Our relationship with food — from eating habits to having reliable access to healthier options — affects not only our physical health, but also our mental well-being.
Social work has a long history of helping prevent food insecurity by supporting programs that supplement diet and nutritional needs of low-income families and single adults.
However, growing research shows an important connection food security and nutrition play not only in physical health, but also mental health, social workers say.
One example is the significant role nutrition plays in both brain and mental health function, particularly in the treatment of eating-related disorders, says NASW member Abigail Natenshon, a psychotherapist and author who has specialized in the treatment of eating disorders for the past four decades.
“Research shows that the neuroplastic brain changes in response to many different kinds of energy-based input and stimuli; the quality of foods we eat is one of the most significant,” she said.
“The process of therapy is about making changes; social workers and health practitioners need to keep in mind that as the person changes, so does the brain; and as the brain changes, so does the person,” Natenshon said. “The body/brain connection is a complete and integrative feedback system. Psychotherapists need to keep in mind that, in treating a client, they are also treating and changing that client’s brain.”
Ingested foods enter the brain as neurochemicals, she said, influencing brain function, for better or for worse.
“Healthful nourishment enhances brain function, which primes the pump for meeting physical, mental and emotional treatment goals,” Natenshon said. “Consider the case of anorexic food restriction, where the malnourished frontal cortex becomes incapable of sound judgment and decision-making, reducing the client’s capacity to benefit from the treatment process.”
Inquiring about a client’s eating habits becomes a very important diagnostic tool for all mental health evaluations, Natenshon said.
“An accurate assessment of a person’s eating lifestyle potentially reflects the origins of physical and mental problems, the client’s self-worth and capacity for self-regulation. It can also shed light on the quality of the client’s functioning in other life spheres,” she noted.
In making a differential diagnosis, physicians and mental health practitioners need to tune in to the significance of asking a simple question: “So, what do you eat on a typical day?” Natenshon said.
“The functioning of our bodies, as well as our brains, is determined through factors both inborn and environmental,” she said. “Both factors require attention in order for human beings to function efficiently and healthfully. As an example, obesity is a condition determined largely by genetics, though it can be affected significantly by the nature of a person’s eating lifestyle.”
Society’s obsession with thinness has led to rampant disordered eating practices, such as skipping meals, dieting, restricting food groups, and binge eating followed by purging, Natenshon said.
These practices have become so prevalent as to be considered “normal,” she noted. Some common misconceptions are: healthy eating is “fat-free/sugar-free eating;” that a person should only eat when hungry; and that a diet soda or energy bar is an adequate meal substitute, she said.
In addition, statistics show that one out of two teenage girls is a disordered eater, and one out of four college females purges to manage their weight, Natenshon said.
“What people tend to lose sight of is that such ‘benign’ disordered eating behaviors can become triggers leading to the onset of clinical eating disorders in genetically susceptible individuals,” she said.
Information about the neuroplastic brain as a partner in promoting mental and physical wellness can be found in Chapter 11 in Natenshon’s NASW Press publication, “Doing What Works: an Integrative System for the treatment of Eating Disorders from Diagnosis to Recovery.” More information is available at Natenshon’s website.
Food security policy
Having reliable access to food also plays a vital role in person’s overall health trajectory, said NASW member Debbie Weinstein, executive director of the Coalition on Human Needs.
In fact, there is a growing body of research on food insecurity that should be setting off alarm bells across the nation, Weinstein said.
“Babies and toddlers living in food-insecure households are more likely to experience bad outcomes that can hold them back for their whole lives,” she said. “That is, if a child is in a family that can’t always afford enough nutritious food, he or she is more likely to get sick, to be hospitalized, and to suffer developmental delays, compared to similar children in households judged to be food secure.”
This is why social workers need to be aware of challenges to food security policies, she said.
“Children who lack nutritious food are subject to the toxic stress experienced in families struggling to find enough money for rent and food,” Weinstein said. Research by the Children’s Health Watch has shown that high stress levels, in addition to inadequate nutrition, may contribute to depression, chronic health conditions, and hospitalizations, she noted.
“Children going without enough nutritious food are also more likely to be absent from school, suffer from hyperactivity, and do less well in school,” she said. “Social workers who work with poor children will almost certainly see these consequences, and it’s very important that they recognize that a more adequate diet will help them.”
Weinstein said food security programs such as school breakfasts and lunches, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, all make a real difference in children’s lives.
When children get school breakfasts, they are absent less and do better in class, according to a study by the group No Kid Hungry, she said, adding that fewer schools offer school breakfasts than school lunches.
In addition, she said children are the ones who suffer when benefits for these programs are cut.
When SNAP benefits were reduced from $1.70 per meal to $1.40 in 2013, households with children were more likely to be food insecure, increasing the risk of ill health and developmental problems among children, Weinstein noted.
“What’s worse — these harms are unnecessary,” she said. “Social workers should take a leadership role in improving nutrition programs so children can get a better start in life.”
Weinstein said this is an opportunity for all social workers to help make a difference at the macro level.
“Social workers are needed to help policymakers and the public see the good that nutrition programs can do, as well as the needless harm of failing to meet basic nutritional needs,” she said.
The Coalition on Human Needs recently cooperated with other organizations in finding people willing to speak about how they or their children had been helped by nutrition programs, Weinstein said.
“Their stories are powerful,” she said. “Social workers can encourage people to speak out, and can speak themselves about the value of SNAP, summer food, or other programs. The facts are clear – social workers are needed to help more people understand how much difference adequate food makes in people’s lives.”
Visit the Coalition on Human Needs.
Greater food choices
NASW member Jack Register, executive director of the National Alliance of Mental Illness North Carolina, said helping clients with eating disorders is also about education.
“In my work, I have found that helping my clients understand the difference between hunger and emotional hunger becomes critical,” he said. “The crash that comes from sugar- and carb-laden foods causes the emotional imbalances to be worse.”
However, missing from the spotlight on food security news is the cost of quality food, Register said.
“Those stuck in cycles of poverty are not able to get the same food choices,” he explained. “This is the role for social work. I believe strongly we must advocate for more options and availability of nonprocessed food for those that are poor. Otherwise we are perpetuating the oppression of poverty being a factor in poor health.”
Taking it one step further, Register said, “We must, must, must get real about the blatant control corporations have on our food supply. Social work has to be the voice of nutrition equality among all programs. This is vital to a healthier society.”
Register said he thinks access to food security and better nutrition will become important issues in the next few years.
“The income gaps are so big now that some families live on the lowest end of mass-produced food because that is all they can afford,” he said. “Social work must advocate and be a leading profession in the work of holistic health.”
Protecting food programs
NASW has strongly advocated for food security programs by signing onto letters, joining coalitions and urging member participation at the federal, state and local levels.
Food security programs not only benefit preschoolers, and older school-age children, they also serve seniors and low-income people of color who are disproportionately in need of food security, said Mel Wilson, manager of NASW’s Department of Social Justice and Human Rights.
The NASW Practice Perspective, “Economic Insecurity Among Older Adults,” notes that 15 percent of older adults, or one in six older adults, faces the risk of hunger and that 3.2 percent face hunger itself. See http://www.socialworkers.org/Practice/Aging
Adding to the survival of food security in the nation are continual threats of congressional budget cutbacks to food programs such as WIC and SNAP. Additionally, there are increasing numbers of states that include testing for illicit drugs as a requirement for eligibility for SNAP, Wilson said.
“NASW opposes the use of drug testing as a condition of eligibility for SNAP,” he said. “While a very small number of SNAP recipients may barter SNAP benefits for drugs, the vast majority have a legitimate need for such support and use their SNAP benefits accordingly. We feel the harm of such drug testing far outweighs any potential fraud or abuse of the program.”
When challenges to food security programs arise, it’s important that social workers fight back, Wilson said.