USPSTF: Not enough evidence to support food insecurity screening in primary care

Key takeaways:

• The USPSTF found no significant impacts on food insecurity screening or interventions in primary care.
• PCPs should be aware of nutritional barriers and refer patients to resources, a USPSTF member said.

According to the U.S. Preventive Services Task Force, there is insufficient evidence to recommend for or against screening for food insecurity in primary care settings.

The I draft recommendation statement applies to adults, adolescents and children.

It is the first time the task force reviewed this topic, and it is the first topic to come out of its recent work on how to incorporate social risk factors into their guidance, according to a press release.

“The task force reviewed the evidence on this topic because we recognize that food security is essential to overall health,” USPSTF member Tumaini Rucker Coker, MD, MBA, said in the release. “While we found limited evidence on whether screening in primary care improves overall health, we know there are important programs available that address food insecurity.”

Coker added that health care professionals “should be aware of barriers to accessing nutritious food in their community, listen to patient concerns and work to connect individuals to available resources.”

Previous data uncovered a rise in food insecurity in the United States over the last 2 decades — particularly among low-income families. About 12% of all households faced food insecurity at some point in 2022, the U.S. Department of Agriculture reported.

According to the task force, certain populations like Black and Hispanic people, veterans, those with disabilities or in the LGBTQ+ community and older adults may be at a greater risk for food insecurity.

Food insecurity has been tied to adverse health outcomes, including greater exposure to violence, risk for cognitive disorders and health care expenditures, but screening rates have remained low in primary care.

In the draft evidence report, researchers assessed 39 studies (n = 198,762) that looked at the impact of screening or interventions on food insecurity. In one randomized controlled trial (n = 789), researchers found no significant difference in the percentage of people who reported food insecurity after 6 months between screening and usual care groups.

A few studies did show that food insecurity interventions were associated with improvements in diet quality and BMI. However, there were limited data specific to primary care on the use of screening tools and how interventions improve people’s health, the task force said.

“The task force recognizes the complexities of addressing social risks like food insecurity in primary care,” USPSTF member James Stevermer, MD, MSPH, said in the release. “In our draft recommendation, we acknowledge the importance of existing efforts to address food insecurity, while explaining the limitations of the evidence, challenges of addressing this issue in primary care, and unique aspects of mitigating social risks.”

The USPSTF underlined that the recommendation applies only to food insecurity interventions and screening in primary care and that it did not review evidence — or is making a statement on — “the use of valuable social services and programs that set out to address food insecurity in the U.S.”

Comments on the draft recommendation can be submitted here from June 25 through July 22.

References:

• Key statistics & graphics. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/. Accessed June 20, 2024.
• Preventive services for food insecurity: A systematic review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/food-insecurity-preventive-services. Accessed June 20, 2024. Published June 25, 2024.
• Screening for food insecurity: U.S. Preventive Services Task Force draft recommendation statement. Accessed June 20, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/food-insecurity-preventive-services#fullrecommendationstart. Published June 25, 2024.
• U.S. Preventive Services Task Force issues draft recommendation statement on screening for food insecurity. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/food-insecurity-draft-bulletin.pdf. Accessed June 20, 2024. Published June 25, 2024.