Food insecurity and the dietitian's role

By the DieticiansWorldwide.com editorial team · 18 October 2026 · Public health & global nutrition

What food insecurity means

Food insecurity is not the same as hunger, although the two overlap. The Food and Agriculture Organization of the United Nations (FAO) defines hunger as "consumption of an insufficient amount of dietary energy to maintain a normal, active, healthy life", and describes food insecurity more broadly as lacking "regular access to enough safe and nutritious food for normal growth and development" (FAO, Hunger and food insecurity). A person can eat enough calories and still be food insecure if they routinely skip fruit, vegetables and protein foods because they cannot afford them, or if they worry each month that food will run out before the next payday.

That broader definition matters for dietitians. Much of the harm linked to food insecurity comes from the quality and predictability of the diet, not only its quantity. Cheap, energy-dense foods stretch a tight budget, irregular meals make blood glucose harder to manage, and the stress of not knowing where the next week's food will come from affects mental health and decisions about medicines and appointments.

The severity scale

Most national surveys grade food insecurity rather than treating it as yes or no. The US Department of Agriculture (USDA) uses four levels (USDA Economic Research Service, key statistics):

• High food security: no problems or anxiety about getting food.
• Marginal food security: some anxiety about running short, but little change to the diet.
• Low food security: households "obtained enough food to avoid substantially disrupting their eating patterns", often by eating a less varied diet or using food pantries.
• Very low food security: the "normal eating patterns of one or more household members were disrupted" and food intake was reduced at times.

USDA counts low and very low together as "food insecure". FAO's Food Insecurity Experience Scale, which it calls "an experience-based metric of food insecurity severity", works on a similar principle, asking people directly about experiences such as skipping meals or running out of food (FAO, Measuring hunger).

How many people are food insecure

The global picture

The latest edition of The State of Food Security and Nutrition in the World (SOFI 2026), published on 21 July 2026 by FAO, IFAD, UNICEF, WFP and WHO, reports that hunger fell for the third year running. FAO's news release gives these figures for 2025 (FAO news release, 21 July 2026):

• Hunger: 7.8% of the global population, about 645 million people.
• Moderate or severe food insecurity: 25.8%, about 2.1 billion people.
• Africa: about 309 million people facing hunger, 20.0% of the population, with 56.6% in moderate or severe food insecurity.
• Cost of a healthy diet: an average of 4.28 purchasing power parity (PPP) dollars per person per day, with 2.69 billion people, 32.7% of the world, unable to afford one.
• Children: about 150 million children under five were stunted.

The agencies project that 510 to 520 million people may still face hunger in 2030. The report's theme this year is the high cost of a healthy diet, which is exactly where food insecurity and diet-related disease meet. Low-income countries often face undernutrition and obesity at the same time, a pattern we cover in our article on the double burden of malnutrition.

Wealthier countries

Food insecurity is also common in high-income countries, which is often a surprise to people outside the field.

• United States. In 2024, 13.7% of US households, 18.3 million, were food insecure at some point in the year, and 5.4% had very low food security. Children themselves were food insecure in 9.1% of households with children, about 3.3 million households (USDA ERS, Household Food Security in the United States in 2024, report summary, December 2025). The 2024 rate was not statistically different from 13.5% in 2023.
• United Kingdom. The Department for Work and Pensions' Family Resources Survey for April 2024 to March 2025 found that 85% of households had high food security, 6% marginal, 4% low and 5% very low. Households with children were more likely to be food insecure (6% low and 6% very low) than those without children (3% and 4%) (DWP, Family Resources Survey 2024 to 2025, published 26 March 2026).
• Canada. PROOF, a research programme at the University of Toronto, analysed Statistics Canada's 2024 Canadian Income Survey, whose food questions were asked between January and July 2025. It found that 24.0% of people in the provinces, about 9.8 million, lived in food-insecure households, down from 25.7% the year before, including 30.8% of children (PROOF, 29 April 2026).

Whose data to trust

These numbers look wildly different, and comparing them directly is a common mistake in reports, grant applications and social media posts. The surveys answer slightly different questions.

Three differences explain most of the gap:

1. People versus households. A household-level rate is lower than a person-level rate when larger families, especially families with children, are more likely to be food insecure.
2. The time window. The UK survey asks about the 30 days before the interview, while the USDA survey covers the whole calendar year, so the UK question will capture fewer people.
3. Where the line is drawn. Canada's published figure includes marginal food insecurity; the US and UK headline figures do not.

Charity surveys add another layer. The Food Foundation's long-running UK food insecurity tracker uses its own questions and sampling, so its figures should be compared only with earlier rounds of the same tracker. The practical rule: quote the source, year, unit and definition every time, and compare like with like. Our compare countries tool puts national nutrition indicators side by side, and the same caution applies there.

How food insecurity affects health

Chronic disease

The best-known US study examined 5,094 low-income adults aged 18 to 65 in the National Health and Nutrition Examination Survey. After adjusting for age, sex, race, education and income, food insecurity was linked with examination evidence of hypertension (adjusted relative risk 1.21) and self-reported hyperlipidaemia (1.30). For laboratory evidence of diabetes, the link was significant only when the authors used a stricter definition of food insecurity, with an adjusted relative risk of 2.42 (Seligman and colleagues, Journal of Nutrition 2010).

A review in Health Affairs found the literature "consistently" links food insecurity with worse health. Food-insecure children were at least twice as likely to be reported in fair or poor health and at least 1.4 times as likely to have asthma, and food-insecure older adults had limitations in daily activities comparable to food-secure people fourteen years older (Gundersen and Ziliak, Health Affairs 2015).

The obesity paradox

It seems contradictory that not having enough food could be linked with higher body weight, yet that is what many studies find. A meta-analysis of 31 studies from 14 countries, covering 115,993 adults, found that adults in food-insecure households had higher odds of obesity (odds ratio 1.15), with a stronger link in women (1.26). At the most severe levels, and in less economically developed countries, the risk shifted towards underweight (Moradi and colleagues, European Journal of Nutrition 2019). The authors warned that the studies varied a great deal, so the size of the effect is uncertain.

Proposed explanations include cheaper energy-dense foods, cycles of plenty and scarcity around pay or benefit dates, and chronic stress. For practice, the important point is that a food-insecure patient with obesity is not "eating too much"; they are often eating what they can afford, and generic advice to buy more fresh produce can feel impossible. Our guide to ultra-processed foods explains why convenience and price push in the same direction.

Screening for food insecurity in clinics

The two-question screen

Most health services that screen for food insecurity use a two-item tool now widely known as the Hunger Vital Sign. It was developed from the first two questions of the USDA's 18-item Household Food Security Survey, which ask whether, in the last 12 months, the household worried food would run out before they had money to buy more, and whether the food they bought didn't last and they had no money to get more. In a study of 30,098 families with young children at seven US urban medical centres, an affirmative answer to either question identified food insecurity with 97% sensitivity and 83% specificity (Hager and colleagues, Pediatrics 2010).

Doing it well

A screen is only useful if something happens next. Good practice in dietetic clinics and primary care tends to include:

• Asking everyone, not only people who "look" poor. Food insecurity appears in working households, students, older people and people with disabilities.
• Normalising the question. Explaining that you ask every patient because food costs affect health makes a "yes" easier.
• Having a referral route ready. That means knowing the local food bank referral process, benefits advice service and nutrition programmes before you ask.
• Recording and re-checking. Food security changes with job loss, illness or a change in benefits, so a negative screen one year does not settle the question.

If you are training for clinical work, our become a dietitian guide covers how social determinants of health fit into dietetic education in different countries.

What dietitians actually do

The Academy of Nutrition and Dietetics' position paper says registered dietitian nutritionists "play key roles in addressing food insecurity", through practice, education, research and advocacy, and calls for adequate funding and use of food and nutrition assistance programmes (Holben and Marshall, Journal of the Academy of Nutrition and Dietetics 2017, republished 2022). In day-to-day work, that looks like this.

In the clinic

• Adapting therapeutic diets to a budget. A renal, diabetes or heart-failure diet built around tinned pulses, frozen vegetables, eggs, oats and own-brand staples is more realistic than one built around fresh fish and specialist products.
• Medication timing. For people taking insulin or sulfonylureas, irregular meals raise the risk of hypoglycaemia, so dietitians work with prescribers when food is unpredictable.
• Cooking and storage. Asking about a fridge, freezer, oven and fuel costs is part of a nutrition assessment, not an afterthought.

With food banks and pantries

Food banks increasingly work with dietitians and nutrition students on the nutritional quality of what they distribute: setting guidelines for donated food, designing parcels for people with diabetes or coeliac disease, labelling, and running cooking sessions with the ingredients people receive. In the UK, Trussell food banks give emergency parcels, usually covering a minimum of three days' food, to people referred for a food voucher by local organisations (Trussell, emergency food). Emergency food is a short-term fix; the dietitian's role is to make it as nutritionally sound as possible while linking people to longer-term income and benefits support.

With federal programmes

In the United States, the Supplemental Nutrition Assistance Program (SNAP) "provides food benefits to low-income families to supplement their grocery budget" (USDA, SNAP). The Health Affairs review cited above found that SNAP "substantially reduces" food insecurity. WIC supports families from pregnancy until a child turns five, providing healthy foods, "personalized nutrition education", breastfeeding support and referrals (USDA, WIC).

There is an active policy debate about whether programmes should restrict what benefits can buy or focus on education and incentives. USDA now runs SNAP Food Restriction Waivers for states that want to limit certain purchases. This mirrors the wider argument between taxes, labels and bans on one side and education campaigns on the other, which we look at in our articles on the sugar tax and on national guidance such as the new US food pyramid. The evidence on each approach is still developing, and dietitians tend to bring the same question to all of them: does it improve what people can actually afford to eat?

For a closer look at programmes that deliver food through the health system, such as produce prescriptions and medically tailored meals, see our guide to food as medicine. Food insecurity also intersects with climate and food-system policy, covered in our article on the sustainable diet, and with nutrient-adding policies like food fortification, which protect people who cannot afford a varied diet.

Where to get help if you are struggling

If you or your family are running short of food, these official and established services are a good first step. Eligibility and rules change, so check the current details with each service.

• United States. Apply for SNAP through your state agency, ask about WIC if you are pregnant or have a child under five, and call or text 211 or visit 211.org to find local food pantries, meal programmes and benefits help.
• United Kingdom. If you are more than 10 weeks pregnant or have a child under four, you may qualify for a Healthy Start card for milk, fruit, vegetables, pulses and infant formula (Scotland runs Best Start Foods instead). Citizens Advice can check your benefit entitlement and refer you for a food bank voucher.
• Canada. Dial 211 or visit 211.ca for local food programmes and income supports.
• Everywhere. Tell your doctor, nurse or dietitian. It changes the advice they should give you, and many clinics can refer you to support you might not know about.

National systems differ a great deal; our country guides for the United States, the United Kingdom and Canada explain how dietetic services are organised in each. For global policy and data resources, start at our global nutrition hub.

If you would like personal advice on eating well on a tight budget, or adapting a medical diet to what you can afford, you can book a session with a registered dietitian.

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