Philadelphia Medicine, Fall 2017 - 22

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FEATURE

Fighting Food Insecurity
in Modern America
By: Jennifer Robbins, MD; Mary Lou Gavin, MD; George Datto, MD; Thao-Ly Phan, MD, MPH

In the moment, I congratulated the boys' mother on taking this
ast week I saw two children for medical evaluation and treatment
of obesity and associated comorbidities in a pediatric weight initiative to try and help her sons. She was proud of this effort and
management clinic. The patients were Hispanic brothers, 9 I couldn't just take that away from her.
and 11 years of age, and each was carrying more than 50 pounds of
I hear similar stories almost every day, where misinformation -
excess weight. They were referred to our clinic because, in addition
to their increased weight, they had lab findings consistent with dys- and marketing claims confused for nutritional advice - only serve
lipidemia and non-alcoholic fatty liver disease. Even before puberty, to deepen the disparities we see in nutrition-related health problems.
the combination of poor nutritional intake and genetic predisposition The stress of food purchasing weighed constantly on this mother, as
it does for so many in the community. Philadelphia County has the
was causing damaging effects to their bodies.
highest rates of Food Insecurity (FI) in Pennsylvania, with nearly
At the start of our visit the boys' mother took out a notepad and 22% of residents lacking consistent access to affordable healthy food.
pencil, and said, "I know we need to make changes, I just don't know
Though FI has historically been linked to states of undernutrition
how." With that, I began to explore the reasons for the boys' weight
gain. I learned that the family was struggling financially, despite both and poor weight gain, our modern society has seen high rates of FI
parents working more than one job and receiving SNAP benefits. among those with overweight and obesity. Over 40% of children in
Their limited budget incentivized purchasing of poor-quality foods Philadelphia are overweight or obese, and there are notably higher
and dollar menu options. The boys' mother confessed that she fre- rates within poverty-stricken regions of North and West Philadelphia,
quently worried about having money to buy enough food to eat, and with some areas approaching 70%.
that she would often skip meals to make sure that the children were
There are many reasons why low-income families are disproporfed. By force of convenience and habit, their diet included frequent
tionately
affected by obesity, including: increased exposure to energy
super-sized portions from the drive-thru and highly processed snack
dense
and
low quality foods, cycles of food deprivation and overeating,
foods. Admittedly, the boys' parents didn't have time to cook, and
increased
prevalence
of stress and depression and increased exposure
they were often left to eat alone as their parents went from one job
to
advertising
for
obesogenic
foods.
to another.
The boys' mother was visibly worried and expressed a true readiness
to make changes. Since learning about their lab results, the mother
had decided to give them a popular juice-drink every day to get more
fruits and vegetables into their diet. The particular juice product she
was buying contained 60 grams of sugar and 300 calories per bottle.
Over the course of a month, this alone could account for 450 extra
teaspoons of sugar and 4 times the expected rate of weight gain for
a pre-pubertal male!

Within the constructs of our current food system, understanding and accessing high quality foods requires additional effort and
resources that many do not have. We as healthcare providers should
start with this understanding to allow us to thoughtfully address
each family's specific needs.

Pediatricians play a critical role in protecting children from food insecurity

KEY FACTS ABOUT CHILDHOOD FOOD INSECURITY

Childhood food
insecurity can lead to:
Poor Health Status
Developmental Risk
Mental Health Problems
Poor Educational Outcomes

1 in 6
U.S. children
lives in a food-insecure
household

22 Philadelphia Medicine : Fall 2017

NUTRITION PROGRAMS TO KNOW

Childhood food
insecurity may present
Developmental Delays
Behavioral Problems
Obesity
Poor Growth
Inappropriate Feeding Practices

Table of Contents for the Digital Edition of Philadelphia Medicine, Fall 2017