The U.S. Preventive Services Task Force released a new recommendation statement today concluding that there is insufficient evidence to assess the balance of benefits and harms of screening for food insecurity in the primary care setting.

Published in JAMA, the I statement applied to all children, adolescents, and adults and represented the U.S. Preventive Services Task Force's (USPSTF) first guidance on this topic.

"The USPSTF concludes that the evidence is insufficient and the balance of benefits and harms for screening for food insecurity on health outcomes in the primary care setting cannot be determined," stated the recommendation authors.

According to U.S. Department of Agriculture's Economic Research Service data cited in the recommendation, 12.8% of U.S. households experienced food insecurity in 2022, with 7.7% experiencing low food security and 5.1% experiencing very low food security. Nearly 33% of households with incomes below the federal poverty threshold were found to have food insecurity.

Significant disparities may exist by race and ethnicity, with 2022 data showing food insecurity affecting 20% of Hispanic households, 22% of non-Hispanic Black households, and 9% of White households.

Food insecurity was defined as "an economic and social condition of perceived limited or uncertain access to sufficient amounts of nutritious food needed for an active and healthy life." The USPSTF distinguished this from hunger, which is "an individual-level physiological state that may result from food insecurity."

The USPSTF found adequate evidence on the accuracy of screening tools to detect food insecurity, particularly the widely used 2-item Hunger Vital Sign tool, which showed sensitivity typically above 95% and specificity above 82% when evaluated within larger questionnaires.

However, the USPSTF identified several critical evidence gaps:

• Inadequate direct evidence about screening for food insecurity in health care settings and changes in health outcomes
• Inadequate evidence about health care–related interventions to address food insecurity and changes in food security outcomes
• Inadequate evidence on health care–related interventions to address food insecurity and changes in intermediate or health outcomes
• Inadequate evidence on the harms of screening and interventions.

The systematic review identified only one fair-quality randomized clinical trial (n = 789) examining the benefits of screening for food insecurity, which found no statistically significant difference in the percentage reporting food insecurity after 6 months between intervention and control groups.

Despite the I statement, the USPSTF acknowledged several important considerations for clinicians: "Clinicians should use their clinical judgment regarding whether to screen for food insecurity. Clinicians should also be aware of the risk factors for food insecurity and listen to patient concerns."

The USPSTF noted that interventions applicable to health care settings included food prescription programs, food boxes or pantries provided in or linked to clinics, medically tailored meals, and care coordination linking patients with assistance programs.

While potential harms of screening were not identified in any studies, the USPSTF noted concerns such as stigma, fear of legal system involvement, and privacy issues.

In a special section addressing the complexity of this topic, the USPSTF acknowledged several challenges in applying their traditional evidence framework to social determinants of health: "As a social condition, food insecurity requires direct intervention on the social circumstances (ie, poverty) that cause it. Primary care–based and primary care–referable interventions generally offer only limited 'treatment' of food insecurity through interventions that provide access to community resources, or limited access to food without changing an [individual's] social circumstance (eg, income)."

The USPSTF is currently "exploring how its established methods for assessing the benefits and harms of a preventive intervention can be most effectively used for food insecurity and perhaps other social determinants of health topics as well," concluded the recommendation authors.

Disclosures can be found in the recommendation statement.