A Brief Intervention for Food Insecurity in Dietetic Practice

Background:

Food insecurity is an international priority. This global issue is affecting developing and developed countries (FAO, IFAD, UNICEF, WFP and WHO 2018). 1 in 10 people within the UK are experiencing food insecurity (Taylor and Loopstra 2016). The prevalence of food insecurity is projected to increase due to continual cuts in the welfare state and introduction of universal credit. A study conducted by the United Nations looking at the food insecurity landscape in the UK identified 8.4million individuals (13%) were food insecure in 2014 (Taylor and Loopstra 2016). In comparison to other European countries the UK has the 11th highest prevalence of food insecurity (10.1%) out of 28 European countries. Put simply food insecurity is not having physical access to enough nutritious food to eat well for good health. When food becomes scarce, hygiene, safety and nutrition are often ignored as people shift to less nutritious diets and consume more 'unsafe foods' (WHO 2018). The United States Department of Agriculture (2018) use the definition of food insecurity provided by Anderson (1990) 'the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways'.

Food insecurity can lead to negative health and wellbeing outcomes (Gunderson and Ziliak 2015). For example, those children who are identified as food insecure are more likely to have asthma, behavioural problems and worse oral health. Mothers who are food insecure are twice as likely to report mental health problems. Diabetic adults who are food insecure are more likely to have poorer health outcomes due to the impact food insecurity can have on adherence to medical recommendations such as following a healthy diet for diabetes management (Gunderson and Ziliak 2015). New ways of tackling the increased socio-economic and health burden of food insecurity needs to be considered. Identifying and acting on food insecurity is fundamental for health professionals working in clinical practice.

Dietitians are best placed to discuss food insecurity as their consultations are focused on diet, food and nutrition, however food insecurity is not routinely discussed or screened for in UK dietetic practice. Dietetic consultations in the UK are increasingly more holistic and brief interventions to make every contact count regarding smoking cessation and physical activity are being promoted. Making every contact count refers to the opportunity every health care professional has to raise health promoting issues irrespective of the reason for the consultation (Health Education England 2018). Commonly mood, physical activity, alcohol intake and smoking status can be raised in a consultation as part of the making every contact count initiative. The evidence around brief interventions being conducted by a variety of healthcare professionals, for several health behaviours, is growing (Lewis et al. 2013). These interventions use the 3 A's approach (ask, advise and act) and should only take a moment of a consultation time.

In the US, Canada and Australia screening for food insecurity is already happening in some areas of clinical practice. The American Academy of Paediatrics released a policy statement in October 2015 that recommends all paediatricians screen all children for food insecurity. The policy statement identifies the short and long term adverse health impacts of food insecurity and recommends the referral to community resources (The American Academy of Paediatrics 2015). There is also emerging evidence in adult care that screening for food insecurity in diabetes and HIV care can have positive outcomes on treatment and now forms part of usual practice (Thomas et al. 2017 and Young et al. 2008).