Research article
Neighborhood Food Environments and Body Mass Index: The Importance of In-Store Contents

https://doi.org/10.1016/j.amepre.2009.04.024Get rights and content

Background

Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior.

Purpose

This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents.

Methods

Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area.

Results

After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI.

Conclusions

Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.

Introduction

Obesity is the most pressing nutritional problem in the U.S. A number of researchers have studied the relationship between neighborhood food environments and the consumption of foods that might affect weight status.1, 2, 3, 4, 5 Researchers have also explored the direct relationship between retail outlets and weight status. A Massachusetts study found that the presence of a supermarket in a ZIP code area was associated with a reduced risk of obesity among area residents.6 Using census-tract data from four states, it was found7 that the presence of a supermarket was associated with a lower prevalence of obesity or overweight status. Another study8 found that the ZIP code–level concentration of chain supermarkets was associated with reduced BMI and overweight among a national sample of U.S. adolescents.

Although these studies have advanced the field of neighborhood analysis, more work is needed to understand the nuances of context. The marketing literature has long realized the importance of shelf-space in affecting consumer behavior,9, 10, 11, 12 yet this aspect has rarely been considered in public health studies on the neighborhood food environment. For example, it has been found10 that doubling the shelf-life of fruits and vegetables resulted in sales increases of about 45%; other studies9, 12 have also documented increased sales resulting from shelf-space manipulations for a wide variety of foods. A second gap in the public health literature is that most of it has focused on supermarkets, but in urban neighborhoods, stores other than supermarkets might play an important role in consumption. A third issue is that geographic scale has not been well explored in these studies. The census tract may be too small an area, because many residents are likely to shop outside the tracts in which they live. ZIP codes or counties may be too broad, particularly for urban residents.

This paper seeks to develop our understanding of the link between weight status and the neighborhood food environment. Environments are characterized at various distances around an individual's residence by summing the shelf-space of specific foods—fruits and vegetables and energy-dense snack foods—in all area stores. BMI is hypothesized to be inversely associated with the availability of fruits and vegetables and positively associated with the availability of energy-dense snack foods.

Section snippets

Study Sample

This study is part of a larger project on neighborhood alcohol and food environments and their relationship to consumption and health outcomes.13 The sample frame consisted of all urban census tracts within a 26-parish (county) area of southeastern Louisiana, and it included the cities of New Orleans, Baton Rouge, and Lafayette. Urban tracts were defined as those that had a population density of ≥2000 people per square mile. Of the 379 urban tracts in this area, 114 were randomly selected for

Results

Two thirds of respondents were women and >60% were aged ≤50 years (Table 1). About half of respondents were white, 42% were African-American, and 5% were Latino. The rate of car ownership in the sample was 88%. Table 1 also presents overall means of BMI. African Americans have a higher mean BMI than whites. Respondents who were aged >50 years had higher BMIs than respondents aged ≤30 years.

The most frequently observed stores in the in-store survey were the gas/convenience/drugstores (n=133),

Discussion

The neighborhood availability of energy-dense snack foods within 1 kilometer of an individual's residence was positively associated with BMI, after controlling for individual- and household-level characteristics. An additional 100 meters of shelf-space for snack foods was associated with an increase in 0.1 BMI units. At this rate, an increase equivalent to 1 SD in the neighborhood shelf-space of energy-dense snack foods would translate to about two extra pounds for a person who is 5′5″.

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