Nutrition And Public Health Problem

The prevalence of obesity has risen at an alarming rate over recent years. Professional are trying to understand the mechanism behind America’s obesity epidemic. On a simplistic level, when one consumes an excess amount of energy compared to those expended it creates a positive caloric imbalance.1 This imbalance causes an individual to gain weight and ultimately could result in obesity. Research is focusing on finding contributing factors, other than simply caloric consumption, playing a role in the rise of obesity. People are realizing along with personal factors, environmental factors can also contribute to losing or maintaining weight, in both short and long-term time frames.

A study found that participants were able to maintain their weight and have longer lasting effects when their environment facilitated a healthy diet. More research is showing that environmental factors have an effect on obesity, specifically an individual’s built environment.Built environments are the human-made environmental surroundings, including homes, schools, workplaces, highways, sidewalks, urban sprawl, and air pollution. It can include, not only one’s physical environment, but also policy and social or cultural environment. An individual’s built environment could deter or promote a healthy lifestyle. For example, the walkability of a neighborhood, comprising of the safety and suitability of sidewalks for walking or biking, could impact physical activity or accessibility to healthy food.

Food access is another part of built environments. Studies have found a connection between increased access to fast-food or convenience stores and a rise in BMI and obesity risk.2 In contrast, those with increased access to supermarkets are associated with having a decrease in BMI and obesity risk. Supermarkets characteristics, such as store size, freshness, quality, and pricing, have an impact on a consumer’s consumption of healthy and unhealthy food.1,4 Krukowski examined if demographic factors of a store neighborhood would influence the availability and price of healthy foods by using the Nutrition Environment Measures Study-Store (NEMS-S).4 The study found the overall price of healthier foods were significantly higher in price than the standard, less healthy items. Also, the availability of healthier foods, such as low-fat milk, was lower at stores in neighborhoods with a lower average income.

Multiple studies have also found that low-income neighborhoods are less likely to have supermarkets and an increase in obesity.1,4 From these results of this study, a possible area of intervention is low-income neighborhoods and finding ways to incorporate healthier food options at a lower price. It is common thought that convenience stores have more availability of energy dense, nutrient poor foods. Therefore, a study looked at how in-store contents affected BMI. The availability of energy-dense foods within about half a mile of one’s home was positively associated with BMI.5 An increase of 100 meters of snack food shelf space was linked to an increase of 0.1 units in BMI. Energy dense foods include salty snacks, candies, and soda. The increase of a food can drive one to impulsively buy energy dense snack foods causing greater calorie intake. This study did not find an association between produce availability and BMI.

This could be due to the fact an individual usually doesn’t impulsively buy fruits or vegetables because produce frequently requires cooking or preparation. Increasing shelf space of fruits and vegetables will ultimately take away shelf space from energy-dense snack foods, leading to less unplanned purchasing and lower energy intake. Marketing research has found that shelf space is a large factor in people’s purchasing decisions.5 While, individuals may not shop at every store around them, more shelf-space availability in a neighborhood creates more opportunities for a consumer to decide when and where to buy certain foods. With more freedom in choices and convenience, it can help make easier and healthier decisions.

Research has found that the presence of a supermarket in one’s zip code has been associated with a lower obesity risk.5 Usually, supermarkets have greater availability to healthy options, therefore, allowing individuals near the supermarket to attain a healthy weight.5 Fruit and vegetable intake may contribute to a healthy weight though it is uncertain if this is solely due to the increase of produce consumption from phytochemicals or antioxidants or the reduction of total energy intake.6 Although it is clear that convenience stores offer increased amounts unhealthy options, which makes it harder for individuals to maintain a healthy weight. A study found that corner stores do have lower availability of healthy options compared to supermarkets.

The ratio of shelf space for healthy to unhealthy foods was 0.18 to 0.30 in corner stores and 0.55 to 0.71 in supermarkets. The availability of healthy and unhealthy food may play a role in poorer diet choices due to an increase in caloric intake leading to a rise in body weight. To lower the risk of obesity and comorbidities, certain urban, low to moderate income neighborhoods could particularly benefit in the improvement of food availability. When looking at a prevention strategy, one must look at the impact and feasibility of project.  It is impossible to just increase the number of supermarkets in an environment. However, professionals can focus on prevention strategies within a corner store since it is feasible and impactful, if done correctly. Within corner stores, initiatives can be done to change the amount of healthy and unhealthy options available.

Possible interventions include giving corner store owners incentives to renovate the store and provide healthier options by using Healthy Food Financing Initiatives or other state initiatives.6 Another intervention is using co-ops to help corner stores get fresh produce at a reduced price.6 Although, it is also important to understand how the community feels about the prevention strategies to be successful. A longitudinal cohort study examined different variables of neighborhood food availability and how it affected BMI over time.6 Zenk found that increased availability to a small grocery store was associated with a rise in BMI. In contrast, the Farmington Heart Study Offspring Cohort Study found that a shorter distance to any size grocery store was associated with a decrease in BMI over time.

Zenk also found no association between BMI and access to large grocery stores, convenience stores, or the number of stores carrying fresh produce. However, there was an association between a lower BMI and one’s views of better neighborhood access to fruits and vegetables.6 While many believe access is the main determinant of healthy food intake, perceptions may have a larger role in one’s intake. Zenk states “it is possible that perceptions more accurately reflect fruit and vegetable access than the observational data, for example, capturing quality and price, in addition to fruit and vegetable availability”. Another longitudinal study measured a neighborhood’s healthy food availability based solely on the community’s views.

The study found that an increase of one standard deviation in the average score was associated with a ten percent decrease in the incidence of obesity.5 When focusing on an intervention, one needs to factor in not only availability but also price and quality of the healthier options and the community’s views on these issues. The prevention strategy focused on corner stores must fit into what the community both needs and wants. When making a community-based change one must gather information and opinions from multiple sources to ensure the change will benefit the majority of the population living in the area.

Steps can include building a strong foundation in the community, identifying your main audience, listening the what the audience wants and needs, developing a strategic plan to implement the change, and monitoring and evaluating the change for improvements in the future.  As an example, a corner store initiative was recently completed in Lexington. A main focus people in the neighborhood stated they wanted was a cleaner and more aesthetically pleasing store.  The outside of the store and floors inside were renovated. More shelf-space was utilized for quality produce throughout the store. Fresh fruit was stationed near the cash register to increase healthy food purchasing and decrease energy-dense snack food impulse buying. Double dollar vouchers were issued to SNAP users to increase their produce purchasing.

With community suggestions and quality research, a success prevention strategy was able to be reached. A built environment contains multiple parts that could be barriers or initiators of a healthy lifestyle. To make a sustainable and impactful prevention strategy, research on the subject is a necessity. Another requirement often overlooked is what the residents in the neighborhood perceive as a barrier to a healthy lifestyle and what they believe would benefit the community. While monitoring and evaluating the intervention, people can assess which strategies worked and which didn’t, therefore continuously improving them to better the community. Working with the community and understanding their perceptions are ways to combat obesity and maintain a healthy lifestyle.