What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us

Abstract

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called ‘cost of living crisis’. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

“…The finding that those who were negatively impacted by the cost of living crisis experienced food insecurity is in line with previous literature that has highlighted the detrimental effects of economic hardship on food security (Brown et al, 2023;Douglas, 2023). Additionally, these findings align with recent Office of National Statistics data showing that households with the lowest incomes experience higher than average inflation rates, which is due to low-income households being more affected by high food and energy prices arising from the cost of living crisis (Office for National Statistics, 2023).…”

“…Given the challenges posed by the cost of living crisis, households with low-incomes have responded by using 'coping strategies' to mitigate experiences of food insecurity, specifically, the ways in which households purchase and prepare food (Douglas, 2023;Eicher-Miller et al, 2023;Johnstone & Lonnie, 2023). In relation to food purchasing behaviours, Ditlevsen et al (2023) reported that households with low-incomes often engage in bulk purchasing to benefit from bulk-buy discounting, and Adams (2023) reported that women experiencing food insecurity made use of 'bargain bins' and coupons to maximize their purchasing power.…”

“…However, in the UK, the food that is on promotion has recently been flagged for its tendency to be high in fat, sugar and salt (HFSS), which has been found to contribute to excess food intake (Watt et al, 2023). Households with low-incomes also report engaging in financial budgeting as this allows households to manage limited resources effectively (Douglas, 2023;Power et al, 2018). However, given the higher cost of healthier food (relative to less healthy food), the 'healthiness' of food may be deprioritised (Puddephatt et al, 2020;Robinson et al, 2022).…”