'Tailoring' Suitable Interventions To Address Food Insecurity Amidst COVID-19

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​Alli Wu, MD

​Alec Shostek, BS

COVID-19 has had far-reaching impact on all aspects of daily life. For at least 11.1% of the U.S. population who face food insecurity, this unprecedented pandemic has brought on significant additional strain and stress. An increasing number of families are dealing with trying decisions when it comes to paying bills, affording rent, and purchasing food. Food insecurity, or the lack of consistent access to adequate and nutritious food, is known to be associated with numerous chronic health conditions. Individuals who are food insecure face increased health care costs compared to food secure individuals; researchers estimate that on average, food insecure adults have annual health expenditures $1,834 higher than food secure adults.  

An innovative strategy to target food insecurity, particularly for medically high-risk individuals with chronic illness, is medically tailored meal delivery. This includes home delivery of meals that meet the individual’s specific nutritional needs – such as low-salt, low-fiber, or high calorie/protein – prepared under the supervision of a registered dietitian. A local Boston organization, Community Servings, provides medically tailored meals as well as nutrition counseling and education to individuals with chronic illness.
The concept of food as medicine is supported by data. A retrospective study that used data from the Massachusetts All-Payer Claims database and Community Servings found that participation in a medically tailored meal program was associated with significantly fewer hospital and skilled nursing admissions, as well as lower overall health care costs. Thoughtful interventions like medically tailored meal delivery that address social and health challenges may be critical for vulnerable populations. 
Children are also a vulnerable population facing food insecurity and its effects on health. Recent literature suggests children from food insecure households are more likely to have higher body mass indices (BMI), greater waist circumferences, to have overweight or obesity, and have higher sugar consumption from sugar-sweetened beverages than children from food-secure households. Recognizing that food insecurity is a household issue, Community Servings also provides meals for a caregiver (such as a parent or spouse) and for any minor children, as well as meals for the critically ill participant.
In response to the pandemic, the Community Servings team has undertaken special efforts to ensure that their clients continue to receive nutritious food while maintaining a safe work environment for all staff and visitors. Aided by dedicated staff, volunteers and the greater Boston community, Community Servings has maintained its weekly meal deliveries, added new clients to the medically tailored meal program, and served meals to food insecure neighbors during this difficult time.
As it stands, food insecurity screening is not regularly incorporated into clinic visits for weight management. Enhanced awareness among providers to screen for food insecurity is warranted, especially as food insecurity becomes increasingly prevalent due to COVID-19 and its consequences, such as unemployment. Providers should connect those who face food insecurity with available resources, such as SNAP, WIC, other supplemental food programs, and food banks. An ideal step further is to provide tailored interventions to those most in need.