Moving from blame to support: rethinking food insecurity in diabetes

Posted by Ruth Boocock, Associate Professor and Dietitian, Teesside University, in Nutrition and Hydration Week.

This work started with a deceptively simple question: ‘How do clinicians identify food insecurity in people living with type 2 diabetes, and what actually helps once they do?’

By clinicians, I mean the people working directly with patients, for example GPs, nurses, dietitians, and others working in busy, often stretched diabetes services.

To explore this, I reviewed published research from across the world. Over many coffees, I read and debated papers, regularly asking other colleagues: ‘Is this really a pattern, or am I reading too much into it?’

What came through very clearly were the human stories beneath the data. Clinicians wanting to help, but constrained by time and systems. People with diabetes trying to manage blood glucose, while also worrying about whether there is enough food at home.

Asking about food only works if there’s something to offer next

Many clinicians want to ask patients about access to food and some already do, but the evidence shows that screening alone is not enough.

Without time, clear processes, or obvious referral routes, screening often stalls. I repeatedly came across similar experiences: ‘I asked the question. They said yes. And then I didn’t know what to do’. That moment matters. It can leave clinicians feeling stuck and distressed, and patients feeling exposed and unsupported.

One of the key messages from the evidence is that this isn’t about individual clinicians doing more. Food insecurity needs to be part of everyday systems, with prompts, shared responsibility across teams, and links to support that actually exists. Without that organisational backing, raising the issue of food tends to fall down the priority list, especially on busy clinic days.

Trust makes disclosure possible

You can’t script disclosure about food insecurity. People tend to talk when they feel listened to and not judged.

Shifts in practice, even just small changes in language came up repeatedly. A nurse replacing ‘Why aren’t you following the diet?’ with ‘What gets in the way?’ or a GP explaining ‘We ask everyone about access to food, because it can affect diabetes management.’

These shifts matter, they help move conversations away from blame and towards problem‑solving.

There was also a consistent tension between dietary advice and financial reality. Guidance may be clinically sound but still impossible to follow when money is tight. Recommended foods and ideal meal plans don’t always match what someone can afford or access.

Across the evidence, one message stood out, ‘Starting where people are really matters’. Advice framed around better, not perfect is far more likely to support engagement than aiming for an ideal that feels unreachable.

This isn’t something clinicians can fix alone

Many clinicians described feeling unsure where to send people for help. Knowledge of local food support was often limited or quickly out of date. Some avoided the conversation altogether, worried about raising an issue they couldn’t help with.

Where things seemed to work better was in areas with strong links between health services and community organisations such as food banks, pantries, community kitchens, and social prescribers. Not just signposting, but relationships and connection.

Another common theme was confidence and skills. Here, even when people accessed food support, they didn’t always feel able to turn unfamiliar ingredients into meals that worked for diabetes. Practical, community‑based support, including cooking sessions or simple recipe swaps helped bridge that gap.

What did I learn?

One of the biggest surprises was how rarely food insecurity appeared on its own. Transport costs, prepayment meters, missed appointments, and medication routines were often part of the same picture.

Stigma also ran throughout the existing research. Many people felt blamed for their diabetes and ashamed of needing help with food. Seen in that light, it becomes easier to understand why disclosure feels risky.

Perhaps most surprising was the impact of small system changes. Adding two evidence-based questions to patient records and a clear referral route doesn’t sound transformative. In practice, it can change conversations and access to support in very real ways.

Where I’ve landed

I started with the academic literature. I ended with a clearer sense that while food insecurity shows up in clinical settings, it isn’t something clinicians can or should be expected to solve alone.

If we want better diabetes outcomes, we need systems that make it:

• easier to ask about food
• realistic to respond to what we hear, and
• normal to work alongside community organisations beyond clinic walls.

My review is now published and available here.

If you’ve tried something that worked, or something that didn’t, I’d really like to hear about it. Being open about the messy space between screening and support feels like a good place to start.

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves

Why Community Food Organisations deserve a place in the Child of the North APPG report

Posted by Andrea Burrows, Dr Claire O’Malley, Dr Helen Moore and Professor Amelia Lake, Fuse researchers from Teesside University

Andrea Burrows, Helen Moore with other contributors at the launch of the report in parliament

Across the North of England, families are facing a dual crisis: rising food insecurity and growing food waste. In response, Community Food Organisations (CFOs) - like social supermarkets and pantries - are stepping up in powerful, community led ways. These aren’t just places to get food. They’re places of dignity, connection, and hope.

But despite their growing role, CFOs are still flying under the radar. They’re under-researched, inconsistently defined, and often left out of the bigger policy picture. That’s why they were included in the Child of the North APPG report.

What is the Child of the North APPG?

The Child of the North All-Party Parliamentary Group (APPG) is a cross-party group of MPs, peers, researchers, and practitioners working together to tackle the deep-rooted inequalities affecting children in the North of England. From poverty and poor health to educational disadvantage, the APPG is committed to finding evidence-based solutions that give every child a fair start in life.

Backed by research from the Northern Health Science Alliance (NHSA), Health Equity North and the N8 Research Partnership, the APPG has already produced influential reports on the cost of living, education, and health. Now, it’s time to shine a light on food, and the role CFOs can play in transforming communities and the lives of children.

A different kind of food support

Unlike traditional food banks, CFOs operate more like supermarkets, offering surplus food at low prices. Often delivered in a familiar, retail-style setting, this model not only reduces food waste but also gives people choice and dignity in how they access food. It’s a far cry from the stigma that can come with emergency food aid.

Research shows that this approach better meets the needs of people experiencing food insecurity. It empowers them, rather than making them feel like recipients of charity.

One model, many faces

CFOs are incredibly diverse. Some are membership-based and serve specific groups; others are open to all. Some offer wraparound support like job training or help with household income; others focus purely on food. This flexibility is a strength, it not only allows CFOs to adapt to local needs, but it also makes it hard to evaluate their impact or share what works best.

"Community Food Organisations... aren’t just places to get food. They're places of dignity, connection, and hope."

A recent review led by by colleague Claire O'Malley (currently under review) found that there’s no single definition of a social supermarket. And many operate informally, relying on local relationships and community goodwill to source food. This makes them agile, but also vulnerable.

Why now?

Since the pandemic, food insecurity has increased, especially in the North. But so too has the rise of CFOs. In the North East and North Cumbria, there are now 67 social supermarkets. In the North East town of Middlesbrough alone, the number of Eco Shops, the dominant social supermarket model, has jumped from nine in 2021 to 28 in 2025.

This growth shows just how much communities value these spaces. But it also raises urgent questions:

• How can we make these models sustainable?
• What support do they need to thrive?
• How do they fit into the bigger picture of public health and food policy?

Why the Child of the North report matters

Including CFOs in the report will:

• Raise national awareness of their role and potential.
• Create shared definitions and standards to help evaluate impact.
• Highlight best practices and support scaling of successful models.
• Ensure CFOs are recognised as part of the wider food and health system - not just a stopgap.

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves. CFOs are already making a difference. With the right recognition and support, they could transform community support with accessible, socially accessible methods of community aid.

About the authors:

Andrea Burrows is a Research Associate at Teesside University and a Fuse Associate member

Dr Claire O'Malley is a Research Associate at Teesside University and a Fuse Associate member

Helen Moore is an Associate Professor at Teesside University and a Fuse Associate member

Amelia Lake is Professor of Public Health Nutrition at Teesside University, Deputy Director of Fuse, the Centre for Translational Research in Public Health, a dietitian and public health nutritionist.

Sustainable diets must be a public health priority

Guest post by Tom Embury, Public Affairs Officer at the British Dietetic Association

The publication this week of the EAT-Lancet Commission report on healthy diets from sustainable food systems makes it clear that our health and the planets are inextricably linked. As such, improving the sustainability of our diets must be a public health priority. This is something that the British Dietetic Association (BDA) has recognised for some time, and we have recently launched our One Blue Dot toolkit to help dietitians, as key public health actors, deliver on that priority.

Pale Blue Dot - photograph of Earth taken by the Voyager 1 space probe

One Blue dot – the only home we have

The BDA chose to name our Environmentally Sustainable Diets Toolkit 'One Blue Dot' for the famous image taken by Voyager 1. It is of the Earth from a distance over 3.5 billion miles, and in it our planet appears as a pale blue speck, less than one pixel wide, in the vast darkness of space. The astronomer Carl Sagan said of the image:

"To my mind, there is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly and compassionately with one another and to preserve and cherish that pale blue dot, the only home we've ever known"

Our eating habits are having an adverse impact on the environment and we are endangering the future of the planet – up to 30% of greenhouse gas emissions (GHGe) come from the production of food – and it’s the only one we’ve got. We also know that our current food system is not providing for human health either. Over 800 million people worldwide still do not have enough to eat, while nearly two billion are now overweight or obese.

We believe that eating more sustainably can be a win-win – good for us and good for the planet. It’s also the responsible thing to do. As Ursula Arens, one of the dietetic experts who helped us write the toolkit put it: "Eat healthily for you, eat sustainably for your grandchildren".

Practical help

The BDA’s 2017 policy statement on sustainable diets emphasised the central role we believe dietitians need to play, translating the complex science of environmental sustainability as it relates to food into practical dietary advice for patients and the public at large. The statement was well received by our members but they also made it clear that we needed to do more to support them to make this policy a reality. This is a big topic and can be daunting, not just for the public but for healthcare professionals as well. That is why the idea for a toolkit was born, designed to provide a summary of the key evidence, some practical tools and links for more advice.

So far, we’ve developed a comprehensive reference guide which looks in detail at the key elements of a sustainable diet, outlines the evidence on the impact of certain foods on areas like GHGe, land use and water use. We’ve included practical meal swaps, which highlight the relatively easy ways in which common meals can be made both more nutritious and have less impact on the environment. We then include detailed information on specific nutritional considerations, in particular those nutrients that may be lacking if red meat is reduced and dairy intake moderated, such as calcium, iron and iodine.

Key recommendations

The main two recommendations within the toolkit are to reduce red and processed meat (RPM), and to moderate dairy intake. These two actions will lead to the biggest reduction in GHGe in particular, and we know that there are positive health benefits from reducing RPM and shifting away from certain dairy sources such as cheese which have high environmental impact and are also typically high in saturated fat and salt.

Other considerations, like sourcing sustainable fish, eating more fruit and veg, consuming locally produced food and reducing food waste will also make an important contribution to public health. No one action will be enough on its own. It becomes clear once you delve into the science and evidence on sustainable diets just how complex this issue is, and that even seemingly innocuous differences in the way (or indeed where) food is produced makes a big difference to its environmental impact.

What next

This toolkit is not finished; it remains a live document which we hope to add to and update over the coming months and years. While the first part is focused on dietitians themselves, we know that the next phase will be to make this a public health message. We’ve already got some more materials planned, and been delighted with all the questions and suggestions from dietitians and others about what we could look to include in future iterations. If you have any further suggestions, including on how this message can be translated for public health audiences, they’re very welcome!

We know that changing our diets alone will not save the planet - we also need to make big changes in transport, energy, waste and many more besides. However, as the experts in diet and health, it’s the area in which we have the expertise to make the biggest difference.

You can find out more about the One Blue Dot toolkit on the BDA website: www.bda.uk.com/onebluedot

Image: 'Carl-Sagan-Pale-Blue-Dot' by Owen Iverson via Flickr.com, copyright © 2006: https://www.flickr.com/photos/oweniverson/4671868416