The prevalence of nutrition-sensitive conditions such as obesity and type 2 diabetes has increased substantially in the US during the past 30 years. These conditions, combined with other diet-related ones such as cardiovascular diseases and certain cancers, are associated with the majority of morbidity, mortality, and health care spending nationally. Simultaneously, income inequality has increased, with accompanying self-reported food insecurity disproportionately affecting individuals with lower incomes. Food insecurity has been defined as the state of being without reliable access to a sufficient quantity of affordable, nutritious food, and in 2019 was estimated to affect 10.5% of US households.1 Food insecurity and poor nutrition are closely linked: individuals who report being most food insecure also have higher risks of developing obesity, diabetes, hypertension, coronary disease, stroke, cancer, and associated conditions, even after adjusting for other risks such as age, sex, employment, marital status, race/ethnicity, smoking, insurance status, family size, education, and income.2
For decades, US policies to address hunger and food insecurity have focused largely on providing sufficient calories or quantities of food. However, effectively addressing the current diet-related challenges in the US will require a shift beyond these concepts to the broader concept of nutrition security. Addressing nutrition security, which can be defined as having consistent access, availability, and affordability of foods and beverages that promote well-being and prevent (and if needed, treat) disease, may be the next needed approach to inform clinical care and public policy.