<i>“We treat the symptom, not the system”:</i> a qualitative study exploring connections between food insecurity and disease-related malnutrition in Canada

Background Food insecurity is a lack of physical and/or economic access to sufficient, safe and nutritious food that meets dietary needs and food preferences. Disease-related malnutrition (DRM) occurs in the context of illness or its treatment and is associated with inadequate nutrient intake and the inflammatory processes of diseases or medical conditions. Food insecurity and DRM both pose significant health risks, are prevalent and have similar underlying foundations, yet minimal research has explored these connections. The objective was to explore the complex relationship between food insecurity and DRM to inform system change, research, intervention and education supporting both topics. Methods We conducted online semistructured interviews and focus groups with clinicians, researchers/academics and staff from health systems and community organisations purposefully recruited from across Canada. A codebook supported inductive thematic analysis. Following the interviews/focus groups, participants were sent a list of research questions which they rated by priority level, actionability, feasibility and health equity considerations. Results Interviews (n=7) and focus groups (2; n=5) were conducted with 12 participants from four provinces. There was an even split between clinicians (n=4), researchers/academics (n=4), management (n=4) or representatives (n=3) from health system or community organisations (n=4). Half (n=6) self-identified as providing more input on DRM, and n=8 on food insecurity. The overarching theme was how structural inequities connected food insecurity and DRM. Participants discussed the need for ethical screening for both, but only if results could connect to services beyond food charity and if screening was unbiased and respectful. The need for system change was reported, alongside opportunities to support practice change through research, intervention and education. A list of research questions was generated. Conclusions This study reveals that food insecurity and DRM are fundamentally linked by structural inequities, necessitating a shift from food charity toward ethical, system-wide intervention. Addressing these interconnected issues requires integrated research and policy changes to support equitable health outcomes.