According to a report by the Urban Institute, a higher density of grocery stores that offer less healthy options is associated with a higher prevalence of obesity.
"We believe that areas with a high prevalence of obesity may influence the types of grocery stores that offer less healthy options, even controlling for differences between countries," Elaine Waxman, LP, PhD, senior research institute. The Center for Income and Benefit Policy and colleagues wrote in the study, "The link between obesity and healthier eating patterns holds true in both rural and urban settings."
The importance of the food environment
The researchers decided to do the study because "with the rapid growth of obesity, there's been a lot of focus on individualized interventions: the medications they can take, the surgeries they can have, the ways they can change their diet," he said. Waxman. MedPage Today. phone conversation
"These are all important parts of the answer, but they miss the structural issues," Waxman continued. "So we've been working to address the issues, if your food environment is generally less healthy choices, that limits your ability to make better choices for yourself. It's an effective framework for creating public policies."
The authors analyzed data on obesity from 2017 and 2018 in the Obesity Factor Surveillance System, a telephone survey that collects information on chronic diseases. "To provide information at the country level, we used the CDC PLACES 2021 publication, an effort to publish information for local areas at a uniform scale," they said.
The grocery store information is 2019 data from Data Axle, a national database of approximately 25 million businesses. The authors examined regional variation in the number of establishments per 1,000 population and identified different types of food establishments, including grocery stores, other grocery stores (including specialty grocery stores), convenience stores, warehouse clubs, convenience stores, including dollars and other departments. . grocery stores (including Walmart, Target, etc.), pharmacies, and gas stations. Stores that did not sell food were excluded.
"We did not include farmers' markets in our analysis, although they can be an important supplement to healthy food offerings in local communities," they said. "Since the majority of food purchases in the United States are made in stores, we prioritized our analysis of these businesses."
They didn't pay much attention to the restaurants either. "What we decided to focus on in this file is how people can buy food to cook at home," Waxman said. "It's something people are going to hear from health care providers. 'What can you cook at home?'" However, the report includes a map that shows how the relationship between obesity and food density changes when restaurants are added to the mix. food facilities, he said.
Low density of food facilities in urban areas
The researchers noted that obesity, while common in the United States, varies greatly from country to country. "The highest rates of obesity in the United States are concentrated in the southern states, especially in parts of Texas, Louisiana, Mississippi, Kentucky and West Virginia. The lowest rates of obesity are concentrated in the western states, especially in parts of Colorado and Wyoming. ..., California and Nevada" .
The researchers found that the highest rates of food establishments per 1,000 residents were found in the most rural areas of the country, from North Dakota to Texas and parts of Maine, Idaho and Texas. 'Oregon'. On the other hand, countries with fewer food establishments per 1,000 inhabitants were mostly located in areas with higher population density. For example, the average rural district would have 9 grocers per 5,732 residents, or about 1.57 grocers per 1,000 people. On the other hand, the average non-rural county would have 42 retail food establishments per 36,971 residents, or about 1,14 food establishments per 1,000 residents.
Combining data on food companies with data on obesity, the researchers found that "on average, countries with high obesity rates have more food establishments per 1,000 inhabitants (1.40), compared to countries with moderate obesity rates 1.29 and low obesity rates 1. compared to .29. . in lower level countries. . institutions by population (1.11). These differences are statistically significant in our regression analysis even after controlling for other country-level characteristics.
They found that countries with higher obesity rates also tend to have more stores. "The difference between high and low obesity areas is particularly large, with high obesity areas averaging $0.24 per 1,000 residents and low obesity areas just $0.09 per 1,000 residents. '
Waxman said he was surprised by "the differences between what we call healthy and unhealthy foods and the high and low levels of obesity. "Hey, if we want to look at the areas with the most obesity, what we're seeing is that they're going to have unhealthy food options, mostly packaged and highly processed foods.
Dollar stores. challenges and opportunities
Dollar stores present a challenge and an opportunity for authors. "Although dollar stores are less likely to carry healthier foods like fruits and vegetables, a recent study found that when available, these items are more expensive than neighborhood grocery stores. Researchers suggest that dollar stores can be viewed as a potential asset to the community. Access to healthy foods affordable creation
One chain, Dollar General, has launched a strategy to increase healthy food options in its stores, although the program won't reach most of its stores in the short term, they said. "Dollar stores may be one of the few business entities willing to expand into areas where demand is limited, so it's important to think about the role they can play in providing access to healthy, affordable food in the future. Grow."
Clinicians can use the research as a reminder of who is involved in their patients' diets, Waxman said. "Health professionals are often unable to advise patients to eat better and there is often not enough awareness in the health sector of what the barriers are; it can be as cheap and easy as the one around you. Thinking is not enough. it's an individual health problem, it's also a population problem."
In this sense, "there are definitely communities where the health system is starting to increase the availability of affordable housing, recognizing it as an important source of stability and getting people into SNAP [Supplemental Nutrition Assistance Program, formerly known as food stamps]," he says, " And if you're in a rural hospital or serving a community of color where [food] options are limited, you can be part of the community response conversation."
Policymakers can also approach this question in a number of ways, Waxman said. For example, the United States Department of Agriculture runs the Gus Schumacher Nutrition Incentive Program (GusNIP), a competitive grant program that pays states and localities to increase the value of SNAP benefits when used to purchase fruits and vegetables. While many GusNIP programs are in areas with high obesity rates, other such areas still lack programs, he said.
Investing in health food funding is another way to bring in health food stores, and local lawmakers could also consider passing zoning laws that favor healthy food businesses over unhealthy ones, as has been done in some states.