Research article
Local Food Outlets, Weight Status, and Dietary Intake: Associations in Children Aged 9–10 Years

https://doi.org/10.1016/j.amepre.2010.12.014Get rights and content

Background

The rising prevalence of childhood obesity is a key public health issue worldwide. Limited evidence suggests that there may be interactions between environmental factors at a neighborhood level and the development of obesity, with the availability and accessibility of food outlets being potentially important.

Purpose

To examine how the weight status and dietary intake of 1669 children aged 9–10 years was associated with neighborhood food outlets in a cross-sectional study.

Methods

Availability of food outlets was computed from GIS data for each child's unique neighborhood. Outlets were grouped into BMI-healthy, BMI-unhealthy, or BMI-intermediate categories according to food type sold. Weight status measurements were objectively collected, and food intake was recorded using 4-day food diaries. Data were collected in 2007 and analyzed in 2009.

Results

Availability of BMI-healthy outlets in neighborhoods was associated with lower body weight (1.3 kg, p=0.03); BMI (0.5 kg/m2, p=0.02); BMI z-score (0.20, p=0.02); waist circumference (1.3 cm, p=0.02); and percentage body fat (1.1%, p=0.03) compared to no availability. In contrast, neighborhood availability of BMI-unhealthy outlets was inversely associated with body weight (1.3 kg, p=0.02); BMI (0.4 kg/m2, p=0.05); BMI z-score (0.15, p=0.05); waist circumference (1.1 cm, p=0.04); and percentage body fat (1.0%, p=0.03). Unhealthy food intake (fizzy drinks 15.3%, p=0.04, and noncarbonated “fruit” drinks 11.8%, p=0.03) was also associated with availability of BMI-unhealthy food outlets.

Conclusions

Features of the built environment relating to food purchasing opportunities are correlated with weight status in children.

Introduction

The prevalence of childhood obesity is rising worldwide, and it is now estimated that 10% of the world's school-aged children are overweight.1 This is a major concern given there is evidence that obesity in childhood tracks to adulthood,2 resulting in higher risks of diseases such as diabetes and cardiovascular disease.3, 4

To date, much research and many interventions aimed at reducing childhood obesity have focused on individual-level factors, with the objective of improving dietary intakes and physical activity levels.5 Research, however, has also started to focus on associations between the neighborhood environment and weight status.6 Most of these investigations have focused on the accessibility and availability of food outlets and weight status in adults; the evidence is equivocal. For example, good access to convenience stores and fast-food restaurants has been associated with higher weight status,7, 8, 9 and access to supermarkets with a lower prevalence of obesity.7 Conversely fast-food restaurants and takeout outlets have been found to be unrelated to obesity and BMI,10, 11 and supermarkets have been associated with higher BMI in a deprived neighborhood.8

Studies12, 13 among preschool children in the U.S. have found no associations between overweight or obesity and proximity or access to food outlets. Yet in older children in the U.S., an increased distance between home and the nearest supermarket has been associated with an increased risk for overweight.14 Further, exposure to fast-food outlets has shown to have little impact on obesity in children, or their parents.15 Nevertheless, studies16, 17, 18, 19 that have examined the association between availability of different food outlets and food intake suggest that location and proximity of food retail outlets are significantly associated with improved diet quality.

Inconsistencies in previous findings may be explained by methodologic limitations such as not considering the whole food environment and not controlling for characteristics of the built environment associated with obesity.20 It is noteworthy that in a study20 in the U.S. that aimed to address some of these limitations, densities of healthy-BMI outlets were collectively inversely associated with BMI in adults, whereas densities of outlets categorized as unhealthy, including fast-food restaurants and small grocery shops, were not associated with BMI.

The aims of the current cross-sectional study were to assess if, in a well-characterized population-based sample of children aged 9–10 years, firstly, objectively and intensively measured parameters of children's neighborhood environments were associated with their weight status independently of other characteristics of the built environment known to be potential influences on bodyweight, and secondly, if any observed associations might be attributable to differences in food intake. It was hypothesized that children with availability of BMI-healthy food outlets in their neighborhoods would have more favorable weight status and dietary intake than children with limited availability.

Section snippets

Methods

The current analysis used data from the SPEEDY study (Sport, Physical activity and Eating behavior: Environmental Determinants in Young people). Participant recruitment procedures for this cross-sectional study have been described in detail previously.21 Briefly, children aged 9–10 years were recruited from 92 schools in Norfolk, United Kingdom (UK), during the summer term (April to July), the schools were purposively sampled to achieve maximum environmental heterogeneity. Ethical approval was

Results

Of the 2064 children recruited to the study, full data on GIS variables, anthropometric measurements, dietary intake, physical activity, and parental education was available for 1669 (81%). The mean age was 10.2 years (SD=0.3), and 56% were girls (Table 1). Twenty-three percent of children were found to be overweight or obese, according to cut-offs defined by the International Obesity Task Force.32 Twenty-seven percent of the children lived in neighborhoods with availability of BMI-healthy food

Discussion

As hypothesized, the availability of food outlets classified as BMI-healthy in a child's neighborhood was associated with lower weight status, whereas the converse was found for children with unhealthy food outlets in their neighborhood. These associations remained significant after controlling for aspects of neighborhood environments that are known to be associated with BMI and obesity. These current data also suggest there are aspects of the diet that are significantly associated with

Conclusion

Knowledge of the food environment may be important in targeting policies and interventions to reduce childhood obesity not only at an individual level but also by identifying and overcoming neighborhood barriers to choosing and purchasing healthier foods.

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      In fact, only urban sprawl and land use mix proved to be associated with weight status in North America (Feng et al., 2010; Mackenbach et al., 2014). Another important issue to highlight is that studies specifically about childhood obesity usually focus in either the social (Kinra, Nelder, & Lewendon, 2000) or built environment features (Jennings et al., 2011) separately, neglecting the fact that the contexts in which children (and all individuals) live in are a combination/interaction of both dimensions (Reidpath et al., 2002; Smith & Cummins, 2009). While some researchers believe that environmental features determine individuals weight status (Townshend & Lake, 2017) despite the inexistence of evidence of a causality effect (Garfinkel-Castro et al., 2017), others remain sceptic and cautious about such matter (Feng et al., 2010).

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