Diagnosing and Treating Hunger in Kids Deborah A. Frank MD Professor of Child Health and Well-Being, Boston University School of Medicine Founder and Principal Investigator, Children’s HealthWatch Founder and Director, Grow Clinic for Children, Boston Medical Center 1/24/14

FOOD INSECURITY IS A PEDIATRIC DISEASE Households with children 2X as likely to be food insecure 15.9 million children (1/5) in 2012 Younger the child the higher the risk 2

FOOD INSECURITY LINKED TO MUTIPLE HARDSHIPS Which all disproportionately Impact families with young children 3

Economic Hardship Food Insecurity Housing Insecurity Energy Insecurity

Young Children Often Invisible Except to Families and Health Providers

The First 1000 Days are Critical for Brain Growth 8

WHAT’S THE PRESCRIPTION?FOOD IS THE CHEAPEST MEDICINE

70% of Benefits Go to Household with Children 10

SNAP Dose Too Low Even Before ARRA Roll back 11

What are the Maternal Child Health Impacts of Food Insecurity ? Does SNAP Help? 12

Food Insecurity Associated with Pregnancy Complications

FOOD INSECURITY IN PREGNANCY ( Carmichael 2007) Is associated with anencephaly and other neural tube defects 14

Food Insecurity in Pregnancy Linked to Low Birth Weight (Borders,2007) :

SNAP DECREASES LOW BIRTHWEIGHT 16

Low Birth Weight Increases Developmental Risk and Lifetime Health Costs Including Metabolic Syndromes

SNAP In Early Life Less Metabolic Syndrome 18

Post-natal Child Health Impacts of Food Insecurity Food Insecure children suffer 2-4 times as many health problems as other children within same income level –Stomach aches, head aches, colds, ear infections –Higher hospitalization rates –Iron-deficiency anemia –Decreased bone mineral density –More susceptible to lead poisoning –Poor oral health

Infection Malnutrition Cycle Why Hospitalizations?

Post-natal Child Health Impacts of Food Insecurity Food Insecure children suffer 2-4 times as many health problems as other children within same income level –Stomach aches, head aches, colds, ear infections –Higher hospitalization rates –Iron-deficiency anemia –Decreased bone mineral density –More susceptible to lead poisoning –Poor oral health

What are the Child Developmental Impacts of Food Insecurity? 22

24 Brain Brain structure most vulnerable to nutritional insults early in development Brain function is sensitive to quality and quantity of foods consumed throughout live span Requires high energy consumption and can’t store energy (Lyle et al, 1984)

Developmental Risk Rose-Jacob, 2008 / Young children in food insecure households are 40% more likely to score at developmental /behavioral risk than other low income children

Congressional Food Stamp Challenge “My focus and co- ordination are not sharp. I have one thought at a time and I am getting very confused – not to mention crabby.”

Developmental Functions Remain at Risk Following Early Undernutrition Language Short Term Memory Audio Visual Equivalence Attention Modulation of Activity and Affect Locomotor Skills

SNAP ASSOCIATED WITH BETTER ACADEMIC ACHIEVEMENT 28

Food Insecurity and SNAP Myths 29

Hunger isn’t the Problem: Obesity is the Problem 30

Puzzle of Poverty and Obesity Cyclical food deprivation/overeating Need to minimize per calorie cost Lack of access to fruits and vegetables in low income neighborhoods Lack of opportunity for safe exercise in low income neighborhoods Obesogenic practices in feeding children Stress hormones

Real Cost of a Healthy Diet Can parents afford to purchase healthy food? $ 0.79 $ calories How do you feed them without giving them harmful things ? Witnesses to Hunger Mother Drewnowski 2004 Stop and Shop Price Check March 2010

Aren’t People Just Ignorant?

Breastmilk is Best Milk but Does Not Prevent Child Food Insecurity Pizza crust and Breastmilk

SNAP Not Linked to More Child Obesity Some Studies Find Less Obesity 35

Myth: Cutting SNAP will Save Money! Excess Health Care Costs for Adults and Children Calculated to Exceed SNAP “savings” 36

Myth: Private Charity Can Make Up the Shortfall: Would be More than 2X what Second Harvest Can do Now

Can We Fix It?

RX: POLICY CHOICES DX: Our Children’s Brains and Bodies Suffering From Hunger and Hardship

 Young children who receive WIC more likely  Good/excellent health  Food secure  Healthy height/weight for age  Lower risk – developmental delays WIC can be located in hospitals and community health centers that serve obstetric and pediatric patients

Could Health Providers Prescribe Healthful Food? 41

Could We Help People Apply for SNAP and Health Insurance at Same Time? 42

Good Medicine for the Economy Too If all eligible participated additional $261 million would flow into San Mateo/Santa Clara Counties 43

WHY BOTHER?

We are Talking Real Children!

“There is no finer investment for any community than putting milk into babies.” - Winston Churchill

Thank You! 88 E. Newton Street | Vose Hall 4 th Floor | Boston, MA | tel: |