Scientific Report of the 2015 Dietary Guidelines Advisory Committee

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Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change

Household Food Insecurity

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Food insecurity is a leading nutrition-related public health issue that is associated with reduced food intake or hunger because the household lacks money and other resources for food. Food insecurity can compromise nutritional intake, potentially leading to increased risk of chronic diseases.9 In addition, food insecurity may promote anxiety and psychological distress, further affecting the health and well-being of an individual or family.113, 114 Food insecurity is typically measured by survey questionnaires, such as the U.S. Household Food Security Survey Module, an 18-item questionnaire that assesses characteristics at the household level and severity of food insecurity (e.g., moderate or severe) over the past 12 months. The standard method of scoring consists of households being considered food secure if respondents affirm less than 3 scale items, food insecure if 3 to 7 items are affirmed, and severely food insecure if 8 or more items are affirmed.9 Surveys in the United States indicate that 14.3 percent or more of households experienced food insecurity at least once during 2013.1 Rates of food insecurity are substantially higher than the national average for those households with incomes near or below the Federal poverty line (38.4 percent vs. 14.3 percent), those households with children and a single parent, and for African American- and Hispanic-headed households.1 Rates of food insecurity are more common in rural areas and large cities compared to suburban and exurban areas surrounding cities.1 Among food-insecure households, 62 percent are participating in one or more of the three largest Federal food and nutrition assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplementation Program for Women, Infants, and Children [WIC], and the National School Breakfast and Lunch Programs).1 The causes of food insecurity are multifactorial and the types of nutrition-related problems resulting from food insecurity are diverse, differing across the life cycle. Among food insecure households, the cycle of having enough food followed by inadequate amounts has been associated with stress in pregnant women,113 poor diet quality among adults,115, 116 poor glycemic control among diabetics,117 and high visceral body fat and body weight gain in some but not all cross-sectional studies of children and adults.118-120 Each of these conditions has a well-documented impact in the development of chronic diseases.121, 122 Thus, the 2015 DGAC chose to examine the relationship between food insecurity and diet quality as well as the causal nature of this public health issue on body weight with a systematic review of prospective cohorts.

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Question 8: What is the relationship between household food insecurity (HFI) and measures of diet quality and body weight?

Source of evidence: NEL systematic review


Limited and inconsistent evidence from studies conducted in adults and children ages 3 to 6 years suggests that a positive association may exist between persistent and/or progressing household food insecurity and higher body weight in older adults, pregnant women, and young children. No studies reported a relationship with lower body weight. DGAC Grade: Limited

Insufficient evidence was available from prospective studies to assess the relationship between household food insecurity and dietary intake. DGAC Grade: Grade Not assignable


Federal food assistance programs, which play an important role in providing relief to families in economic distress, should carefully document and monitor food insecurity and nutritional risk in program participants. Participants should receive tailored counseling to choose foods with their limited budgets that meet the Dietary Guidelines for Americans and to achieve or maintain a healthy body weight. Federal food assistance programs should also regularly assess, evaluate, and update the methods they use to help recipients select healthier foods, consistent with best practices.

Review of the Evidence

This systematic review included nine prospective cohort studies examining the relationship between household food insecurity and body weight status.118, 123-130 In adults, four prospective cohort studies assessed the relationship between household food insecurity and measures of body weight, with one study focusing on elderly men and women126 and three studies focusing only on women.118, 128, 130 The study of older adults derived data from two large cohorts including the Health and Retirement Survey and the Asset and Health Dynamics among the Oldest Old.126 The studies on women ranged in size from 303 to 1,707, with the data derived from relatively small cohort study populations, including the Bassett Mothers Health Project cohort study,128 the Pregnancy, Infection, and Nutrition cohort,118 and the Fragile Families and Child Wellbeing Study.130 The study of older adults focused on a relatively homogenous population who were mostly Caucasian.126 Of the studies of women, two assessed diverse populations,118, 130 while one had a study population almost entirely composed of Caucasian women.128 

In children, a total of five prospective cohort studies (three cohorts)123-125, 127, 129 assessed the relationship between household food insecurity and measures of body weight, with one of the five studies assessing household food insufficiency, a similar measure considered more severe than the concept of food security, although not as severe as hunger.124 Four of the studies were conducted on populations in the United States123, 125, 127, 129 and one study in a Canadian population.124 The studies ranged in size from 1,514 to 28,353 subjects. The data were derived from nationally representative cohorts, including three studies using data from the Early Child Longitudinal Study-Kindergarten Cohort,123, 125, 129 one study using data from the Longitudinal Study of Child Development in Quebec,124 and one study deriving data from a large cohort participating in the Massachusetts WIC Program.127

Based on this evidence, the impact of food insecurity on body weight is not clear. Among older adults, becoming food insecure during follow-up was positively associated with BMI in one large cohort but there was no association in a different cohort from the same study.126 Among pregnant women, findings were inconsistent, with 1 of 2 studies suggesting no association between food insecurity and pregnancy weight gain outcomes.128 One study found null findings among the marginally food secure, but greater weight gain (absolute and relative to the 2009 IOM Guidelines),131 and severe pre-gravid obesity among food insecure women.118 Among children, findings were inconsistent. Two studies found no association between food insecurity and body weight outcomes.123, 129 Dubois et al. found that food insufficiency was associated greater likelihood of overweight and obesity in preschool-aged children.124 One study found that persistent food insecurity without hunger was associated with child obesity but non-persistent food insecurity with hunger was not associated with obesity risk.127 Jyoti et al. reported that there was an association between food insecurity and weight gain for girls but not boys.125 However, the data provided some suggestion of an association between food insecurity and higher body weight among girls and those who are of low birth weight.

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