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In the USA, a wide variety of affordable, nutritious food, such as vegetables, fruits, whole grains and lean proteins, found in supermarkets is often less available in economically deprived neighbourhoods compared with more affluent neighbourhoods.1–3 At the same time, availability of inexpensive, energy-dense nutrient-poor foods, such as salty snacks, sweets and non-diet soft drinks found in convenience stores (fig 1A) are highly prevalent in deprived neighbourhoods.4 5 This double burden (lack of affordable, nutritious foods, combined with a plethora of inexpensive, unhealthy foods) is thought to contribute to high rates of obesity and its deleterious consequences, including diabetes, hypertension and cardiovascular disease, which are also more prevalent in deprived neighbourhoods. Compounding this burden are the challenges faced by people with low incomes (those most likely to live in deprived neighbourhoods) to find sufficient time, energy, and financial resources to pursue lifestyles that support healthy dietary habits and adequate physical activity in safe environments. These constraints are given little attention in the research literature. Furthermore, innovative resources that residents of deprived neighbourhoods often mobilise to enhance their health, such as transporting local produce directly to residents (fig 1B), are rarely acknowledged.
This study was funded as part of the National Institute of Environmental Health Sciences Initiative, in collaboration with six other National Institutes of Health (National Heart, Lung, and Blood Institute grant R01 HL67731 to Dr Winkleby). We wish to thank Alana Koehler for technical and administrative assistance.