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David H. Holben , PhD, RDN, LD, FAND

Food Insecurity – Implications for Sport, Cardiovascular, and Wellness Practitioners – From Clinic to Playing Field and Community. David H. Holben , PhD, RDN, LD, FAND. Navigating the Path of Wellness. REQUIRES food security!. After the presentation, participants will be able to:

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David H. Holben , PhD, RDN, LD, FAND

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  1. Food Insecurity – Implications for Sport, Cardiovascular, and Wellness Practitioners – From Clinic to Playing Field and Community David H. Holben, PhD, RDN, LD, FAND

  2. Navigating the Path of Wellness REQUIRES food security! After the presentation, participants will be able to: screen clients for food insecurity. state those at-risk for food insecurity and outcomes of food insecurity. implement intervention strategies for clients in a variety of settings.

  3. Food Security Concepts Food Availability Food Access Food Utilization

  4. The Food System http://www.fao.org/cfs/cfs-hlpe/en/

  5. Food security is… …an essential, universal dimension of household and personal well-being. All people at all times have access to enough food for an active, healthy life (Anderson, 1990). This includes the ready availability of nutritionally-adequate, safe foods and the assured ability to acquire them in socially acceptable ways.

  6. Food Security in the US: 2017 Sources: ERR-256; ers.usda.gov Food Secure Households ~112.3 million Food Insecure Households ~15.0 million These households were uncertain of having, or unable to acquire, enough food due to insufficient money or other resources.

  7. Household Food Security in the US Sources: ERR-256; ers.usda.gov

  8. Household Food Security in the US Sources: ERR-256; ers.usda.gov Estimated prevalence rates of food insecurity ranged from 7.4 percent in Hawaii to 17.9 percent in New Mexico. Estimated prevalence rates of very low food security ranged from 2.9 percent in Hawaii and Delaware to 7.1 percent in Alabama and Louisiana.

  9. Household Food Security in the US Sources: ERR-256; ers.usda.gov Estimated prevalence rates of food insecurity ranged from 7.4 percent in Hawaii to 17.9 percent in New Mexico. Estimated prevalence rates of very low food security ranged from 2.9 percent in Hawaii and Delaware to 7.1 percent in Alabama and Louisiana.

  10. USDA Survey Module 18-item Questionnaire; Current Population Survey Worry about food budget or food supply. Experience of money/food shortage in quality or quantity. Adjustments to normal food use. Consequences of reduced food intakes for adults/children. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  11. Who’s at Risk in the US… …for food insecurity? Poverty Under/unemployment High housing costs Triggers Inflation Food prices Stress on budget Increased fuel/utility costs Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000.

  12. Who’s at Risk in the US… …for food insecurity? <185% income-to-poverty Households with children Female- or male-headed with children Male or female living alone Black or Hispanic Living in rural or urban areas Living in south Source: ERR-256

  13. Food Insecurity - Possible Nutrition Implications? Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  14. What’s the Bottom Line… for SCAN-related clients? Food insecurity: • Is a barrier to positive health and nutrition outcomes. • May be precipitated by poor health outcomes. Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  15. Food Security – Who’s At Risk? Sports Limited research. Male collegiate athletes.Poll et al. Both high school and collegiate food insecurity associated with preoccupation with food. Collegiate food insecurity associated with food hoarding. Wetherill et al. Poll, Holben, Valliant, Joung, J Am Coll Health. In press. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  16. Food Security – Who’s At Risk? Sports/Collegiate Emerging literature. Factors associated with collegiate food insecurity.Benefield 2019 Living alone/single parents Pell Grant/financial aid/student loans Substance use Partner conflict Wetherill et al. Benefield (Thesis). 2019. In press. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  17. Food Security – Who’s At Risk? Sports/Children Households with children experience food insecurity at rates greater than the national average.Holben & Berger-Marshall,2017 USDA 2018 Wetherill et al. Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. USDA (ERR 256), 2018. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  18. Food Security – Who’s At Risk? CVD/Wellness (Adults) Adult food insecurity is associated with poor physical and mental health.Holben & Berger-Marshall, 2017 Wetherill et al. Gregory et al., ERR-235 (USDA), 2017. Holben& Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  19. Food Security – Who’s At Risk? CVD/Wellness (Adults) OW/OB (adult females).Holben & Berger-Marshall, 2017 Food insecurity associated with high probability of chronic disease (≤200% I-to-P).*Gregory et al., 2017 HTN Coronary Heart Disease Stroke Diabetes Kidney Disease Cancer Asthma Arthritis COPD Hepatitis *Food insecurity-all 10; Income-only 3 Wetherill et al. Gregory et al., ERR-235 (USDA), 2017. Holben& Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  20. Food Security – Who’s At Risk? CVD/Wellness (Children) OW/OB-Literature Inconsistent.Holben& Berger-Marshall, 2017 Food insecurity associated with chronic health conditions and behaviors.Holben & Berger-Marshall, 2017 Anemia, Asthma Aggression, Anxiety, Depression, Hyperactivity Fracture Risk (Males) Dental caries Decreased physical activity More likely to implement coping strategies that increase chronic disease risk in adulthood. Wetherill et al. Holben& Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  21. Food Security – Who’s At Risk? Eating Disorders NCAA Males (Sports) Food hoarding and overconsumption of energy-dense, nutrient-poor foods (OW/OB).Holben& Berger-Marshall, 2017;Olson 2005. Low food security and very low food security were both associated with increased likelihood of binge-eating disorder and obesity.Rasmusson et al., 2019 Wetherill et al. Holben& Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Olson, Top ClinNutr. 2005. Rasmusson et al., Int J Eat Disord. 2019;52:28-35. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  22. Food Security – Nutrition Care Process Screening “…widespread screening in all settings and subsequent referrals….”Holben & Berger-Marshall Two itemsGunderson/Hager/HolbenPollValliantJoung Wetherill et al. Gunderson et al., Public Health Nutr. 2017; 20(8): 1367-1371. Hager et al., Pediatrics. 2010; 126(1):e26-e32. Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Holben, Poll, Valliant, Joung, ACSM, 2017 (Thematic Poster) Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  23. Food Insecurity – Nutrition Care Process Screening/Assessment Screening – Two-item Screening Tool Referral to appropriate health care and community-based resources. Assessment – Five Domains (Food & Nutrition History, Anthropometric, Biochemical/other, Physical Exam, Client History Further probing (Six-item measure? 10-item measure? 18-item measure?). Hager et al. Pediatrics. 2010;126(1): e26-e32. Wetherill et al., J AcadNutr Diet. 2018;118(12)2223-2234.

  24. Food insecurity may be present when… …individuals or families: Lack access to food ($) Substitute nutritious foods with less expensive alternatives Garden Hunt/fish for food Skip meals Get help from friends and family Depend on food assistance programs Seek assistance from soup kitchens and food pantries Make tradeoffs (“Heat or Eat”) Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234. Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000.

  25. Food Insecurity – Nutrition Care Process Diagnosis/Intervention Diagnosis – Intake/Clinical/Behavioral-Environmental PES statement Intervention – Food and Nutrition Delivery/ Nutrition Education/Nutrition Counseling/Coordination of Nutrition Care Implement interventions that address food insecurity-related etiology or signs and symptoms Referral to appropriate health care and community-based resources. Community-based and other resources in your region Federal SNAP WIC/CSFP/Senior-WIC Farmers Market Nutrition Program School Meals Wetherill et al., J AcadNutr Diet. 2018;118(12)2223-2234.

  26. Food Insecurity – Nutrition Care Process Monitoring and Evaluation Reassess for changes in food security status. Compare current findings to previous status, intervention goals, and/or reference standards. Hager et al. Pediatrics. 2010;126(1): e26-e32. Wetherill et al., J AcadNutr Diet. 2018;118(12)2223-2234.

  27. Navigating the Path of Wellness REQUIRES food security! After the presentation, participants will be able to: screen clients for food insecurity. state those at-risk for food insecurity and outcomes of food insecurity. implement intervention strategies for clients in a variety of settings. √ √ √

  28. Change the Bottom Line… for SCAN-related clients. Food insecurity: • Is a barrier to positive health and nutrition outcomes. • You change the bottom line when you address it in practice! Holben & Berger-Marshall, J AcadNutr Diet. 2017; 117(12): 1991-2000. Wetherill et al., Figure 1. J AcadNutr Diet. 2018; 118(12): 2223-2234.

  29. Thank you! Questions?

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