Why is food insecurity associated with health outcomes? A review of possible pathways

Food insecurity (FI) in high income countries has become a major focus of academic and policy concern. FI is prevalent, and is consistently associated with poor physical and mental health outcomes. These associations are attenuated but not eliminated by controlling for more general social determinants, with which food insecurity is correlated. Though it is clear that the associations exist, it is less clear why. In this paper, we review four possible pathways between FI and poor health: (A) FI is a non-causal correlate of general deprivation and disadvantage; (B) FI causes poor health, but this is not mediated by diet; (C) FI causes poor health by changing what people eat; (D) FI causes poor health by changing the temporal patterning of their eating. These pathways are not mutually exclusive and we suggest that several play a role. Understanding their relative importance is nonetheless an important goal if we wish to intervene effectively to mitigate the health burden of FI.