Food Insecurity and Child Malnutrition in the United States

[TheCommuter]

Emily, a 9-year-old with a cinnamon skin tone and a strikingly angular face dotted by a set of chocolate-colored eyes, sits inside an examination room at the local children's outreach clinic. She comes to the clinic once a month with her siblings to have routine labs drawn and to be seen by the program's sole pediatrician, Dr. Graham.

Emily lives with her mother, stepfather and two younger brothers in a cramped one-bedroom apartment located in the southeast section of a large central Californian city where nearly one-quarter of residents' household incomes fall below the federal poverty line. Her mother works mornings as a cashier at a gas station during the week and earns extra money as a cocktail waitress on weekend nights. From the middle of March until the end of October her stepfather mows yards in an affluent suburb for a local lawn service, and during the winter months he picks up odd day labor jobs to supplement the family's income. Emily's family does not qualify for many forms of public assistance since the annual household income of $38,000 exceeds poverty level guidelines for a five-member home. Her parents receive monthly WIC vouchers for her three-year-old brother that can be redeemed for specific grocery items such as eggs, cheese, milk and cereal. However, this form of assistance will cease soon after the boy reaches his fifth birthday.

Dr. Graham glances at Emily's lab results. The albumin, prealbumin and total protein are all low. The serum iron, ferritin, TIBC, B12, folate, and other labs are all low. With a height of 4'9" and a weight of 77 pounds, Emily is very underweight. The objective and subjective indications come together to paint a picture of malnutrition, a condition that Dr. Graham has been noticing more and more in children and elderly patients during this languid economic period.

The doctor inquires, "What do you usually eat in a normal day, Emily?"

The girl pauses for a moment. Her parents have instructed her to screen all responses carefully because of their fear of authorities removing the children from their custody if it is discovered that the household runs out of food several days before payday. She fibs, "I eat toast, eggs and fruit for breakfast, whatever the school gives out for lunch, and chicken, spinach and rolls for dinner."

Dr. Graham suspects the streetwise Emily of lying. After completing her examination of the three siblings, she gives her parents a pamphlet with the addresses of local churches that offer free meals on certain days of the week. She also thanks the parents for bringing the kids in regularly.

According to the Johns Hopkins Children's Center, malnutrition occurs when the body is deprived of the vitamins, minerals and other nutrients needed to sustain healthy tissue and organ function. A balanced diet is required in order to obtain these nutrients, but millions of children in the United States live in homes where food insecurity is a pervasive problem. Recent statistics indicate that 13 million children in this country are in households where access to an adequate quantity of food is restricted. The problem of food insecurity has only worsened in the jobless recovery that has followed the depths of the Great Recession.

Many working poor families in higher cost-of-living areas are disproportionately affected by food insecurity since annual earnings tend to be slightly above the federal poverty line, but increased costs for housing, food and utilities rapidly consume residents' net pay. In addition, numerous working poor families earn a little too much to qualify for forms of public assistance such as food stamps. The heads of these households often choose between paying rent and keeping the family sufficiently fed.

RESOURCES

Malnutrition | Johns Hopkins Children's Center

Malnutrition Impairs U.S. Children’s Health, Behavior - LSU AgCenter

Malnutrition

[morte, LPN, LVN]

if they have cooking facilities.

Store-brand 5 pound/bag of vitamin-enriched white flour costs around $1.99 where I live. Same of whole-wheat costs $2.49. Yeast is $ 0.99/pack of three. Salt is almost free. These plus some water, and you'll get more than enough fiber, vitamins-B group, and protein-enriched, home-baked sourdough bread for a family of five for a whole week for less than $7 total, including electricity and water. 10 lbs. bag of chicken leg quarters goes for $6 in Walmart nationwide. Bag of dried beans (equals up to 8 15 oz. cans) costs between $1 and $2 there.

I can understand that people may not have money on gourmet or special healthy foods, but their "inability" to get basics like above and cook them is, IMH(onest)O is pretty close to being plain lazy and not willing to learn cooking beyond pushing "defrost" button on microwave. If I can do it all while working full time, they sure could do it too.

[TheCommuter, BSN, RN]

if they have cooking facilities.

Good point, morte.

The number of poor children and families who live in crowded motel rooms skyrocketed during the recession and has remained high during this 'jobless recovery.' Some of the nicer rooms might have a microwave, hot plate and tiny fridge, but most of these places have no cooking facilities whatsoever. Certainly I've never seen a room with an oven where baking breads and meals can take place.

When people live in motel rooms without facilities for food storage or cooking, this results in frequent trips to the store and/or eating off the $1 menu at the local fast food joint.

[LadyFree28, BSN, LPN, RN]

if they have cooking facilities.

THIS.

People are not just sitting up in a well lit; adequately plumbed house twiddling their thumbs saying, "gee what should I REALLY get from the market?"

Some get their meals through food programs that were cut funding wise; some from soup kitchens; Kids eat breakfast and lunch during school programs.

The power of a great meal-accessibility of food in conjunction with the ability to make a meal-varies; and right now there are too many people (I don't care if it's 1 percent of the population-it's too much) that are TRULY not having the access to a well balanced diet economically.

[LadyFree28, BSN, LPN, RN]

In the summertime when we've got corn coming out of our ears it is easy to find "4 ears for a dollar". Obviously other times of the year would be harder. I buy veggie burgers - love the black bean ones - and they are around $3.00 a box. [/quote']

Location location, location is the name of the game in my area; my black bean burgers are 7 dollars EVERYWHERE; at the shopping club I get for more; more bang for my buck.

I have a hard time with believing that every piece of produce in a grocery store is bad. I worked in a small store when I was younger and yes, the manager did keep out some produce way past it's time but there was still produce that could be used. Also, there are canned and frozen veggies to chose from.

You are welcome to come into many neighborhoods in my city...you buy, take it home, sleep, and find the "fresh" fruits and veggies spoiled; many produce stores and grocery stores are on hard times just as much as their customers; if you have a high percentage of your customers below the poverty line; there's more apt to find people stretching their money, and not buying the produce in a timely manner; or better yet buying subpar produce to save a buck.

Personally, I always buy what is on sale. Yesterday I found a good sale on a good brand of veggies and bought a bunch of cans. I'm not a fan of canned veggies and prefer fresh but I can use them in soups or casseroles. I still think, with proper education, people could buy healthier food and it wouldn't cost more than junk food.

Even the items on sale still may not be enough it the economic situation depending on family size is up to par...sales help.

I'll betcha that a bag of Lay's Potato chips in any store is still more than the price of carrots if you go by portion size. Fresh carrots are pretty darn cheap if you stay away from the baby carrots and even those aren't bad. I don't live in a fancy city with Trader Joes and Costco nearby. Our stores gouge us a bit due to being up in the mountains (same with the gas stations). But, there are always sales going on and I consistently only buy stuff on sale. In every category, there are sales. You have to be a savvy buyer. It isn't hard. I still believe that it is a myth that good nutritious food is more costly than junk food.

My city is FAR from fancy if you want to hold cities with high distain; we have hard working professions that do the best that they can; we have the same worries and issues regardless of where someone lives, btw. :)

Produce is sold by the pound; carrots cost 4-7 dollars; can veggies with water are a dollar higher, salted veggies in cans are 1 dollar; gone are the days where canned vegetables are 59 cents; and that wasn't too long ago...there has been and uptick on food prices for a long time; the fact is when you have more buying power; your money goes longer and the opportunity to pick up more healthier food is possible or it happens.

I have always are healthy; I don't use coupons due to the fact I can budget effectively and some coupons, in my opinion, are not as economical when you go through the buying process. I am able to stretch my money; but I can tell when I had to prioritize my money, I had to get other items that I had to get for my budget, and Lays were that LAST thing for me to get; I had to cut back on produce just to get the essentials.

[KatieMI, BSN, MSN, RN]

if they have cooking facilities.

The family discussed in the article supposedly lives in apartment, although "crowded" one. Living in motel would be much worse, but still OK for an electrical skillet, 1-burner electrical stovetop and a couple of basic pots (all that available, with some luck and time investment, used in Salvation army stores for about $10 - or in Walmart, new, for total $50 or so). That's what I had back in my own country while living in a dorm with three other girls with very little money. Can't say our meals would worth Zagat's review, but we had three meals daily cooked there, and they were much better than McDonald's.

I recently started to volunteer in elective "culinary arts" class in a high school designed for low-income teens to teach them basic cooking and healthy eating. We were told to always discuss "the menu" of the class with counselor beforehead and be careful not to mention things like fresh salmon and chia and zerekh so that not to hurt student's feelings about these nutritional powerhouses. But, seriously, some of these kids have no idea how to hard boil an egg and think that peeling potatoes "takes too long". Their idea of "porridge" is limited to instant oatmeal. They just do not value healthy food and good nutrition as something significant in their lives. And, yes, most of them are at least overweight and most have clinical signs of malnutrition clear without lab draws.

[LadyFree28, BSN, LPN, RN]

KatieMI, do these children's families travel to get groceries? What is the general income level of the area? How can one "value" food when some of the staples in the household are quick meals due to environmental and economic factors? Most low income people live day to day, in the present to make it another day. Have you visited these homes and done an assessment on where and how the environment is in their households? I'm curious.

[herring_RN, ASN, BSN]

I sometimes buy a veggie burger at a drive thru, but we are doing well. They have good salads too: Sunny Grill - Home

I never bought frozen or packaged burgers. i'd soak soy beans over night, cook them a long time, and then mash them with finely chopped onions, a grated carrot and egg. They fry into nice burgers.

Other cooked beans do too.

I donate large bags of beans, brown rice, onions, bell peppers, and apples to the local food bank along with recipes, soap, tooth brushes, and tooth paste.

[Spidey's mom, ADN, BSN, RN]

Location location, location is the name of the game in my area; my black bean burgers are 7 dollars EVERYWHERE; at the shopping club I get for more; more bang for my buck.

I just did an online check and found them between $3 and $4.

price list morningstar farms

You are welcome to come into many neighborhoods in my city...you buy, take it home, sleep, and find the "fresh" fruits and veggies spoiled; many produce stores and grocery stores are on hard times just as much as their customers; if you have a high percentage of your customers below the poverty line; there's more apt to find people stretching their money, and not buying the produce in a timely manner; or better yet buying subpar produce to save a buck.

I'd be very interested in coming to your city and looking around. :)

Even the items on sale still may not be enough it the economic situation depending on family size is up to par...sales help.

My city is FAR from fancy if you want to hold cities with high distain; we have hard working professions that do the best that they can; we have the same worries and issues regardless of where someone lives, btw. :)

I don't hold cities with high disdain. And yes, we all share the same worries and issues.

Produce is sold by the pound; carrots cost 4-7 dollars; can veggies with water are a dollar higher, salted veggies in cans are 1 dollar; gone are the days where canned vegetables are 59 cents; and that wasn't too long ago...there has been and uptick on food prices for a long time; the fact is when you have more buying power; your money goes longer and the opportunity to pick up more healthier food is possible or it happens.

Carrots are 4-7 dollars a pound???? That's more than ground beef or seafood. Yikes! (edited - I just did a price check at my two local markets and baby carrots are $1.69 a pound and the loose carrots are $1.26 a pound.

Right now my local Safeway has their brand of canned veggies for 89 cents a can. That includes the low-salt and there isn't much water in the cans. I also buy sugar-free fruit for my diabetic husband at 89 cents a can although we have a lot of veggies and fruit we can during the summer to choose from as well.

I have always are healthy; I don't use coupons due to the fact I can budget effectively and some coupons, in my opinion, are not as economical when you go through the buying process. I am able to stretch my money; but I can tell when I had to prioritize my money, I had to get other items that I had to get for my budget, and Lays were that LAST thing for me to get; I had to cut back on produce just to get the essentials.

I'm not a big fan of coupons either. We don't buy potato chips - I was just using that as an example.

[Spidey's mom, ADN, BSN, RN]

Forgot the link to the prices above . . .it's from a food co-op, it is mostly organic, it is in Brooklyn, New York.

Produce Price List : Park Slope Food Coop : Organic Food in Park Slope - Locally Grown Fruits and Vegetables, grass fed meats, organic cheese in Brooklyn, New York

[KatieMI, BSN, MSN, RN]

KatieMI, do these children's families travel to get groceries?

What is the general income level of the area? How can one "value" food when some of the staples in the household are quick meals due to environmental and economic factors? Most low income people live day to day, in the present to make it another day. Have you visited these homes and done an assessment on where and how the environment is in their households? I'm curious.

1) Most of them shop for groceries in Walmart or Aldi (where all basics for balanced diet are available). Some get "almost all the things" in local pharmacies, which puzzles me because it is way more expensive. Many - don't know about everybody - have cars in families and so can use them for travel.

2) This school serves classical "small poor city of Midwest" in an area with relatively low cost of living. I do not know exactly how many of them are officially below "poverty line", but generally in this area around 50% of total population is below this income level. 80+% students qualify for free food in school.

3) No, I didn't do any "assessments". That's not my role there.

4). I lived through last decade of 20th century in my native Russia where we also lived day by day and sometimes went hungry. I also visited China, India and Japan, where one bedroom apartment for five people is considered to be pretty much a norm and American-sized kitchens are next to unthinkable. Despite of these environmental and economic factors, and the much higher cost of food there, people in these countries have remarkably different "values" toward food. It seems illogical to me to compare prevalence of obesity and different forms of malnutrition in this countries and in the USA because, for example, ascorbic acid deficiency can happen easily on a "diet" of tea and toast but virtually unknown in Japan where "poor's food" (rice with pickles and seaweed) is rich in it. The difference lies, for example, in the fact that in India still only very rich girl can get married without being able to cook - and even then she's expected to know a whole lot about food and spices.

I suspect that not only "environmental and economic" factors and "cheapness" of junk food and frozen meals make the situation possible. As it was already shown here and in other places, all that costs not much less, or even more than "healthier" foodstuff. People found ways to cook during Great Depression, during the wars and in Oregon trail - and saw nothing special in doing that. I think that availability of incredibly easy, (seemingly) cheap, artificially tasty and widely advertised foods for generations in a row has much more to do with it. One has to grow in place where a women of the house can give delicious two course meal to her whole family plus a couple of guests having one small chicken and not much more and be proud of herself as wife and hostess in order to refuse to consider frozen burger as something worth to eat.

[LadyFree28, BSN, LPN, RN]

I'm not a big fan of coupons either. We don't buy potato chips - I was just using that as an example.

I could respond to your entire post on my phone; however it seems to be wrapped into my previous post.

In response to the burgers as an example they are 12 for 7 vs 8 for 7; whole carrots in a bag can cost that much in a low income neighborhood vs a bulk area they are 4 dollars for 2 lbs; baby carrots are 4 dollars at a supermarket vs 4 dollars for an extra 2 pounds; these are examples of ACTUAL PRICES...again, location location location.

Please look up redlining; it used to occur on a real estate basis; and now it's a business way of life, unfortunately in urban areas.

As far as co-ops in my city; there are a few main areas that still would be a make or break for a low income family; public transportation is starting to be a luxury as I lined out the ACTUALS in my previous post.

The realities are the same; food is still a bill that people are stressing over; let's not kid ourselves that it's not happening; that's MY position, my reality that I have experienced; I'm sticking to that position.

[douxmusique]

All I know is I've seen people using $300 of SNAP (because all the snap cards look the same....) on frozen fried chicken appetizers, pizza rolls and huge boxes of fruit loops while I dont even walk down chip and dessert aisles in order to afford food for my family of three adults and three school aged kids.... there is no way I could afford the "cheaper" junk foods. I have never been able to (im in nursing school and we have always been a one income lower enlisted military family). Ive never understood the correlation between poor and obese since when we are broke we stretxh our beans and rice pretty far... and not every poor obese person lives in a hotel... whats the stats on that figure?. It doesnt make any sense to me but I dont really argue its truth. I just dont get it. But the numbers are there I guess?