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Date: November 26, 2018

The Honorable Robert Wittman

United States House of Representatives

Washington, DC 20515

Dear Representative Wittman,

My name is XXX, and I am a Master of Nutrition candidate at George Mason University.

As a constituent of Virginia’s Congressional District 1, I would like to urge you to support

increasing the Supplemental Nutrition Assistance Program’s (SNAP) reach and effectiveness

through increasing its budget. I would also urge you to vote against proposed bills which seek to

decrease program participation for citizens at risk for food insecurity such as H.R. 1760. Food

insecurity is defined as, “food-insecure individuals and families have limited access to or

availability of food or a limited or uncertain ability to acquire food in socially acceptable ways

(e.g., without resorting to emergency supplies, scavenging, stealing, and other coping strategies) 1

”. H.R. 1760 would amend the Food and Nutrition Act of 2008 to eliminate the authority of the

Secretary of Agriculture to grant a waiver from the work requirements for participation in SNAP

on account of an area's high unemployment rate or limited employment availability for

individuals who reside in the area. It is my intent in this letter to showcase the research which

indicates the association between food insecurity and increased incidence of chronic illness. I

will then demonstrate through the examination of peer-reviewed studies that SNAP is and has

been effective at reducing food insecurity.

The Supplemental Nutrition Assistance Program (SNAP) was established initially in

1939 by President Franklin D. Roosevelt as a means of alleviating the economic strain caused by

the Great Depression and the Recession of 1937. The initial program ran for four years ending in

1943, due to a reduction in the conditions which necessitated the program’s creation, food

surpluses and high unemployment 2 . The program was reinstated by the Food Stamp Act of 1964

which was signed into law by President Lyndon B. Johnson 2 . The program’s new purpose was

to “help low-income families, the elderly, and people with disabilities afford an adequate diet 3 .”

This safety net feature is important to the nation because as I will demonstrate, there is a strong

association between food insecurity and increases in health care costs, cardiovascular health

risks, metabolic syndrome, and many other serious health consequences.

Food insecurity is a significant problem of concern in the U.S. In 2010, 14.5% of

Americans were food insecure; this is nearly 50 million people who are unsure as to whether

they will have access to food 4 . Holben and Pheley in 2006 found that obesity was higher among

individuals from food insecure households, 48.1% than those from food secure households

35.1%, P<.001 5 . Holben and Pheley’s research focused on food insecure households located in

the rural Appalachian Region of Ohio and found that the self-reported poor health status was also

associated with high food insecurity levels.

Seligman et al. in 2010 found that food insecurity was positively associated with chronic

disease in adults. Seligman’s research used NHANES data collected on more than 5,000

participants over a six-year period. “Food insecurity was associated with self-reported

hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04–1.38] and hyperlipidemia (ARR

1.30; 95% CI, 1.09–1.55), but not diabetes (ARR 1.19; 95% CI, 0.89–1.58). Food insecurity was

associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04–

1.41) and diabetes (ARR 1.48; 95% CI, 0.94–2.32). The association with laboratory evidence of

diabetes did not reach significance in the fully adjusted model unless we used a stricter definition

of food insecurity (ARR 2.42; 95% CI, 1.44–4.08). These data show that food insecurity is

associated with cardiovascular risk factors 6 .”

A 2013 review article in Advances in Nutrition, examined the associations between food

insecurity and high healthcare costs amongst the elderly. The review highlighted the mechanisms

which lead to these increased costs, primarily being poor nutritional intake often due to being

forced to make decisions between medical care and food 7 .

The previous research studies identify the association between food insecurity and

adverse health outcomes specifically chronic illnesses which are associated with nutritionally

poor diets. SNAP participation has been shown to decrease food insecurity in participants as

compared to SNAP eligible nonparticipants. A 2015 analysis of more than 6500 households

found that SNAP participation reduced food insecurity 6 - 17% and also reduced households

experiencing severe food insecurity (designated by very low food security) by 12- 19% 8 . For the

determination of food insecurity and severe food insecurity, the researchers used Food Security

Supplement Questionnaire and considered respondents who affirmed more than three questions

food insecure and those who affirmed more than six items to be severe food insecure 9 . A 2016

study published in The Journal of Nutrition examined SNAP education and long-term food

security in Indiana Households with children. Rivera et al. found that SNAP-Ed improved food

security over a longitudinal time frame and that SNAP-Ed may be a successful intervention for

improving food security 10

.

A 2018 White Paper from the Center on Budget and Policy Priorities highlighted the

association between SNAP participation and the increased likelihood of reporting that they are in

good health, 10% more likely than nonparticipants 11

. The paper also highlighted data from a

2011 study by Ratcliffe et al. which found that SNAP participation reduced food insecurity by

30% and severe food insecurity by 20% 12

. These data indicate that reductions in food insecurity

are positively associated with participation in the SNAP program.

There is, as you are now more aware, a clear association between chronic disease and food

insecurity. The association between food insecurity reductions and SNAP is well documented. I

would again urge you to push for increases in the SNAP budget in order to allow the program to

reach more at-risk people in order to reduce chronic illness in the nation. Thank you for your

consideration and please feel free to contact me if you would like to discuss this further as I have

additional data which examines Medicaid spending for chronic illness treatment being nearly ten

times the annual spending for SNAP; $565 billion 13

versus $66 billion 14

. This comparison is

interesting due to both programs serving populations at-risk for food insecurity 15

. SNAP which

has been shown to reduce food insecurity could potentially reduce healthcare costs for treatment

of chronic illnesses caused by food insecurity through reducing incidence of food insecurity.

Sincerely,

Your Name Here

Your Title Here

Street Address

City, State, Zip Code

10 Digit Phone Number

References

1. Anderson S. Core Indicators of Nutritional State for Difficult-to-Sample Populations. J Nutr.

1990;120(suppl_11):1555-1600. doi:10.1093/jn/120.suppl_11.1555

2. A Short History of SNAP | Food and Nutrition Service. A Short History of SNAP.

https://www.fns.usda.gov/snap/short-history-snap. Published 17 2018. Accessed October 21,

2018.

3. Policy Basics-Food Stamps. Cent Budg Policy Priorities. February 2018:13.

4. Gundersen C. Food Insecurity Is an Ongoing National Concern123. Adv Nutr. 2013;4(1):36-

41. doi:10.3945/an.112.003244

5. Holben DH, Pheley AM. Diabetes Risk and Obesity in Food-Insecure Households in Rural

Appalachian Ohio. Prev Chronic Dis. 2006;3(3).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636722/. Accessed October 23, 2018.

6. Seligman HK, Laraia BA, Kushel MB. Food Insecurity Is Associated with Chronic Disease

among Low-Income NHANES Participants. J Nutr. 2010;140(2):304-310.

doi:10.3945/jn.109.112573

7. Lee JS. Food Insecurity and Healthcare Costs: Research Strategies Using Local, State, and

National Data Sources for Older Adults12. Adv Nutr. 2013;4(1):42-50.

doi:10.3945/an.112.003194

8. Mabli J, Ohls J. Supplemental Nutrition Assistance Program Participation Is Associated with

an Increase in Household Food Security in a National Evaluation. J Nutr. 2015;145(2):344-

351. doi:10.3945/jn.114.198697

9. Coleman-Jensen A. QUESTIONNAIRE - DECEMBER 2017 FOOD SECURITY

SUPPLEMENT. 2017:33.

10. Rivera RL, Maulding MK, Abbott AR, Craig BA, Eicher-Miller HA. SNAP-Ed

(Supplemental Nutrition Assistance Program–Education) Increases Long-Term Food

Security among Indiana Households with Children in a Randomized Controlled Study. J

Nutr. 2016;146(11):2375-2382. doi:10.3945/jn.116.231373

11. Carlson S, Keith-Jennings B. SNAP Is Linked with Improved Nutritional Outcomes and

Lower Health Care Costs. January 2018:19.

12. Ratcliffe C, McKernan S-M, Zhang S. How Much Does the Supplemental Nutrition

Assistance Program Reduce Food Insecurity? Am J Agric Econ. 2011;93(4):1082-1098.

doi:10.1093/ajae/aar026

13. Medicare C for, Baltimore MS 7500 SB, Usa M. NHE-Fact-Sheet.

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-

reports/nationalhealthexpenddata/nhe-fact-sheet.html. Published April 17, 2018. Accessed

November 23, 2018.

14. Supplemental Nutrition Assistance Program Participation and Costs. https://fns-

prod.azureedge.net/sites/default/files/pd/SNAPsummary.pdf. Published November 9, 2018.

Accessed November 23, 2018.

15. Medicaid.Gov/ Eligibility. Eligibility.

https://www.medicaid.gov/medicaid/eligibility/index.html. Published November 23, 2018.

Accessed November 23, 2018.