How are food insecurity and health connected? IHPI research sheds light

IHPI RESEARCH ROUNDUP

In 2023, more than 47 million people across the U.S. lived in households that struggled with food insecurity, meaning they didn’t always have reliable access to enough food, according to data from the U.S. Department of Agriculture. 

As rising costs, economic disparities, and changes to federal food assistance programs make it harder for families to put meals on the table, recent studies by researchers at the University of Michigan Institute for Healthcare Policy and Innovation (IHPI) examine food insecurity and health across the lifespan — and how policies can help improve access to nutritious food. Below are several findings from their work.

Food insecurity and health conditions linked across the lifespan

Children with chronic health conditions—such as asthma, ADHD, autism, and depression—are more likely to experience food insecurity than their peers without such conditions, according to a recent JAMA Network Open study led by Nina Hill, M.D., clinical instructor of internal medicine and pediatrics at Michigan Medicine and a national clinician scholar at IHPI. Using data from more than 34,000 children nationwide, the study found that the risk of food insecurity increases among those with chronic conditions. Between 2019 and 2023, about 15% of children with chronic health conditions experienced food insecurity, compared with 9% of those without a condition. Even after accounting for differences in family income, education, and other factors, this gap remained significant. The authors recommend routine screening for food insecurity in pediatric care settings and stronger policy supports to help families meet children’s nutritional needs.

A broader review of 164 studies, led by Eric Brandt, M.D, M.H.S., and published in Circulation Research, reinforces the potential long-term stakes of early-life food insecurity. It found strong evidence that limited or inconsistent access to nutritious food during childhood and adolescence increases the risk of obesity, diabetes, high blood pressure, and other cardiometabolic conditions in adulthood. Even brief periods of poor nutrition were shown to disrupt growth and metabolism in ways that may have lasting effects.

Brandt and colleagues extended this line of research in a JAMA Cardiology study analyzing two decades of national data. They found that food insecurity among U.S. adults with cardiovascular disease more than doubled—from 16.3% in 1999–2000 to nearly 38% in 2017–2018. The increases were most pronounced among younger adults, women, and racial and ethnic minority groups. The authors describe this overlap of economic hardship and chronic illness as a “double jeopardy” for health, emphasizing policy measures that address both food access and medical vulnerabilities.

“Food insecurity and chronic disease often go hand in hand, creating a double burden for patients and families. Improving access to nutritious food is essential to supporting cardiovascular health and reducing preventable illness.” - Eric Brandt, M.D., M.H.S.

Food insecurity also remains all too common in older adulthood, where health challenges and limited financial resources can make consistent access to food more difficult. Research published in Applied Economic Perspective Policy by Helen Levy, Ph.D., and colleagues examined the probability that older adults will experience food insufficiency, or not having enough to eat, at some point over a 20-year period. While about 8% of adults between the ages of 60 and 80 reported a lack of food in a given year, more than 20% experienced it at some point in their 60s or 70s. Such risks were shown to be highest among people with poorer health and non-Hispanic Black adults.

Findings from IHPI’s National Poll on Healthy Aging reflect similar trends. In December 2019, 14% of adults age 50 to 80 said they experienced food insecurity within the previous year, and among them, 45% rated their physical health as fair or poor, compared with just 14% of those who were food secure. Additional poll results from July 2022, during the COVID-19 pandemic, showed that 37% of older adults said rising grocery costs had impacted them a lot. The impact was especially pronounced among those who rated their physical health (46%) or mental health (58%) as fair or poor. 

Dietary patterns associated with health and social factors

A national study led by Eric Brandt examined how Americans’ eating patterns reflect their health and socioeconomic conditions. Using data from more than 32,000 adults, representing 231 million people, the team identified four predominant dietary patterns—processed and animal-based foods; prudent (vegetable- and seafood-rich); legume-based (beans and lentils); and fruit/whole-grain/dairy. They then explored how each dietary pattern relates to heart disease, diabetes, and social risk factors.

Adults who followed the processed and animal-based pattern were more likely to have diabetes, high blood pressure, and obesity. Those receiving or eligible for SNAP, the federal food assistance program, were also more likely to follow the processed/ animal-based food pattern and less likely to follow the prudent or fruit/whole-grain/dairy patterns. Each additional social vulnerability—such as lower income, less education, or food insecurity—increased the likelihood of following a less-healthy diet. Notably, increasing social vulnerability did not impact following a legume-based dietary pattern.

Published in The Journal of Nutrition, the study suggests that unhealthy diets may contribute to the overlap between heart disease, chronic conditions, and social disadvantage, while also noting that some lower-cost, nutrient-dense diets—like those rich in legumes—remain accessible. Brandt and his coauthors say these findings point to the value of aligning nutrition programs with people’s existing eating habits and social circumstances.

“Our findings show that what people eat is shaped not just by personal choices, but by the social and economic environments they live in. By recognizing and supporting the eating patterns that are both affordable and nutritious—like legume-based diets—we can better tailor public health and nutrition programs to meet people where they are.” - Eric Brandt, M.D., M.H.S.

Nutrition support pilot program shows promise for supporting the health of food insecure adults with diabetes

A Michigan-based nutritional support pilot program called Jumpstart shows promising results in helping adults with type 2 diabetes who experience food insecurity improve their health through nutrition education, grocery delivery, and food credits. 

Developed through a partnership between the Healthy Behavior Optimization for Michigan Collaborative Quality Initiative and the Michigan Collaborative for Type 2 Diabetes, the program enrolled 83 adults from 21 clinics across the state with type 2 diabetes who self-identified as food insecure or low income. Participants received multi-format nutrition education focused on low carb eating, $80 per month in healthy food credits, and free grocery delivery via Shipt.

Among the 68 participants with follow-up data, average blood sugar levels (HbA1c) dropped by nearly half a percentage point within six or more months and remained lower over time. In diabetes care, a 0.5% drop is considered clinically meaningful. Participants also saw modest but sustained weight improvements: among the 38 with longer-term data, average body weight decreased by 2.1% (about 2.2 pounds). Even small, lasting weight losses can help improve blood sugar, cholesterol, and blood pressure. Participants also reported greater nutrition knowledge, more confidence in making healthy choices, and appreciation for the financial support that helped them buy nutritious foods.

While larger studies are needed, these early results suggest that programs combining grocery delivery, financial support, and nutritional education may effectively reduce barriers to healthy eating and improve chronic disease management among food-insecure adults.

“[The Jumpstart program] was very helpful to me because I’m on a fixed income with Social Security, and it was a big benefit to help me make ends meet, grocery-wise, especially with the way prices are. Being able to get groceries delivered was a huge help, since I don’t drive and it’s difficult for me to get to the store. I was able to select what I needed by browsing on the screen rather than walking through the aisles, and that really helped me shop for things that fit my diet.” - a Jumpstart pilot program participant 

Many families experience stigma and discrimination when accessing food assistance

Many families face stigma or discrimination when relying on federal nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP), or local food pantries, according to a study published in Social Science & Medicine  by Kate Bauer, Ph.D., M.S., associate professor of nutritional sciences, and colleagues. 

More than one-third of parents who participated in the Feeding MI Families project reported feeling judged or mistreated while using food assistance, with Black, Hispanic/Latino, and immigrant families disproportionately affected. The grocery store was a particularly common place where parents experienced stigma. Many parents reported that when they were purchasing groceries with their food assistance benefits, store staff and fellow customers made rude or dismissive comments to them and their children. The research, conducted between November 2022 and June 2023, drew on surveys from 781 parents experiencing food insecurity in three Michigan cities. Their responses revealed the emotional and social toll that can accompany efforts to meet basic food needs. 

To reduce stigma and barriers, the study’s authors suggest that food assistance programs could be improved with discreet benefit cards, better food assistance and food retail staff training, and simpler processes to help families access support with less fear of judgment. 

“Families are doing their best to provide healthy meals, yet too often they’re met with judgment when seeking help. These experiences of stigma can discourage families from using benefits they’re eligible for and need. Reducing bias within food systems—through staff training, thoughtful program design, and more dignified service—can make a real difference in families’ willingness to seek support.” - Kate Bauer, Ph.D., M.S.

First-time pandemic-era food assistance users were more likely to remain food insecure

People who turned to food assistance for the first time during the early months of the pandemic (mid-2020) were most likely to remain food insecure or experience episodic food insecurity in subsequent years, according to a study led by James Buszkiewicz, Ph.D., M.P.H., a social epidemiologist at the U-M School of Public Health.

Published in PLOS ONE, the study followed more than 700 Washington State residents from 2020 to 2023, finding that while 57% of participants stayed food secure throughout the three years, about one in five (20.2%) were persistently food insecure, and nearly a quarter (22.5%) moved in and out of food insecurity at least once. After accounting for other factors, people who began using food assistance for the first time early in the COVID-19 pandemic were 32% more likely to remain food insecure and 22% more likely to move in and out of food insecurity over time compared with those who never used assistance.

The findings indicate that individuals who are new to food assistance programs may encounter added challenges in navigating them, suggesting value in simplifying access and enhancing outreach. Related work by Buszkiewicz and colleagues at the University of Washington School of Public Health further explores the pandemic’s impact on food systems, food security, and access in Washington State. Learn more about that research.