Background
National health surveys in the US indicated a higher odds of chronic health conditions, through pathways of food insecurity, financial challenges, and poor disease management. Food assistance programs offer a unique opportunity to address the nutritional needs of participants in light of their health conditions. Characterizing the challenges and opportunities in USFB would be a first step to addressing the health needs of those food insecure.

Objective
The purpose of this systematic scoping review was to characterize the challenges in the USFB and to identify areas for further research and intervention.

Study Design, Settings, Participants
Systematic scoping review.

Measurable Outcome/Analysis
Adhering to the guidelines for systematic scoping review, the search results were reported per the PRISMA guidelines. Five electronic search engines, PubMed, ScienceDirect, Google Scholar, Embase, and Cochrane Library, were searched for articles on USFB or pantries, published between 2013-2023. Intervention studies were excluded.

Results
A total of 96 articles were selected. Themes under operational challenges encompassed supply-chain, partnerships, distribution, and adherence to equity principles. Resource accrual, allocation, and infrastructure that affect food safety and waste were other challenges. Beneficiaries particularly, the elderly, people with disabilities, and refugees, and their unmet needs were documented. During the pandemic the resilience of FBs was tested by lack of trained staff, increased exposure of staff to the virus, and disruptions in the supply-chain. Despite challenges, opportunities such as meeting the health needs of vulnerable demographics, increasing awareness through pantries, testing models for supply efficiency, and inviting donations were identified. Regardless of the opportunities to improve health through USFB, our synthesis revealed a higher representation of articles on operational challenges and limited literature (5 out of 96) on the nutritional needs to manage chronic conditions.

Conclusions
The scope of USFB has evolved, and so have the challenges. Given the established association between food insecurity and the surge of chronic diseases among the poor, our findings prioritize assessment of health needs and evidence-based interventions through the robust food security program.