Most of us know what it’s like to feel hungry—but for many, that sensation is quickly resolved by a trip to the pantry, vending machine, or drive-thru. For millions of Americans, though, hunger isn’t a passing inconvenience—it’s a persistent barrier to health and stability.
And yet, when it comes to designing policies to end hunger, we hit a roadblock: there is no agreed-upon definition for hunger. That’s a problem when you are developing a policy to end hunger.
The USDA, in consultation with the National Academies of Sciences, defines hunger not as a constant condition but as a consequence of food insecurity:
“a prolonged, involuntary lack of food that results in discomfort, illness, or weakness.”
Food insecurity itself is defined more broadly:
“limited or uncertain access to nutritionally adequate and safe foods or the inability to acquire food in socially acceptable ways."
These definitions may sound precise, but they’re just proxies—imperfect stand-ins for lived experience. Most federal food support, including SNAP, isn’t based on hunger or nutritional status at all; it is based on income. And income doesn’t always tell the whole story.
If we want to design policies that truly nourish the population—not just with calories, but with health-supporting food—we need a better model. One that accounts for more than just quantity.
Models: Good Intentions, Faulty Blueprints
We all use models to navigate the world—they help us simplify complexity and make decisions. Your brain, for example, models what your eyes sense. Optical illusions happen when that model breaks down. Public policy works the same way. Programs like SNAP (Supplemental Nutrition Assistance Program) and the Thrifty Food Plan (TFP) are based on models of hunger and food access. They aim to predict what a household needs and provide minimum resources to get there.
But, like all models, they make assumptions. And when those assumptions don’t match reality, the system fails.
- SNAP assumes that if you provide a certain amount of money, people can buy enough food.
- TFP assumes a set of fixed ingredients and recipes—often based on ideal conditions: stable income, access to a car, proximity to a full-service grocery store, time to cook, and a working kitchen.
These models don’t account for the actual cost of nutritious food nor reflect the constraints most low-income families face, such as limited store options, long work hours, or cultural food preferences.
Worse, they separate food access from nutrition, as if all calories are created equal. SNAP benefits may make it possible to buy enough food, but not necessarily enough good food. That’s why many recipients report relying on cheap, calorie-dense items—not because they don’t care about nutrition, but because that’s what the model enables.
If we take seriously the idea that food is medicine, as Make America Healthy Again (MAHA) suggests, we need to move beyond these limited frameworks. We need a model that supports nutritional security, not just calorie sufficiency.
From Food to Nutrition Security: A Model Worth Chewing On
A meta-analysis of 58 studies involving roughly 2700 participants across 27 states and DC suggests we shift our model from “enough” food to “enough good” food.
“Nutrition security emphasizes the connection between food insecurity and diet-related health disparities more so than food security alone.”
The researchers build upon the food insecurity model to identify several key factors that shape how people interact with the food system.
The model breaks down three essential layers: access, environment, and the human element.
Layer One: The Basics of Food Access
Access isn’t just about whether healthy food exists in a neighborhood—it’s about whether people can actually obtain and use it. Many participants described a frustrating tradeoff between quality and cost. Grocery stores with better prices and higher-quality produce were often farther away, while closer options like corner stores carried more expensive or lower-quality food. Without reliable transportation, the healthiest choices were literally out of reach.
Affordability shaped nearly every decision. Participants often had to stretch limited budgets by using coupons or visiting multiple stores—when transportation allowed. In winter, when fresh food prices rose, cheaper, calorie-dense options like fast food became the default, not the exception.
Even when healthy food was technically available, it wasn’t always acceptable. People reported settling for poor-quality meat or wilted produce—especially as the month wore on and money ran out. Meals became starch-heavy and canned, reducing both variety and nutritional value.
While some stores were praised for offering culturally relevant ingredients, many weren’t as accommodating. Urban shoppers tended to have more options and better store hours, while rural communities struggled with limited inventory. Even when stores did stock healthy foods, their layout often promoted sugary snacks and processed items over fresh produce—especially tough for parents shopping with kids in tow.
Layer Two: The Environment Beyond the Store Shelf
Food access doesn’t end at the store—it continues at home. And here, many households hit another wall: appliance access. A working stove and refrigerator are essential for cooking fresh, nutritious meals. Yet some participants lacked these basics, forcing them to rely on takeout or charitable hot meals that were often less healthy.
While federal food programs like SNAP were described as helpful, they often didn’t provide enough to sustain a nutrient-dense diet throughout the month. Many recipients described running out of benefits before their next allocation or earning just enough to be disqualified from assistance—even though they still couldn’t afford healthy food.
Stability was another major issue. Food access wasn’t consistent over time. Many participants cycled through feast and famine each month as benefits ran dry. With multiple jobs and little time to shop or cook, fast food became a convenient fallback. Some even reported feeling unwelcome in healthier grocery stores due to the stigma tied to using benefits—adding social pressure to the already-complicated act of feeding their families.
Layer Three: The Human Element
Beneath the structural and environmental factors are deeply personal forces that shape what people eat. Cognitive coping strategies emerged as a survival tool—people spent significant energy thinking about food, rationing, restricting, and adjusting their diets to meet physical and emotional needs.
Many also prioritized their obligation to the preferences of others in the household, especially children, elderly parents, or spouses. That sometimes meant choosing less nutritious or more expensive foods to keep the peace—or skipping meals altogether so someone else could eat.
Finances influenced everything. Participants discussed using unconventional pairings to stretch ingredients and choosing filling over nutritious foods to make it through the week. In an informal food economy, trading services for food often fill the gaps left by formal assistance.
Despite these challenges, many expressed a strong sense of agency—gardening, preserving, and using passed-down cooking skills to make the most of what they had. This self-reliance was a source of pride, even when circumstances were tough.
Self-efficacy—knowing what’s healthy and feeling confident about putting it into practice—was often a barrier. People weren’t lacking knowledge; they were lacking time, tools, and support. And support matters. Encouragement from friends, family, and even healthcare providers helped some stay motivated to eat well. But when that support came with judgment or unrealistic expectations, it had the opposite effect, leaving people discouraged and misunderstood.
MAHA’s Mantra: Food Is Medicine... But Is It Enough?
Make America Healthy Again (MAHA) promotes a simple but powerful idea: "Food is medicine.” The goal? Combat chronic illnesses—like diabetes, heart disease, and obesity—by improving diets. It’s a compelling message that taps into common sense: eat better, live longer.
Yet MAHA’s ‘food is medicine’ is narrowly focused on what’s in the grocery bag, ignoring the broader system determining whether that food gets eaten. The MAHA approach often assumes that if we hand out the right foods, we’ll fix the problem. But nutrition isn’t only about what you eat. It’s about how, where, when, and whether you can eat it.
Changing the food or disallowing soda and candy doesn’t automatically improve nutrition and end hunger. If someone doesn’t have a working stove, can’t find or afford the box of leafy greens, or must feed three kids on a tight budget, they’re not suddenly “healthy” just because red dye #3 has been removed from cereal, and they get some quinoa.
The MAHA vision ignores the barriers that surfaced in nutrition security research: inconsistent access, social pressure, limited time, appliance gaps, and deeply human, emotional, and cultural factors. These aren't minor details—they're the core of why “food is medicine” alone is not a cure.
Our current system addresses proxies (income, calories). Even MAHA’s “nutritional food” lacks a consistent definition, which makes targeted interventions harder to design and evaluate. As all models do, both models miss the bigger picture of real-world hunger and poor nutrition. To end hunger and chronic illness, we need better data and models, frameworks that factor in emotional, cultural, practical, and economic realities, and human-centered thinking, not just dietary guidelines and income brackets.
Hunger and poor nutrition aren’t just about empty stomachs and poor choices. It’s about broken systems. Let’s model that.
Source: A Meta-Ethnography to Determine Critical Constructs of Nutrition Security Journal of Nutrition Education and Behavior DOI: 10.1016/j.jneb.2024.11.004
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
