Nutrition Insecurity–What’s In A Name?

I have–in my small circles–laid claim to a few things. These include wearing a lot of black in the 1970s, bridging the gap between the Beats and the Goths. I also take credit for casualizing professional wear, by donning sneakers with skirts and dresses in the 1980s, thus paving the way for working women to be more comfortable. (Boy, did that one take off.) Since then, my trendsetting has leveled off, until a few years ago, when I forwarded the matter of nutrition insecurity back into wider awareness.

Now, that might be the most audacious statement that I have ever made public, or that you have ever heard. But, hear me out. In my recent post, Could Not Afford Balanced Meal, I admitted to being late to the use of the term Food Insecurity and mused over how instead I described that issue. However, once I was brought up to speed, I comfortably integrated the terminology into my work at a national organization dedicated to addressing Food Insecurity by providing its program participants with a small subsidy for a few months to procure fresh fruits and vegetables.

I most certainly appreciated and supported the core of the mission. I enthusiastically imagined the mastication of sweet oranges, bright red peppers, emerald spinach, and juicy black and blue berries releasing their rich phytonutrients and antioxidants down the gullets of a couple of hundred individuals fortunate to be enrolled in one of our funded initiatives. I believed such provisions would bring benefit to those who suffered the indignity of not being able to afford and prioritize the intake of nature’s bounty. I could tout the potential impacts–but wasn’t sure how deep they would reach.

As my tenure at the organization lengthened, I observed its focused messaging around Food Insecurity. I began to wonder if that was what we were actually addressing. Of course, we were adding some dollars to food budgets, and our evaluations indicated that most participants made use of the benefits and claimed increased consumption of fruits and vegetables–albeit small. We highlighted the story of one woman who was thrilled to be able to purchase a fresh pineapple. Some who were surveyed described improved well-being. So, what then was I troubled by?

Perhaps I was just getting caught in the weeds. Maybe we were addressing some of the aspects as defined by Low Food Security–the reduced quality, variety, or desirability of one’s diet. But, I doubted that we were making a dent in the other–being without reliable access to a sufficient quantity of food. In September 2019, a year into this work, I began to wonder if it was more accurate to say that we were addressing Nutrition Insecurity, a term I’d not heard being used at that time. So, I took to Google.

My cursory search for Nutrition Insecurity yielded only links to papers investigating severe micronutrient deficiencies like Vitamin A, zinc, and iodine; and Protein-Energy Malnutrition in remote, from here, pockets of the globe–due to a true lack of food from various causes. This is the malnutrition I learned about in college decades ago. Here, our problems are instead ascribed to Food Insecurity, though this is ironic as certainly there is no actual lack of food. Such emphasis on food rather than nutrition allows for the nutritional consequences of the compromised diets rampant in our society, a different type of malnutrition, to remain ill-defined at best or ignored. This diminishes a focus on nutrition and the need for requisite nutrients to ward off disease and to enhance mental and physical health.

If the good mission of my organization was to provide a modicum of fruits and vegetables, weren’t we trying to address Nutrition Insecurity? I raised the issue with my colleagues. They weren’t sure. I raised it with a group of Yale Public Health students. Their ears perked up and they expressed interest in further consideration of the distinction. My Dilemma roused itself from a long hibernation and asked, “What’s up with you, girl? Does it matter?”

Shortly thereafter, my work at the organization ended. And then, a pandemic ensued. With a vengeance, all of our insecurities came bursting out onto the scene. Food Insecurity, came center stage. It hit the big time. Suddenly, food was being flung everywhere, from wherever it had been withheld or going to waste. I surrendered my query, accepting that the nuance I was trying to suss out was irrelevant. Food was food, and it was going to do its function of providing basic nourishment and keeping bellies full. Good enough. It was time to get to work to get people fed, no matter what. Food Insecurity was running amok. No one needed a fussy Nutritionist in times like these.

Feeling useless, I took myself to the streets a couple of times, volunteering at food drives. I stood in parking lots, with a few dozen others, filling the trunks of hundreds of cars with food. Some of it was good, while other was of a dubious nature. (I did pull the nutrition label from an unappealing package of a meat product to keep for my own edification.) And, where did those few little pretty, purple heads of radicchio come from, I wondered? My Dilemma, who always seems to present itself as a dog–like a big Yellow Lab–growled lowly for only me to hear and obey. It grabbed my chain, holding my vicious little whole foods, vegetarian, junk-food judgmental self back. I said, “You’re welcome,” and wished well the multitude of thankful drivers. I crawled back home with a little more humility.

And then a funny thing happened. One day, I found my Dilemma under the table, about to eat my homework. “Drop!”, I commanded. I unfurled the only slightly chewed pages. It was a paper entitled, Time to shift from ‘food security’ to ‘nutrition security’ to increase health and well-being. Dated April 1, 2021, it argues that this shift enables a more inclusive perspective, one necessary to ‘catalyze appropriate focus and policies on access not just to food but to healthy, nourishing food.’ It promotes ‘consistent access to and availability and affordability of food and beverages that promote well-being, while preventing–and if needed, treating disease.’ It was authored by Public Health leaders, Dariush Mozaffarian (Tufts University), Sheila Fleischhacker (Georgetown University), and one of my personal heroes, Chef José Andrés, the founder of World Central Kitchen.

I suspect that those Yale students chatted up my question with their friends at these other institutions, word got out and it floated up to the top. Thanks to them for picking up on my idea and growing this trend. One might still wonder, what’s in a name? Haven’t we already acknowledged that our current healthcare crisis is largely due to diet-related causes? Yes, but it is bigger and broader than that. Adding Nutrition Insecurity to the headlines and to healthcare policy may promote further change and accelerate solutions. Instilling it into our language and infusing it into a wider consciousness may remind us how much it matters. If Chef Andrés can accomplish what he is doing by deploying food and nutrition around the world at a moment’s notice, then we can certainly do better. (Let’s utilize school cafeterias as community meal preparation sites, staffed by a cadre of trained community members–so that everyone can have a warm, nutrient-rich meal to bring to their dinner table.)

Thank you for listening, sharing, following, and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

Be well. Take care. Stay safe. Let’s heal.

In health, Elyn

Reference: JAMA. 2021;325(16):1605-1606. doi:10.1001/jama.2021.1915

Update March 17, 2022: It seems that Nutrition Insecurity has now taken hold at the USDA. See this.

My Plate Haiku

Every day, I see hunger

But the hunger I see is not only for calories

But for nourishing meals. Chef Andrés,

Right now the people of Ukraine a facing a humanitarian and food crisis. Please click this link to see Chef Andrés’ work feeding people in multiple locations in Ukraine and in the adjoining countries accepting refugees, and to make a donation.

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