The Hunger–Obesity Paradox in Older Americans

By Joel Berg

Given that older adults sacrificed so much to establish and protect life in America as we know it, why do we allow millions of them to face the threat of hunger? And why do we allow millions of older adults—some of whom also face hunger—to suffer, against their will, from obesity?

The answer is that our national policies are fundamentally broken and our national priorities are fundamentally skewed. Instead of raising income, reducing expenses and providing more subsidized food for our elders, national leaders have funded wars and tax cuts for the wealthy, and proposed cuts to Social Security.

Nutrition Benefits for Older Americans

Federal USDA/SNAP benefits. Formerly the Food Stamp Program, SNAP is a federal program funded by the USDA. In 2012, overall program funding was $78.4 billion, but only 9 percent of SNAP recipients were older adults. Program participants use an electronic benefit card to buy any food they want (excluding prepared foods for immediate consumption) at food stores and farmers markets. Given that the average benefit for older adults equals only about $1.44 per meal, many older SNAP recipients report trouble affording the healthiest, most expensive, foods. The USDA also funds a small program ($21 million per year) to increase the purchasing power of elders at farmers markets.

Congregate Nutrition Services of the Older Americans Act (OAA). Provides funding for the provision of meals and related services in a variety of congregate settings, often at senior centers. In fiscal year 2009, more than 92 million congregate meals were provided to nearly 1.7 million older adults.

Home-Delivered Nutrition Services. Provides funding for the delivery of meals (often Meals on Wheels) and related services to elders who are homebound due to illness, disability or geographic isolation. In fiscal year 2009, nearly 149 million home-delivered meals were provided to more than 880,000 homebound individuals. The nutritional value and quality of meals offered by these OAA programs vary widely, often depending on how much, if any, non- federal matching funds local program sites receive from state and local government or private sources.

Public/Private Food Pantries and Soup Kitchens. More than 200 nonprofit regional food banks nationwide provide food to more than 50,000 food pantries and soup kitchens, most of which serve at least some older adults, but many of these entities receive food and cash from the federal government, and some also receive state and local government funding. Much of the food distributed by these banks is processed food that is high in sodium, sugar and fat. Agencies supplied by the Feeding America food bank network help feed 7 million older Americans.

—Joel Berg

Food Insecurity by the Numbers

According to the United States Department of Agriculture, in 2013, 2.9 million (9 percent) of households with older adults experienced food insecurity—meaning they couldn’t always afford an adequate supply of food. Fully 1.1 million (9 percent) of households of elders living alone experienced food insecurity. Meaning, in the wealthiest nation in the history of the world, nearly 1 in 10 older adults lacks sufficient food.

Such food insecure elders, according to a 2009 University of Kentucky study sponsored by the Meals on Wheels Association of America, are at increased risk for chronic health conditions, even when controlling for other factors such as income. Sixty percent are more likely to experience depression, 53 percent are more likely to report a heart attack, 52 percent are more likely to develop asthma and 40 percent are more likely to report an experience of congestive heart failure.

Food insecure older adults have significantly lower intakes of vital nutrients in their diets when compared to their food secure counterparts. In addition, food insecure elders are 2.3 times more likely to report fair or poor health status and had higher nutritional risk, according to Lee and Frongillo in the Journal of Nutrition (131:5, 2001).

According to the national food bank network, Feeding America, food pantries and soup kitchens served by their network feed 7 million older adults annually. Of all their client households, 33 percent have at least one member who is age 60 or older, and 76 percent of these households are food insecure—an estimated 3.9 million households. Thirty percent of client households with at least one elder also report having served in the U.S. military. Veterans can receive Supplemental Nutrition Assistance Program (SNAP) benefits if they are income-eligible, but there is no program specific to veterans.

Older adult food bank clients also faced poorer health: among client households with at least one elder, 47 percent reported that a household member had diabetes and 77 percent reported that a household member had high blood pressure, according to Feeding America. See sidebar for details on food subsidies in the United States.

Why Older People Are Going Hungry

Why do so many older adults go hungry in America? The nuanced answer is complicated, but the short answer is simple: For millions of older Americans, their expenses are higher than their fixed incomes.

Social Security payments are inadequate and private and public pensions have been cut. Rent, mortgages and property taxes continue to skyrocket, and many home values never fully rebounded from economic collapse of 2007–2009. Many older adults now have to care for their grandchildren. At the same time, funding for senior center meals and home-delivered meals has not kept up with need. Rather than rising to meet increased need, both programs were cut by the federal sequestration process, according to a 2013 CNN report.

Older adult households are much less likely to receive help through SNAP than non-senior households, even when expected benefits are roughly the same. According to the National Council on Aging, only one in three seniors eligible for SNAP receives it, and the average benefit for elders equals only about $1.44 per meal. Older adults generally are hesitant to apply for SNAP benefits because of the stigma attached to food stamps, low benefit amounts, the belief they are ineligible as well as the cumbersome application process.

The Hunger–Obesity Paradox

In a seeming paradox, according to the Centers for Disease Control and Prevention (CDC), about 35 percent of adults ages 65 and older were obese in 2007–2010, representing more than 8 million adults ages 65 to 74, and almost 5 million adults ages 75 and older.

The CDC defines overweight and obesity as “labels for ranges of weight that are greater than what is generally considered healthy for a given height,” as determined by Body Mass Index (BMI). An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese.

While at first blush it would seem that hunger and obesity are incompatible, the reality is that food insecurity is a key contributor to the growing obesity problem among low-income older Americans. Hunger and obesity are flip sides of the same malnutrition coin because healthier food is more expensive, harder to find and more time-consuming to prepare than less healthy food, and disparities are exacerbated by government policies that tend to subsidize junk food rather than produce. While some of the hungriest and poorest Americans eat so little they lose weight, many others, with a marginally better ability to get food (either through limited food purchases, meager SNAP allotments or food bank pantry donations) eat food of such poor nutritional quality that they gain weight.

If people can’t afford or can’t gain access to nutritious food (especially during a time of skyrocketing food prices), they can’t eat it. While many people believe that the reason low-income people don’t eat more healthfully is that they have low nutrition literacy, by far the most common reason is that they have less money. Not only is this morally repugnant, but it also costs our society tens of billions of dollars annually in extra healthcare spending.

Ready Solutions to Hunger and Obesity

To solve these problems, we first need to understand what works. For instance, it is vital to note that Social Security payments have dramatically reduced elder poverty and hunger. The 9 percent food insecurity rate for older adults is far less that the 14.3 percent rate for families and the 19.5 percent rate for families with children.

Yet because the overall U.S. safety net for older adults is less robust than that of other Western industrialized countries, our rates of senior hunger are higher.

It is well within the power of the U.S. government to end older adult hunger and obesity, by better enabling older adults to meet basic food and other expenses while ensuring adequate, low-stigma food assistance programs. Because high housing costs often are a prime reason elders can’t afford enough food, all levels of government should work together to lower property taxes for middle- and lower income elders, while increasing rental assistance. The federal government should make SNAP benefits for older people more generous, to give them the ability to purchase healthier food, and make applying for SNAP easier by combining it with Social Security and Medicaid applications. Lastly, the president and Congress should fully fund congregate meals and home-delivered meals for older adults.

Doing so would be the right thing for our nation’s economy and its soul. Given all that older people have done for our nation, ensuring that they have three nutritious meals per day is the least we can do. 

Joel Berg is executive director of the New York Coalition Against Hunger in New York City, and senior fellow at the Center for American Progress.

Editor’s Notes: This article appears in the September/October 2015 issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store or Join ASA.