pepper, J. V., & Roy, M. (2016). Identifying the effects of WIC on food insecurity among infants and children. Southern Economic Journal, 82 (4), 1106–1122.

Ratcliffe, C., McKernan, S. M., & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity? American Journal of Agricultural Economics, 93 (4), 1082–1098.

Larson, N. I., & Story, M. T. (2011). Food insecurity and weight status among U.S. children and families: A review of the literature. American Journal of Preventive Medicine, 40 (2), 166–173.

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Food Security Update | World Bank Response to Rising Food Insecurity

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• What is Food Security

Latest Update – July 1, 2024

Domestic food price inflation remains high in many low- and middle-income countries. Inflation higher than 5% is experienced in 59.1% of low-income countries (no change since the last update on May 30, 2024), 63% of lower-middle-income countries (no change), 36% of upper-middle-income countries (5.0 percentage points higher), and 10.9 percent of high-income countries (3.6 percentage points lower). In real terms, food price inflation exceeded overall inflation in 46.7% of the 167 countries where data is available.

Download the latest brief on rising food insecurity and World Bank responses

Since the last update on May 30, 2024, the agricultural, cereal, and export price indices closed 8%, 10%, and 9% lower, respectively. A fall in cocoa (16%) and cotton (11%) prices drove the decrease in the export price index. Maize and wheat prices closed 8% and 23% lower, respectively, and rice closed at the same level. Maize prices are 28% lower, wheat prices 8% higher, and rice prices 18% higher on a year-on-year basis. Maize prices are 10% higher, wheat prices 5% lower, and rice prices 46% higher than in January 2020. (See “ pink sheet”  data for agricultural commodity and food commodity prices indices, updated monthly.)

In the latest Hunger Hotspots report covering the period between June and October 2024, the Food and Agriculture Organization (FAO) and World Food Programme (WFP) have issued a joint warning about the escalating food insecurity crisis in 18 critical hotspots comprising 17 countries or territories and one regional cluster. Mali, the Palestinian Territories, South Sudan, and Sudan are of the highest concern, and Haiti is newly added because of escalating violence by non-state armed groups. These areas are experiencing famine or are at severe risk, requiring urgent action to prevent catastrophic conditions. The report emphasizes the critical need for expanded humanitarian assistance in all 18 hotspots to protect livelihoods and increase access to food. Early intervention is crucial to mitigate food gaps and prevent further deterioration into famine conditions. The international community is urged to invest in integrated solutions that address the multifaceted causes of food insecurity, ensuring sustainable support beyond emergency responses to build resilience and stability in affected regions.

A new report from the Integrated Food Security Phase Classification (IPC) confirms that the food insecurity situation in Gaza continues to be catastrophic. High risk of famine will persist across the whole Gaza Strip as long as conflict continues, and humanitarian access is restricted. The report finds that 96% of the population, equivalent to 2.15 million people, face acute food insecurity (IPC Phase 3 or above), with 495,000 individuals experiencing catastrophic levels of food insecurity (IPC Phase 5) through September 2024. The gravity of the situation is a reminder of the urgent need to make sure food and other supplies reach all people in Gaza. Only cessation of hostilities in conjunction with sustained humanitarian access to the entire Gaza Strip can reduce the risk of famine occurring in the Gaza Strip, the report argues.

The AMIS Market Monitor for June 2024 highlights the initial forecasts for global cereal production released in May, underscoring significant uncertainty because planting of many crops is pending in the Northern hemisphere. The report scrutinizes the validity of early projections for 2024/25 wheat production, now challenged by adverse weather conditions such as drought and prolonged frost in key Russian regions that affect yield expectations. Consequently, world wheat export prices rose in May, driven by mounting concerns over production constraints, particularly in the Black Sea region. Given wheat's critical role as a staple food with limited substitutes, importing nations are closely monitoring developments for potential impacts on food security.

Following Russia’s invasion of Ukraine, trade-related policies imposed by countries have surged. The global food crisis has been partially made worse by the growing number of food and fertilizer trade restrictions put in place by countries with a goal of increasing domestic supply and reducing prices. As of June 26, 2024, 16 countries have implemented 22 food export bans, and 8 have implemented 15 export-limiting measures.

World Bank Action

Our food and nutrition security portfolio now spans across 90 countries. It includes both short term interventions such as expanding social protection, also longer-term resilience such as boosting productivity and climate-smart agriculture. The Bank's intervention is expected to benefit 296 million people. Some examples include:

• In Honduras, the Rural Competitiveness Project series (COMRURAL II and III) aims to generate entrepreneurship and employment opportunities while promoting a climate-conscious, nutrition-smart strategy in agri-food value chains. To date, the program is benefiting around 6,287 rural small-scale producers (of which 33% are women, 15% youth, and 11% indigenous) of coffee, vegetables, dairy, honey, and other commodities through enhanced market connections and adoption of improved agricultural technologies and has created 6,678 new jobs.
• In Honduras, the Corredor Seco Food Security Project (PROSASUR) strives to enhance food security for impoverished and vulnerable rural households in the country’s Dry Corridor. This project has supported 12,202 extremely vulnerable families through nutrition-smart agricultural subprojects, food security plans, community nutrition plans, and nutrition and hygiene education. Within the beneficiary population, 70% of children under the age of five and their mothers now have a dietary diversity score of at least 4 (i.e., consume at least four food groups).
• The $2.75 billion  Food Systems Resilience Program for Eastern and Southern Africa , helps countries in Eastern and Southern Africa increase the resilience of the region’s food systems and ability to tackle growing food insecurity. Now in phase three, the program will enhance inter-agency food crisis response also boost medium- and long-term efforts for resilient agricultural production, sustainable development of natural resources, expanded market access, and a greater focus on food systems resilience in policymaking.
• A  $95 million credit from IDA for the Malawi Agriculture Commercialization Project (AGCOM) to increase commercialization of select agriculture value chain products and to provide immediate and effective response to an eligible crisis or emergency.
• The  $200 million IDA grant for Madagascar  to strengthen decentralized service delivery, upgrade water supply, restore and protect landscapes, and strengthen the resilience of food and livelihood systems in the drought-prone ‘Grand Sud’ .
• A $60 million credit for the Integrated Community Development Project that works with refugees and host communities in four northern provinces of Burundi to improve food and nutrition security, build socio-economic infrastructure, and support micro-enterprise development through a participatory approach.
• The $175 million Sahel Irrigation Initiative Regional Support Project is helping build resilience and boost productivity of agricultural and pastoral activities in Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal. More than 130,000 farmers and members of pastoral communities are benefiting from small and medium-sized irrigation initiatives. The project is building a portfolio of bankable irrigation investment projects of around 68,000 ha, particularly in medium and large-scale irrigation in the Sahel region.
• Through the $50 million Emergency Food Security Response project , 329,000 smallholder farmers in Central Africa Republic have received seeds, farming tools and training in agricultural and post-harvest techniques to boost crop production and become more resilient to climate and conflict risks.
• The $15 million Guinea Bissau Emergency Food Security Project is helping increase agriculture production and  access to food to vulnerable families. Over 72,000 farmers have received drought-resistant and high-yielding seeds, fertilizers, agricultural equipment; and livestock vaccines for the country-wide vaccination program. In addition, 8,000 vulnerable households have received cash transfer to purchase food and tackle food insecurity.
• The $60 million Accelerating the Impact of CGIAR Research for Africa (AICCRA) project has reached nearly 3 million African farmers (39% women) with critical climate smart agriculture tools and information services in partnership with the Consortium of International Agricultural Research Centers (CGIAR). These tools and services are helping farmers to increase production and build resilience in the face of climate crisis. In Mali, studies showed that farmers using recommendations from the AICCRA-supported RiceAdvice had on average 0.9 ton per hectare higher yield and US$320 per hectare higher income.
• The $766 million West Africa Food Systems Resilience Program is working to increase preparedness against food insecurity and improve the resilience of food systems in West Africa. The program is increasing digital advisory services for agriculture and food crisis prevention and management, boosting adaption capacity of agriculture system actors, and investing in regional food market integration and trade to increase food security. An additional $345 million is currently under preparation for Senegal, Sierra Leone and Togo.
• A $150 million grant for the second phase of the Yemen Food Security Response and Resilience Project, which will help address food insecurity, strengthen resilience and protect livelihoods.
• $50 million grant of additional financing for Tajikistan  to mitigate food and nutrition insecurity impacts on households and enhance the overall resilience of the agriculture sector.
• A $125 million project in Jordan aims to strengthen the development the agriculture sector by enhancing its climate resilience, increasing competitiveness and inclusion, and ensuring medium- to long-term food security.
• A  $300 million project in Bolivia  that will contribute to increasing food security, market access and the adoption of climate-smart agricultural practices.
• A  $315 million loan to support Chad, Ghana and Sierra Leone  to increase their preparedness against food insecurity and to improve the resilience of their food systems.
• A  $500 million Emergency Food Security and Resilience Support Project  to bolster Egypt's efforts to ensure that poor and vulnerable households have uninterrupted access to bread, help strengthen the country's resilience to food crises, and support to reforms that will help improve nutritional outcomes.
• A  $130 million loan for Tunisia , seeking to lessen the impact of the Ukraine war by financing vital soft wheat imports and providing emergency support to cover barley imports for dairy production and seeds for smallholder farmers for the upcoming planting season.

In May 2022, the World Bank Group and the G7 Presidency co-convened  the Global Alliance for Food Security , which aims to catalyze an immediate and concerted response to the unfolding global hunger crisis. The Alliance has developed the publicly accessible Global Food and Nutrition Security Dashboard , which provides timely information for global and local decision-makers to help improve coordination of the policy and financial response to the food crisis.

The heads of the FAO, IMF, World Bank Group, WFP, and WTO released a Third Joint Statement on February 8, 2023. The statement calls to prevent a worsening of the food and nutrition security crisis, further urgent actions are required to (i) rescue hunger hotspots, (ii) facilitate trade, improve the functioning of markets, and enhance the role of the private sector, and (iii) reform and repurpose harmful subsidies with careful targeting and efficiency. Countries should balance short-term urgent interventions with longer-term resilience efforts as they respond to the crisis.

Last Updated: Jul 01, 2024

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Smart food choices at family level can ease chronic illness

by Krisy Gashler, Cornell University

Promoting healthy diets for the entire family can better improve health outcomes for people with chronic illnesses, according to a new Cornell study.

"Families are an essential social unit, and food is a social medium: families pool and negotiate food choices, and it's also the way we pass on dietary preferences, traditions and build kinship," said Ramya Ambikapthi, senior research associate in the Food Systems & Global Change program in the Department of Global Development, in the College of Agriculture and Life Sciences.

"If you can change food behaviors at the family level, you have the opportunity to achieve healthier diets for all, now and for the next generation."

Ambikapthi is the co-first author of the paper, published Aug. 7 in Global Food Security and co-written with colleagues from Purdue University, University of South Carolina, Harvard University, Muhimbili University of Health and Allied Sciences in Tanzania, Tanzania Food and Nutrition Center, London School of Hygiene and Tropical Medicine, and the University of Illinois.

Research and policy on nutrition support have historically focused on external factors, such as market prices and availability, and individual factors, including affordability and physical distance from food resources . In the last few years, researchers have begun emphasizing the importance of family food dynamics as both a factor influencing individual food choices and as a policy lever to improve healthy, sustainable diets for all, Ambikapthi said.

In the current study, researchers used HIV as a case study to understand family food dynamics, reviewing almost 7,000 relevant articles. Then they developed a Family Dynamics Food Environment Framework (FDF), which they hope will inform research and policy on an array of chronic illnesses , especially as diet-related illnesses such as diabetes and heart disease grow across the globe.

Because of improvements in disease management, HIV has become a chronic illness that many people can live with for decades; however, such a diagnosis can have devastating economic impacts for individuals and families, especially those already living in poverty in the Global South. HIV-positive individuals may lack energy to perform farm labor or be denied employment because of social stigma.

"If your family supports you, that determines how well you survive, and food is an important part of family support," Ambikapthi said. Food security is particularly important for HIV patients prescribed antiretroviral therapy (ART) drugs, which require a full meal to be absorbed. "When people who have HIV and are food insecure are told to take ART, they don't take it, because if they don't have enough food, ART just makes them throw up."

In low-income households, families also have to cope with the constant pressure of competing basic needs , such as allocating scarce resources to fuel or schooling, or choosing which family members will receive sufficient nutritious food: children, elderly family members, those performing the most manual labor or individuals with HIV.

"Nutrition programs generally focus on pregnant women and small children, due to their critical nutrition needs. But what we want is healthy diets for all," Ambikapthi said. "Understanding how family dynamics impact food choices can help people who implement nutrition policies to structure intervention messages in ways that enable healthy diets for the entire family."

The researchers plan for future work on this topic to explore how family food dynamics can be applied in other contexts; for example, achieving sustainable, healthy diets in urban areas.

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Article Contents

Introduction, acknowledgements, compliant with ethical standards.

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Food insecurity and obesity: research gaps, opportunities, and challenges

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Alison G M Brown, Layla E Esposito, Rachel A Fisher, Holly L Nicastro, Derrick C Tabor, Jenelle R Walker, Food insecurity and obesity: research gaps, opportunities, and challenges, Translational Behavioral Medicine , Volume 9, Issue 5, October 2019, Pages 980–987, https://doi.org/10.1093/tbm/ibz117

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Food insecurity, defined as a lack of consistent access to enough food for an active, healthy life, is a major public health concern with 11.8% of U.S. households (15.0 million) estimated to be affected at some point in 2017 according to the United States Department of Agriculture Economic Research Service. While the link between food insecurity, diet quality, and obesity is well documented in the literature, additional research and policy considerations are needed to better understand underlying mechanisms, associated risks, and effective strategies to mitigate the adverse impact of obesity related food insecurity on health. With its Strategic Plan for NIH Obesity Research, the NIH has invested in a broad spectrum of obesity research over the past 10 years to understand the multifaceted factors that contribute to the disease. The issue of food insecurity, obesity and nutrition is cross-cutting and relates to many activities and research priorities of the institutes and centers within the NIH. Several research gaps exist, including the mechanisms and pathways that underscore the complex relationship between food insecurity, diet, and weight outcomes, the impacts on pregnant and lactating women, children, and other vulnerable populations, its cumulative impact over the life course, and the development of effective multi-level intervention strategies to address this critical social determinant of health. Challenges and barriers such as the episodic nature of food insecurity and the inconsistencies of how food insecurity is measured in different studies also remain. Overall, food insecurity research aligns with the upcoming release of the Strategic Plan for NIH Nutrition Research and will continue to be prioritized in order to enhance health, lengthen life, reduce illness and disability and health disparities.

Practice : This research can provide evidence of effective programs or strategies to reduce food insecurity or obesity related to food insecurity that can be integrated into practices in the real-world setting.

Policy : Food insecurity and obesity are serious public health challenges and research related to programs, policies, and/or environmental strategies could be considered to reduce risk factors associated with food insecurity patterns and promote sustainable approaches for healthy food access, especially among the most vulnerable.

Research : To address gaps in food insecurity and obesity research, the National Institutes of Health supports a broad-spectrum of biomedical and behavioral research that seeks to identify underlying mechanisms, associated risks, and effective strategies to mitigate this public health concern.

Food insecurity—a lack of consistent access to enough food for an active, healthy life—is a significant global and domestic public health concern. An estimated 11.8 per cent of American households were food insecure at some point during 2017 [ 1 ]. About 4.5 per cent of households had very low food security , a more severe range of food insecurity in which the food intake of some household members was reduced, and normal eating patterns were disrupted at times during the year due to limited resources. Overall, rates of food insecurity were higher than the national average in low-income households, Black- and Hispanic-headed households, and households with children [ 1 ].

A negative association between food insecurity and health has been consistently demonstrated in the literature [ 2 ]. Among children and adolescents, food insecurity has been associated with a variety of outcomes such as asthma [ 3 ], anemia [ 4 ], and behavioral, academic, and emotional problems [ 5 ]. Among adults, studies have shown that food insecurity is associated with poor dietary quality [ 6 ], depression [ 7 ], cardiometabolic diseases [ 8 ], diabetes and poor diabetes control [ 9 ] and obesity, particularly among adult women [ 8 , 10 , 11 ]. The question of whether food insecurity causes obesity was first published in 1995 [ 12 ]. Since then, the body of evidence exploring this relationship has grown substantially. Despite several hypotheses that have been proposed in the literature to explain the link between food insecurity and body weight, it is not well understood if food insecurity plays a causative role in the development of obesity, and if it does, what mechanisms are involved [ 10 ].

Food insecurity, nutrition, and obesity are cross-cutting scientific topics that are within the National Institutes of Health (NIH)-supported research, however, are often not examined in tandem within individual studies. This research is facilitated across several Institutes and Centers to progress toward reducing chronic diseases; understanding genetic, behavioral, and environmental causes; and studying impacts of innovative prevention and treatment strategies designed to address them. The NIH and other funding agencies have made investments in this area of research; however, additional studies are needed to better understand underlying mechanisms, associated risks, and effective strategies to mitigate these public health concerns. Furthermore, the NIH has the opportunity and ability to promote translational research and implementation science to adequately address issues of food security and obesity within the U.S. population.

The purpose of this commentary was to consider the challenges, gaps, and opportunities in the research exploring the link between food insecurity and obesity. In this commentary, we:

Describe the food insecurity and obesity research within the various NIH Institutes and Centers;

Identify key fundamental challenges with how food insecurity is defined;

Explain research gaps ranging from the need for more research and potential strategies to explore the continuum of research from the mechanisms and pathways of the relationship to more longitudinal and multilevel intervention research; and

Highlight research opportunities through existing funding mechanisms and epidemiological cohort studies and future research stemming from the Strategic Plan for NIH Nutrition Research.

NIH-wide investments

With its Strategic Plan for NIH Obesity Research, the NIH has invested in a broad-spectrum of obesity research over the past 10 years to understand the multifaceted factors that contribute to the disease [ 13 ]). The issues of food insecurity, obesity, and nutrition are cross-cutting and relate to many funded research studies throughout the Institutes and Centers within the NIH. There is also a specific focus within the NIH to promote implementation science and study the methods and strategies that enhance the uptake of effective interventions into routine practice with the aim of improving population health [ 14 ]. From fiscal years (FY) 2009–2017, the most recent year for which complete data were available, the NIH funded 30 grants, related to food insecurity and obesity (NIH RePORTER tool, search terms “food insecurity” or “food desert” + RCDC code = “obesity”, fiscal years 2009-2017, awarded grants only). The NIH spent $31.6 million from FY09 to FY17 on these grants. Eight (27 per cent) of these grants were funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Other major funders included the National Institute of Diabetes and Digestive and Kidney Diseases (five grants, 17 per cent), the National Cancer Institute (four grants, 13 per cent), the National Heart, Lung, and Blood Institute (three grants, 10 per cent), and the National Institute on Minority Health and Health Disparities (three grants, 10 per cent). The majority (22; 73 per cent) of these grants were research project grants, whereas 3 (10 per cent) used training mechanisms, and the remainder were intramural or other.

Prominent thematic and topical areas covered by the most recent grants, identified using the NIH iSearch tool, include maternal stress, food stamps, pediatric obesity, and corner or convenience stores. Studies ranged from secondary data analysis of existing datasets to community-based interventions to change individual-level dietary behaviors and food insecurity outcomes. For example, one study explored the influence of stress on household food insecurity and dysregulated eating behaviors on weight among women postpartum [ 15 ]. Formative research from a community-based participatory research study, Tribal Health and Resilience in Vulnerable Environment Study, assessed for correlates of food insecurity within an Oklahoma tribal community to inform development of a community-based intervention within convenience stores to increase the availability of fruit and vegetables [ 16 ]. This research included practical applications to expand the impact of the research. For example, the partnerships formed as a result of the study informed policies used to address the issue of food insecurity, including the development of a community supported agriculture and community food program, increased access to culturally appropriate produce at local farmers' markets, restructuring the placement of healthy foods in local grocery stores, and the introduction of Electronic Benefits Transfer (EBT; the method for which Supplemental Nutrition Assistance Program, the largest federal food assistance program, is redeemed) [ 16 ] ( Fig. 1 ).

The National Institutes of Health (NIH)-funded grants on food insecurity and obesity, 2009–2017, by the NIH Institute/Center. “Other” category includes National Institute of General Medical Sciences, National Institute on Alcohol Abuse and Alcoholism, National Center for Complementary and Integrative Health, National Institute on Aging, and National Institute of Nursing Research. Each Institute/Center in the “Other” category funded one grant. Abbreviations: NICHD, Eunice Kennedy Shriver National Institute of Child Health and Human Development; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NCI, National Cancer Institute; National Institute of Mental Health; NHLBI, National Heart, Lung, and Blood Institute; NIMHD, National Institute on Minority Health and Health Disparities; NIMH, National Institute of Mental Health.

Research challenges and barriers

Despite investments by the NIH and others in this area, key challenges and barriers remain, particularly on the accuracy of measurement, definitions, and operationalization of the food security measure. Although there is variation in how food security is assessed across the literature, most studies in U.S. population use instruments that are based on the United States Department of Agriculture (USDA) Food Security Supplement, which is administered annually in conjunction with the Census Bureau's nationally representative Current Population Survey. The Food Security Supplement includes a series of 18 questions (10 questions if no children are included in the household) that ask respondents about their experiences over the past 12 months related to concerns that food would run out, perceptions about the quantity and quality of the meals they could afford, and whether any adults or children had to forgo food due to a lack of resources. A validated 6-item “short form” has also been created by the USDA for surveys that cannot implement the 18-item or 10-item questionnaire [ 17 ]. Instruments used in the literature range from a single question to all 18 items [ 8 ]. In addition to the instrument developed by the USDA, a review by Ashby et al. [ 18 ] identified eight other multi-item tools that were used to assess food security in developed countries. These tools were shown to have moderate-to-high internal consistency but varying levels of validity among the subpopulations at risk for food insecurity [ 18 ].

The severity and duration of exposure to food insecurity can be difficult to quantify. This is due in part to the heterogeneous circumstances of food-insecure individuals and a range of situations that can fluctuate throughout the year causing many households to cycle in and out of food insecurity [ 8 , 19 ]. Categories of food insecurity include marginal food security, low food security, and very low food security; however, current measurement tools do not distinguish between acute and chronic food insecurity and may not adequately capture information in vulnerable subgroups (i.e., among non-English speakers) or the nuance of the experience of food insecurity among different cultures, for example, among immigrant populations [ 20 , 21 ]. In addition, the USDA metric of food insecurity primarily focuses on the economic definition of food insecurity and does not capture behavioral coping patterns such as the trade-offs between food purchases and other expenses [ 22 ]. There are few longitudinal surveys that assess food insecurity at multiple time points or over the life course. These limitations create a challenge when evaluating the relationship between food insecurity and health outcomes, such as obesity.

Another research challenge comes from the fact that many studies measure food insecurity at the household level, which may not accurately reflect the degree of food insecurity experienced by any one individual. Studies in the international context suggest differences in intra-household food allocation based on gender and age [ 23 ]. For example, children in a food-insecure household may be shielded from the impact of a food shortage by their parents, and thus, will not be affected by food insecurity to the same extent as an adult living in the same household [ 24 ]. Even among food-insecure adults, there may be a large variation in the severity of the food insecurity that they experience. This variation is difficult to capture and may explain some of the mixed results in the literature.

Research gaps

To explore the state of the research in this area and identify predominate research gaps, we examined the existing literature and systematic reviews on the topic. Four main research gap areas emerged ( Table 1 ) including: (a) the mechanisms and pathways underlying the relationship between food insecurity and obesity; (b) the impact of food insecurity on pregnant and lactating women, children, and other vulnerable populations; (c) longitudinal studies; and (d) effective multilevel intervention strategies that could be used for greater real-world impact.

Research gaps and direction for future research

Mechanisms and pathways

Although the link between obesity, food insecurity, and diet has been examined, the research literature shows conflicting results depending on the subpopulation and dataset used [ 11 , 25 , 26 ]. The varying effects and contradictory findings that differ by gender, race, ethnicity, and age group warrant further exploration. Future research should also explain the underlying mechanisms and pathways underscoring this relationship and contradictory findings.

Previous research has posited that food insecurity contributes to irregular eating patterns characterized by periods of underconsumption and food deprivation when resources are limited, and compensatory overconsumption when resources are adequate, contributing to adiposity [ 27–29 . Coupled with this cycle is the widespread availability of high calorie, low-cost foods consumed by those experiencing food insecurity. Theoretical models have proposed a mechanistic explanation drawing in findings from the intersection of evolutionary biology, ecology, and obesity research [ 10 , 30 ]. Yet, the driving mechanisms remain unclear.

Impact on pregnant and lactating women, children, and other populations

Given the critical role nutrition plays in fetal and childhood development, additional research exploring the long-term impact of food insecurity on pregnant and lactating women, and during infancy, toddlerhood, and adolescence are still needed [ 8 , 31 ]. Understanding the influence of food insecurity patterns on the onset and progression of chronic diseases such as obesity and diabetes and its influence across the life course and critical periods of development are of particular interest. Existing studies show food insecurity in pregnancy and postpartum to be associated with disordered eating, variations in gestational weight gain depending on prepregnancy weight [ 15 , 32 ], and decreased duration of breastfeeding [ 32 ]. In addition, as previously stated, most of the literature measures food insecurity at the household level and extrapolates these data to represent the childhood experience, meanwhile children may be protected from the influence of food insecurity due to intra-household food allocation strategies (i.e., a mother feeding her children before herself to shield her children from food insecurity) [ 8 , 23 ].

Examining the consequences of food insecurity at different stages of child and adolescent development is also important. For instance, one study found that infants and toddlers from low-income households that had food insecurity were at significantly greater developmental risk (in areas such as language, motor, and socio-emotional development) than those from low-income households without food insecurity [ 33 ]. Another study showed that in a large sample of U.S. adolescents, food insecurity was associated with greater risk of mental disorders, after controlling for other socioeconomic (SES)-related variables, such as extreme poverty [ 34 ]. Understanding how food insecurity affects development across the lifespan is key to informing both interventions and policy approaches for particular segments of the population.

Additional research among other diverse and vulnerable populations is also a priority to ensure that the knowledge and evidence base and results are relevant, reliable, and valid in these populations. Food insecurity, for example, affects a greater proportion of racial/ethnic minority and socially disadvantaged groups in the USA that are already at increased risk for diseases related to diet such as heart disease, stroke, and diabetes. Typically, such populations are underrepresented in research studies and are considered hard to reach due to a lack of responsiveness to interventions that are designed for general audiences within dissemination and implementation research [ 35 ]. However, there are broader levels of influence to be understood such as the role of inadequate outreach and engagement, insufficient capacity or infrastructure within these communities, use of culturally unacceptable research methods, and in some populations, low participation due to various issues, including historical mistrust [ 35 , 36 ]. Examining food insecurity in rural and urban settings and coping strategies people use to mitigate consequences of food-related hardship in each context is also important and will assist in unraveling these complex associations [ 37 , 38 ]. Improving our understanding of food insecurity among diverse population groups will ultimately help to design interventions and pragmatic approaches to address these known health disparities. By expanding knowledge related to the specific barriers, moderators, and mediating pathways of each group, successful interventions can be better designed and implemented through targeted screening and referral programs or the establishment of new food distribution programs or innovative partnerships.

Longitudinal studies

Because of the complexity of the relationship between food insecurity, diet, and obesity, additional cross-sectional analyses are limited in their ability to answer key research questions. For example, cross-sectional studies cannot establish directionality of associations between food insecurity and obesity. In addition, researchers can statistically control for a variety of sociodemographic factors such as income, education, and race to consider the influence of these factors on both weight and food insecurity, but other unmeasured variables related to food insecurity (i.e., timing, duration, and coping strategies) cannot be accounted for in cross-sectional studies. Although longitudinal studies present similar concerns of unmeasured confounders, the time sequence of events can be clarified with this approach. To the best of our knowledge, there are very few longitudinal studies that explore this area [ 39 , 40 ].

More innovative longitudinal evidence is thus a priority. These studies would elucidate the issue of timing and temporality and support an important criterion for causality as well as shed light on the long-term effect of food insecurity on diet and weight status. In addition, well-designed longitudinal studies would allow for the exploration of the pathways and mechanisms underlying this relationship, which is also critical. Although causality cannot be confirmed given the limitations of longitudinal studies, the inability to conduct conventional randomized control trials to examine this issue should also be acknowledged [ 41 ]. Instead, comparative effectiveness studies offer another alternative to explore these associations.

Development of effective multilevel intervention strategies

Given the systems and social factors that contribute and perpetuate food insecurity and the complexity of the issue, the development of innovative multilevel interventions strategies to address obesity among those experiencing food insecurity is an additional priority. Existing interventions mainly focus on low-income families participating in federal food and nutrition programs (i.e., Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and have targeted individual-level behaviors, such as diet and physical activity [ 42–44 ]. A more policy-focused initiative includes the USDA-funded Healthy Incentives Pilot, which evaluated the short-term impact of financial incentives to purchase fruit, vegetables, or other healthful foods on the diet quality of SNAP participants [ 45 ]. Because of the pilot nature of the study, the long-term impacts on weight outcomes were not explored. However, this pilot program and other USDA-funded incentive programs have led to permanent funding in the 2018 Farm Bill in what is called the Gus Schumacher Nutrition Incentive Program, providing opportunity for future research and evaluation [ 46 ]). Meanwhile, relatively few intervention studies have considered the influence of the various elements of food and nutrition programs (i.e., amount and timing of EBT benefit, and length of time on benefits) on reducing the risk of obesity in their design. Meanwhile, research suggests that these factors may have implications in the link between food insecurity and food programs and obesity [ 47 , 48 ], and therefore should be examined further.

Novel methods that leverage natural experiments or evaluation of the influence of large-scale programs and policies on food access (i.e., policy changes resulting in reductions in EBT benefits) and health outcomes should be explored. It is also important to examine how food environments affect food insecurity and improve the ability to collect more granular geographic data to quantify better local or small area variation of food environments and accessibility to healthy, affordable food resources. These data could improve research efforts related to various disease outcomes and help identify contextual features that may facilitate or hinder successful implementation of intervention strategies. For example, the differential impacts of interventions in rural and urban environments are of interest. In addition, leveraging of electronic and other technologies to address issues of food insecurity are also opportunities for future research growth.

Research opportunities

Current funding opportunity announcements.

Recognizing the need for more research to explore the link between obesity and food insecurity and effectively address these concerns, the NIH is currently seeking innovative applications to address these research gaps. In addition to supporting investigator-initiated grant applications through parent funding opportunity announcements (FOAs), the NIH solicits potential projects related to food insecurity and obesity through three targeted funding opportunity announcements. PAR-18-854, “Time-Sensitive Obesity Policy and Program Evaluation (R01 Clinical Trial Not Allowed)” supports research to evaluate programs and policies that target obesity-related behaviors and/or weight outcomes in an effort to prevent or reduce obesity. It also uses an expedited review and award process to support time-sensitive evaluation of programs or policies with imminent implementation. PA-18-032, “Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development (R01 Clinical Trial Optional)” seeks applications that propose research to identify or characterize factors from birth to 24 months that affect obesity risk in children, a key demographic vulnerable to the effects of food insecurity.

Current and former cohorts available for analysis

A few large current and former NIH studies have included the assessment of household-level food insecurity among study participants, which provides the potential for future research studies on the topic. For example, launched in 2015, the Environmental Influences on Child Health Outcomes Program is a 7-year initiative to understand the effects of environmental exposures on children's health [ 49 ]. Through the synergistic study of multiple extant longitudinal cohorts, researchers are collecting food insecurity measures, as well as data on physical, chemical, biological, social, behavioral, natural, and built environments on child health outcomes, such as obesity [ 49 ]. The Healthy Communities Study, conducted between 2010 and 2016, is another NIH-funded study that collected dietary data and a food insecurity measure [ 50 ]. The goal of the study included the examination of community characteristics and how these relate to children's dietary and physical activity behaviors, and health outcomes, particularly childhood obesity. The diverse cohort represented 130 communities and over 5,000 children and their families in the USA [ 50 ]. Ultimately, these cohorts include measures that would support the development of research to strengthen our understanding of the impact of food insecurity on the weight status of children over time.

The Strategic Plan for NIH Nutrition Research

The upcoming release of the Strategic Plan for NIH Nutrition Research will continue to prioritize research to expand our understanding of the link between food insecurity and obesity. In October 2016, Dr. Francis Collins, the Director of NIH, established an NIH Nutrition Research Task Force to coordinate and accelerate progress in the NIH-funded nutrition research and to guide the development of the first NIH-wide Strategic Plan for Nutrition Research. Through a collaborative process of gathering information across the various Institutes, Offices, and Centers within the NIH and from the external nutrition research community, literature searches, and public crowdsourcing opportunities, the NIH identified research gaps and areas of opportunity to prioritize the future of nutrition research. The culmination of these efforts is the Strategic Plan for NIH Nutrition Research , which will serve as a guide to accelerate basic, translational, and clinical research, as well as research training activities, over the next 10 years. The Plan is organized by seven themes that each contain major research priorities and examples of related research activities. Equally important to the identification of evidence-based nutrition strategies to improve health is the translation of this research into practice so that health-care providers, patients, families, caregivers, and communities are equipped with tools to adapt and sustain successful nutrition practices. Therefore, the Plan specifically prioritizes efforts to expand implementation science (i.e., the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health).

A need for further research related to the direct and indirect consequences of food insecurity and how these consequences alter nutrition and health relationships is highlighted in the Strategic Plan. How food insecurity and other social determinants of health and environmental factors contribute individually and in combination to interindividual variability in the relationships between diet and health requires further elucidation. In addition, research areas aimed at determining the mechanisms underlying the co-existence of food insecurity, obesity, and other related metabolic conditions are described.

The Strategic Plan also calls for increased efforts in systems science and advancement in bioinformatics and computational approaches in nutrition research. As these approaches continue to advance, new opportunities to evaluate the systemic factors and relationships that affect and are affected by nutrition are emerging and may offer opportunities to expand research capabilities. Such approaches may help to untangle the pathways and mechanisms associated with the complex relationships between food insecurity, diet, and weight status or other health outcomes that are difficult to investigate. Insights provided by this research may provide new opportunities for interventions to address food insecurity and related health consequences.

Translational implications

Beyond the topics identified as challenges and gaps for food insecurity and obesity in this article, there is the importance of putting research into practice to positively affect the 11.8 per cent of American households who face food insecurity every year in the USA. As mentioned, implementation science plays an important role in identifying barriers to, and enablers of, effective health programming and policymaking, and leveraging that knowledge to develop evidence-based innovations in effective delivery approaches. It is important for researchers to go beyond studying outcomes for effectiveness and begin systematically targeting implementation outcomes as well. This would include outcomes such as acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability that are key in the effective translation of evidence-based outcomes into any population [ 51 ].

Identifying which intervention studies are effective and testing approaches to scale up and sustain these interventions will therefore be critical in the decades to come. For example, should food insecurity screenings be implemented in the dissemination of SNAP benefits? Could interventions be implemented through the SNAP-Ed or are there other settings that are practical for dissemination, such as the clinical setting? Providers across the health-care setting, for example, screen for food insecurity, but providers need a way to connect their patients to resources that best address the specific needs of their patients. Conducting implementation studies and addressing food insecurity from a multidisciplinary platform may help to identify critical partnerships and technologies or capacity solutions that will increase uptake of evidence-based practices and ultimately reduce food insecurity among American households.

This commentary highlights the gaps in the literature examining the association between food insecurity and obesity, former and current efforts within the NIH to address these gaps, and future research opportunities. Although the link between food insecurity and obesity are well documented, additional research and policy considerations are needed to better understand underlying mechanisms, associated risks, and effective strategies to mitigate these public health concerns. The relationship between food insecurity and obesity is at a critical juncture that could greatly benefit from the utilization of translational research and implementation science to effectively shape the field to create lasting change and results. The use of multidisciplinary teams from food insecurity, obesity, and an array of other fields is essential for the understanding and targeting of the problem. Research is needed to test effective approaches and scale up these interventions into diverse contexts to adequately address obesity among those who experience the varying levels of food insecurity. Current funding opportunity announcements focusing on obesity, particularly among children, are potential vehicles for funding in this area. The upcoming release of the Strategic Plan for NIH Nutrition Research and its future implementation is yet another opportunity to expand research to better understand the mechanisms underscoring the link between food insecurity and obesity and more importantly develop effective translatable behavioral interventions to address this important social determinant of health.

We would like to acknowledge those who helped review and edit the manuscript including Patrice Armstrong, PhD, MPH, Lawrence Fine, MD, PhD, Charlotte Pratt, MS, PhD, RD, and Pamela L. Thornton, PhD.

This commentary was not funded.

Conflict of Interest: All authors declare they have no conflicts of interest.

Ethical Approval: Human rights, informed consent, and animal welfare ethical statements are not applicable.

Disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Minority Health and Health Disparities; the National Institutes of Health; or the U.S. Department of Health and Human Services.

Primary Data: Data presented in the portfolio analysis of this manuscript is from NIH RePORTER.

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Food Insecurity - Science topic

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• Land Use Change: Food insecurity often leads to unsustainable agricultural practices such as deforestation, land degradation, and soil erosion. These practices contribute to the loss of biodiversity and ecosystem services, such as carbon storage, soil fertility, and water regulation.
• Climate Change: Food insecurity can contribute to climate change through the emissions of greenhouse gases from agricultural practices, such as livestock production, fertilizers, and transportation. Climate change, in turn, can exacerbate food insecurity through increased frequency and intensity of extreme weather events, such as droughts, floods, and heat waves.
• Water Scarcity: Food production requires significant amounts of water, and food insecurity can exacerbate water scarcity in regions already experiencing water stress. Unsustainable water use in agriculture can lead to groundwater depletion, soil salinization, and other environmental impacts.
• Loss of Ecosystem Services: Food insecurity can lead to the loss of ecosystem services, such as pollination, pest control, and nutrient cycling, which are essential for sustainable food production.
• Health Impacts: Food insecurity can also have significant health impacts, including malnutrition, chronic disease, and mental health problems. These health impacts can, in turn, have further environmental impacts, such as increased healthcare costs and reduced productivity.
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Report examines Michigan families’ experience with food access and assistance

August 8, 2024

Each year, hundreds of thousands of Michigan parents worry whether they can afford to feed their children. Increased food prices, the state’s housing crisis , and the end of COVID-era financial support have all led to more Michigan families experiencing food insecurity today than before the pandemic. Now, a new report led by the University of Michigan School of Public Health details the first-hand experiences of these families; their challenges signing up for food assistance, the stress and shame of having to ask for help with food, and parents’ deep commitment to making sure their children are fed—even if it means that they go without.

Called “ Feeding MI Families: Michigan Families’ Lived Experience of Food Access and Food Assistance ,” the report describes the findings of the Feeding MI Families community-based participatory research project, which has engaged nearly 1,300 parents from urban and rural communities across the state. The goal of the project is to elevate the lived experience of food insecurity in order to spur improvements in federal, state, and local food systems so they work better for families.

Feeding MI Families was established in 2021 with a grant from the W.K. Kellogg Foundation to elevate the experiences of food-insecure families from Detroit, Grand Rapids, and Battle Creek. In 2022, with support from Michigan Farm Bureau Family of Companies, Feeding MI Families expanded to include families from the state’s 57 rural counties . Rural communities often have food insecurity rates comparable to urban areas. According to the report, 22% of children in Michigan’s Wayne and Roscommon counties are food insecure. 

“While we think that living in Michigan’s Upper Peninsula could not be more different than living in Detroit, over and over, we heard the same challenges when it comes to buying food, whether it be lack of transportation, high food prices at local grocery stores, or not being able to find brands that can be purchased with WIC benefits,” says Kate Bauer , director of Feeding MI Families and an associate professor of Nutritional Sciences at Michigan Public Health. “While the solutions to these challenges may differ based on location, families' needs and wants are the same.” 

Feeding MI Families approach: We’re Listening. We’re Learning.

Aligning with the project’s motto, “We’re Listening. We’re Learning,” Feeding MI Families gathered parents’ experiences through text message-based surveys and in-depth phone interviews offered in English and Spanish. Parents were asked to share their perspectives on formal and informal food assistance programs, including:

• Supplemental Nutrition Assistance Program/Food Assistance Program (SNAP/FAP)
• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
• Pandemic EBT (P-EBT) benefits
• School food distribution during COVID-19
• Charitable food systems

Three overarching themes emerged from parents’ experiences: 

• Stigma and discrimination are central barriers to food security
• Small modifications make big differences to families
• Families want dignified access to fresh and safe produce, proteins, and dairy products

Within each of these themes, the report provides parent-driven recommendations for policy and programmatic change at all levels of government and within the nonprofit and for-profit sectors. 

One recommendation that emerged is to change the design of the state’s EBT card, called the Bridge Card, which is loaded with food assistance benefits and can be used like a credit card at grocery stores.

“Parents reported feeling shame and embarrassment when purchasing food with a Bridge Card because it is brightly colored and easily identifiable,” Bauer explains. “One mother said she only uses self-checkout so she can hide her Bridge Card from the people behind her in line. While we need to end discrimination at its root, making the Bridge Card more discreet is a simple strategy to improve the shopping experience.”

Elevating family experiences through storytelling

In addition to the survey and interview findings, the report elevates compelling personal stories from families and highlights unique Michigan populations with consistent barriers to healthy food access, including Hispanic/Latino families, families living in the Upper Peninsula, and families that include individuals with disabilities.

Bauer notes that many food assistance programs want client and community input but don’t have the resources to gather this information, and that there are often disconnects between those who hold power and those who rely on services. 

“There are a lot of stereotypes and assumptions about families experiencing food insecurity,” Bauer says. “We hope that Feeding MI Families helps dispel these inaccuracies and motivates more organizations to meaningfully engage individuals with lived experience in decision making. Communities know what they need to overcome food insecurity. We need to listen and learn from them.”

• Read the report at feedingmifamilies.org .

Contact Destiny Cook Senior Public Relations Specialist University of Michigan School of Public Health [email protected] 734-647-8650

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Political economy of maternal child malnutrition: experiences about water, food, and nutrition policies in pakistan.

1. Introduction

2. materials and methods, 2.1. data collection and analysis, 2.2. ethical consideration, 2.3. strength and limitation, 3.1. quantitative water and food insecurity experiences, 3.2. qualitative water and food insecurity experiences, 3.2.1. water insecurity experiences at the community level, 3.2.2. food insecurity experiences at community level, 3.2.3. experiences with nutritional programs and policies, 4. discussion, 4.1. political economy of water insecurity, 4.2. political economy of food insecurity, 4.3. political-economy of nutrition programs, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Ahmed, F.; Malik, N.I.; Bashir, S.; Noureen, N.; Ahmad, J.B.; Tang, K. Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan. Nutrients 2024 , 16 , 2642. https://doi.org/10.3390/nu16162642

Ahmed F, Malik NI, Bashir S, Noureen N, Ahmad JB, Tang K. Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan. Nutrients . 2024; 16(16):2642. https://doi.org/10.3390/nu16162642

Ahmed, Farooq, Najma Iqbal Malik, Shamshad Bashir, Nazia Noureen, Jam Bilal Ahmad, and Kun Tang. 2024. "Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan" Nutrients 16, no. 16: 2642. https://doi.org/10.3390/nu16162642

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Farms and farmers markets support food-insecure families. Can these initiatives meet growing demands?

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PUEBLO — Urban farmer Perdita Butler was ready to harvest her bok choy and fresh, crunchy kohlrabi outside her 1940s stucco home in Pueblo. It was early spring, and the nymph grasshoppers were already munching her crops, forcing her to cover her beds with protective gauze nets. She carefully peeled back the nets to reveal blue potatoes, golden beets, dinosaur kale and other vegetables erupting from the soil.

“What I love about farming is there’s always something new to learn,” Butler said, looking at the snap peas taking off on one side of the garden.

Later this summer, she’ll sell these vegetables and others she’s growing at a new farmers market on Pueblo’s East Side neighborhood—a community without a grocery store since the Safeway in the area closed seven years ago. Butler hopes to build community and improve nutrition in the neighborhood by selling fresh, affordable produce grown five miles away on her microfarm Quarter Acre and a Mule.

Federal, state and local programs that incentivize buying produce at farmers markets, including those in Pueblo, make them affordable to some low-income families and older adults in Colorado. In addition to increasing participants’ access to fresh fruit and vegetables, these programs support small farmers like Butler and boost local economies, especially during the summer and fall harvest cycles.

Three programs specifically help low-income older adults and women and their children in Colorado: Colorado Women, Infants, and Children (WIC) Farmers’ Market Nutrition Program, Boulder County WIC Farmers Market Program, and the Colorado Nutrition Incentive Program.

“It’s a win-win. You’re feeding people. You’re supporting farmers,” said Daysi Sweaney, director of healthy food incentives at Nourish, a nonprofit that helps implement and run some of these programs.

Consumers and growers have participated in farmers market programs in Colorado over the past five years, but barriers such as funding cuts and limited time, transportation and money remain challenges.

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What’s working: as food-insecurity funds end, colorado farmers focus on food hub, ag incubator, good food and stable housing have huge effects on health. so colorado medicaid wants to cover those, too., colorado is so behind on processing food assistance benefits that it’s under a federal corrective action plan, farmers market programs.

According to the nonprofit Feeding America, Pueblo is among 10 counties with the  highest rates of food insecurity  in the state. Still, efforts to help families afford local produce are growing in the area. At the other  Pueblo Farmers Market  location, in downtown Mineral Palace Park, redemption of incentives for fruit and vegetables by low-income families increased significantly from $9,000 in 2020 when it began accepting them to $25,000 last year.

Growth of the federal Supplemental Nutrition Assistance Program (SNAP) and Double Up Food Bucks—a grant-funded program available in some states like Colorado that gives SNAP participants double the amount to spend on fruit and vegetables—and the WIC Farmers’ Market Nutrition Program has contributed to the increased use, said Marci Cochran, market director for the Pueblo Farmers Market.

“The WIC Farmers’ Market Nutrition Program is explosive in Pueblo,” Cochran said of the program.

Funded by the U.S. Department of Agriculture, the Colorado Department of Public Health and Environment program gives $30 annually in coupons for each participating family member to spend at 22  participating farmers markets  (down from 24 last year) statewide before Oct. 31. For example, a pregnant or new mom and her two children over six months of age would have $90 to spend during the season, an increase of roughly 8% from their annual WIC budget of approximately $1,092 for fruit and vegetables.

Angelika Sunie, 25, of Pueblo, who has two children ages 1 and 4, has used the WIC Farmers’ Market Nutrition Program for the past two seasons.

“It really helped stretch my benefits,” said Sunie, who also uses SNAP and Double Up Food Bucks .

Sunie bought green beans, Pueblo chiles and Palisade peaches at the farmers market. She made a peach crisp and a simple syrup out of peaches for tea.

She said it helped her bring healthier foods into her home during the summer. Sunie added that she would have spent twice the amount allocated if it had been available.

When she was pregnant with her son in 2022, Sunie said eating more nutritious foods from the farmers market helped her pregnancy. However, she does not qualify for the program now that she has started a new job at UCHealth.

Sweaney said WIC families’ spending at farmers markets is highest along the Front Range corridor stretching from Pueblo to Greeley, but the redemption rate statewide is relatively low.

According to CDPHE data, the use of the coupons has risen from 17% in 2021 to 23% in 2023. (The program was first piloted in 2020.) Emily Bash, a nutrition and physical activity specialist at CDPHE, said she hopes to increase the rate this year by mailing coupons earlier, using text reminders and offering handouts in multiple languages.

Bash and her colleagues also received a $350,000 USDA grant to move from paper coupons to a digital system. It’s easy to lose paper coupons or forget to bring them to a farmers market, Bash said, and buyers can’t get change if their purchase is less than the coupon amount. She said these digital systems are already successful in Nebraska, New Mexico and Washington.

Nourish’s budget to help run programs like these was drastically cut this year by federal WIC funding. Sweaney said there is always fear that money for extra initiatives like these will dry up.

Sweaney and Bash noted that transportation is also a barrier for program participants. According to 2023 CDPHE data, families who live farther away from a farmers market were less likely to use coupons than those who lived in the same zip code as a farmers market.

Cochran said that proximity is why the Pueblo Eastside Farmers Market could be a game changer for residents. “We have a Dollar General and a Dollar Tree and a convenience store, but there is no real food access.”

Local solutions

Meanwhile, county governments like Boulder have created their own solutions. Making local produce affordable and accessible is the focus of a 7-year-old program that provides a punch card worth $80 for Boulder County WIC families and $160 for City of Boulder WIC families per month to spend at farmers markets, helping to supplement the federal money they receive.

Zhuldyz Tokbulatova, 32, a stay-at-home mom, bikes with her 3-year-old son in a bike trailer to the Boulder Farmers Market on Wednesdays and Saturdays to participate in the program. On one Saturday in June, she bought fava beans, tomatoes and cucumbers. Cherries were in season, along with her son’s favorite fruit, aprium, a mix between an apricot and plum.

“He’s a picky eater. He doesn’t eat everything. But he likes to come with me to the farmers market, and he likes to shop there,” Tokbulatova said. “He talks to the vendors and helps pick out vegetables.” His first solid food as an infant was squash from the market.

Tokbulatova, who has participated in the program for four years, said she would not be able to afford to shop at the farmers market without the program. The family’s income is low, and they are careful about their spending.

“It’s very important for me to be able to provide local, fresh produce,” she said. Tokbulatova did not grow up eating many vegetables in her native Kazakhstan, but the program allows her to make more salads or add extra vegetables to staples like beef stew. “It fulfills me as a mother.”

More than 1,000 Boulder County families bought $296,000 worth of farmers market produce from April to November last year—more than double the $116,000 spent by WIC families statewide. It is entirely locally funded by the county’s sustainability tax, the City of Boulder’s Health Equity Fund and the City of Longmont’s Human Services Fund. To overcome transportation challenges, volunteers deliver farmers market produce to families’ homes.

In Garfield County, the local WIC agency used extra funds at the end of the 2023 season to purchase produce from Early Morning Orchard in Palisade, then gave it away for free to 130 families who came in for height and weight measurements as part of WIC wellness checks in Rifle and Glenwood Springs. The hope is for this to become an annual tradition in Garfield County, said Christine Dolan, nutrition programs manager for Garfield County Public Health.

Community-supported agriculture

The Colorado Nutrition Incentive Program connects some of these families directly to produce from local growers — no farmers market required. Community-supported agriculture, or CSA, shares — which run through the summer months — provide weekly boxes of freshly harvested fruit and vegetables to Colorado WIC families and older adults.

For the past three years, Highwater Farm in Silt has provided CSA shares to WIC families in Garfield County. Families visit the 3-acre farm weekly to select harvested produce, with an option to walk into the fields and pick things like cherry tomatoes, snap peas, herbs and flowers. Alternatively, Highwater Farm delivers shares to pickup spots in Glenwood Springs and Carbondale, where families receive a curated share of produce.

Highwater Farm Manager Rebecca Gourlay said CSAs are a relatively new concept for some families along Colorado’s Western Slope. She includes familiar vegetables like lettuce, onions, garlic, beans and peppers in the boxes.

But it’s also an opportunity to introduce families to new vegetables like arugula or mustard greens. These are explained in a weekly newsletter in English and Spanish that includes new recipes. The farm has a part-time bilingual outreach coordinator who talks to families during pickups.

“She helps us connect with our Latino community in a more meaningful way,” Gourlay said.

Without subsidies, it’s difficult for low-income families to afford CSAs, Gourley said, because a person has to pay upfront in the winter for produce provided throughout the summer and fall seasons.

Despite successful partnerships like those at Highwater, overall funding for the CSA program in Colorado dipped to $320,000 in 2024, down from $1.2 million in 2023. Since the program’s inception in 2019, it has relied on state, federal and philanthropic funding. This year, its grant did not allow Nourish to pay farmers 100% upfront for the summer’s produce, and some small farmers, already operating on thin margins, could no longer afford to participate, Sweaney said. Fewer than 30 farmers signed up this year, compared with 115 last year.

Becca Jablonski, co-director of the Food Systems Institute at Colorado State University, worries about farmers relying on subsidies and venues that may not exist in the future. While more data points are needed to fully understand how nutrition incentive programs benefit farmers’ overall bottom lines compared to alternatives, Jablonski said the programs could make rural farmers markets more attractive to farmers if they significantly increase the overall amount of money spent. (Cochran, with the Pueblo Farmers Market, said that nutrition incentive programs kept the market afloat during the COVID-19 pandemic.)

Jablonski’s research has shown that incentive programs benefit local economies in states like California and Colorado.

“For every $1 invested in a healthy food incentive program, we can expect to see up to $3 in economic activity generated,” she and her co-authors  wrote . In Colorado, conservative estimates for scaling these programs statewide would create 92 jobs, $4.3 million in labor income, and an economic contribution of $19.8 million, based on data from 2018 and 2019.

At the state level, there is some stability for these programs next year. In June, the Colorado legislature created the  Healthy Food Incentives Program —a bill allocating $500,0000 for fiscal year 2024-25 to support Nourish’s work, including CSA produce boxes for low-income families.

But Sweaney said the appropriation is insufficient to meet the box demand. Nourish plans to work with the state legislature’s Joint Budget Committee to secure more state funds and advocate for more federal funding for local food systems and food access in the upcoming U.S. Farm Bill.

Building community through food

On a Saturday morning in May, farmer Brett Mills of Sweet Valley Farm drove 45 minutes to sell plant starters for heirloom tomatoes as part of an early-season pop-up event at the Pueblo Farmers Market. Whatever he didn’t sell, he planned to donate to community gardens.

“We want to be helpful to people growing their own food in the community,” Mills said.

Community is something that advocates like Butler and Cochran say nutrition incentive programs can help build as part of broader efforts to create local food systems for families and growers. Eastside Farmers Market is the next step of a community redevelopment project in Pueblo that will eventually include a grocery store at the site of the former, now-abandoned Spann Elementary School.

Bringing fresh, local produce to Pueblo’s East Side at a farmers market is a first, said Monique Marez, a food systems practitioner who grew up in Pueblo and ran the  Pueblo Food Project  for three years. However, other treasures exist at the farmers market besides fruit and vegetables.

“The goal is to open up a conversation about how the community is doing,” Marez said.

The market is also an opportunity for families and children to connect with farmers and learn how food grows. “You never know when you might meet the next generation of farmers,” Cochran said.

Back at her urban farm, with railroad tracks several feet away and the Wet Mountains in view, Butler talked with reverence about a sweet pepper variety that she couldn’t wait to taste. She was eager to sell basil, beans, cilantro, tomatoes and 20 other types of fruit and vegetables at Eastside Farmers Market.

Butler said she fully supports nutrition incentive programs, but the idea is more significant than improving access to local produce. It encompasses nutrition, empowerment and agency, community and relationship building.

“The farmers market is the hub—the start, the seed,” Butler said.

Freelance reporter Kate Ruder wrote this story for The Colorado Trust, a philanthropic foundation that works on health equity issues statewide and also funds a reporting position at The Colorado Sun. It appeared at  coloradotrust.org on July, 29, 2024,  and can be read in Spanish at  collective.coloradotrust.org/es . 

Type of Story: News Service

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Twitter: @KateRuderWriter More by Kate Ruder

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Current childhood obesity statistics are dramatic and worrisome. Today's children may live shorter lives than their parents – a first in this nation’s history. Over the past 40 years, rates of obesity have doubled in 2- to 5-year-olds, quadrupled in 6- to 11-year-olds, and tripled in 12- to 19-year-olds. The causes of obesity are complex and interconnected. The environment created by culture, societal norms, community assets, and practices within the home all influence a child’s ability to make healthy choices and, ultimately, affect his or her weight status.

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Feed the Future - Nutrition Innovation Lab

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The Feinstein International Center is a research and teaching center based at the Friedman School of Nutrition Science and Policy at Tufts University. Their mission is to promote the use of evidence and learning in operational and policy responses to protect and strengthen the lives, livelihoods and dignity of people affected by or at risk of humanitarian crises.

FORCE - Fatty Acids and Outcomes Research Consortium

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Our goal is to understand the relationships between fatty acids from our diet and metabolic processes, measured using biomarkers, on chronic disease outcomes (cardiovascular disease, cancer, and other conditions). We invite all longitudinal studies with fatty acid biomarker data and ascertained events to participate.

Instacart, DispatchHealth Team Up To Improve Food Insecurity

Instacart and DispatchHealth recently launched a partnership that allows DispatchHealth to provide food interventions to patients in need of nutrition support.

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Food insecurity adds an annual expenditure of about $52 billion, according to the Centers for Disease Control and Prevention . A new partnership seeks to move the needle on this stat.

Grocery technology company Instacart and home care company DispatchHealth are collaborating to prescribe food interventions to patients, the companies announced last week. Denver-based DispatchHealth offers urgent care and recovery care in patients’ homes, while San Francisco-based Instacart Health uses Instacart’s platform to provide access to healthy food and partners with healthcare organizations for food as medicine programs. Its recent partners include Alignment Healthcare, Kaiser Permanente and Mount Sinai Solutions.

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Through the new partnership, DispatchHealth’s providers will be able to offer Instacart Fresh Funds to patients, which are digital stipends that they can use to shop for healthy food. Patients can also shop on Instacart’s virtual storefront, where there are medically-tailored shopping lists customized for DispatchHealth.

These two offerings are beneficial because they give “patients the power and dignity of choice to select the nutritious foods that work best for them based on their unique food preferences — all within DispatchHealth’s provider-recommended guidelines,” said Sarah Mastrorocco, vice president and general manager of health at Instacart, in an email.

In addition, DispatchHealth providers can send food directly to patients who need extra support through Instacart Care Carts. 

“Our healthcare providers can now prescribe food interventions as easily as they do medications,” said Andrea Pearson, chief growth officer of DispatchHealth, in an email. “This partnership allows us to bridge the gap between healthcare and nutrition, ensuring that our patients receive comprehensive care that addresses their holistic well-being and helps them recover faster.”

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Instacart can deliver to more than 95% of U.S. households, including 93% of residents living in food deserts, according to Mastrorocco.

DispatchHealth chose to launch this partnership with Instacart after recognizing a need among its patients, Pearson said. Based on data from more than 1,000 DispatchHealth patients, 22% battle food insecurity. It chose Instacart as a partner because it “made it easy” to create clinician-directed menus and allows for multiple payment types, including through Health Savings Accounts, Medicare Advantage debit cards and the Supplemental Nutrition Assistance Program.

Food interventions can greatly improve health outcomes and costs as well. Medically-tailored meals could prevent 1.6 million hospitalizations and save $13.6 billion in healthcare costs annually.

The partnership comes at a time when both care in the home and the use of food as medicine are growing in popularity. It also represents the growing trend of whole-person care, according to Pearson.

“Healthcare discussions increasingly emphasize the importance of understanding a patient’s life outside the traditional healthcare setting,” Pearson said. “By placing high-acuity caregivers directly into patients’ homes, we create an unparalleled level of intimacy and visibility into their lives. This visibility is particularly crucial in areas like nutrition, which often gets underestimated. Poor nutrition is linked to nearly half of deaths from heart disease, diabetes, and stroke.”

Both Instacart and DispatchHealth are in crowded spaces in their respective areas. Other companies working to improve food security include Season Health and NourishedRx . Companies providing in-home care included Medically Home and MedArrive .

By partnering with Instacart, DispatchHealth ultimately aims to “positively impact the health and well-being of the communities we serve,” Pearson said. She added that the company hopes to have similar partnerships in the future that “address all the needs required to truly treat the whole person.”

“Access to healthy food is just one aspect of this,” she said. “While there are many social services organizations available to help individuals with various needs, what’s often missing is a mechanism to connect the dots.”

Photo: fcafotodigital, Getty Images

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Measuring Food Insecurity in India: A Systematic Review of the Current Evidence

Fiona h. mckay.

1 School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia

2 Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia

Paige van der Pligt

3 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia

Associated Data

Purpose of review.

India is home to an estimated 200 million malnourished people, suggesting widespread food insecurity. However, variations in the methods used for determining food insecurity status mean there is uncertainty in the data and severity of food insecurity across the country. This systematic review investigated the peer-reviewed literature examining food insecurity in India to identify both the breadth of research being conducted as well as the instruments used and the populations under study.

Recent Findings

Nine databases were searched in March 2020. After excluding articles that did not meet the inclusion criteria, 53 articles were reviewed. The most common tool for measuring food insecurity was the Household Food Insecurity Access Scale (HFIAS), followed by the Household Food Security Survey Module (HFSSM), and the Food Insecurity Experience Scale (FIES). Reported food insecurity ranged from 8.7 to 99% depending on the measurement tool and population under investigation. This study found variations in methods for the assessment of food insecurity in India and the reliance on cross-sectional studies.

Based on the findings of this review and the size and diversity of the Indian population, there is an opportunity for the development and implementation of an Indian-specific food security measure to allow researchers to collect better data on food insecurity. Considering India’s widespread malnutrition and high prevalence of food insecurity, the development of such a tool will go part of way in addressing nutrition-related public health in India.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13668-023-00470-3.

Introduction

Food insecurity has been identified as a “pressing public health concern” in India [ 1 •]. At the household level, food security exists when all members, at all times, have access to enough food for an active, healthy life [ 2 ••]. Individuals who are food secure do not live with hunger or fear starvation. Across urban settings, the prevalence of food insecurity has been found to range from 51 to 77%, yet over 70% of India’s population resides rurally, where data concerning food insecurity is limited [ 3 ].

The concept of food security consists of six main dimensions: availability, access, utilization, stability, agency, and sustainability. The first three dimensions are interlinked and hierarchical. Food availability is concerned with ensuring that sufficient quantities of food of appropriate quality are supplied through domestic production or imports (including food aid). Access to food is necessary but not sufficient for access. Access is concerned with ensuring adequate resources, or entitlements, are available for the acquisition of appropriate foods for a nutritious diet. Access is necessary but not sufficient for utilization. Utilization is concerned with the ability of an individual to access an adequate diet, clean water, sanitation, and health care to reach a state of nutritional well-being. The three other concepts have become increasingly accepted as important, as risks such as climatic fluctuations, conflict, job loss, and epidemic disease can disrupt any one of the first three factors. Stability refers to the constancy of the first three dimensions. Agency is recognized as the capacity of individuals or groups to make their own food decisions, including about what they eat, what and how they produce food, and how that food is distributed within food systems and governance. Finally, sustainability refers to the long-term ability of food systems to provide food security and nutrition in a way that does not compromise the economic, social, and environmental bases that generate food security and nutrition for future generations [ 4 ••].

Two hundred million people living in India are estimated to be malnourished [ 5 •]. Poverty, a lack of clean drinking water, and poor sanitation have been identified as common factors contributing to malnutrition in India [ 1 •]. Yet to date, despite high rates of malnutrition pointing toward widespread food insecurity [ 6 ], the link between food insecurity and malnutrition in India has seldom been explored. Of the limited data available, associations have been found between household food insecurity and child stunting, wasting, and being underweight [ 7 ], highlighting the urgency of food insecurity as a public health priority.

Considering the high rates of child stunting, wasting, and overall malnutrition in India, exploring past and emerging research which has both assessed and addressed food insecurity is a crucial step in better understanding nutrition-related health at the population level. Currently, to the best of our knowledge, there is no published systematic review which has explored household food insecurity in India. To understand the factors that contribute to food insecurity at the household level, the related health and nutrition outcomes, and to conceptualize potential strategies which target food insecurity in India, a systematic review of published research undertaken to date which has focused on food insecurity in India is urgently needed. This review seeks to (1) systematically investigate the peer-reviewed literature that purports to investigate food insecurity in India, (2) identify the breadth of research being conducted in India, including the instruments used and the populations under study, and (3) provide an overview of the severity of food insecurity in India as presented by these studies.

A systematic search was undertaken to identify all food security research conducted at the household level in India. The search was conducted in March 2020. Key search terms were based on the FAO [ 8 ] definition of food security: “food access*,” OR “food afford*,” OR “food insecur*,” OR “food poverty*,” OR “food secur*,” OR “food suppl*,” OR “food sufficien*,” OR “food insufficien*,” OR “hung*” AND “household*” OR “house*” AND “India.” Searched databases included Academic Search Complete, CINAHL Complete, Global Health, MEDLINE, Embase, SCOPUS, ProQuest, PsychInfo, and Web of Science. To gain a full collection of articles that reported on research investigating household food security in India, no limits were placed on publication dates. Only peer-reviewed articles published in English were considered; unpublished articles, books, theses, dissertations, and non-peer-reviewed articles were excluded. This review adheres to the PRISMA statement [ 9 , 10 ], see Fig. ​ Fig.1 for 1  for a flowchart describing the process of screened included and excluded articles.

Flow chart of articles meeting search criteria, number of articles excluded, and final number of articles meeting inclusion criteria for review

Two authors (FHM and AS) and a research assistant reviewed all articles to identify relevant studies. Articles underwent a three-step review process (see Fig. ​ Fig.1). 1 ). All articles were downloaded into EndNote X7, duplicates were identified and removed, and the article titles, journal titles, year, and author names were then exported to Microsoft Excel 365 to facilitate reviewing. Articles were first screened by title and abstract based on the inclusion and exclusion criteria described above by two authors independently. Any article that clearly did not meet the inclusion criteria was removed at this stage, any that did, or possibly could meet the inclusion criteria on further inspection, were retained. The full text of the remaining articles was obtained, and at least two authors (FHM and AS) or a research assistant independently read all 161 articles that remained at this stage to determine if the article met the inclusion criteria. Any articles at this stage that clearly did not meet the inclusion criteria were removed. Any disagreements on those that were retained were discussed and settled by consensus between the authors.

Articles that discussed food insecurity in general but collected no new data (for example, Gopalan [ 11 ] and Gustafson [ 12 ]) were excluded, as were previously conducted reviews in the region (for example, del Ninno, Dorosh [ 13 ], Harris-Fry, Shrestha [ 14 ]). As this review was primarily interested in studies that purported to measure food insecurity in India, studies that discussed food insecurity, either as the standard measured construct or as a construct created by the authors but termed food insecurity, were included. While there are many non-government organizations and inter-government organizations that work to measure food or nutritional insecurity, the construct of “hunger,” the associated conditions of malnutrition (either with overweight or obesity) or conditions that might indicate malnutrition (including anemia or under-5 mortality), these reports generally do not include a complete description of the method used to collect data if data were collected at the household level and often use the sale or production of crops as a proxy; as such, these reports have been excluded from this review.

Data were extracted from each article by the three authors. Data were extracted into a Microsoft Excel 365 spreadsheet that allowed for the capture of specific information across all included articles. Data extracted at this stage included the following: location; population group; findings; measured food security (Y/N); method for determining food insecurity; and prevalence of food insecurity.

The search identified 1018 articles, of which 395 were duplicates. The titles and abstracts of the remaining 616 articles were read, with 518 articles excluded as they did not refer, either directly or indirectly, to food insecurity research in India, leaving 161 articles for further investigation. The full text of the 161 articles was reviewed; 108 articles were excluded as they did not meet the inclusion criteria. The remaining 53 articles were included in this review.

Most articles ( n  = 48, 90%) were cross-sectional studies; three were longitudinal, with data covering 27 years [ 15 ], 11 years [ 16 ], and 4 years [ 17 ], and one was a randomized controlled trial [ 18 ]. Eight studies employed a mixed methods approach, seven were qualitative, and the remaining 38 were quantitative studies. Participant numbers ranged in size from the smallest study with 10 participants [ 19 ] to population-level studies with over 100,000 participants [ 15 , 20 ]. See the supplementary material for an overview of the studies included.

Most food insecurity research was conducted in the state of West Bengal, where 9 studies were conducted, followed by 6 studies each in Maharashtra and the union territory of Delhi (see Fig. ​ Fig.2). 2 ). India consists of 28 states and 8 union territories; this review found research from 17 states and five union territories, as well as four nationwide studies showing good coverage across the country.

Distribution of studies exploring food insecurity in India

Measuring Food Insecurity

All studies included in this review purported to measure food insecurity directly, with the main aim of the majority ( n  = 45, 85%) of articles to determine the prevalence of food insecurity. These articles employed a range of measurement tools to achieve this aim. The most common way to measure food insecurity was via the Household Food Insecurity Access Scale (HFIAS) which was employed in 17 studies. The second most common method employed to measure food insecurity was via the Household Food Security Survey Module (HFSSM), employed in 13 studies. Other measures of food insecurity include the Food Insecurity Experience Scale (FIES), used in three studies, the Comprehensive Nutrition Survey in Maharashtra used in two studies, and the Radimer/Cornell used in one study. The remaining 17 studies used a proxy measure, either one devised by the authors or by using data from the India National Sample Survey (NSS). See Table ​ Table1 1 for an overview of these measurement tools.

Food insecurity measurement tools

The prevalence of food insecurity in these studies ranged from 8.7 to 99%; 13 studies stated that they measured food insecurity but did not report food insecurity results. The most common way for food insecurity to be measured in India was through employing Household Food Insecurity Access Scale (HFIAS). This experiential scale was designed to be used cross-culturally and consists of nine questions, with frequency questions asked if participants experience the condition. Responses to these questions are scored so that “never” receives a score of 0, “rarely” is scored 1, “sometimes” is scored 2, and “often” is scored 3, so that when summed, the lowest possible score is 0 and the highest is 27. A higher score represents greater food insecurity, with continuous scores typically divided into four categories, representing food-secure and mildly, moderately, and severely food-insecure households according to the scheme recommended by the HFIAS Indicator Guide [ 21 ]. The scale is based on a household’s experience of problems regarding access to food and represents three aspects of food insecurity found to be universal across cultures [ 22 – 24 ]. This scale measures feelings of uncertainty or anxiety about household food supplies, perceptions that household food is of insufficient quality, and insufficient food intake [ 21 ]. The questions asked in the HFIAS allow households to assign a score along a continuum of severity, from food secure to food insecure. Food insecurity measured via the HFIAS ranged from 77.2% in a population of 250 women who resided in an urban area in South Delhi [ 25 ] to 8.7% in Indian children [ 26 ].

The second most common measurement tool identified in this search is the US Household Food Security Survey Module (HFSSM). This tool was developed to measure whether households have enough food or money to meet basic food needs and what their behavioral and subjective responses to that condition were [ 27 ]. The HFSSM module consists of a set of 18 items, 8 of which are specific to households with children. It captures four types of household food insecurity experiences: (1) uncertainty and worry, (2) inadequate food quality, and insufficient food quantity for (3) adults and (4) children [ 28 ]. It is available in an 18-item and 6-item forms and allows households to be assigned a category of food insecurity: high food security, marginal food insecurity, low food insecurity, and very low food insecurity. In accordance with the method proposed by Coleman-Jensen et al. [ 29 ], food security scores are combined to create one measure for the level of food security for a household. Food security status is determined by the number of food-insecure conditions and behaviors that the household reports. Households are classified as food secure if they report fewer than two food-insecure conditions. They are classified as food insecure if they report three or more food-insecure conditions, or two or more food-insecure conditions if they have children. Food-insecure households are further classified as having either low food security if they report between three and five food-insecure conditions (or three and seven if they have children), or very low food security if they have six or more food-insecurity conditions (eight if they have children). Studies that employed the HFSSM reported food insecurity ranging from 15.4 [ 30 – 32 ] to over 80% of study participants [ 33 ]. The HFSSM is a commonly used measure of food insecurity and can be used in several valid forms. Studies included in this review used the 4-, 6-, and 18-item versions of the HFSSM.

The Food Insecurity Experience Scale (FIES) module was used by three studies included in this review. The FIES questions refer to the experiences of the individual or household. This scale was created by the Food and Agriculture Organization of the United Nations (FAO) and has been tested for use globally [ 28 ]. The questions focus on self-reported food-related behaviors and experiences associated with increasing difficulties in accessing food due to resource constraints. The FIES allows for the calibration of other measures, including the HFIAS and the HSSM with the FIES against a standard reference scale allowing for comparability of the estimated prevalence rates of food insecurity [ 34 ], as well as a raw score that can be used by authors as a way to create discrete categories of food insecurity severity [ 35 ]. The three studies that employed the FIES all reported food insecurity within a range of 66–77%, despite different population groups, locations, and sample sizes.

One study employed the Radimer/Cornell scale, a widely used and validated scale [ 36 ]. The scale includes ten items that relate to food anxiety and the quantity and quality of food available. The instrument allows for the categorization of households into four categories of food insecurity: food security, household food insecurity, individual food insecurity, and child hunger.

The Comprehensive National Nutrition Survey (CNNS) was used in two studies. It is a state-specific (Maharashtra) nutrition survey with a focus on infants and children under two and their mothers. The CNSM measured household food security using nine questions [ 37 ]. The questions capture experiences of uncertainty or anxiety over food, insufficient quality, insufficient quantity, and reductions in food intake [ 38 ]. Households are categorized as food secure, mildly food insecure, moderately food insecure, or severely food insecure.

The National Sample Survey (NSS) organization conducts nationwide household consumer expenditure surveys at regular intervals in “rounds,” typically 1 year. These surveys are conducted through interviews with a representative sample of households [ 20 ]. This survey includes only one question about household daily access to food [ 39 ], and while it does provide a method for estimating food insecurity in India, it assumes that financial access equates to physical access to available food; as such, this survey is unlikely to be able to comprehensively capture the intensity of household food insecurity in India [ 40 ]. Four studies employed the NSS. Given that these studies did not specifically collect food insecurity data, the use of the NSS has been considered a proxy indicator here as it generally reflects the measurement of food availability or acquisition rather than food insecurity per se.

Other proxy measures were commonly used. The variety of proxy measures included information on calorie intake, purchasing power, the quantity of food consumed, and agricultural productivity. These proxy measures provide only a partial, usually indirect, measure of food insecurity [ 41 ]. There are also challenges with these measures, as the relationship between food and caloric quantity and household food security is unpredictable [ 42 ]. For example, in a study of households in Gujarat, Sujoy [ 43 ] found that around 85% of households are food insecure at some point in a typical year. This study employed a range of measures to explore the experiences of hunger and food insecurity and the strategies employed by these population groups to mitigate hunger. Exploring the food insecurity experiences of farmers in Bihar, Sajjad and Nasreen [ 44 ] found that 75% of households had very low food security. While not using a standard measure, Sajjad and Nasreen [ 44 ] interviewed households alongside interviews with government officials, food production, food costs, and food acquisition to form an index of food security that could be applied at the household level. A study by George and Daga [ 45 ] using calorie consumption as a proxy for food security identified 57% of participants were food insecure, with the suggestion that income and family size play a role in food security among children. Of the 17 studies that employed a proxy measure of food insecurity, 10 provided no indication of the level of food security in their results.

Population Groups Under Investigation

Studies identified in this review included a variety of population groups. Most studies ( n  = 30) focused on food insecurity at the household level; half of these studies employed one of the standard food insecurity measurement tools, while the other half relied on proxy measures.

Fourteen studies focused specifically on young children, and one on teenagers. These studies used a variety of methods to determine food insecurity among this population, with rates of food insecurity shown to range from 8.7 [ 26 ] to 80.3% [ 33 ]; within this range, most studies reported that food insecurity among children was in the range of 40 to 60%. Interestingly, while the study conducted by Humphries [ 26 ] reported lower levels of child food insecurity (8.7%) than the other studies included in this review, other findings of this study were consistent with other research reviewed. Across all studies that explored food insecurity among children and teenagers, findings suggest problematic infant and young child feeding practices, caregiving, and hygiene practices, with many studies reporting impaired growth in children and teenagers due to these practices.

Seven studies focused specifically on the experiences of women or used the experiences of women as an indicator of food insecurity in their households. All of these studies employed one of the standard measures of food insecurity, with food insecurity in these studies ranging from 32 [ 3 ] to 77.9% [ 46 ]. These studies identified a range of health outcomes related to food insecurity and hunger. For example, in a study of mothers of children under the age of 5, Das and Krishna [ 47 ] found that two-thirds of households were food insecure and that younger mothers were more likely to be food insecure, with the children of these mothers more likely to be underweight and stunted. Among mothers in a study by Chyne et al. [ 48 ], those who had low literacy levels, low income, and large family size were more likely to be food insecure, with many of the children of these mothers being vitamin A deficient, anemic, stunted, and/or wasted. This is consistent with the work of Chatterjee et al. [ 49 ] who found that food insecurity among women was associated with low income and a range of socioeconomic measures including education, employment, and relationship status.

Thirteen studies were conducted in slums. Four of these studies were conducted in slums in Delhi, finding that food insecurity among slum populations ranges between 12% among children aged 1–2 years [ 50 ] and 77% in households more broadly [ 25 ]. Three studies were located in slums in Kolkata, all conducted by Maitra and colleagues [ 30 – 32 ]. These studies found food insecurity to be 15.4%, finding that low income, household composition, and education are all predictors of household food insecurity. The remaining studies were conducted in slums in Jaipur [ 51 ], Mumbai [ 49 ], Varanasi [ 52 ], Vellore [ 53 ], and West Bengal [ 33 , 54 ]. Slums are an important setting for an exploration of food insecurity, especially in India, where 25% of the urban population resides in slums or slum-like settings. People living in slums have been found to have poorer quality of life, are generally lower income, and have lower educational attainment than non-slum-dwelling populations—all factors that are known to contribute to food insecurity [ 49 ].

Five studies explored food insecurity among people with an underlying health condition. Four of these explored food insecurity among people living with HIV/AIDS [ 55 – 58 ]. These studies found that food insecurity ranged from 16 to 99% with people who are food insecure and also living with HIV/AIDS more likely to experience depression and a lower quality of life [ 57 ] and that low income [ 58 ] and low education [ 55 ] are contributing factors to food insecurity, while ownership of a pressure cooker was found to be protective against food insecurity [ 56 ]. Finally, one study explored the experiences of food insecurity among people with tuberculosis [ 59 ]. This study found that around 34% of study participants were food insecure, with low income and employment being associated with food insecurity status.

India has seen massive growth and economic change over the past 2 decades; however, this increase in financial wealth has had little impact on food insecurity and population nutrition [ 60 ]. While India has increased production and, overall, the availability of food has increased [ 61 ], these increases have not yet translated into gains for the general population. Overall, India is seeing increasing income inequality which is having a negative impact on health [ 62 ]. As a result of the disconnect between economic growth and positive health outcomes, there has been an increased interest in food insecurity and nutrition in India over the past two decades, resulting in research that seeks to measure food insecurity.

The main finding of this study is the variation in the methods for the assessment of food insecurity prevalence in India and the reliance on cross-sectional studies to elicit food insecurity data. This may be explained by the fact that food security is notoriously difficult to measure. Initial descriptions of food insecurity were conceptualized through the lens of famine [ 63 ], meaning that solutions were often confined to domestic agriculture [ 41 ]. However, in an increasingly globalized world where countries easily sell and buy goods from each other, it is now important to consider food security in a holistic manner, incorporating the whole definition of food insecurity. By considering the six main dimensions of food security: availability, access, utilization, stability, agency, and sustainability, we can better understand the experiences and drivers of food security. However, as this review has found, few studies measure more than one dimension.

Studies included in this review utilized scales that focused on household food access or availability and were assessed through experience-based scales. Experiential food insecurity scales have been used since the 1990s [ 64 ], first used in the USA and later adopted for use in low- and middle-income countries [ 21 , 65 ]. Experiential measures are based on the notion that food insecurity is associated with a set of knowable and predictable characteristics that can be assessed and quantified [ 17 , 21 ]. This assumes that households will attempt to mitigate food insecurity through a generalizable or standard pattern of responses [ 17 , 22 ]. Strategies include reducing expenditure on education expenses [ 66 ], selling assets or seeking increased employment [ 67 ], and skipping meals or limiting the sizes of meals [ 68 ]. Measures of food insecurity that are based on experience seek to capture some of these strategies and actions, and compared to other metrics, such as agriculture production, caloric intake, or anthropometric measures, they enable direct measurement of the prevalence and severity of the extent of household food insecurity, as well as the perception of the quality of their diets [ 31 ].

Given the wide variety of measurement tools used, it is difficult to present a comprehensive understanding of food insecurity in India. What is clear is that some households are experiencing food insecurity but are not hungry, while others are both hungry and food insecure. Finding a way to identify and measure at-risk households and intervene to reduce hunger is essential to closing the economic-income gap in India. However, without a measure that can be used consistently across the country that takes into consideration each of the dimensions of food security and the diversity within the Indian population, this will not be possible.

Limitations

There are some limitations to this review that should also be acknowledged. While every attempt was made to ensure this review was comprehensive, additional articles may have been missed, particularly if articles were written in a language other than English. However, given that this is the first review of its kind, with the inclusion of several databases and broad key terms, the authors are confident that there is little information that is not presented here. The articles presented in this review are largely cross-sectional, and as such, the quality of the studies means that the conclusions drawn by their authors are limited to the study population and are not widely generalizable. The cross-sectional nature of many of the studies limited the potential impact of quality assessment; as such, no quality assessment was conducted. This is a limitation of both this review and the studies included, and in general, a reflection on the rigor with which food security research has been conducted in these settings. Given the variety of approaches taken to measure food insecurity as found in this review, there are challenges in comparing the outcomes of different studies; as such, this review has not sought to present a meta-analysis. If, in the future, there can be some consistency in the use of measurement tools by researchers and agencies, a meta-analysis may be appropriate. The authors do not feel this should invalidate these findings at this time.

An Indian-specific food security measure needs to be urgently developed and implemented so that food insecurity data can more accurately and consistently be collected and contrasted for the purpose of developing suitable responses to food insecurity. Considering India’s widespread malnutrition and high prevalence of food insecurity, future work should prioritize the development of such a tool in addressing nutrition-related public health in India.

Below is the link to the electronic supplementary material.

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Miss USA 2024 Alma Cooper Says Her Mom's Past Food Insecurity Spurs Her Research in the Field (Exclusive)

The newly crowned title Miss USA is researching "food insecurity, health, and nutrition" at Stanford University

Alberto E. Rodriguez/Getty; Alma Cooper/Instagram

Miss USA 2024 says her mom's past food insecurity spurred her research in the field.

On Sunday, Alma Cooper bested 51 other contestants including first-runner-up Miss Kentucky Connor Perry and second-runner-up Miss Oklahoma Danika Christopherson to take the title.

Cooper, 22, is a 2023 graduate of West Point and is currently a Knight-Hennessy Scholar at Stanford University pursuing a master’s in statistics and intends to focus her research on food insecurity — a topic she feels personally connected to.

Gilbert Flores/Variety via Getty 

Following her win, Cooper revealed her mother Oralia was previously impacted by food insecurity.

"I know she is not alone in that in this country, one in five children is food insecure. And I want to make a difference," she tells PEOPLE, adding, "That's what truly has propelled me to work in the field of food insecurity, health, and nutrition."

Cooper was born to retired Army major Stacey Cooper, who served 24 years in the military, and mom Oralia, who migrated to the U.S. at 6 and was a migrant farm worker as a child. Oralia completed her Bachelor’s degree from Idaho State University and attended Saginaw Valley State University, where she earned a Master’s in Educational Administration. Oralia now works as a school administrator.

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Alma Cooper/Instagram

Cooper added that growing up as a nerd and serving in the U.S. Army, where she became an officer, shaped her life.

She encouraged young girls “to be multi-passionate, to be a math nerd, to be a nerd in the classroom, and then serve your country as an army officer to earn a scholarship,” adding, "If you can see me, you can be me."

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“My story and my message is that I'm here to serve. And I know that regardless of any circumstances, regardless of tumultuous times, I'm eager to serve and willing to lead as Miss USA 2024," she said of her newly crowned role.

Cooper will next compete in the Miss Universe 2024 contest, which will be held in Mexico this November.

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