Inequity and food insecurity and effects on obesity and associated co-morbidities: meeting report and research priorities

A Rank Forum was convened to discuss the evidence around food insecurity (FIS), its impact on health, and interventions which could make a difference both at individual and societal level, with a focus on the UK. This paper summarises the proceedings and recommendations. Speakers highlighted the growing issue of FIS due to current economic and social pressures. The health implications of FIS vary geographically since food insecure women in higher income regions tend to be living with overweight or obesity, in contrast to those living in low-to-middle-income countries. This paradox could be due to stress and/or metabolic or behavioural responses to an unpredictable food supply. The gut microbiota may play a role given the negative effects of low fibre diets on bacterial diversity. Solutions to FIS involve individual behavioural change, targeted services and societal/policy change. Obesity-related services are currently difficult to access. Whilst poverty is the root cause of FIS, it cannot be solved solely by making healthy food cheaper due to ingrained beliefs, attitudes and behaviours in target groups. Person-centred models, such as Capability-Opportunity-Motivation Behavioural Change Techniques and Elicit-Provide-Elicit communication techniques, are recommended. Societal change or improved resilience through psychological support may be more equitable ways to address FIS. They can combine with fiscal or food environment policies to shift purchasing towards healthier foods. Policy implementation can be slow to enact due to the need for strong evidence, consultation and political will. Eradicating FIS must involve co-creation of interventions and policies to ensure a consensus on solutions.