Longitudinal geo-referenced field evidence for the heightened BMI responsiveness of obese women to price discounts on carbonated soft drinks

There is increasing interest in the effect that food environments may have on obesity, particularly through mechanisms related to the marketing and consumption of calorie-dense, nutrient-poor foods and sugary beverages. Price promotions, such as temporary price discounts, have been particularly effective in the marketing of carbonated soft drinks (CSDs) among consumers. Research has also suggested that the purchasing behavior of consumer groups may be differentially sensitive to price discounts on CSDs, with obese women particularly sensitive. In addition, the intensity of price discount in a person’s food environment may also vary across geography and over time. This study examines whether the weight change of obese women, compared to overweight or normal BMI women, is more sensitive to the intensity of price discounts on CSDs in the food environment. This study used longitudinal survey data from 1622 women in the Montreal Neighborhood Networks and Health Aging (MoNNET-HA) Panel. Women were asked to report their height and weight in 2008, 2010 and 2013 in order to calculate women’s BMI in 2008 and their change of weight between 2008 and 2013. Women’s exposure to an unhealthy food environment was based on the frequency in which their neighborhood food stores placed price discounts on CSDs in 2008. The price discount frequency on CSDs within women’s neighborhoods was calculated from Nielsen point-of sales transaction data in 2008 and geocoded to participant’s forward sortation area. The prevalence of obesity and overweight among MoNNET-HA female participants was 18.3% in 2008, 19.9% in 2010 and 20.7% in 2013 respectively. Results showed that among obese women, exposure to unhealthy food environments was associated with a 3.25 kilogram (SE = 1.35, p-value = 0.02) weight gain over the five-year study period. Exposure to price discounts on CSDs may disproportionately affect and reinforce weight gain in women who are already obese.

Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya

The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.

An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index (Food-EPI) in Japan

Objective: This study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI). Design: Public health experts rated the extent of implementation of food environment-related the Policy and the Infrastructure-support components, compared to international best practices. Subsequently, the experts proposed and prioritized future actions to address implementation gaps in an online workshop. Setting: Japan Participants: A total of 66 experts rated policy implementation by the Japanese Government, and 23 participated in the workshop on future actions. Results: The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling, Food promotion, Food prices, and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components. Conclusions: This study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared to international best practices. This study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales, and accessibility of unhealthy foods and non-alcoholic beverages are needed to improve the health of food environments in Japan.

A Food Box Intervention to Reduce Blood Pressure in Native American Adults With Hypertension: The CHEERS Study

Diet-related chronic diseases, such as hypertension and obesity, are prevalent in Native American (NA) communities where poor food environments are prominent and healthy food access is limited. The Chickasaw Healthy Eating Environments Research Study (CHEERS) is an NIH-funded study aimed to improve Body Mass Index and blood pressure control among NA adults with uncontrolled hypertension. This multi-level randomized trial, guided by a community-based participatory research orientation, was co-created by tribal and university partners and is implemented within the Chickasaw Nation of Oklahoma. We created hypertension-specific food boxes that contained DASH diet foods, coupons for purchasing vegetables and fruits, educational materials, and heart-healthy recipes for supporting healthy eating. Food boxes were packed and shipped monthly to intervention participants with a 30-day supply of: one fruit serving/day, one vegetable serving/day, one serving of unsalted nuts or seeds/day, one serving of beans or lentils/day, and two servings of fatty fish/week. We will present our participatory approach in co-developing the CHEERS study methods, findings with a focus on older adults, and lessons learned. CHEERS is the first innovative food box intervention to be conducted in NA communities. Food box interventions show promise in improving dietary intake and reducing hypertension and obesity in rural and poor food environments.

Food Insecurity, Food Environments, and Disparities in Diet Quality and Obesity

Food insecurity is a public health concern that is associated with poor diet and obesity. Poor food environments with low access to healthy, affordable food may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of 6,395 older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive. Weighted regression models were estimated to examine the relationship between food insecurity and food environments with diet quality and obesity. Both food insecurity and poor food environment were associated with lower healthy eating index scores, indicating poorer quality diet. Food insecure older adults were more likely to be obese than food secure older adults and poor food environments exacerbate the negative impact of food insecurity on obesity risk. However, there was no statistical difference in obesity risk by food environment among food secure respondents. Findings from this study highlight the negative impact of limited access to healthy food due to financial difficulties and/or poor food environments on diet quality and obesity risk. Providing financial or nutritional supports along with efforts to promote healthy food environment may reduce disparities in diet quality and obesity. Special support should be provided to food insecure older adults with poor food environment, those at the greatest risk of poor diet quality and obesity.

A Direct Assessment of the External Domain of Food Environments in the National Capital Region of India

Data on food environments in India and other low- and middle-income countries are scarce. The objective of this study was to assess the four dimensions of the external domain of food environments (availability, price, vendor and product properties, and marketing) in food establishments in the National Capital Region of India. The assessment focused on fruits, vegetables, and ultra-processed foods. The 60 food establishments surveyed were categorized as stores, restaurants, or mobile food vendors. Only 13.3% of food establishments sold fruits and vegetables. Stores were more likely to sell vegetables than mobile food vendors (14.8 vs. 6.2%, respectively) and sold a greater variety of both fruits and vegetables as compared to mobile food vendors [mean (SD) of 8.6 (3.2) fruits and 18.6 (9.2) vegetables available at stores vs. 5.5 (5.7) fruits and 25 vegetables available at the one mobile food vendor who sold vegetables]. However, these healthy food items were more expensive at stores. The availability (100% of stores, 12.5% of mobile food vendors, and 12.5% of restaurants) and variety (156 types) of ultra-processed foods across food establishments were higher than fruits and vegetables. A greater percentage of food establishments displayed advertisements for ultra-processed foods as compared to unprocessed or minimally processed foods such as fruits and vegetables. The National Capital Region of India has an unhealthy food environment. Regulations that limit the availability of ultra-processed foods and improve the availability and affordability of fruits and vegetables are needed to reverse the rising tide of chronic non-communicable diseases in this setting.

A continuous indicator of food environment nutritional quality

Food environments can profoundly impact diet and related diseases. Effective, robust measures of food environment nutritional quality are required by researchers and policymakers investigating their effects on individual dietary behavior and designing targeted public health interventions. The most commonly used indicators of food environment nutritional quality are limited to measuring the binary presence or absence of entire categories of food outlet type, such as 'fast-food' outlets, which can range from burger joints to salad chains. This work introduces a summarizing indicator of restaurant nutritional quality that exists along a continuum, and which can be applied at scale to make distinctions between diverse restaurants within and across categories of food outlets. Verified nutrient data for a set of over 500 chain restaurants is used as ground-truth data to validate the approach. We illustrate the use of the validated indicator to characterize food environments at the scale of an entire jurisdiction, demonstrating how making distinctions between different shades of nutritiousness can help to uncover hidden patterns of disparities in access to high nutritional quality food.