Childhood Hunger and Food Insecurity in the U.S.: Hungry for Change

1applesFood security has been officially defined as “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” by the World Food Summit of 1996(1). Food insecurity, therefore, is the opposite of this: when someone’s food supply is occasionally or always insufficient, unsafe, or unhealthy, and they are unable to live out a healthy lifestyle as a result. Food insecurity includes disrupted meal intake, decreased food quality, a sense of worry regarding where food will come from, reliance on emergency food sources, or not being able to eat in line with food preferences.
Many, if not all of us, have come into contact with individuals lacking either physical or economic access to nutritious, healthy food. There is really no place we could not see someone who may be classified as food insecure. Food is not a right in the United States, and so as citizens we have come to understand, and adapt to, the hard truth that not everyone has the luxury of nutritious food, let alone food at all. 48.1 million people in the United States are living in food-insecure households, and more than 15 million of those are children(2). In Virginia, despite having one of the lowest rates of childhood food insecurity in the country according to the USDA, the prevalence of food insecurity is still 11.8%, or roughly 913,000 people. Of note, the District of Columbia, a state close to home for many Virginians, has the highest prevalence of childhood food insecurity, coming in at over 31% in 2013(3). Rates of food insecurity are highest among households with children, households with single parents, black, non-Hispanic families, and households living below 185% of the poverty threshold(2).

Peeled peanut andl peanuts in shell, studio shot
So what does food insecurity look like in America? Perhaps families or individuals are food insecure because they do not live near a grocery store, without enough gas money to fill up their car. Maybe they don’t even have a car, and must rely on their feet or public transportation to get to the nearest food outlet. They may not be able to afford as much food as the end of the month approaches if their income and/or government assistance (if applicable) starts to run out before they make it to the next month. If a gas station or convenience store is someone’s most accessible and affordable source of food, they are at the complete disposal of whatever that store may be selling, healthy or unhealthy. Many families do not have control over what is physically or economically available to them, forcing them to make consistently unhealthy and/or undesirable food choices. Household adults will often disrupt their own intake before allowing their child to miss out on meals or go hungry, but sometimes there just isn’t enough to go around, and children suffer alongside their adult family members. At the 2016 VAND annual meeting, Dr. Robert Murray, a professor from the Ohio State University School of Medicine, discussed the importance of adequate nutrition for proper early childhood development. He highlighted the vital role of nutrition in neurological development, adding that prolonged hunger or food insecurity can be a persistent stressor in children. Such prolonged stressors can lead to impaired neurocognitive, social and emotional development, as well as numerous adverse health outcomes later in life(4). Potential long-term health consequences include increased risk of developing type 2 diabetes, obesity, high blood pressure, heart disease, metabolic syndrome, and high blood cholesterol. Adding to chronic physical health problems, food insecurity can also contribute to mental health issues, not limited to depression, anxiety and chronic stress.
Many public federal assistance programs are in place to help those struggling with food insecurity, such as SNAP (Supplemental Nutrition Assistance Program), WIC (Women, Infants and Children), the National School Lunch and Breakfast Programs, and various summer food programs. These programs provide families with supplemental monetary assistance or vouchers to purchase foods in line with government dietary recommendations; however, these benefits are not intended to totally support dietary intakes of participating individuals. Emergency food assistance, such as food banks, pantries and soup kitchens, can be used independent of or in conjunction with federal assistance programs to further help provide adequate food, yet their typical food options are often lacking nutritionally and can further contribute to adverse health outcomes down the road.

So what can we do? It is important for healthcare providers, including dietitians, to stay informed on the prevalence of food insecurity in their area and to consider economic and social barriers that may be present in patients when conducting nutrition educations or providing dietary recommendations. Tailoring recommendations and goals to the individual person and/or family is more likely to make a lasting impact on their health compared to something generalized that may not be feasible for them to put into action. Helping people become familiar with sources of aid in their community could help them live as healthfully as possible, despite maybe not having access to ideal food resources. As health professionals and as a community, we can also advocate for public policy. Dorothy McAuliffe, the First Lady of the Commonwealth of Virginia, has made eliminating childhood hunger and improving everyone’s access to healthy and local food a policy priority. A believer in the importance of early childhood nutrition for long-term academic and social success, Mrs. McAuliffe promotes community efforts which educate families on the value of locally grown food, education, nutrition and overall health and well-being(5). Childhood hunger and community food insecurity are worldwide problems that aren’t going to disappear overnight. Spreading awareness, advocating for public and governmental support, and providing personalized patient care are a few steps in the right direction. I encourage you to show Virginia, the United States, and the world how hungry you are for change – for no child should have to experience hunger.

1.  WHO. Glossary of globalization, trade and health terms: food security. World Health Organization. 2016.
2.  Coleman-Jensen A, Rabbitt M, Gregory C, Singh A. Household food security in the United States in 2014. USDA ERS. 2015.
3.  Gundersen C, Satoh A, Dewey A, Kato M, Engelhard E. Map the meal gap 2015: food insecurity and child food insecurity estimates at the county level. Feeding America. 2015.
4.  Dr. Murray R. PowerPoint Presentation: The learning connection. VAND Annual Meeting Conference. 2016.
5.  Dorothy McAuliffe. 2015.


HersheyMonica Hershey is currently a dietetic intern at the University of Virginia Health System in Charlottesville, VA. A Pennsylvania native, Monica earned her undergraduate degree in nutritional sciences at Penn State University with an emphasis in community nutrition and food security. Upon graduation, Monica would like to work as a clinical RD at a large medical facility on the East Coast, with hopes of working as a renal dietitian in the near future. Her personal interests include hiking with friends, recipe-less cooking and exploring all the fun that Charlottesville has to offer!


The Learning Connection by Dr. Robert Murray, The Ohio State University

Dr. Robert Murray, a professor in the Department of Pediatrics at the Ohio State University School of Medicine, kicked off the last day of the VAND annual meeting on April 12, 2016 in Fairfax, VA. He presented an engaging talk on epigenetics and the importance of nutrition in early childhood development. He opened his talk by discussing the Carolina Abecedarian Study, a study conducted in North Carolina in 1977 to study the benefits of early childhood education for impoverished children. Two groups of children were randomized to receive either quality preschool education, or the healthcare and education available to them by the government. The intervention, or quality preschool group, was provided with 8 hours of child care daily from birth to 5 years of age, health care, nutrition provisions including 2 meals and one snack, and cognitive and social stimulation. Children in the control group were set up with Medicaid, WIC, food stamps, and did not receive child care.

Their findings from this study were ground-breaking and have set the stage for public health interventions: as adolescents, children in the intervention group were less likely to fail or repeat a grade, 4x more likely to graduate from college, 4.4x more likely to hold a skilled job, had stronger social and emotional skills, were more physically active, drank less alcohol and had fewer run-ins with the law when compared to the control group. At age 40, these same children had much lower blood pressure, lower blood cholesterol, less obesity, lower type 2 diabetes risk and much lower heart disease risk than the children in the control group. Dr. Murray discussed this great impact from early childhood interventions focused on emotional, social and cognitive stimulation, as well as proper health care and nutrition, on neurological (brain) development and future health outcomes.

From there, Dr. Murray went on to discuss the role epigenetics have to play on future health and well-being. Epigenetics is the study of modified gene expression; in other words, the people we become is not entirely dictated by our DNA. Environmental factors humans are exposed to throughout their lives can change how their genes are expressed, despite not changing the genes themselves — changing how our body works and how we behave, ultimately altering who we become. A mother’s diet is a “powerful epigenetic force” during fetal growth and development. How a mother eats during pregnancy, independent of genetics, can impact how that infant’s genes are expressed, in addition to affecting overall adequacy of growth and proper development. He noted some of the common nutritional intake issues associated with many women of child-bearing age today, including high saturated fat and sodium intake, low fiber, vitamin E, calcium, magnesium and potassium intake with inadequate intake of other essential vitamins and minerals, and common deficiencies in iron and vitamin D. Mom’s nutrition status entering pregnancy influences her growing fetus, and maternal and child nutrition continue to play a vital role in the postnatal period, particularly regarding brain development in the first two years of a child’s life.

In the first year of life, a baby’s brain will double in size, and by the third year of life its size has tripled. During this time, the brain is forming 700 synaptic (communication) connections per second as the baby continues to explore and analyze every last detail of its seemingly simple life. If synapses are formed but not used regularly, they are forever lost, which is another reason cognitive and social stimulation is so important in a child’s first years. In addition, diet quality and stable health were two of four necessary things Dr. Murray highlighted to optimize brain development (social and emotional support as well as sensory-motor exploration were the remaining two contributors). Stress, a reaction controlled by the “middle brain”, is also a contributor to overall neurological development. Though brief stress can be a good thing, prolonged stress can be detrimental to a child’s overall development, potentially leading to disease, disability, social and emotional issues, and even early death. Since adequate nutrition and intake of vitamins and minerals fuel proper brain development and positively impact overall health, prolonged hunger and inadequate nutrient intake are both considered prolonged stressors on the body that can result in adverse outcomes.

BerriesAccording to Dr. Murray, research has confirmed that diet quality and regular activity make people healthier, regardless of size, age, or risk factors. This includes risk of heart disease, diabetes, stroke, obesity, hypertension, cancer, and other chronic diseases. The Dietary Guidelines for Americans can help adults establish a healthy eating plan that works for them. With the new recommendations for 2015-2020, Americans are especially encouraged to limit sodium, saturated fat and added sugar intake, while making sure to get enough calcium, vitamin D, iron and fiber in their diet by focusing on eating whole foods from the five food groups (whole grains, fruits, vegetables, protein and dairy). It is in part due to the most recent dietary guidelines that people started to analyze the impact of too much dietary sugar on the body, and how to reduce added sugar consumption.

When we think about a child’s diet, certain foods such as flavored yogurt, flavored milks, sugar-sweetened cereals and fruit juice may come to mind as a few of the major contributors to a child’s added sugar intake. Dr. Murray pointed out that, though these foods and drinks certainly contribute to overall added sugar intake, the largest contributors by far are sugar-sweetened beverages (not milk or 100% fruit juice) and sugary snacks, thus the focus should be on limiting these. This applies to adults as well; Dr. Murray stated health will never be the number one reason people choose to eat certain foods – taste, value and convenience are the current reigning champions. He noted a French study discovered substituting better food choices within the same food category (i.e. white vs. brown rice, carrot cake vs. chocolate cake, etc.) improved long-term dietary patterns better than simply consuming lower fat versions of the same foods.

Dr. Murray concluded his presentation by restating the power of nutrition in epigenetics, how hunger can be a persistent and sometimes toxic stressor, the constant nutrient requirements of the brain, particularly during early life development, and how breakfast and snacks are our best bet at improving the dietary intake of children and adolescents.

Source: “The Learning Connection”, PowerPoint presentation by Dr. Murray



Monica Hershey is currently a dietetic intern at the University of Virginia Health System in Charlottesville, VA. A Pennsylvania native, Monica earned her undergraduate degree in nutritional sciences at Penn State University. Upon graduation, Monica would like to work as a clinical RD at a large medical facility on the East Coast, with hopes of working as a renal dietitian in the near future. Her personal interests include hiking with friends, recipe-less cooking and exploring all the fun that Charlottesville has to offer!

Poster Presentations as a Dietetic Intern: Monica Hershey shares her experience!

Monica PosterAt the 2016 VAND Annual Meeting held this year in Fairfax, VA, selected VAND members presented posters on research they had recently conducted. It was a pleasant surprise to see the number of dietetic interns chosen to participate in this year’s session, as well as a number of nutrition professionals. Dietetic interns and Registered Dietitians from across the state of Virginia were present at the session, with posters reporting on quality improvement projects, patient satisfaction studies, program research and development, development of nutrition-related screening tools, community resource development, clinical research studies and more. The poster session was heavily attended, giving poster presenters a chance to share something they are passionate about, or at least something they have put a great deal of work into, with many of their professional peers. The poster session provided networking opportunities for interns and established nutrition professionals alike, as well as the ability to gather new perspectives on poster topics.

As a dietetic intern and first-time poster presenter, I was not sure what to expect. However, the more people came by my poster, the more passionate I became about the work I had completed over the last 6 months. My research, completed as a “capstone project” through my internship program with the guidance and oversight of a preceptor, focused on whether the Braden Scale was a positive predictor of nutrition risk in acute care patients, and if it should be used as a nutrition screening trigger for RD services. Consisting of prospective medical chart data collection as well as a nurses’ survey, we obtained data from 121 patients and 50 members of the nursing staff. Our data indicated opportunities for improvement in how the Braden Scale is completed at our facility, as well as how RDs and patients alike would be impacted with the addition of a RD trigger based around Braden Scale scores. It was a privilege of mine to work with both Wendy Phillips and Kate Willcutts on this project, and it was an honor to stand before my professional role models and peers, discussing the importance of quality patient care in the acute care setting. I was able to meet and network with new people, gain new perspectives on my research, and hear how my research could impact nutrition practice in various settings. It was particularly valuable for me to hear from RDs currently employed in an acute care setting about how my findings are consistent with what they thought, but never had proof of being true. Other intern presenters I spoke with after the conference echoed these statements, some adding they didn’t expect so many people to be interested in their projects, that it helped them realize what they had accomplished, and that they felt as though they were making a difference as a result of their work!

To current and future dietetic interns…I highly recommend taking advantage of research opportunities with your dietetics program if possible, and participating in poster sessions like the one at VAND!  The personal and professional growth you experience as a result is absolutely worth the hard work. The number of young people interested in nutrition research was extremely encouraging to see, affirming the future of our field is in good hands. I cannot wait to see where the future of dietetics research is headed and look forward to participating in more poster sessions as my career blooms!

Monica Hershey is currently a dietetic intern at the University of Virginia Health System in Charlottesville, VA. Monica earned her undergraduate degree in nutritional sciences at Penn State University. Upon graduation, Monica would like to work as a clinical RD at a large medical facility on the East Coast, with hopes of working as a renal dietitian in the near future. Her personal interests include hiking with friends, recipe-less cooking and exploring all the fun that Charlottesville has to offer!