What if hunger were treated like a vital sign?

Food insecurity adds an estimated $53 billion to the nation’s medical bill every year, per a 2019 study. Yet most providers still log it as a note in the patient chart rather than a vital sign worth treating. It’s a problem with few headlines or funding dollars, but it has an outsized impact on people’s health.

More Americans are food insecure now than in 2020: roughly 1 in 7 households, or almost 48 million people. They enter surgery and hospitalization with a sicker baseline, higher rates of chronic disease, impaired immune response, and slower tissue repair, which drives wound complications, infections, longer recoveries, and premature mortality. That shows up as more emergency department visits, inpatient admissions, and longer hospital stays.

In trauma patients, food insecurity yields a threefold higher post-operative complication rate and a median hospital stay more than double that of other patients. For seniors, it can limit daily activities equivalent to aging an extra 14 years.

These patients can also incur health care costs more than double those of patients who don’t. Many of them skip medical visits, physicals, or medications because they have to choose.

VITAL SIGN WORTHY

Hunger behaves like a vital sign in that it’s predictive, measurable, treatable, and tightly tied to patient outcomes. It’s arguably more predictive than some of the vitals we already track. Vitals get monitored because the infrastructure to screen and act on them was built decades ago. Food insecurity is still handled as a separate problem, disconnected from the clinical record.

If a vital sign doubled a patient’s odds of poor health and stacked on more emergency department visits and hospital days, it would already be hardwired into every workflow. Food insecurity meets that bar and then some.

Hospitals increasingly screen for it and are well-positioned to identify it. The failure is in the gap between hospital care and home or the next point of treatment. Most route patients through one-off referrals and are given resource lists rather than put into embedded, trackable workflows. There is no connection back to the provider to confirm whether the patient ever received food or improved. Hunger screening today works like a smoke alarm with no sprinkler attached. The alert goes off, and nobody finds out whether the fire ever got put out.

CLOSED LOOP IS THE INNOVATION

The innovation isn’t a smarter screening tool or smarter algorithm. It’s closing the loop with two-way communication so everyone involved can confirm the patient actually got the support for which they were referred. That matters because healthcare has a transition problem. Most patient outcomes, whether they are clinical or social, are decided in the space between organizations that are not properly connected. The social intervention and the clinical outcome must become directly linked instead of assumed. It must also be replicable for other needs, like transportation or housing.

USA Health, the academic health system of the University of South Alabama, and Feeding the Gulf Coast are a working example. With Watershed Health, they built a model where an at-risk patient is identified in the hospital, a referral flows automatically through the network, and the food bank engages with resources in a closed-loop system back to the hospitals. The patient isn’t just handed a flyer for the food bank; the referral and proof of help tie back to the same chart tracking their blood pressure and A1c.

The real shift is in what gets measured in this model. Success stops being “we screened and referred” and becomes “we delivered food, and here’s how hospital days, complications, and readmissions changed as a result.”

CLOSE THE LOOP FOR GOOD

Hunger and other social determinants of health must be tracked and acted on with the same rigor as a vital sign. It must then go into a closed-loop system instead of a disappearing referral. From there, hospitals can measure real improvements in patient health rather than checking a box on a social work form.

The technology to do this already exists, and it can run without added cost, staff, or IT infrastructure—from the smallest food banks up to the largest health systems.

Healthcare’s next leap should be finally closing the loop on the entrenched human problems it has never been able to solve in the past. We must stop forcing families to choose between dinner and insulin and start treating the choice itself as the medical emergency it already is.

Effie Carlson is CEO of Watershed Health.