Podcast Transcript

Episode 66: Food Insecurity: A Public Health Crisis Across Our Country and A Leading Risk Factor for Eating Disorders

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Ashley: The organization Feeding America tells us that across the US, 40 million people, including 14 million children, are food insecure. We know that more than 50 million people used various food assistance programs in 2023, and 100% of counties in the US have food insecurity. Within the eating disorder field, we know that in the U.S., 9 % of the U.S. population or 28.8 million Americans will have an eating disorder in their lifetime, with approximately 6 to 8% of adolescents developing one before the age of 18. The overlap of food insecurity and eating disorders is an area that we have to dive into. Today, Sam, myself and Patrilie Hernandez will discuss how our cultural environment, local and federal policies, and other social drivers influence access to food or non-access, alongside the cultural and fat-phobic mainstream ideology that praises the thin ideal. This intersection had gone untouched for quite some time. However, many people are surprised to learn that food insecurity is a risk factor for an eating disorder. Within the last 10 years, we have seen the research pick up and we are beginning to better understand how to support someone that may have these shared experiences. To give a little background on our guest, Patrilie Hernandez, (they/she). Patrilie has over 16 years of experience as an educator, advocate, policy analyst, and community builder,  which has deeply impacted their understanding of how the pursuit of health seamlessly intersects with the built environment, policies, and other social drivers. It wasn’t until they were diagnosed with an eating disorder in 2017 that they realized how much of their disordered behaviors and thoughts around food, health, and bodies infiltrated all aspects of their personal life and career. In 2018, Patrilie founded Embodied Lib, a community platform and now consulting practice that specializes in transforming organizational culture,  policies, practices, and programs that impacts the many dimensions  of well-being of those who have been historically excluded from  decision-making power and resources.  Drawing on their lived experience as a higher weight, neurotypical, multiracial, queer, femme, of the Puerto Rican diaspora, Patrilie challenges the status quo in the nonprofit and public sectors. In their spare time, Patrilie enjoys cooking for others, tending to their garden and house plants, and gazing at the moon.  They also love spending time with their spouse and dog at their home in the District of Columbia.

Hey everybody, welcome back to another episode of All Bodies, All Foods.  Ashley here and I’m joined with my co-host, Sam and our wonderful guest, Patrilie Hernandez. Patrilie, thank you so much for joining us today.

Patrilie: Thank you for having me on. I’m really excited to chat with you both.

Ashley: Yeah!  So today we’re definitely going to jump into the topic of food insecurity and eating disorders. However, before we do that, Patrilie, we would love to learn a little bit more about you.  I was on your website and just kind of reading through all of the various avenues that you work with and noticed that you’re an educator, an advocate, a policy analyst, and a community builder.  You work with supporting local and state governments and other institutions, I would say, on being trauma-informed and not harmful with the community. And so I would just love to start with a little bit about yourself, Patrilie. How did you get into this work? What’s your background? And yeah, go from there.

Patrilie: Absolutely. Thank you so much. Well I think when folks look at my resume and  my past experience,  they see definitely a smorgasbord of different  roles,  different sets of work, and different sectors that I’ve worked in. So my, I would say my professional experience with food really started actually in the culinary world. I did grow up cooking and I come from a line on my  both  sides of the family, but my mother’s side from a line of really amazing cooks.  She has 16 brothers and sisters, so we all learned how to cook for an army basically.  But I started working in the professional food and hospitality industry shortly after I actually dropped out of college the first time.  And so I went to school for a couple of years and decided that I needed to kind of get a little bit more grounded in what I wanted to do. So I started working in a restaurant and the executive chef there said I had a real knack for cooking, and I never considered going to school for it. And I took that as… So I enrolled in my local community college back in St. Louis that has an excellent program, and I ended up getting an Associates in both hospitality management and also culinary training. So I worked in the restaurant industry for about the first six years of my twenties, moved from back of the house to front of the house.  So doing more of the front-facing customer facing work, people said I talk too much, so that’s why I fit better.  And because of that experience, I got a closer look of how food insecurity and houselessness really impacted quality of life and health for specifically the people in my neighborhood and the people that worked  in the area where the restaurant that I was working at was located. And so next to this restaurant that I worked at,  there was a nonprofit organization that served as a kind of like a communal feeding site, right? Where they prepare hot meals and folks can get social services there, but they also ran a workforce development program where they actually trained people that were unhoused and also returning citizens that were formerly incarcerated in the culinary arts and how to run the kitchen.  That building was located right next to the restaurant, so I would see every day folks coming in and out,  and I learned a little bit more of the program.  It wasn’t through that program, but I actually started volunteering as a chef instructor for another non-profit organization that basically held cooking classes for children, families, and adults on cooking on a budget because the majority of the participants receive SNAP benefits. So that was really my intro to the world of food access and food insecurity, and it kind of took off from there. I became interested more in the nutrition piece, more in the public health policy piece. And so from St. Louis, it took me to Mobile, Alabama for two years where I worked at a food bank.  And then here in the District of Columbia where I’ve been for 12 years.  And I have a total of 16 years kind of working in the food policy and food access space that really, really, I think was turned upside down again. It seems like every couple of years, something kind of informs my perspective even more of when I was diagnosed with an eating disorder in 2017.  And that’s where I realized a lot, I was holding a lot of really unhelpful thoughts and behaviors around what people’s relationship to food should look like,  what  so-called healthy eating looks like,  that I really thought to divest from. So the past eight years has really been focused on approaching public health and food access and food security through, primarily through a weight inclusive and trauma-informed lens, just as you mentioned, to make sure that we’re not causing more harm to folks that are already struggling with food insecurity and with food access issues.

Ashley: Yeah. Wow, Patrilie,  I’m so excited to be able to have this conversation then with you today. And it sounds like your journey has really led you to the perfect place. You’re like, everything kind of lined up for you to be  in the right place at the right time with your advocacy work.

Patrilie: Yeah, I think so. I think that every kind of step I took in my life led me to growth  in my career, but also in my personal life and in my personal politic and how I choose to engage in advocacy work, in local grassroots organizing.  So it’s already been, so every step has really been critical  o my evolution of who I am today and what and how I choose to talk about different issues that are impacting my community.

Ashley: Yeah.  And I would say so Sam and I, when we’re kind of like planning for these seasons, we’re definitely researching and looking  up  different relevant topics that are obviously affecting our listeners and the clientele that we work with, and I think I saw your information-I think you were speaking for Project Heal,  if I remember correctly. And I saw your information on LinkedIn and I was like, we need to have them on.  I would really love to get some information from you. So thank you. Yeah, we’re just excited that you’re here.

Patrilie: Yeah, absolutely.  I have been kind of sharing knowledge and trying to bridge a few different fields, which is the eating disorder treatment and and like prevention field  with the public health nutrition fields  specifically around food access.  Because in my personal experience doing  specifically food insecurity policy work, and just like community health work, anecdotally  after I learned about what eating disorders kind of looked like specifically for populations and  for communities that are not typically represented in eating disorder treatment spaces, I started to see a lot of that within my community,  especially those  that were experiencing or previously experienced chronic food insecurity. Seeing a lot of the same symptoms and, in some cases,  seeing what  might be that I’m like I’m not a clinical  doctor, so I can’t provide like a diagnosis,  but  opportunities for folks to learn more about eating disorders and  talk to their doctors about  what they were feeling and what they were  doing to their bodies, right? Because historically, eating disorders and eating disorder prevention hasn’t really targeted like the communities that I belong to. So just to be specific, because folks, I’m not sure if they’ll be able to see me, but I identify as, so I’ve always been higher weight, right?  I am a Latine multiracial person of color, right? So I grew up in predominantly Black, Brown, and like Latine neighborhoods, right? That had people with bodies very similar to mine and eating disorders and disordered eating were never a topic that was broached  by our health providers, by our doctors, even in like community health work.  So being introduced to this world really helped me see the gaps in the public health nutrition space, specifically around food access and food security work.

Ashley: What you’re doing here reminds me of Dr. Nadine Burke when she discovered ACEs and like how or how ACEs kind of impacted our different communities. So I think that this has the ability really to be huge and impactful and influential in the way that we work with communities across the spectrum. So just wanted to say thank you.

Sam: You do such important work. Food insecurity is such an important topic. It’s relatively new in the research when you sort of look at eating disorders as a whole.  I didn’t really even hear about the intersection of food insecurity and eating disorders until, oh my gosh, what was it, 2016 or something like that?

Ashley: Yeah, pretty new.

Sam: Yeah. And so I thought maybe for our audience, we could start with the basics. What is food insecurity? How would you define it?  And maybe we can learn a little bit about the history of food insecurity in this country.

Patrilie: Absolutely. Yeah, I think it’s important to provide a background because food insecurity in this country, so my area of expertise lies around domestic food insecurity.  So the way that we define and we assess and we treat so-called food insecurity looks different than across the rest of the globe. So the USDA defines food insecurity as, quote, the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.  So here they say socially acceptable ways. So that’s most likely by purchasing food, right? Or by getting food that is free of cost. So you might hear me go back and forth. I try to be more distinctive because I understand the audience might be new, like this might be a newer concept for them, but in policy spaces, we’re pretty interchangeable between using food insecurity  and hunger.  So for example, I worked for a policy think tank where we addressed anti-hunger through federal food policy.  But there is a distinction between food insecurity and hunger, right? So hunger is the psychological and biological condition that results from food insecurity.  So hunger is a potential consequence of food insecurity that might, because you have a  prolonged involuntary lack of food, results in feelings of discomfort, illness, weakness, and pain that goes beyond the usual hunger peg.  So you’re feeling this is a physiological condition that persists because you don’t have access to food. So in the United States, food insecurity is assessed  on a spectrum. It can range anywhere from high food security,  where an individual or a household  reports zero problems or no limitations  when it comes to accessing food that they need to fully nourish themselves.  And that goes all the way down to very low food insecurity, where in addition to having kind of constant anxiety over not having a variety of high quality and palatable food to feed your family, you’re also facing a overall general food shortage, right? And it’s so much so that your eating patterns are disrupted, and you have to consistently reduce your food intake. So there’s something called the Household Food Security Report, which has been published by the USDA’s Economic Research Service annually since 1995 and it has shown since then that there has been a statistically significant increase in overall food insecurity and especially low food security, right? With 13.5% of US households reporting that they had low or very low food insecurity in 2023. So we’re looking at over one in 10 households in this country. And so you might be like, well, that’s not that high, right? Like one in 10, sure.  But a couple of things about that, because we live in a country where we produce way more food than is actually consumed. In fact, upwards of over 40% of our food supply is wasted.  So from a production standpoint, there’s no reason people should be experiencing food insecurity in this country.  And there are certain groups who are more at risk  for for food insecurity.  So for example, of these 13.5% households, the vast majority of them are households with children, right? You are also at higher risk to experience food insecurity if you live in a household that identifies as Black, non-Hispanic, Latine or Native American, seniors are at disproportionate risk to experience food insecurity. Those that identify as  LGTBQIA +,  and those that have disabilities, right? And what we see is that these groups have also been disproportionately impacted by policies, by systems, and by structures that have historically excluded them or have minimized access to resources and opportunities  that allow them to have more decision-making power and body autonomy.

Ashley: Wow.

Sam: Thank you so much for all of that information. A lot of it is, I’m sure, will surprise our audience to discover. Would you describe this as a public health crisis?

Patrilie: Absolutely. And historically, right, food insecurity and food scarcity, because of our food system and because of our economic system and because of different policies throughout our history, people have always experienced food scarcity, right?  And it’s been specifically targeted to certain groups of people. So during the civil rights era, there was an increased interest in addressing food scarcity through a policy perspective, right?  And so that’s why we start seeing a lot of targeted  intervention specifically through federal nutrition programs emerge during the late 1960s to really kind of mitigat  a lot of the adverse health effects of food insecurity, right?  There was a lot more research being done around not just the biological or the physiological impact, but also the impact on learning, the impact on development, the impact on mental health, and so this has been so much so, and we are seeing more and more research show about the impacts of the negative impacts of  food insecurity  is that it is named as a driver of health. So when we look at key health outcomes,  we see that a person’s food access or a person’s level of food access really determines  how they thrive, right? And so because of that, it has been,  so it has become a key focus of public health research,  but also public health practice,  because this is something that is solvable, right, because we produce enough food, so it’s not a production issue. It is a policy issue.  It is a systems issue.  So it definitely has become a key focus of public health practice.

Sam: I’m so happy to hear that because it seems like in this culture, the onus is always pushed on the individual to make yourself healthier.  You know, this concept of healthism and food insecurity is one of those social determinants of health, and the focus becomes on what you should eat, what you shouldn’t eat. But instead, we should really be talking about, do we have enough to eat? Do people have enough to eat?

Patrilie: Absolutely. And I feel like, right, we very much work in our silos, right? Because I  specifically work like an anti-hunger policy  that had, you know, that was all that I was surrounded with. And I was very aware of  how our, for example, how our federal budget allocates appropriations towards federal food nutrition programs that are key pieces of how people are able to support themselves during times where they’re financially struggling. I knew of the importance of it, but entering spaces, for example, like the eating disorder prevention and  treatment space,  I think I had assumed for a long time that this was on their radar, that if we’re doing treatment for  conditions  where we are looking at folks to nourish themselves as a path to recovery,  but we aren’t assessing if when they go home or  before they got to the treatment center or when they leave the treatment center to make sure that they have  access to the resources they need to buy food,  to purchase or to prepare food,  I think I just had always assumed that that was part of the infrastructure  of treatment, but then going through my own treatment, right? I was an intensive outpatient for six months and then learning more about the treatment field as a whole, I quickly learned that that wasn’t the case. And that was actually pretty surprising.

Ashley: Yeah, that does seem to be quite a large gap there between the two industries. I’m thinking about, I don’t know, I can only speak from my experience, Patrilie. I’m, I live in the South, really between Tennessee and Kentucky, and I noticed, I remembered after COVID, when COVID was happening, that actually the school district where I was living was busing around daily meals to the students.  And really that was so that the kiddos would continue to have access to food because as  we now know, that does indicate whether or not they can thrive in the school environment, whether or not they can pay attention as if they’re nourished or not. And since then, what I’ve seen in the communities that I’ve lived in is that both breakfast at school and lunches at school can be provided at no cost to those folks that need that. Is that something that came out from this kind of like food insecurity work? Do you know?

Patrilie: I’m so glad you brought that up because, interestingly enough, right, what I was sharing about what the rates were of like food insecurity over the years since they started publishing this annual report in the mid-90s, is that we have seen a significant increase, right, over the years, except for the years of 2020, 2021, and the first half of 2022. Why is that? It is because with the onset of the COVID-19  pandemic, there were unprecedented  investments  into our infrastructure and into our program aimed at reducing food insecurity. Basically, in a nutshell, you brought the example around the bus being able to deliver food to families.  Schools were granted a waiver to be able to do that, right, and they were given extra funding to be able to make that happen logistically. And so for those years, 2020, 2021, first half of 2022, food insecurity in this country actually dipped to under 10%. And we have not seen that in decades. And then as soon as those programs, as soon as that funding was rescinded in May of 2022, we see those numbers creeping up again, especially over the past year and a half where we have seen a drastic increase in the pricing of food because of inflation.  We are now at historic levels of food insecurity. So that just shows is that when there is public investment, we see the impact, right?  But unfortunately, we’re not only back where we started, we’re in a worse place.

Ashley: Yeah. Is that part of what you do in your advocacy work then is to show these numbers to people, like educate people on this so that hopefully we can get more policy generated?

Patrilie: Yeah. So I’m just very well versed in it because I worked in that space. I’m not currently working in that space anymore, but I am very well connected to the research. I am very well connected to the trends. So I am an advocate like in the sense that I always have these numbers kind of  on hand because I think it’s really important for folks, like especially like in other sectors to be aware of. But there are some wonderful organizations that are leading this work, that have been leading this work and do excellent research and do excellent advocacy around this very topic.

Ashley: Yeah. Thank you. OK, I have another question for you. I’m going to read it because I want to make sure I get it right because I pulled some information from your website. So you mentioned that you specialize in transforming organizational culture, policies, practices, and programs that impact mental, emotional, social, spiritual, and physical well-being of people holding systemically marginalized identities. I’m curious if you can speak more about this work and how does food insecurity, you’ve answered some of this, but how does it show up in the food or in the advocacy work that you do, and does it show up in a larger capacity for those within the systemically marginalized identities?

Patrilie: Yeah, absolutely. And I think, Sam, I think that you pointed this earlier is that  \in a lot of spaces when we talk about health, when we talk about well-being, mainstream conversations often portray them as individual responsibilities. It is up to us. We have full control over the choices we make, and because of the choices we make, that determines whether we are healthy or we are unhealthy.  And when we kind of center this narrative in these types of conversations, is we overlook the collective dimensions of health and well-being that are influenced by the built environment, influenced by policies and other social drivers. I work with nonprofit organizations, with public health institutions, local state government, and eating disorder treatment centers, right, because I recognize that they hold this substantial power when it comes to shaping the environment, the systems and structures that enable people to thrive, right? Whether it’s in their recovery, whether it’s when they go back to the communities that they are a part of. So the work that I have pivoted to after all these years of experience, I do have a Masters of science in nutrition,  but I don’t do one-on-one health coaching.  I don’t do nutrition counseling, but really I feel like my work is called to help work towards the collective change, to equip organizations and institutions and providers with the tools  and the strategies and the frameworks that they need to build kind of more sustainable justice centered approaches  to improving the health of the people they serve that take account the many dimensions of well-being. So, you know, we use a library of cross disciplinary tools because my,  so I started out in culinary school, but then I went back to school. I have an undergrad in cultural anthropology specifically around food and health,  my Masters, and so I draw from all of these  disciplines, right,  to really equip folks, right,  with what they need in order to make  these  changes for their staff, whether it’s their board of directors, for their patients, for the communities they serve, et cetera.  And then how this influences my work in food insecurity, I think that when we look at a broader level, right, having access to a variety of food that one, you like to eat, two,  reflects your cultural and your personal identity, three, nourishes you in the ways that you need and also choose to be nourished  is a key driver of health, right? And I think we like talked about that earlier.  And the thing about this food access piece is that it’s not mostly, it is not by individual choice, right? It is determined by policy, it’s determined by economic systems.  And it also takes into account who is most likely to experience historical discrimination and systemic exclusion, right? So because of all these factors, this is a systemic issue, right? And so I aim to work with organizations that want to work towards the systemic collective change.

Ashley: Yeah. Yeah. Thank you, Patrilie.

Sam: Patrilie, we wanted to do this episode for a lot of reasons, but not the least of which is that food insecurity is a risk factor for eating disorders and disordered eating. And at the same time,  I’m not sure if clinicians,  providers out there are actually screening for food insecurity or a history of food insecurity, and so I was hoping we can learn more, if you could talk more about  the food insecurity screener and how it’s used, and whether or not, does it identify mental health needs. Maybe we can talk more about how food insecurity impacts mental health also. 

Patrilie: Yeah, no, absolutely.  And I will say that it goes both ways, right? Where in the eating disorder world, screening for food insecurity is not a current practice that is widespread.  On the other side, in community health interventions, specifically around food security, disordered eating screeners are not part of like common practice.  So I think there are opportunities for both, right? And there is a need, I think, for both sectors to be working together in this space.  And so basically, but I’m talking from the community health side, screening for food insecurity over the years, we have been able to develop a validated screening tool. This was actually started by one of my former employers, the Food Research Action Center, and they worked with the American Academy of Pediatrics to develop something  called the Hunger Vital Sign.  Basically, it is a way to assess individual and household food insecurity in clinical settings, so in the doctor’s office.  Basically, it is a two-statement or a two-question screening tool that could be done very quickly to measure a patient or client’s concerns about access to food. People that are screened, they respond to the following statements with either often true, sometimes true, or never true. The first statement is, “within the past 12 months, we worried whether our food would run out before we had money to buy more.” The second statement is, “within the past 12 months, the food we bought didn’t last and we didn’t have enough money to get more.” So these are very two basic questions that could be included as part of assessments, but there is a slightly longer form with six statements  called the US Household Food Security Survey Module  that folks can choose to ask. But what we struggle with in, especially community health clinical settings is time, right?  So very, very often, clinicians are pressed for time. So these two screeners have been validated and they’ve been translated, also, into other languages to really get to  whether or not someone is experiencing food insecurity.  And a lot of the times these two questions are embedded into a larger SDOH screener, which is the Social Determinants of Health Screener,  where the clinician also asks questions around housing, around  if they’re experiencing domestic violence or other forms of interpersonal violence, things like that.  In a lot of community health settings, federally qualified health centers, you see the screening embedded into the larger SDOA screener,  but there’s nothing asking about disordered eating.  There is nothing asking about whether people skip meals, whether people have weight and shape concerns, etc. And I find this really interesting, right? Because they talk about, in the community health space, of how important mental health is, right? And we see that mental health and food security have a bi-directional relationship.  So what do I mean by that?  Meaning that food insecurity is a risk factor for developing or worsening severe mental illness, right?  Like across the spectrum.  And those with struggling that are already struggling with mental illness have a higher risk of experiencing food insecurity.  And the relationship between poor mental health and food insecurity impacts people of all ages, right? Starting from children, there are decades of research that have linked childhood food insecurity to a number of negative health outcomes.  In addition to overall poor health, it’s been also attributed to reduced immune system functioning,  asthma,  anxiety, depression,  developmental and cognitive delays, and poor concentration, memory,  mood, and also motor skills, right, that impact learning, impact  behavioral issues, things like that.  I not only, so it impacts children, but it is just as impactful on our seniors, right? Where there is data from a poll from the University of Michigan that revealed that elderly adults, so those between the ages of 50 to 80, experience fair or poor mental health, or that experience poor mental health are more likely to experience food insecurity.  So mental health and food insecurity are very much intertwined, and I would assume that that also falls under eating disorders. If you’re struggling with an eating disorder, because a lot of them also have co-occurring conditions, assessing for food insecurity might be a key mitigation factor.

Sam: I agree.

Ashley: Yeah, this is kind of,  I feel a little bit guilty for saying this and also it’s like blowing my mind right now. I’m thinking about my own intake screening tools and how I can begin to incorporate these questions and something that I perhaps have had the privilege to  not have had to think about in the past.  I’m curious, Patrilie, so I was  reading some research around this and found a study that was done in 2017. I think it was a look at multiple studies, but they labeled, they were looking at food insecurities and food insecurity and they labeled four different categories on the spectrum.  Okay.  And so the one that was the most severe form of food insecurity, was the one where both the child and the adult at home reported hunger.  So what they found is that the children belonging to the most severe form of food insecurity group reported significantly more binge eating, over eating and night eating than those experiencing the other levels of food insecurity.  You’re absolutely right. I mean, there are so many implications here between food insecurity and disordered eating or eating disorder.  And I’m curious what you think this means for our children. How do we best support them in this avenue? You know, if the lunch thing has gone away with the schools, what are other areas that we can support them with?

Patrilie: Absolutely. And yes, you’re right. So you’re referring to the very low level of food insecurity. And as I kind of previously mentioned with that level, right, you not only have the anxiety around not having enough food, food shortages  are so consistent and that you’re reducing your food intake. And so what happens, normally in households with children is that when adults are, when they are experiencing food insecurity, they will make sure the child and/or children will have enough to eat first, right? And so they will reduce their own intake in order to make sure that the child has enough to eat.  But there are households in this country  where there is so little food where even the child isn’t even getting enough, right?  And so in these types of households, we do see that the children and also adults cope by engaging in disordered eating behaviors, which can set the stage for the development of a full-blown eating disorder later on, right? So the body of research is small, but it’s growing, right?  As Sam mentioned, really started, the body of research really started becoming more dense around 2016, right?  Which has grown since then, just in the past three years there has been a lot more, there have been a significant higher number of studies done around this.  And so the interesting thing is that the study that you referenced from 2016 that recorded the relationship between children that are experiencing these low levels of food insecurity and binge eating, since then, we have seen that the association between food insecurity and binge eating disorder is the same as bulimia. So we actually see kind of parity among those two. And households with the lowest level of food insecurity also tend to engage in significantly higher disordered eating behaviors, things like dietary restraint and a lot of internalized weight control or weight control concerns, right? And I think it’s because there’s this kind of, I don’t know exactly how to phrase it in one word, but this is just another reason of why folks in the eating disorder world need to be talking to  folks that are in the food insecurity space, because what we’re seeing  is that a lot of the interventions for food insecurity, especially ones that are nutrition-focused,  focus more around,  yes, eating, but also healthy eating, because you often see there is a comorbidity with food insecurity,  chronic disease rates,  specifically those like specifically type 2 diabetes,  cardiovascular disease, right, and a lot of those are co-occurring with higher body weight, right? So when we see a lot of these interventions, we see that they are nutrition-focused, wanting people to eat, but to eat healthy, but a lot of this messaging also includes like reducing your calories, right? Like engaging in where in eating disorder treatment center would qualify as concerning behaviors. What you see is that a lot of these folks that are experiencing food insecurity are also being told that what they’re eating is wrong, how much they’re eating is wrong.  You start to see these elevated concerns about body shape and about weight status while still struggling with food insecurity. This leads to a lot of, I think complicated body image issues,  and to possibly the development of like compensatory behaviors  as a way to manage body weight. But these behaviors increase as your level of food insecurity also gets worse.  So there’s a lot of potential for like complications there that just show how important it is for these two areas to be addressed at the same time.

Sam: Absolutely. But, Patrilie, as a community member, you know, we have a lot of listeners out there that might be wondering, what can we do to help? What can we do to combat food insecurity? Because it can feel really discouraging.

Patrilie: Yeah, I think, especially now in this current point in time, you know, looking at early of 2025, where a lot of the access to like federal nutrition programs are currently under scrutiny, right? We have deep cuts being made to first line defenses against food insecurity, things like SNAP, things like Childhood Nutrition Programs, things like WIC, right?  And just also understanding that I think one of the challenges that people with food insecurity face, and it’s not just actually physically accessing the food, right, or having the financial capital to access food.  I think it requires infrastructure.  Because for example, with SNAP,  you aren’t allowed to purchase what’s called ready-made food, so like hot food  from the salad bar, and so you can’t get food from restaurants, so that’s a huge stipulation. The idea of SNAP is that you buy raw food, right, to be able to prepare in your home. But what if somebody doesn’t have access to a kitchen?  On top of that, they have access to a kitchen, but they don’t have the equipment, right?

Sam: Or they work two jobs and they just don’t have the time to prep and prepare.

Patrilie: Absolutely.  And it takes a level of skill, right? Because you don’t want to burn your house down, but like also, right, you want to have like a certain amount of knowledge, right? That if you’re trying to feed your family a nourishing meal with, you know, vegetables, meat, et cetera,  what are ways that you could prepare them safely and in a way  that your family  will actually eat? So I think when it comes to solutions, we really have to look at what can be possible from a policy perspective.  Ashley, I think you were mentioning something about children having access to a free lunch and breakfast no matter who you are, right?  And that is actually part of a large policy campaign called Universal School Meals.  States that have championed Universal School Meals, meaning that no matter your socioeconomic background, you have access to a free and a nourishing breakfast, lunch, and snack in a school setting has led to like very significant improvements in learning, in child health, mental health, physical health,  Also, right, looking at because we’re currently facing with high cost of food,  instead of cutting SNAP, we should actually be adjusting SNAP to our current  inflation rates,  right?  Because the thing is, is people are spending more money, but they’re getting less for their dollar, right? So like, what are ways that we can make adjustments based on that? Another thing  is around Medicaid. We are currently experiencing  cuts to this essential healthcare program. These healthcare programs, specifically Medicaid, can be a great channel to expand access through food, through like food as medicine programs where folks can get a prescription to foods, where they can get a produce box delivered to them.  My approach about food is, give folks a variety of foods that are tasty to them, that are essential to their cultural identity, and that have like different kinds of like nourishment  and people will be able to make the choices that they need to fit their life circumstance. Right?  And so offering Medicaid, having that covered by like public health benefits can improve people’s access to food in a monumental way.  But other policy  interventions that, yes can be done on a federal level, but also  at your state and your local level, right?  Are folks being paid a living wage, right, for the work that they do?  Is housing affordable?  Right? Those are going to make significant impacts in a person’s ability to buy and also prepare food for them and for their families.  In terms of grassroots solutions, right, things like food banks and food pantries, they can be a short-term solution, but they really are a band-aid, right? We do need to make significant investments into our infrastructure, into our systems as a way to fully address food insecurity.  That I think grassroots solutions might be able to move the needle very, very minutely, but it’s really these large-scale investments that are going to be the key factor.

Ashley: Yeah. Thank you so much. And I feel like, honestly, just starting this conversation today, and not that we’re starting it today, but like having it, putting it out there, educating all of us in our various industries so that we know how to move forward with this.  So we know the right questions to ask. We know how to advocate. I mean, this just feels so good, like I’m feeling quite inspired actually. like, “ooh, how can I support,  how can I support these initiatives?”  And even like, I don’t know, like I’m thinking of getting connected with a local nonprofit and even offering like free cooking classes with like basic foods that somebody might be, you know, given at a  food shelter or something, you know, like that just, it sounds really cool to be able to kind of lean into that work and yeah.

Patrilie: Yeah, I think as a provider, as a dietitian, as the folks that are listening to this podcast that work in the professional space, there are definite strategies that you can incorporate into your practice. And I think you named one of them, Ashley, which is assessing what’s available in your community.  Because what I find when I work with providers and even on the community health,like in the clinical space,  is that, okay we have these screeners, but then what do we do? What do we do when someone, when they’re affirmative, right? Like when they do have food insecurity, then  what?  And so that’s why it’s incredibly important. I think this is more important than the screener actually is to make sure that you’re creating a solid referral network, right? Is that you know what is happening within your community, ways to address food insecurity, whether it’s a food bank, a food pantry, a mutual aid network, a social service organization that can get them connected to different forms of like federal benefits,  right? That’s going to be a key piece of you as an individual being able to take steps to really make an impact on the clients/patients you serve. 

Ashley: Yeah.

Sam: Patrilie, thank you so much for coming on today. You’ve given us so much really important education. You’ve inspired us to get out there and start doing some of this work. And we’re so grateful for you today. Thank you so much.

Patrilie: Thank you for offering the opportunity for me to share about this important topic.

Ashley: Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders. 

Sam: We’re looking forward to you joining us next time as we continue these conversations.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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