Screening for food insecurity: US preventive services task force recommendation statement

Services Task Force US Preventive; Nicholson WK; Silverstein M; Wong JB; Chelmow D; Coker TR; Fernandez A; Gibson E; Jaen CR; Krousel-Wood M; Lee S; Rao G; Ruiz JM; Stevermer J; Tsevat J; Underwood SM; Wiehe S

doi:10.1530/ey.22.15.14

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ESPE Yearbook of Paediatric Endocrinology (2025) 22 15.14 | DOI: 10.1530/ey.22.15.14

ESPEYB25 15. Editors' Choice Miscellaneous (3 abstracts)

15.14. Screening for food insecurity: US preventive services task force recommendation statement

US Preventive Services Task Force , Nicholson WK , Silverstein M , Wong JB , Chelmow D , Coker TR , Fernandez A , Gibson E , Jaen CR , Krousel-Wood M , Lee S , Rao G , Ruiz JM , Stevermer J , Tsevat J , Underwood SM & Wiehe S

JAMA. 2025;333(15):1333-1339. doi: 10.1001/jama.2025.0879

In Brief: This systematic review by the US Preventive Services Task Force concludes that food security can be accurately assessed in clinical settings, without causing any harms. However, due to insufficient evidence of effective interventions on health outcomes they do not recommend routine screening for food insecurity in primary care settings.

Comment: Surveys in the USA estimated that 13% of households experienced food insecurity in 2022. Similar or even higher figures are emerging in other high-income countries. Poverty is the primary cause of food insecurity, with significant variation by race and ethnicity and, unsurprisingly, food insecurity is associated with adverse health outcomes in both children and adults.

The authors found that screening tools perform well in clinical settings. The 2-item Hunger Vital Sign tool is frequently used and shows sensitivity >95% and specificity >82%. It simply asks:

• During the past 12 months, have you worried about running out of food and not having money to buy more?

• During the past 12 months, have you experienced running out of food and not having money to buy more?

Unfortunately, no identified interventions were effective on any health outcome. Unsuccessful trials have examined: informing families about national and local food-related resources; access to a mobile food pantry; or home delivery of meals (tailored to patients with diabetes).

JAMA allows an interesting publication format, where the authors publish a separate Viewpoint, allowing them to express the personal views, free from the constraints of the evidence-based medicine format. They remind us that health outcomes are not determined only by clinical interventions, but are significantly influenced by social and economic conditions. They say “It would be antithetical to a patient- and family-centered approach to ignore the presence of food insecurity for patients while awaiting more evidence” (1).

The management of many conditions that we see as Paediatric Endocrinologists are underpinned by dietary advice and support, including Type 1 and Type 2 diabetes, obesity, and inborn errors of metabolism. It would indeed be good practice to show our care by sensitively enquiring about the possible presence and impact of food insecurity.

Reference: 1. Tumaini Coker, Michael Silverstein, Michael J Barry, Wanda Nicholson. Navigating the Complexity of Food Insecurity Screening. JAMA 2025;333;(15):1293-1294. doi: 10.1001/jama.2024.28194.