Obesity prevalence and the local food environment
Introduction
Over the past decade, researchers have investigated the associations between food environments, diet, and health outcomes. Studies have demonstrated that access to food stores and restaurant types differ by neighborhood characteristics, such as socioeconomic and race/ethnic composition (Sooman and Macintyre, 1993; Wechsler et al., 1995; Fisher and Strogatz, 1999; Morland et al., 2002a; Zenk et al., 2005a; Horowitz et al., 2004; Austin et al., 2005; Block et al., 2004; Lewis et al., 2005; Cummins et al., 2005; Moore and Diez Roux, 2006; Galvez et al., 2007; Morland and Filomena, 2007). In addition, investigators have measured associations between the types of food stores (ex. supermarkets, small grocery stores) and restaurants (ex. full service, fast food) available in areas and the dietary intake of residents. For instance, Laraia et al. (2004) found pregnant women living in areas with fewer supermarkets had poorer diets. Similar results have been found in other populations (Morland et al., 2002b; Zenk et al., 2005b). The association between neighborhood availability of healthy affordable foods and dietary intake has been further supported by school-based interventions where exchanges for healthier foods were associated with better diets among children (French and Stables, 2003; Gortmaker et al., 1999).
Fewer studies have demonstrated the association between the local food environment and diet-related health outcomes. Inagami et al. (2006) evaluated the relationship between body mass index (BMI), neighborhood disadvantage, and distance to grocery stores. They found that BMI was higher when individuals shopped for groceries in more disadvantaged neighborhoods, but the effect was not influenced by the location of worship, medical care, entertainment, or work. These findings suggest a unique relationship between neighborhood socioeconomic status of grocery store and BMI. Morland et al. (2006) studied the association between the location of supermarkets and other food stores and the prevalence of obesity among men and women living in Mississippi, Maryland, North Carolina, and Minnesota. Authors found that adults living in areas with supermarkets had a lower prevalence of obesity compared to adults who lived in census tracts with no supermarkets. Alter and Eny (2005) found the density of fast food restaurants to be associated with cardiovascular events in Canada. In the United States, Maddock (2004) used state-level data to demonstrate a correlation between the density of fast food restaurants and state-level obesity prevalence. Finally, among a younger population, Sturm and Datar (2005) measured the association between changes in food prices, per capita number of restaurants and food stores with changes in BMI among children K-3rd grade. The authors found that fruit and vegetable prices were inversely associated with BMI.
All of these studies have made important contributions to the public health literature by beginning to provide empirical evidence of (a) disparities in access to healthy foods, (b) the impact of environmental factors on individuals’ behaviors, and (c) the impact on subsequent diet-related health conditions. Because few published studies have linked the disparities in the types of food stores and restaurants with health outcomes, this study aimed to measure the association between neighborhood availability of food stores and cardiovascular health among adults living in the southern region of the United States. Because of these findings from other investigators (Inagami et al., 2006; Morland et al., 2006; Alter and Eny, 2005; Maddock, 2004; Sturm and Datar, 2005), we hypothesized that a higher prevalence of supermarket and a lower prevalence of small grocery stores and fast food restaurants would be associated with a lower prevalence of obesity among adult residents. Moreover, we hypothesized that those individuals living closer to supermarkets, as well as those living further from small grocery stores and fast food restaurants, would have lower BMIs.
Section snippets
Source population
From January to July 2003, a cross-sectional study was carried out in which a random digit dialed phone survey of the non-institutionalized adult population in two distinct geographic locations (Forsyth County, NC, and the city of Jackson MS) was conducted. A disproportionate sampling strategy was adopted for the Forsyth County, NC sample frame in order to ensure representation for areas outside of the Winston–Salem metropolitan area (but within the county). A further description of the study
Results
The mean age for participants was 48 years and the majority of participants were women (64.7%) and white (61.5%) (Table 1). Almost half of the participants were married (49.4%) and approximately two-thirds were currently employed (63.0%). Over two-thirds had an education beyond high school (67.8%). The mean BMI was 27.8 kg/m2 with over a quarter of the population being obese (26.6%). The average distance to the nearest supermarket was farther than the nearest franchised fast food restaurant
Discussion
Investigators have been interested in the factors associated with dietary choices for many years. Furthermore, the structural influences of neighborhood availability of healthy foods have been considered a factor for the past 20 years (Turrell, 1996; US House of Representatives Select Committee on Hunger, 1987, US House of Representatives Select Committee on Hunger, 1992). Our study is placed in a small body of research, where investigators are beginning to measure the associations between the
Acknowledgements
This study was funded by a grant from the American Heart Association. The authors thank Fang Wen and Susan Filomena for their assistance. K. Morland was funded in part by the National Institutes of Environmental Health Sciences grant R25 ES014315 under the “Environmental Justice Partnerships for Communication” program.
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