1. Diet and food insecurity University of Warwick 16 th April 2015

2. Food Security FAO definition: ‘all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life’ USDA definition of food insecurity: ‘limited or uncertain availability of nutritionally accepted or safe foods’

3. 1.Availability of foods 2.Physical and economic access to foods 3.Food utilization Food security depends on:

4. Food insecurity not routinely measured in UK surveys Income, SES or other measure of deprivation most commonly used What is the evidence for the impact of food insecurity on diet in the UK?

5. Spend more Buy less Trade down Changes to food purchasing in response to higher food prices

6. Consumer reaction to high food prices between 2007 and 2013 Taken from Family Food 2013 – DEFRA

7. Consumer reaction to high food prices between 2007 and 2013 Taken from Family Food 2013 – DEFRA

8. Trends in fruit and vegetable purchases 2001 -2013 Taken from Family Food 2013 – DEFRA

9. Mean price of foods by Eatwell food group, 2002–2012. Jones NRV, Conklin AI, Suhrcke M, Monsivais P (2014) The Growing Price Gap between More and Less Healthy Foods: Analysis of a Novel Longitudinal UK Dataset. PLoS ONE 9(10): e109343. doi:10.1371/journal.pone.0109343 http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0109343

10. Mean price of foods by Food Standards Agency nutrient profiling score category, 2002–2012 Jones NRV, Conklin AI, Suhrcke M, Monsivais P (2014) The Growing Price Gap between More and Less Healthy Foods: Analysis of a Novel Longitudinal UK Dataset. PLoS ONE 9(10): e109343. doi:10.1371/journal.pone.0109343 http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0109343

12. % achieving 5-a-day by equivalised income quintile NDNS 2008/09 – 2011/12

13. Proportion adults aged 16 years and over achieving 5-a-day by income Health Survey for England 2011 Taken from Social and economic inequalities in diet and physical activity – Public Health England 2013

14. Energy and macronutrient intake for adults aged 19 to 64 years by equivalised income quintile NDNS 2008/09 – 2011/12 Lowest QuintileHighest Quintile Food energy (kcal)16781790 % E from Fat33.735.5 % E from Non-Milk Extrinsic Sugars 14.111.5 Fibre (g)12.314.5

15. % RNI for selected micronutrients by equivalised income quintile NDNS 2008/09 – 2011/12

16. % with iron intake below LRNI by equivalised income quintile NDNS 2008/09 – 2011/12

17. Low Income Diet and Nutrition Survey (LIDNS)

18. Food insecurity based on USDA questions Individuals – adults and children categorized into 3 groups Food secure 71% Mildly food insecure 15% Moderately or severely food insecure 14% Relationships with diet very clear for women (less clear for men and children) Food insecurity in LIDNS

19. LOWER amounts of: Wholemeal bread Wholegrain breakfast cereals* Fruit Meat & meat dishes GREATER amounts of White bread* Processed meat* Soft drinks (diet & not diet)* Alcoholic drinks* * Not statistically significant Women in food insecure households consumed Holmes (2008) The influence of food security and other social and environmental factors on diet in the National Low Income Diet and Nutrition Survey. Proc Nut Soc 67, E88

20. % RNI by food security (women) Holmes (2008) The influence of food security and other social and environmental factors on diet in the National Low Income Diet and Nutrition Survey. Proc Nut Soc 67, E88

21. % below the LRNI by food security (women) Holmes (2008) The influence of food security and other social and environmental factors on diet in the National Low Income Diet and Nutrition Survey. Proc Nut Soc 67, E88

22. Adults in food insecure households more likely to have type 2 diabetes and hypertension (Seligman 2007) have increased predicted 10 year cardiovascular disease risk (Ford 2013) be overweight - women only (Townsend 2001; Basiotis 2002; Ford 2013) Food insecurity and health

23. Food insecure households may have:: Fewer opportunities for physical activity Cycles of food deprivation and over-eating High levels of stress Food insecurity and obesity FRAC Food Insecurity and Obesity: Understanding the Connections 2011.Basiotis PP, Lino M. Food insufficiency and prevalence of overweight among adult women. Nutrition Insights 2002;26:1–2.

24. Future Need to include food security measures in UK national health surveys – like NDNS or HSE?? Longitudinal data to determine causal link?