How stigma, anxiety and other psychological factors can contribute to food insecurity

The Research Brief is a short take about interesting academic work.

The big idea

Finding out if someone has feelings of stress, anxiety or stigma that are related to what they can eat may help make it easier to know if they are experiencing food insecurity. As a result, the problem could be more widespread than government estimates indicate.

My colleagues and I reached these conclusions when we created a new kind of survey to detect food insecurity, which means not having consistent access to enough nutritious food. We piloted it with 109 low-income women in North Carolina, all of whom had children under 18. We collected comprehensive data for these mothers and their kids for five years.

Our new survey classifies some experiences of food insecurity in the same way as the survey that the government has used since 1995.

But when we conducted it in an area where food insecurity is more common than in the country as a whole, we found that 68% of the people we surveyed experienced food insecurity – far higher than the 39% prevalence for the same demographic group found using the government survey. Our findings are part of a peer-reviewed study published in the journal Translational Behavioral Medicine.

The government’s survey seeks to find out if people have to skip meals, eat less food than they think they should and can’t afford to buy the ingredients they need to prepare balanced meals.

With our survey, we are trying to identify things the government misses. For example, we check on whether they are feeling like they have no other option than to eat too much of the same thing, and if they have feelings of stress, anxiety or stigma related to the quality of the food they eat.

So we are including questions like “How often did you eat very little of the foods you preferred to eat because there was not enough food?” and “How often did you feel anxious or stressed because you did not know how you would get enough food?”

We also ask people who take our survey to say if this statement reflects their experience: “I felt different from other people because I could not get enough food.”

Why it matters

The national share of people experiencing food insecurity grew to an independently estimated 13.9% in 2020, affecting about 45 million Americans, up from 10.9% in 2019.

This situation can contribute to eating a less nutritious diet and many chronic diseases. It’s also linked to other problems, including mental health conditions, especially for women and mothers.

Detecting food insecurity is tricky. It requires more than assessing what’s in your refrigerator or measuring the distance between your home and the closest supermarket. Without accurate methods, the government cannot correctly determine who should get related benefits, such as the Supplemental Nutrition Assistance Program, or SNAP.

To be sure, the government’s survey includes many good questions, such as asking whether people often, sometimes or never worry whether their food will run out before getting money to buy more. But its survey also asks: “Did you lose weight because there wasn’t enough money for food?”

That question is problematic. Many Americans, especially those who can’t afford to eat well, get too few vitamins and minerals and too many calories from added fats and sugar from their diet. As a result, they are more likely to gain weight, rather than lose a few pounds, due to food insecurity.

What still isn’t known

We tested the new survey with one small group of people. Using the new survey to assess food insecurity for other demographic groups might lead to different findings.

What’s next

We intend to assess food insecurity with the new survey among different demographic groups and places. We also plan to examine the connections between food insecurity and mental health, nutrition-related medical conditions and diet quality for the same group of mothers in North Carolina.