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Food insecurity is a problem for millions of Americans, according to reports from the U.S. Census Bureau. The bureau’s Household Pulse Survey, released in July, showed more than 20 million respondents sometimes or often didn’t have enough to eat.

The survey is part of the agency’s Experimental Data Series, designed to quickly and efficiently examine the social and economic impact of COVID-19. Data is used to aid recovery from aftershocks of the pandemic. Two of these impacts – unemployment and poverty –have contributed to households experiencing uncertain or limited access to nutritious food.

When people struggle to afford food, they may have to opt for less-healthy alternatives or skip meals, said Dr. Arshed Quyyumi, a cardiologist and director of the Emory Clinical Cardiovascular Research Institute at Emory University in Atlanta. These people may also forgo essentials such as medical care, he said.

“Food insecurity or limited access to good food makes a difference in one’s overall health and the long-term outcomes for people with heart conditions,” Quyyumi said. “Food insecurity is one of the issues facing our patients that deserves increased awareness from doctors and policymakers.”

The nonprofit hunger-relief organization Feeding America found that people who were food insecure before the COVID-19 pandemic started in March 2020 continue to be disproportionately affected. Feeding America projects that 1 in 8 people and 1 in 6 children may experience food insecurity this year, with significant disparities seen in certain racial and ethnic groups. For instance, Feeding America estimates 21% of Black people may experience food insecurity, compared to 11% of white people.

Other underlying factors often contributing to food insecurity include income level, structural racism and discrimination, and proximity to grocery stores with affordable and nutritious food. Exploring these problems and finding solutions deserve more attention, Quyyumi said.

“The awareness on social determinants of health has increased over the past year in large part due to COVID-19,” he said. “There is now more of a focus on how certain sections of the public are disproportionately affected and on how interlinked so many of these problems are.”

For a healthy person, a temporary lack of food may cause some suffering, Quyyumi said. But for those who have heart disease or other underlying health problems, the strain of poor nutrition and the stress it adds could be fatal.

Research has shown food insecurity can:

Contribute to conditions such as obesity, heart disease, diabetes and some types of cancer.

• Increase stress, depression, anxiety and other mental-health issues.
• Cause sleeping difficulties.
• Create behavioral issues and developmental delays in school for children and teens.

According to an American Heart Association report last year, food insecurity is often higher for those with hardening of the arteries and can affect 1 in 2 people who are in the most disadvantaged socioeconomic groups. 

A 2019 study in the Journal of General Internal Medicine found that nearly twice as many people had diabetes in the food-insecure group as those who were food-secure. The study of nearly 15,000 U.S. adults ages 24-32 also found food insecurity resulted in higher rates of hypertension, obesity and obstructive airway disease.

The consequences of food insecurity can affect even the youngest family members. The Census Bureau’s Household Pulse Survey shows that in July more than 10 million respondents in households with children sometimes or often didn’t have enough to eat.

“Kids are stressed by food insecurity. It’s not just the parents,” Quyyumi said. “Kids learn how and what to eat because of what their parents did. If you are stuck eating bad choices because you were food insecure as a child, then a lot needs to change fundamentally when you grow up.”

Tackling food insecurity will require a multifaceted approach, Quyyumi said. This includes funding future research, getting support from policy makers and improving access to local and federal nutrition programs. A study commissioned by the U.S. Department of Agriculture found that the Supplemental Nutrition Assistance Program (SNAP) reduced the likelihood of being food insecure by about 30%.

“There are ways doctors can advocate for better care for patients, even though it’s not medicine,” Quyyumi said. “Often the last thing we do as cardiologists is evaluate the social determinants of health when we’re seeing a patient. But more and more, we see how outcomes are so dependent on these determinants and on how much social support our patients are getting.”