Affordability and Obesity: Issues in the Multifunctionality of Agricultural/Food Systems

Relative Density of Away from Home Food Establishments and Food Spend for 24,047 Households in England: A Cross-Sectional Study

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health.

Global warming and obesity: a systematic review

Global warming and the obesity epidemic are two unprecedented challenges mankind faces today. A literature search was conducted in the PubMed, Web of Science, EBSCO and Scopus for articles published until July 2017 that reported findings on the relationship between global warming and the obesity epidemic. Fifty studies were identified. Topic-wise, articles were classified into four relationships - global warming and the obesity epidemic are correlated because of common drivers (n = 21); global warming influences the obesity epidemic (n = 13); the obesity epidemic influences global warming (n = 13); and global warming and the obesity epidemic influence each other (n = 3). We constructed a conceptual model linking global warming and the obesity epidemic - the fossil fuel economy, population growth and industrialization impact land use and urbanization, motorized transportation and agricultural productivity and consequently influences global warming by excess greenhouse gas emission and the obesity epidemic by nutrition transition and physical inactivity; global warming also directly impacts obesity by food supply/price shock and adaptive thermogenesis, and the obesity epidemic impacts global warming by the elevated energy consumption. Policies that endorse deployment of clean and sustainable energy sources, and urban designs that promote active lifestyles, are likely to alleviate the societal burden of global warming and obesity.

Obesity and economic environments

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). It suggests that if one wants to understand the role of the environment in the obesity epidemic, one needs to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the United States and this may continue until the role of environmental factors is accepted more widely. As opinion leaders, clinicians play an important role in shaping the understanding of the causes of obesity.

Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum

OBJECTIVE

Many recent policies focus on socioeconomic inequities in availability of healthy food stores and restaurants. Yet understanding of how socioeconomic inequities vary across neighbourhood racial composition and across the range from rural to urban settings is limited, largely due to lack of large, geographically and socio-demographically diverse study populations. Using a national sample, the authors examined differences in neighbourhood food resource availability according to neighbourhood-level poverty and racial/ethnic population in non-urban, low-density urban and high-density urban areas.

DESIGN

Cross-sectional data from an observational cohort study representative of the US middle and high school-aged population in 1994 followed into young adulthood.

PARTICIPANTS

Using neighbourhood characteristics of participants in the National Longitudinal Study of Adolescent Health (Wave III, 2001-2002; n=13 995 young adults aged 18-28 years representing 7588 US block groups), the authors examined associations between neighbourhood poverty and race/ethnicity with neighbourhood food resource availability in urbanicity-stratified multivariable linear regression.

PRIMARY AND SECONDARY OUTCOME MEASURES

Neighbourhood availability of grocery/supermarkets, convenience stores and fast-food restaurants (measured as number of outlets per 100 km roadway).

RESULTS

Neighbourhood race and income disparities were most pronounced in low-density urban areas, where high-poverty/high-minority areas had lower availability of grocery/supermarkets (β coefficient (β)=-1.91, 95% CI -2.73 to -1.09) and convenience stores (β=-2.38, 95% CI -3.62 to -1.14) and greater availability of fast-food restaurants (β=4.87, 95% CI 2.26 to 7.48) than low-poverty/low-minority areas. However, in high-density urban areas, high-poverty/low-minority neighbourhoods had comparatively greater availability of grocery/supermarkets (β=8.05, 95% CI 2.52 to 13.57), convenience stores (β=2.89, 95% CI 0.64 to 5.14) and fast-food restaurants (β=4.03, 95% CI 1.97 to 6.09), relative to low-poverty/low-minority areas.

CONCLUSIONS

In addition to targeting disproportionate fast-food availability in disadvantaged dense urban areas, our findings suggest that policies should also target disparities in grocery/supermarket and fast-food restaurant availability in low-density areas.