Research articleNeighborhood Food Environments and Body Mass Index: The Importance of In-Store Contents
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″.
References (24)
- et al.
Proximity of supermarkets is positively associated with diet quality index for pregnancy
Prev Med
(2004) - et al.
Supermarkets, other food stores, and obesity: the Atherosclerosis Risk in Communities Study
Am J Prev Med
(2006) - et al.
Associations between access to food stores and adolescent body mass index
Am J Prev Med
(2007) Self-reported weight and height
Am J Clin Nutr
(1990)- et al.
Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994
J Am Diet Assoc
(2001) - et al.
Strategies for increasing fruit and vegetable intake in grocery stores and communities: policy, pricing, and environmental change
Prev Med
(2004) - et al.
The contextual effect of the local food environment on residents' diets: the Atherosclerosis Risk in Communities Study
Am J Public Health
(2002) - et al.
Food store access and household fruit and vegetable use among participants in the U.S. Food Stamp Program
Public Health Nutr
(2004) - et al.
Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects
Int J Behav Nutr Phys Act
(2007) - et al.
Associations of the local food environment with diet quality—a comparison of assessments based on surveys and geographic information systems: the Multi-Ethnic Study of Atherosclerosis
Am J Epidemiol
(2008)
Neighborhood risk factors for obesity
Obesity (Silver Spring)
The relationship between shelf space and unit sales in supermarkets
J Market Res
Cited by (112)
SAR-Gi*: Taking a spatial approach to understand food deserts and food swamps
2021, Applied GeographyUnderstanding the healthfulness of outlets providing lunch and dinner meals: a census of a rural food retail environment in Victoria, Australia
2021, Australian and New Zealand Journal of Public HealthRegulation of phosphate in health and disease
2021, Fibroblast Growth Factor 23Calorie changes among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017
2019, Preventive Medicine ReportsCitation Excerpt :A growing number of consumers are spending more of their food budget on food purchased at convenience stores and less on food from large restaurant chains (Maze 2017). Efforts aimed at combating diet-related disease should consider the shifting role of convenience stores, which are not only a source of unhealthy snack foods and beverages, but offer an increasing number of prepared foods at low prices (Larson et al. 2009; Morland et al. 2006; Rose et al. 2009). Furthermore, food items sold at convenience stores may be disproportionately consumed by populations at high risk of obesity and related chronic disease.