The Health Curve

Food Insecurity in America: Why Millions Go Hungry in the World’s Richest Nation | Prof. Hilary Seligman, UCSF

• Dr. Jason Arora • Season 1 • Episode 20

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Premiering October 21 for World Food Day 2025 — just one day before the U.S. Department of Agriculture releases its final annual report on household food insecurity in the United States (Oct 22).

In this episode, host Dr. Jason Arora sits down with Professor Hilary Seligman (UCSF) — one of the world’s leading experts on food insecurity, nutrition policy, and health equity — to uncover why 1 in 7 U.S. households (over 44 million people) struggle to access affordable, nutritious food in the world’s richest nation.

They explore what food insecurity really means, how it fuels chronic disease, why pandemic-era policies worked, and what must happen next to ensure healthy food for all.

⏱️ Chapters

00:00 Introduction | Why Food Insecurity Matters for World Food Day
 01:00 What “Food Insecurity” Really Means — and How It Differs from Hunger
 03:00 Prof. Hilary Seligman’s Story — From Patient Encounter to National Policy
 05:30 Food Insecurity in the U.S. — Rising Again After Years of Decline
 08:40 Defining Food vs. Nutrition Security | Why Both Matter for Health
 10:20 The Chronic Disease Connection — Obesity, Diabetes & Heart Disease
 11:50 Why It’s Not Just About Money — Marketing, Culture & Convenience
 14:00 How Time Pressure and Family Life Shape the American Diet
 15:30 Health Impacts Across the Life Course — From Pregnancy to Adulthood
 20:00 Recent Policy Shifts in SNAP (Food Stamps) & Nutrition Programs
 23:00 Inflation and Rising Food Prices — What Comes Next
 24:30 What Works | Evidence-Based Solutions to Food and Nutrition Insecurity
 26:30 How You Can Help — Community, Policy & Local Action
 28:00 Top Myths About Food Insecurity (And Why They’re Wrong)
 31:00 Closing Reflections | Food as Medicine & Hope for the Future

Food is foundational to health. Access to healthy food isn’t charity — it’s healthcare.

🔔 Subscribe to The Health Curve on YouTube for evidence-based conversations on the issues that shape our health and future. 

#WorldFoodDay #FoodInsecurity #NutritionSecurity #FoodIsMedicine #HealthEquity #HilarySeligman #JasonArora #TheHealthCurve #SNAP #HungerCrisis #PublicHealth #HealthyFoodForAll #USDA #ERS #ChronicDisease #FoodPolicy

SPEAKER_00:

Food insecurity is the limited or uncertain access to enough affordable, safe, and nutritious food for a healthy life. It affects one in seven US households, which is more than 44 million people. To help us understand the problem and what can be done about it, I'm very grateful to be joined by Professor Hilary Seligman of UCSF, who is one of the world's leading experts on food insecurity and its impact on health. Hilary, thank you so much for joining me today. It's a real pleasure to have you here.

SPEAKER_01:

It's really a great to be with you today.

SPEAKER_00:

And now you were recently on the Food is Medicine panel at the Aspen Ideas Health Conference, which I'm sad I missed. I was actually recording another episode in their studio at the same time. But can you just tell us what was your main message there and why is it so urgent today? What were you there to talk about?

SPEAKER_01:

Well, people mean really different things when they think about or talk about food as medicine. When I'm talking about food as medicine, I'm talking about how does the US support people in getting access to the kinds of healthy foods that you need to stay healthy, to prevent chronic disease, to treat your chronic disease if you already have obesity or diabetes or high blood pressure. And how is the health system helping or not helping people get access to those healthy foods? So that's what I'm thinking about. There are a lot of challenges in the way our health system is constructed, and particularly in the way it supports people in accessing healthy foods. And so at the Aspen Health Festival, we were really trying to tease apart how can our health system do better?

SPEAKER_00:

Excellent. And we do have an episode with Corby Kummer at Aspen that's going to be coming soon. And that's all about food is medicine. But your specialty area, I guess, is food insecurity, right? But you've been a physician, you worked across public health policy research, you've done a lot of things. Why did you choose to focus on food insecurity?

SPEAKER_01:

Well, actually, it was an interaction I had with a patient who came in and I checked him for diabetes, and he had a condition we call prediabetes, which means he was on the road to developing diabetes, was likely to develop it in the long term. And the solution to that is either food, medicine, or both. And I asked that patient about his diet. And what he revealed to me was that he ate for lunch every day a piece of spam between two cinnamon rolls. And that image was shocking enough to me that it made me really stop and think about what was driving him to eat a piece of spam between two cinnamon rolls every day for lunch. And it turned out that it was extraordinarily inexpensive and he didn't have enough money to purchase the amount of food he needed. But when he ate that, it kept him full until the next day. And so I, as a physician, had a choice. I could write him a prescription for a medication that might have side effects and would only treat prediabetes and it would probably be free to him. Or I could tell him he needed to shift his diet to something that was going to cost him a lot more money. And I knew that that wasn't going to be feasible to him. And so I didn't have the tools in my toolbox that I thought I needed. Because if I could get him access to healthy food, I would lower his risk of progressing to diabetes. I may also lower his cancer risk. I may lower his high blood pressure risk, but I didn't have a way to do that. And it made me start thinking 20 years ago about what if I could write a prescription for healthy food, just the same way I could write a prescription for a medicine that would help prevent him from developing diabetes.

SPEAKER_00:

And I think every physician must have at least one story like this. I know that I had many instances when I saw this in the UK, when I was volunteering abroad, it was the same root cause issues that I was seeing everywhere. And I just thought, and this is actually what encouraged me to go into public health. But what we're seeing, from my understanding, is that food insecurity, which we'll define in a moment, is rising again after several years in decline in the US. And that's a surprise, right? What's going on there?

SPEAKER_01:

Well, actually, if you think back to the early days of the pandemic, what you probably saw on the news was increased attention to food insecurity and the lines that were developing at food banks that were sometimes miles long to pick up food in the context of people not being able to go to work and not having a paycheck. And that was really evidence of how many people in the United States are living paycheck to paycheck. And the assumption was that food insecurity rates were going to soar in the United States, but they didn't. We were tracking and monitoring food insecurity rates every year, just like we always do. And what we saw is that food insecurity rates stayed stable. And what we attribute that to is that we had very effective policies that were very quickly put into place, that raised SNAP benefits, that allowed people to stay in their federal nutrition programs for longer, that brought school meals to children at home when they weren't going to school, that mobilized food banks and food pantries to get foods out into the community quickly. That stuff worked and it held food insecurity rates constant through 2020, 2021. But when these policy changes associated with the pandemic expired, that's when we started to see rises in food insecurity rates again. And that's what we've been observing in the data over the last couple of years.

SPEAKER_00:

Okay, so we'll dig into that in a second. But just taking a step back, can you help us define what this means? There's food insecurity, there's nutrition insecurity, hunger. What do each of these mean and how are they different?

SPEAKER_01:

Yeah, so let's start with hunger. Hunger is a physical sensation that everybody feels when you, I don't know, you're on a diet or you miss lunch or, you know, you only had soup for dinner. That's something that everybody feels. And interestingly enough, if you don't have enough calories in your diet day after day and month after month, that physical sensation of hunger may actually be blunted a little bit. It may go away a little bit. And that's probably a coping strategy. And so sometimes when people are living on a very low food budget in the United States and making very difficult choices about what food to buy because they don't have enough money, they may actually not be feeling that physical sensation of hunger. And so we have this concept of food insecurity that encompasses both that physical sensation of hunger and all those coping strategies that people use to try to get to the end of the month with enough calories if they don't have enough money in their food budget. And that might mean changing the kinds of foods that they eat so that they're eating more inexpensive foods. It may mean skipping meals. It may be mean worrying about where your next meal is going to come from. So you're doing things like pushing your kids to go eat dinner at a friend's house or to eat dinner at a family member's house. All of these coping strategies that prevent the physical sensation of hunger, but are really related to not having enough money in the household to eat, we bundle all of those together and call those food insecurity. Food insecurity has always included an element of whether you have access to a healthy diet, but it isn't the only focus of food insecurity. And over time, food insecurity has really become more strongly associated with having enough calories, regardless of whether those calories are good for you. And the challenge with that is that people who are living in food insecure households also often are pushed to eat very poor diets because they're cheaper. Highly processed, shelf-stable foods cost less money. And so this new term nutrition security has recently been coined that helps shift our focus towards not just having enough calories, but having the right calories for people to stay healthy.

SPEAKER_00:

So just to paint a picture of how big a problem this is, what do the statistics say today? I mean, how common is food insecurity in general, then how common is nutrition insecurity? What does that look like in the country at the moment?

SPEAKER_01:

Well, about one in eight US households report being food insecure every year. And the rate of food insecurity is higher in certain households. Households, for example, with single parents at the head. They have less money coming in, therefore more food insecurity. Households that are racial and ethnic minority-headed, those households tend to also have less money coming in because of barriers to employment, barriers to education. And the downstream impact of that is higher rates of food insecurity. So rates are very high in specific populations, and overall, about one in eight Americans. Nutrition security, as I said, is a more recent term. And so we don't really know how many people in the US are nutrition secure because we don't measure it across the entire population overall. But if you just think of it as how many people in the US do not eat a healthy diet, it's almost all of us. Most people in the United States, regardless of income, do not eat a healthy diet. But if your income is really low, you're even less likely to eat a healthy diet. And that's because a healthy diet costs more money.

SPEAKER_00:

And then when you start thinking about rates of chronic disease, obesity, you know, diabetes, et cetera, it starts to color that picture in about how common nutritional insecurity is, right?

SPEAKER_01:

Exactly. The epidemics of our day in chronic disease, obesity, diabetes, heart disease, these are all diseases that are very strongly rooted in changes in our food environment. So that access to highly processed foods with a lot of added sugars is really, really high and really common. And intake of more healthy foods like fruits and vegetables and lean meats gets crowded out by the American diet, which focuses more on ultra-processed shell-stable foods with added sugars and fats.

SPEAKER_00:

And we've got quite a few episodes on those topics. Please do check them out. We're talking about economics quite a lot as a problem here, as a cause of this issue. But it's not just economics, right? Can you tell us a little bit more about where the issue stems from?

SPEAKER_01:

Well, fundamentally, the reason we have high intake of these foods that are not healthy isn't just about how much they cost. We know that because even people in very high-income households are mostly eating unhealthy foods. And that is because these foods are well marketed, they are highly palatable, which really means they taste incredibly good. And not only do they taste good, for many people, they have a lot of qualities that are similar to an addiction. It makes our brains say, we need more of that potato chip. We need more of that, whatever ultra-processed food is your favorite. And so people continue to eat and to overconsume. And so these are probably twin problems. The food is highly palatable, it's easily accessible, and it's also in the context of it being cheap, and in many cases, us having peer pressure or cultural norms or people around us that are encouraging us to eat these foods because they're popular and they're fun. And so these are big problems across our food system.

SPEAKER_00:

And not to take us too far down the show, because there's a lot to cover, but from a cultural perspective as well, it's about convenience and food and mealtime and food prep and all that. Perhaps there's not as much of a priority or a time to slow down in the culture here. Is that right?

SPEAKER_01:

Well, I've only lived in the United States, but I will tell you that people who have lived outside of the United States tell me that we move at a very fast pace here.

SPEAKER_00:

I would second that.

SPEAKER_01:

Yes. And people here are very busy. We don't have the kinds of structural support for family life that are available in many other countries. And so if you think about a single mother getting home at the end of a long day of work and having three children to feed, that mother is going to make difficult choices whether to use her time and energy to cook or to use her time and energy to help her children with their homework or to take their children to, you know, purchase the school supplies they really need to purchase. These are difficult decisions, particularly in the United States, where people don't have support for many of these other parenting duties. And so we hear parents all the time talking about how the number one driver of the food they put on their table at home is how quickly they can get it there. And that pushes people towards using highly processed foods that can be heated up in the microwave and put it put on the table quickly. And trust me, I get it. I have three kids myself. And that is my primary motivator, too. And so there's something we have to think about changing something in our food environment to help make it easier for people to get healthy food into their homes and onto their tables.

SPEAKER_00:

And this is relevant for all of us in some way. I mean, both my wife and I work full-time. We have two kids. And when you're both working full-time, the same problem presents itself. It's okay, who's gonna cook dinner tonight if we want to have fresh whole foods versus we got a batch cook? Or you may have to go for an expensive, you know, delivery service where the food is prepped but not processed. And so we're having to get creative over something that's supposed to be quite simple, I guess. We'll get back to this conversation in just a moment. But if you're finding this episode helpful, here's a quick ask. Take a second to follow or subscribe to the Healthcurve Podcast wherever you're listening. And if someone else in your life would benefit from this episode or any of the others you've heard, please send it that way. All right, let's get back to it. Just to switch gears, if we start to think about the impact of food insecurity and all of the related sort of versions of this that we've just discussed across the life course, can you tell us a bit about how this impacts health throughout life?

SPEAKER_01:

People who are food insecure at every age are going to experience health impacts from it. Let's start with a pregnant person who has a baby developing. One of the really interesting things about the science behind food insecurity is all of the changes that are going on in the developing baby that allows that baby to be perfectly ready to confront the world that it thinks it's going to be living in after it exits the womb. And so if the mom is eating a really healthy, consistent diet, that baby is likely to come out into the world ready to live in an environment that is full of calories and nutrition and healthfulness and to really thrive. But what happens to a mother that actually is eating a very poor diet that doesn't have a lot of vitamins and nutrients, that baby may see that it's going to come out into a world that doesn't have much available. And what we think we are seeing in these babies is that they are primed to suck up as many vitamins and minerals and even potentially calories as they have available to them when they exit the womb. And so even though these babies may come out small because they haven't had as much nutrition in utero, they suck up calories, they hold on to them, and these children may actually end up over time having a higher risk of obesity and diabetes, even though their parents were food insecure or their mothers were food insecure during pregnancy. We have really interesting data about this that comes from episodes of famine and poor access to food back many, many decades ago. And so it's really important that we start focusing very young, even before babies are born, and getting healthy foods and nutrients to babies. And then once they are born, critical that children are exposed to fruits and vegetables early. That's when they get their taste for them. And so if you're living in a food insecure household and you're a child, you may never develop a taste for healthy foods. And that's going to follow you throughout your life. So we have to get healthy foods into these children's homes very early. Children living in food insecure households also have a higher risk of being hospitalized, higher risk of stomach aches. They have more headaches, they have more mistakes from school. It's not good for you. And then as you start getting older, similar things. People living in food insecure households have poorer diets. In some cases, they are more likely to develop obesity. In all cases, they are more likely to be to develop diabetes. So it really sticks with you throughout the life course. Being in a food insecure household is not good for your health.

SPEAKER_00:

It's probably also worth mentioning that all is not lost if this is your scenario thus far. Human biology is very adaptable and these things can be solved if you act now. And also during pregnancy and during other times, a sort of 80-20 approach is not a bad thing, right?

SPEAKER_01:

Exactly. And you know what? I'm really happy you said that because I spent a lot of years in my own work trying to understand the impact that food insecurity had on people's health. And then eventually came to the realization that there are a lot of things that we can do that will walk back these risks. If you start eating a healthy diet today, you're going to see those impacts on your health almost immediately in some cases. And so what we need to do, I think, as a society, is to build in more tools and opportunities for people to get access to healthy food. And then if you want to take advantage of it, great. If today's not the day and you had a really bad day and Cheetos are going to make you feel better, go for it. But if you want your healthy food in the United States, I think everybody should have access to it. And I think if that were the case, we would have a lower incidence of obesity and diabetes and other of these diet-related diseases. Those diseases might go down if everyone had an opportunity to eat healthy when they wanted to.

SPEAKER_00:

So we have had some policy changes recently, changes to SNAP benefits, et cetera. Can you help people understand what's going on there and what the impact is?

SPEAKER_01:

SNAP, which used to be called the Food Stamps Program, is one of the largest and most effective programs in the United States for reducing poverty. And so it is considered a really important, if not foundational and critical part of our social safety net. As other components of the social safety net have gotten smaller over time, more people have enrolled in SNAP benefits. And it has caused some alarm and concern in some sectors that we have a great percentage of the US population enrolled in SNAP at any given moment. And so there have been a lot of recent efforts to reduce the number of people who are on SNAP benefits using a number of different mechanisms. And there have also been attempts to shift some of the funding for SNAP away from the federal government to the state government. And finally, I will say that there have been recent policy changes that allow states to restrict the kinds of foods that you can get with your SNAP benefits so that no longer are any foods allowable. But for example, foods like sugar-sweetened beverages, sodas might not be covered in some states starting in the near future.

SPEAKER_00:

Okay. And so if we think about some of the policy changes that are going to start having an impact in the coming months and years, what do we expect to see based on what's happened recently?

SPEAKER_01:

Well, I think you'll see many fewer people on SNAP, both because fewer people will be eligible and also because some people who are eligible will choose to no longer enroll. I also think we will see a continued reduction in the kinds of foods that are accessible with your SNAP benefits, so that over time it becomes a narrower and narrower package of items. And I think it is likely that with these changes, the program overall will become more stigmatized. And I fear, based on other times in history when this has happened, that the people who are having to rely on SNAP benefits themselves may become more stigmatized as the language around the program changes.

SPEAKER_00:

Okay. And then how about some of the other things to do with inflation, rising cost of living? There are a few things going on here outside of, let's say, the tax bill and some other policy changes. So taken together, what should people know about and understand better?

SPEAKER_01:

So there are a lot of pressures on people's household food budgets that we're going to see in the coming years. If you are enrolled in SNAP today, one of those pressures might be that you will no longer be enrolled in SNAP, or that your SNAP benefit may go down as states elect to pull out or to reduce benefits because they're on the hook for more of the costs. But it's happening at the same time as food prices are rising. That is because of general inflation. It's also because of tariffs being put into place and other economic pressures. And so I think what we're going to see is that overall the percentage of people's budget that they're going to have to spend on food is going to go up. And that's going to squeeze out other things. It's going to make it more difficult for households, particularly low-income households, to afford other things like other basic necessities, transportation, utilities, and other leisure activities, which I think is going to be really hard for people.

SPEAKER_00:

On this podcast, we're really big about solutions and trying to help people do what they can themselves, of course, empower them with information, literacy, and some practical tools. So let's move on to the solutions aspect, Sherry. So we now have a better understanding of what's going on and what we're talking about. What are some of the interventions that you've seen be really effective for this problem of food insecurity? Let's include nutritional insecurity as well. What can people do that we know works, that the evidence shows works?

SPEAKER_01:

Well, first of all, if you are able to enroll in SNAP or WIC or the National School Lunch Program for your children or the school breakfast program, and you haven't done that, do it. Because many well-meaning people will tell you that you can eat a healthy diet on a very, very low budget, and it is really difficult to do. You have to put in a lot of your own time or other resources to make that work. And so if you can enroll in these other programs, take that help so that you can afford healthier food. If you aren't eligible for these programs and you have the time to spend, you can use that time to do all of the things that people do in the kitchen to help save money. Buying in bulk, buying in season, cooking in batches. That takes a lot of time again, but if you can do it, do it. And talk to your healthcare provider. There are often ways, and again, this is called part of the food is medicine, the drive towards bringing food closer to the healthcare sector, especially if you have a chronic disease. There may be ways that your healthcare provider can help get you access to what we call medically tailored groceries or produce prescriptions that could help you access those foods. Finally, talk to others around you to be able to team up with them, to talk about solutions in your own community, and to brainstorm ways that you can pool your time and your money in order to make ends meet, because it may be a really challenging couple of years when it comes to addressing food and nutrition security.

SPEAKER_00:

And just a couple more things. So for those who aren't directly affected, what can those folks do to help and make a difference?

SPEAKER_01:

One of the things that we forget sometimes when we're thinking about food is we think initially very big about what's happening in the United States when actually what's happening in your local community is really most important for how people have access to food. Are your corner stores only carrying junk food or are they carrying fruits and vegetables too? Are the foods in those corner stores that are healthy as expensive, more expensive, or less expensive than the unhealthy foods? These are often decisions that are nudged by policies in your city or in your county. And those are places where people can get really involved. And are you supporting your local farmers? Because if you're supporting your local farmers, then you're create, you're helping to support the infrastructure that brings less expensive fruits and vegetables into your community because you're not having to pay the costs of shipping them across the country. So buy from your local farmers and help to make that local farm produce available to other people in your community.

SPEAKER_00:

Problems and solutions are always local, right? And of course, this is a potential stimulus for communities to get together again and eat together and share food and do that sort of thing, which is how we lived for a very long time and how much of the world still lives, right?

SPEAKER_01:

And I will mention on that point, if you are looking for partners in that, a lot of communities have started what they often refer to as a food policy council to help coordinate and think about these issues at the local food system level. So that's the term you want to look for if you're gonna go to Google and look for getting involved in your community. Does your community have a local food policy council?

SPEAKER_00:

And just to close, for the last section of this episode, I just wanted to go through some myth busters. And so you will see this a lot in your work. What are the top myths that you come across on this topic? And let's take this opportunity to dispel them.

SPEAKER_01:

Okay. Number one, it's easy to eat healthy on a very low budget. That is a myth. It is possible, but it is hard. It takes a lot of planning and it takes a lot of time. Number two, people who are getting support from federal nutrition programs like SNAP are drawing away from the productivity and economy of the United States. That is false. SNAP is a really important economic driver in this country. One of the most effective ways the government has to move money into our local economies is to put it into SNAP, because that money gets spent almost immediately in our local communities at our food vendors. And so SNAP actually plays a really important role in keeping our local economies going when we are heading towards recession or when there are a lot of pressures on our food economy, and our economy tends to be contracting. SNAP helps keep things going. And the number three thing I Will say is that there is a myth that food insecurity is an urban problem. Rural America is going to have a really challenging time in the coming years because our farming communities are likely going to have a very difficult time with the agricultural policies being put into place right now. And they're at very high risk of food insecurity. And so I think we really need to keep an eye on the people who live in rural communities and offer our support to them because access to federal nutrition programs and food banks and food pantries are really important in rural communities as well. Food is one of those things that we can invest in early as a society and as a nation that will reap great benefits in the end. If we have access to healthy food, we see children perform better at school. We see them more likely to reach their economic potential, to be self-sufficient as they age. Older adults who have access to healthy food are more likely to stay in their homes and not have to be institutionalized, which costs us a lot of money. So paying for food or supporting people's food needs now may seem like a huge crazy investment, but it pays off in the long term. And it's really important for us because food is foundational to making sure that our society stays healthy and ready for the future.