People don't starve to death in the United States, but they do face lack of consistent, adequate nutrition. —Ross Fraser, communications director for Feeding America

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    When Jill Warner's husband lost his job as a product manager in 2009 and entered a bout of hard-core unemployment, they and their four children eventually turned to food stamps.

    For the first four months, they had zero family income and received $900 a month in food stamps. "We ate what we wanted," Warner recalls. "And we had plenty of flexibility." She would leave Costco loaded with snap peas, Brussels sprouts, broccoli and fresh meat, and after a busy day she would stop at Papa Murphy's on the way home. Because Murphy's is "take and bake," rather than served hot, she could use food stamps. "Food access was great," she said, "but mortgage, utilities and car payments were another matter."

    After a few months, her husband found entry level work that barely paid the bills, and their food benefit dropped to $500. "That was very tight," Warner said. "We had to compromise and buy more basic foods, and it was a close call."

    Firmly entrenched in middle class habits and attitudes, Warner is not quite the face of American hunger. That would be Matt Damon. "My family's lived in this neighborhood for years," says Damon, playing a serious young man dressed in a white T-shirt and baseball cap as he steps off his front porch in a recent commercial. "Recently things got so tight we had to go to the local food bank for help. I lost a lot of sleep wondering what the neighbors might think. That is, until I saw them there, too." Damon is one of a handful of Hollywood stars in television ads sponsored by Feeding America and the Ad Council.

    The muscle behind America's food banks, Feeding America was listed by Forbes in 2011 as the third largest charity in the United States, just behind the United Way and Salvation Army. Feeding America, which collects and distributes food to the hungry all across the U.S., is also the voice behind the ubiquitous message echoing daily from the radio to the backs of cereal boxes that "1 in 6 Americans suffers from hunger."

    The "1 in 6" number comes from the U.S. Department of Agriculture, but the rest of the wording does not. Since 2006, the USDA has dropped the term "hunger" in favor of "food insecurity," a more complicated and accurate concept. The change aims at better scientific precision, according to USDA officials. But it also serves to highlight complicated links between poverty, nutrition, obesity and overall well-being.

    Insecurity or hunger?

    "Those public service announcements come back to haunt me," said Mark Nord, the USDA sociologist in charge of food insecurity data. The people behind the campaign are "people of good will," Nord said, "but if you exaggerate the severity or scope of the problem it doesn't help the cause, as people tend to discount the whole problem."

    This paradox came into sharp focus during the GOP presidential primary, when then-candidate Rick Santorum attacked the food stamp program at an Iowa campaign stop: "If hunger is a problem in America, then why do we have an obesity problem among the people who we say have a hunger problem?"

    As Santorum's comment suggests, the politics of hunger in the U.S. are tightly connected to food stamps. According to the USDA, more than 46 million Americans are now on food stamps, formally called the Supplemental Nutrition Assistance Program, with an average monthly benefit of $133 per person, according to the USDA. In 2008, food stamp participation hovered around 9 percent of the U.S. population. Today, more than 14.5 percent of Americans use food stamps.

    Santorum's jibe hits directly on Nord's concern: The same audience being pounded with hunger campaigns is also being told that the country has a severe obesity problem — and that poverty is tightly linked to obesity. "We are still worried about hunger," Nord said, "but we have shifted our focus more toward quality as nutrition has become a problem."

    Using surveys, the USDA sketches two layers of food insecurity in American homes: "low food security" (9.4 percent of households in 2010) and very low food security (5.4 percent of households). These categories combined produce the famous "1 in 6" hunger number. But only in the smaller and more severe category is reduced intake a concern.

    "Households classified as having low food security have reported multiple indications of food access problems," reads a passage in the 2010 USDA Household Food Security report, "but typically have reported few, if any, indications of reduced food intake." This group often worries about money lasting for food, and often cannot afford balanced meals, but they almost never go hungry. In contrast, the "very low security" group reports a significant decrease in calories consumed.

    Survey questions focused on food variety and quality asked respondents to react to statements including "We couldn't afford to eat balanced meals" and "We relied on only a few kinds of low-cost food to feed our children."

    Filling in gaps

    "The face of hunger has changed," said Ross Fraser, communications director for Feeding America, noting that the popular image of vagrants in soup kitchens is long gone. "Today, only 10 percent of the hungry are homeless." Most food-insecure households have a child, a senior citizen or a disabled person in the household, Fraser said. One third is home to a wage earner, but the worker generally has a job that cannot support the dependents. "They work in gas stations, as security guards or cleaning your hotel," Fraser said.

    The behemoth behind most of America's soup kitchens and food banks, Feeding America stocks the agencies and charities that at some point fed 1 in 8 Americans last year. The group pulls in $90 million in cash donations annually, but more than $900 million in food donations.

    "People don't starve to death in the United States," Fraser said, "but they do face lack of consistent, adequate nutrition." He describes a cycle that often involves food stamps that run out toward the end of the month, with the last week or 10 days involving severe food uncertainty.

    "We have a very strong push to get nutritious food to the people we serve," Fraser said, noting that the organization began as a simple salvage effort, aimed at redirecting materials destined for the dumpster. "But as we've evolved, we find that more and more low-income people regularly rely on our food kitchens and pantries, and we work to ensure that we are getting them nutritious food."

    Cheap calories

    The problem, according to Julian Moore of the libertarian Reason Foundation, is that the government and food industries that funnel food to Feeding America have their own interests — and nutrition is not high on the list. Many critics have long contended that the Department of Agriculture, which runs the food stamp program, is co-opted by the food industry.

    This lurking conflict of interest is discernible in Feeding America's food chain. One quarter of its donations generally come from the federal government's agricultural programs, Fraser said, but the rest comes from retailers and wholesalers. Feeding America volunteers find mislabeled or expiring products. They also acquire produce that is too small or oddly shaped for market. But the organization is heavily dependent on the highly processed food products that stock the average grocery store.

    The food stamp program is similarly compromised, critics argue. "Buying chewing gum with food stamps is clearly absurd," Reason's Julian Bond said, noting the range of non-nutritious products available with food stamps, from gum to potato chips, candy and cola. Bond blames the paradox of non-nutritive food support on the "bureaucratic nature of the state supplying this safety net," and he cites the vested interests in the food industry that prevent change.

    Heather Hartline-Grafton of the Food Research and Action Center says FRAC opposes restrictions on what can be purchased with food stamps. "We have found that food stamps purchases are not really different from the general public, and we are very concerned that limiting choice and creating stigma might reduce participation," she said, adding that FRAC's emphasis is on increasing food stamp benefits to allow better food access, rather than restricting choice.

    Critiques of the food industry-USDA nexus have long echoed across the political spectrum. "Almost $300 billion of government subsidies support an agriculture industry that focuses on quantity not quality, on producing cheap sugar and fats from corn and soy that fuel both hunger and obesity," wrote Dr. Mark Hyman in a 2010 Huffington Post article. "These calorie-rich, sugary, processed foods are what most people buy if they don't have enough money. You can fill up on 1,200 calories of cookies or potato chips for $1, but you'll only get 250 calories from carrots for that same $1. If you were hungry, what would you buy?"

    A strong statistical link between food stamps and obesity among women was uncovered in a 2010 study by Jay Zaogorsky at Ohio State University. "We can't prove that the food stamp program causes weight gain, but this study suggests a strong linkage," Zagorsky said in a statement. "While food stamps may help fight hunger, they may have the unintended consequence of encouraging weight gain among women."

    A poverty-obesity link was also explored in a 2004 study published in the American Journal of Clinical Nutrition, where researchers confirmed that calorically dense foods are cheaper than low-calorie foods and that food insecurity leads to binging when food is available. "Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit," the authors stated, concluding that "we need a better understanding of how food prices affect consumer food choices and the selection of a healthy diet."

    Perhaps not destiny

    This improved understanding may require more than simple economics. While it is clear that prices and poverty combine to drive low-income consumers to cheap, processed food choices, availability and personal preferences also seem to play a role.

    Significant buzz recently centered on "food deserts," urban zones where fresh fruits and vegetables were simply unavailable. But some recent studies, including one by the RAND Corp., have questioned this claim. "You can get basically any type of food," said Roland Sturm of the RAND Corp., the New York Times reported. "Maybe we should call it a food swamp rather than a desert."

    Sturm's characterization is controversial, and FRAC's Heather Hartline-Grafton disputes it. She describes urban settings where the only readily available food source is the corner market and the "bananas are overpriced and rotting."

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    If access and price are part of the equation, just how inevitable are the links among obesity, poverty and food insecurity? Using data from the U.S. Centers for Disease Control, U.S. Census Bureau, and the Department of Agriculture, the Deseret News did an informal analysis comparing the worst-performing 15 states on three measures: obesity, poverty, and food insecurity. We then compared the overlap among these low performers.

    Not surprisingly, of the 15 most food-insecure states, 10 also appear on the bottom 15 poverty list. Eight of these 10 also make the obesity list, all of them adjoining states in the deep South. Only Arizona and New Mexico appear on the bottom 15 for both poverty and food insecurity — but not for obesity, where it ranks 35th and 39th, respectively. These two adjoining southwestern states are uniquely poor and hungry but lean.

    "Obesity is a very complicated condition, with great regional differences and many cultural and environmental factors. There is no easy answer," said FRAC's Hartline-Grafton. Accounting for differences in culture or culinary habits may give policymakers something to chew on as they contemplate next moves on the food insecurity, nutrition and obesity fronts.

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