Q&A: Asking about food insecurity

Q: Why do some patients seem so unwilling to talk about food insecurity?

A: Food insecurity is among the easiest social determinants of health to address although among the toughest to assess. It can be difficult to know when clients are hungry, unless they tell us. For my case management colleagues who work in hospitals, this becomes an especially challenging mission. Dealing with clients who are ill and facing physical or behavioral health challenges is not synonymous with their having an appetite. It is also a daunting effort for any professional to deal with clients only by phone. Case managers may struggle with knowing the best way to ask a client suitable questions about their diet or food intake. Does the question come across in a biased fashion that embarrasses the client or family? Will the client even respond honestly? How do we know that clients aren’t simply telling us what they think we want to hear versus the truth? Because everything in life is relative, it stands to reason that clients may not even realize they are hungry. Perhaps your client is so used to budgeting dollars that eating less is the norm. As a result, the thought of eating three or even two real meals each day is from another time long ago and far away, if at all.

For more information, see The Social Determinants of Health: Case Management's Next Frontier.