Analysis of food insecurity indicators: A critical literature synthesis

Differing levels of severity define food insecurity. The commonality found within these simplified levels of severity, low, high, and marginal, is an individual's inability to access nutritionally dense, sustainable food pathways. This inequity can result from a lack of economic resources, transportation, economic opportunities, and educational opportunities. The circumstances that lead to food insecurity are often confounding. This critical literature review examines the experiences, risk factors, health impacts, and interventions associated with food insecurity within the United States. To understand food insecurity screening indicators’ validity, reliability, and effectiveness at the population level, this paper focuses on federally funded key measures. In particular, the Medical Expenditure Panel Survey (MEPS), the National Health and Nutrition Survey (NHANES), the United States Agriculture Department (USDA), The Census Bureau (USCB), and the National Health Interview Survey (NHIS). These indicators are most frequently used in the United States to indicate food insecurity. One reviewer searched three databases to find original research articles published in English utilizing United States-based data within the years 2018 to 2024. A total of 520 titles and abstracts were reviewed (after removing duplicates), after which 127 articles remained. Of the articles reviewed 61 articles met inclusion criteria and were included within this review. One reviewer conducted data extraction. Findings showcase that most of the research uses a cross-sectional study design, conducted within low-income populations, and frequently resulted in several adverse health outcomes. Studies show that food insecurity represents a serious risk factor for developing health outcomes such as hypertension, depression, anxiety, diabetes, liver disease, heart disease, tooth decay, and negative behavioral eating patterns. Several interventions exist to mediate the effects of food insecurity within the United States. This process begins with the utilization of federally funded indicators to identify food insecurity severity and presence for individuals. Further research should be conducted at a smaller scale, within community-based organizations, to better understand the impact of a food insecurity indicator that approaches defining food insecurity based on an individual’s social determinants of health. It is critical that federally funded food insecurity indicators expand their scope and solidify the confounding factors associated with food insecurity.