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Food Insecurity & Obesity: Measurement is the missing link

Today the Food Foundation and the End Hunger UK Coalition released new figures showing that 16% of adults and 23% of parents in the UK are skipping meals out of financial necessity. These findings build upon 2014 data from the FAO’s Voices of the Hungry project showing that 8.4 million people in the UK live in food insecure households, and from 2016 figures from the Food Standards Agency’s Food and You Survey in which 21% of respondents reported very poor to moderate food insecurity. The survey was commissioned in the lead up to a private member’s bill put forward by Emma Lewell-Buck MP, which will have its second reading on Feb 2nd.

The bill proposes to measure food insecurity in the UK by using a standard survey tool currently used in the US and Canada, which asks people about their experience of food insecurity. The questions ask people about common experiences which affect people who have too few resources to ensure they get enough to eat.  While income/expenditure/asset based measures can be very important for estimating the size of a food gap, they fail to capture people’s lived experience.  In contrast the food insecurity experience scale includes questions related to people’s worry or anxiety about securing the food they need, acknowledging that while this might not be accompanied by tangible reductions in food access, the stress incurred by the thought that money could run out, is in and of itself, an important factor in determining the outcomes experienced.

In some countries, such as Canada and the United States, these data have been gathered for some time and are deeply embedded in the policy process – used to inform, galvanise and evaluate policy interventions.  In Canada, they have been used to shift political attention away from food banks as a strategy to tackle food insecurity, towards using policy instruments such as entitlement to social assistance to prevent it (see http://www.utpjournals.press/doi/abs/10.3138/cpp.2014-080) .  Importantly in countries where this measurement is routine it provides excellent material for civil society organisations and campaigners to drive accountability for intervention by policy makers to protect those most at risk.

The challenge now is to convince the UK government that incorporation of these questions into national survey instruments is a valuable investment.  As the figures released today show, this is supported by the public, with 77% of respondents agreeing that the government should measure food insecurity.

For the Food Foundation, and those concerned with nutritional outcomes, and all forms of malnutrition, we are interested in how experiences of food insecurity influence nutritional outcomes and how closely they are aligned.  Obviously, estimates of food insecurity and nutritional outcomes are measuring different things.  Food insecurity measures often capture experience at household rather than individual level, and at a single point in time, or over a short period, while nutritional status reflects long term nutritional experiences of individuals.  Moreover, nutrition is affected by many factors in addition to the availability of household resources to access food including health status, the caring environment in the household and society at large, as well as the food environment and the extent to which it facilitates or hinders access to a healthy diet. This is clearly demonstrated in the figures released today, 21% of respondents report buying cheaper or discounted food out of financial necessity – and we know that more often than not, the most inexpensive and discounted foods are also less healthy.  But it is for these reasons that the measurement of food insecurity, alongside nutritional outcomes, can be so valuable for informing policy.

There is a risk, very evident in the UK, that concerns about food insecurity and hunger are completely detached from nutritional outcomes (ie overweight and obesity).  Policy solutions to address them are separate and the suggestion that they have something in common is generally seen as laughable. To give just one example, in 2016 the Food Foundation published a briefing in the UK entitled “Too Poor to Eat” drawing attention to the first round of UK data coming from the FAO’s Voices of the Hungry project.  Two national newspapers covered the story, and the results were very different:

 

As the difference in the two stories shows, the connections between food insecurity and undernutrition may be intuitive but they are often not so for obesity.  However, considerable work has been conducted over the last 20 years in the USA examining these relationships and a common finding is that for women, particularly women with children, there is a strong association between food insecurity and obesity (FRAC, 2015).  There are a number of explanations given for this including that the cheapest food is often the most energy dense and least nutritious, that mothers act as the nutritional buffer in households and where meals are irregular and uncertain they may develop unhealthy eating patterns which create risks of obesity or where anxiety and stress about securing enough food to eat triggers a raft of mental health problems which expose these women to additional risks of obesity.

In the UK, where obesity is one of our most pressing health concerns, and 8 million people are believed to be living in food insecure households, it is clear that we need to tackle malnutrition in all of its forms. We have regular reporting and monitoring of obesity in the UK, but not for food insecurity.  So if we are to make progress on malnutrition in all its forms a first step has to be reliable, high quality data that can be used to track food insecurity at the household level, and using that data to identify its drivers and policy levers. That is why we support Emma Lewell-Buck’s bill on Friday (and you should too!).

You can write to your MP in support of the bill on the EHUK website: http://endhungeruk.org/measure/