Hunger Matters
Hunger directly affects disease risk, adherence to treatment, and health outcomes. This guide offers 10 practical steps for clinicians interested in prioritizing hunger screening as a part of their clinical workflow and in search of ideas to help patients combat hunger.
Firsts can be formative. The first organic chemistry lab report that begged the question, “Do I really want to become a healthcare provider?” The first day training on the floor in a huddle of white coats under a cacophony of unfamiliar beeps, shuffling footsteps, and rolling wheels. The first patient who passed away, a sobering reminder of medicine’s limitations and life’s fragility.
One college summer, I caught the New Jersey Transit to New York a few times each week. From Penn Station, a subway took me to a hospital in Queens or The Bronx. There, Memorial Sloan-Kettering (MSK) cancer care navigators and I would move pantry staples — canned salmon, bags of dried beans, jars of peanut butter, pasta, rice, oatmeal, applesauce, and more — from storage closets to the rooms where we ran Food to Overcome Outcome Disparities (FOOD), a program within MSK’s Immigrant Health and Cancer Disparities department, which seeks to improve patients’ food security, adherence to clinical treatments, and quality of life.
Throughout these mornings, we’d greet familiar faces who arrived for their regular chemotherapy treatments or stopped by on behalf of a family member with cancer. As one of the MSK navigators conducted surveys to evaluate and monitor patients’ needs for social services, I’d fill bags with their preferred items.
One morning, I began asking a new patient the routine questions, “Le gustaria frijoles negros o rojos?” Would you like black beans or red? Her eyes welled up and with an “Oh!”, her hand fluttered to her heart. She couldn’t remember the last time she’d been offered the luxury of making a food choice.
This formative experience exposed the disparities patients can face and made the concept of social determinants of health very real to me, someone who was fortunate enough to be selective about where her foods came from and how they were produced. Yet it was patients’ resilience — in the face of food insecurity, inadequate transportation, stressful housing situations, language barriers, the fear of deportation, and other comorbidities on top of their cancer diagnosis — that left the deepest impressions and keeps hunger at the forefront of my attention as a pediatric dietitian today.
Whether patients are encouraged to calorie boost their meals for weight gain or increase their consumption of fruits, vegetables, whole grains, and lean proteins as a component of their healthy lifestyle plan, they cannot implement nutritional recommendations without affordable, stable, culturally appropriate, and dignified access to food. Try as we may to effectively educate about choosing foods appropriate for a medical diagnosis, if our patients do not have the means to act on their knowledge, what lifestyle, mental health, and clinical changes can we as clinicians expect to see?
As I’ve begun to incorporate food insecurity screening into my outpatient visits, my awareness of hunger’s pervasiveness has grown. There have been days when 50–75% of my patients and families report worrying about or not having enough money for enough food to last through the month. This new practice of actively inquiring about food insecurity has invited a tension between my sense of committed responsibility to advocate for my patients and my sense of helplessness when I feel that the resources at my disposal have been exhausted.
In this challenge to find practical ways to address patients’ hunger, I’ve had to challenge my constructs of a “clinical pediatric dietitian” and think about ways to apply my connections, voice, and credentials towards hunger relief, acute and long-term. Limited access to food is a nutrition diagnosis that requires compassionate, collaborative, creative, and consistent measures to address. It demands interventions to bridge urgent gaps and multi-pronged strategies to maintain lasting solutions.
The national baby formula shortage was a recent crisis that proved to me that under unprecedented circumstances and exacerbated disparities, people rise to the challenge. The shortage has forged intensified partnerships between families, clinical dietitians and other healthcare providers, local WIC dietitians and program staff, formula companies and representatives, pharmacies, durable medical equipment companies, and policy makers in order to keep the youngest in our country fed. Parents have shared formulas through Facebook groups, fact-checking organizations have informed the public about the hazards of homemade recipes, public and private sectors have coordinated to bridge supply gaps by sending formula samples.
Much like any other clinical challenge, hunger calls for all hands on deck and a relentless determination to advocate for the patient’s well-being. So many people are regularly involved in food production or feeding to some degree. Who else should I reach out to for collaboration?
In addition to community organizations and policy leaders, my patients and their families, people with lived and living experiences, are critical voices I want to hear from with humble curiosity. As a clinician who has never experienced food insecurity herself, I am at high risk of thinking about hunger as an issue that persists solely because of inadequate financial resources. Underlying is a complex web of factors, including systemic racism, trauma, and food policy, that contribute to food insecurity’s persistence. Prioritizing their seat at the table reinforces how necessary their participation is in defining priorities and developing lasting, effective, and equitable solutions. A collaborative spirit drives the motivational interviewing I use to develop feasible, sustainable dietary and lifestyle goals with patients, and I believe a similar partnership is required when tackling hunger.
Hunger is a pervasive, complex problem in the U.S. And clinicians are uniquely positioned to help support patients in navigating food insecurity. Consider these 10 practical steps outlined in this guide: The Clinician’s Response to Food Insecurity: A Practical Guide. The suggestions listed are preliminary and by no means exhaustive, and I invite you to continue the conversation.
