April 20, 2016
"Did you ever not eat for a whole day because there wasn't enough money for food?"
That was the question a researcher asked a 66-year-old patient at Philadelphia's Einstein Medical Center as part of a study on food insecurity among people who are frequently hospitalized.
"That's a rough question. Yes," the patient admitted.
"Is that something you can tell me about?" the researcher asked.
"Not really," she said. "It just wasn't there."
Einstein surveyed 40 patients who had been hospitalized at least three times in the past year. The majority of them were dealing with six or more chronic conditions at the same time, like diabetes or kidney disease, and the average age was 60 years.
Those health issues alone would be enough for any person to deal with, but researchers discovered a bigger issue: 30 percent of the patients were food insecure, meaning that they often had to worry about where their next meal was going to come from.
The U.S. Department of Agriculture defines food insecurity as "household-level economic and social condition of limited or uncertain access to adequate food." In other words, food insecurity isn't the same as hunger: It's the poverty that leads to hunger.
Researchers asked patients seven questions related to food security in the last month, like whether they ever ate smaller meals to save food. Those who answered at least three affirmatively were considered food insecure. An additional 25 percent of the patients checked off one or two of the questions, making them marginally food insecure.
For example, 16 out of 40 patients said they had "worried that their food would run out" in the last month. Seven patients reported that they had skipped a full day of eating at least once.
"At the end of the month I don't have money really," the patient above explained, as quoted in the study. "I'm by myself and that is my only income. By the time you buy personal, household…you've got to have coffee, you've got to pay your co-pays for doctors…I go to doctors a lot, transportation, gas."
Community food programs did help make sure that many patients got enough to eat. Thirteen patients used food pantries, 17 got food from church programs, and six used free meal delivery programs.
However, researchers found that being able to shop for and cook food was an even greater issue for patients than being able to afford food. Three out of four patients could not shop for food without assistance from others, and more than half needed help cooking the meals.
"That's what I worry about most," a 60-year-old man told researchers. "Being found where I can't prepare my own food, or...I'm in a condition where I can't fix it or eat it."
One 68-year-old woman in a wheelchair, for example, had to go shopping with a cousin who could reach items off high shelves for her. Another woman in a wheelchair said she can't use her stove because it's at eye level and "I can't see in the pot."
Leader author Etienne Phipps, director of Einstein's Center for Urban Health Policy, said that it is crucial that doctors ask patients about their food situation.
“Without access to sufficient and healthful food, patients simply cannot care for their own health, cannot comply with diet regimens, cannot promote healing,” said Phipps.
Read the full study, published in the journal Population Health Management, here.