Screening Tool Combats Food Insecurity and Pediatric Obesity

The aim of the study was to identify individuals with food insecurity and establish processes to refer patients and families to federal and community resources.

Screening for food insecurity should to be taken into consideration when evaluating children for obesity in the primary care setting, according to findings presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) virtual conference held April 26 to 29, 2022.1

“Screening and referring for food insecurity needs to be a standardized process in the primary care setting to support the overall health of children,” including their mental and physical health as well as overall well-being, reported study author Gina A. Friel, DNP, RN, CRNP-PC, of Annapolis Pediatrics and Villanova University M. Louise Fitzpatrick College of Nursing.

The overall prevalence of obesity among children and adolescents in the US is 19.3%. The COVID-19 pandemic has increased the number of children with food insecurity from 1 in 7 to 1 in 5 and 5% of people with food insecurity tend to be obese. Dr Friel noted that a standardized system for identifying food insecurity and referring families to federal and community resources are lacking.

Primary care is an ideal setting to screen for food insecurity because “primary care providers are able to build a relationship and a rapport with patients and their families over time,” Dr. Friel said in an interview. To study food insecurity in her practice, Dr Friel used the 2-statement, Hunger Vital Sign (HVS) screening tool (Table 1).2 Participants screened positive if their response was “often true” or “sometimes true” to either or both statements presented in a written format.

Table 1. Hunger Vital Sign2

1. Within the past 12 months, we worried whether our food would run out before we got money to buy more2. Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more
Source: Hager et al.

The study was implemented in 3 steps:

  • Preintervention: providers were educated on the obesity and food insecurity paradox, HVS screening tool, federal and community resource organizations, Maryland Hunger Solutions (MDHS), and the root causes of food insecurity (eg, low income)
  • Intervention step: HVS was administered to 601 parents of children and adolescents younger than 21 years at 645 well-child visits at Annapolis Pediatrics
  • Postintervention: families that screened positive on the HVS were referred to MDHS to receive information on federal and community resource availability

Table 2. Hunger Vital Sign Results Before and After Intervention

Positive HVS015 (2.5%)
Negative HVS0586 (97.5%)
HVS, Hunger Vital Sign

The study was conducted from July 2021 to September 2021 and of the 601 patients screened with the HVS, 15 (2.5%) were positive for food insecurity. Before the intervention, no screenings were conducted and no families were identified with food insecurity. All of the families who screened positive were referred to the MDHS for resources. Approximately 27% of families referred to MDHS were receiving benefits and 60% were in the process of doing so at the end of the implementation time frame.

It was noted that patients were more inclined to fill out the HVS screening tool when the layout only of the written form was reformatted. Dr Friel noted that initially, patients were less inclined to fill out the screening tool when the statements were presented in a landscape, side by side format. This prompted her to change the color of the paper (from white to yellow) and also the layout of the screening tool from landscape to portrait format (top to bottom). The content of the HVS screening tool remained unchanged. This adjustment, which included the format only, increased the number of families that were filling out the HVS screening tool.

With the help of this program, obesity can be tackled over time. “Encouraging healthy habits and addressing food insecurity is a conversation that we will have with patients and families over time to help them,” she noted. “Establishing healthy habits over time, as best you can, that’s the goal.”

By implementing food insecurity screening in primary care settings, providers can encourage conversations about available resources for families to utilize and refer families for available federal (WIC and SNAP) and other community services.

“In the primary care setting, providers have many important topics to discuss with patients and families in a short period of time during annual well-child visits. Within the context of promoting a healthy lifestyle, it is important to take into account social determinants of health, most notably food insecurity, in order to impart meaningful guidance toward meeting patients and families where they are and taking into account what a healthy lifestyle means to them,” Dr Friel concluded.


1. Friel GA. Pediatric obesity & food insecurity paradox: the identification & management of food insecurity in a pediatric primary care setting. Presented at: National Association of Pediatric Nurse Practitioners (NAPNAP) virtual conference; April 26-19, 2022.

2. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurityPediatrics. 2010;126(1):e26-32. doi:10.1542/peds.2009-3146

This article originally appeared on Clinical Advisor