2.1.1 Prevalence of undernourishment


One of the most pervasive global health challenges is malnutrition, affecting every country in the world. Although the United States is a “developed” country, 1 out of every 9 Americans faces hunger. Additionally, misconceptions equate hunger and malnutrition when in reality, not starving is not the same as being nourished. According to the World Health Organization, malnutrition “refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients,” which can manifest themselves as conditions of undernutrition such as stunting and wasting but also as being overweight or obese. Malnutrition does not exclusively refer to the quantity of food consumed, but also the quality. “Hidden hunger” refers to malnutrition that results from not consuming sufficient essential nutrients, which is more difficult to quantify and accurately represent than food insecurity more broadly. 

Due to the lack of data relating specifically to malnutrition, understanding the local landscape of malnutrition in DC, Maryland, and Virginia requires a look at food insecurity within the region. According to the UN Committee on World Food Security, food security “means that all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for an active and healthy life.”  Food insecurity, the lack of such access, results from intersecting forms of material insecurity such as low wages, lack of affordable housing, low access to transportation, and more. According to a 2020 Report on the State of Food Insecurity in Greater Washington produced by Capital Area Food Bank, food insecurity is both a symptom and a driver of inequity in the National Capital Area. In a region where the living wage is almost three times the federal poverty level, it’s no surprise that many DC, Maryland, and Virginia residents struggle to afford nutritious food. It is not only limited to the most visibly poor; the Capital Area Food Bank notes that only 5% of the people they serve are homeless. Food is often the first expense people cut when faced with financial hardship; meals are sacrificed to pay rent, utilities, tuition bills, and medical expenses. Eating less is perceived as less harmful than missing such payments, when in reality it can have severe impacts on health and achievement. Among children, hunger and malnutrition can harm both short- and long-term physical and mental health, impair development, and hinder academic achievement. Meanwhile, food-insecure seniors are more likely to have health problems such as heart attacks, congestive heart failure, and asthma. 

Even before the COVID-19 pandemic, the Capital Area Food Bank served nearly 415,000 people who could not afford food: 82,020 from DC, 194,120 from Maryland’s Montgomery and Prince George counties, and 136,560 from Virginia’s Arlington, Fairfax, and Prince William counties as well as Alexandria.  According to Feeding America, the 2019 food insecurity rate was 9.4% in Virginia, 11% in Maryland, and 10% in DC. Food insecurity is not distributed evenly throughout the region, but manifests itself along other lines of inequity, including income, race, gender, and age. There is a strong correlation between poverty and hunger; for instance, DC’s high-income Ward 3 has a low rate of SNAP benefit usage, meanwhile SNAP usage is high where income is low, such as in Wards 7 and 8.  Additionally, communities of color account for the majority of food insecurity in the region.  Food insecurity also disproportionately impacts women; households led by a single mother are more likely to be food insecure, and many women faced with food insecurity skip meals to feed their children. Senior citizens, immigrants, and even college students are also particularly vulnerable to food insecurity

The COVID-19 pandemic “has exacerbated existing trends in food insecurity and created new issues surrounding access for vulnerable populations.” Save the Children’s 2021 Childhood Report ranked Maryland among the 10 worst states in the nation for having enough to eat in 2020; 21.6% of Maryland adults living in households with children aged 0-17 reported their household sometimes or often did not have enough food to eat in the past week. Had it been included in the ranking as a state, DC would have also made the bottom ten with 21.7%. Virginia performed better, almost making the 10 best states; however, 14.2% adults still reported a lack of food in their households.