Mapping dietary habits may provide clues about the factors that determine food choice

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

Sedentariness of College Students Is Negatively Associated with Perceived Neighborhood Greenness at Home, but Not at University

Previous studies reported contradictory evidence for associations between perceived greenness and obesity mediated by physical activity, focusing on people’s homes or general greenness. Data are lacking in other environments. We studied the association of perceived greenness at home and at university with BMI and physical activity. An online survey collected data from 601 participants, living and studying in and around the city of Graz, Austria; mean age of 24 years. Greenness was assessed using questions on quality of and access to green space; Body mass index (BMI) was derived from self-reported measures; physical activity and sedentariness were measured using the IPAQ questionnaire (short version). On average, BMI was 22.6 (SD = 3.7), physical activity was 63.3 (SD = 51.7) METh/week, and participants spent 5.8 (SD = 4.0) h/day sitting. Regression analyses revealed no associations between perceived greenness and BMI and physical activity for all environments, but a negative association for sedentariness and perceived greenness at home, but not at university. The results indicate a relation between perceived greenness and sedentariness, which differs for the home-and study environment.

Geographic disparities in Healthy Eating Index scores (HEI-2005 and 2010) by residential property values: Findings from Seattle Obesity Study (SOS)

BACKGROUND

Higher socioeconomic status (SES) has been linked with higher-quality diets. New GIS methods allow for geographic mapping of diet quality at a very granular level.

OBJECTIVE

To examine the geographic distribution of two measures of diet quality: Healthy Eating Index (HEI 2005 and HEI 2010) in relation to residential property values in Seattle-King County.

METHODS

The Seattle Obesity Study (SOS) collected data from a population-based sample of King County adults in 2008-09. Socio-demographic data were obtained by 20-min telephone survey. Dietary data were obtained from food frequency questionnaires (FFQs). Home addresses were geocoded to the tax parcel and residential property values were obtained from the King County tax assessor. Multivariable regression analyses using 1116 adults tested associations between SES variables and diet quality measured (HEI scores).

RESULTS

Residential property values, education, and incomes were associated with higher HEI scores in bivariate analyses. Property values were not collinear with either education or income. In adjusted multivariable models, education and residential property were better associated with HEI, compared to than income. Mapping of HEI-2005 and HEI-2010 at the census block level illustrated the geographic distribution of diet quality across Seattle-King County.

CONCLUSION

The use of residential property values, an objective measure of SES, allowed for the first visual exploration of diet quality at high spatial resolution: the census block level.

Fast-food intake and perceived and objective measures of the local fast-food environment in adolescents

Objective

We examined associations between fast-food intake and perceived and objective fast-food outlet exposure.

Design

Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures.

Subjects

Data represent 4642 adolescents (aged 11–15 years) in Denmark.

Results

Boys reporting two or more fast-food outlets had 34 % higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (ORall=1·74; 95 % CI 1·40, 2·18; ORboys=2·20; 95 % CI 1·66, 2·91; ORgirls=1·41; 95 % CI 1·03, 1·92), Danish speakers (ORall=2·32; 95 % CI 1·68, 3·19; ORboys=2·58; 95 % CI 1·69, 3·93; ORgirls=2·37; 95 % CI 1·46, 3·84) and those travelling 15 min or less to school (ORall=1·21; 95 % CI 1·00, 1·46; ORgirls=1·44; 95 % CI 1·08, 1·93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle- (OR=1·28; 95 % CI 1·00, 1·65) and girls from low-income families (OR=1·46; 95 % CI 1·05, 2·04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR=1·47; 95 % CI 1·00, 2·15) had higher odds of at least weekly fast-food intake than girls at schools without canteens.

Conclusions

The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources.

Characterizing the food environment: pitfalls and future directions

OBJECTIVE

To assess a county population’s exposure to different types of food sources reported to affect both diet quality and obesity rates.

DESIGN

Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups.

SETTING

King County, WA, USA.

SUBJECTS

Full census of food sources.

RESULTS

According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health.

CONCLUSIONS

To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.

Associations between children's diets and features of their residential and school neighbourhood food environments

OBJECTIVES

Among studies of the built environment, few examine neighbourhood food environments in relation to children's diets. We examined the associations of residential and school neighbourhood access to different types of food establishments with children's diets.

METHODS

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity, were analyzed (n=512). Three 24-hour diet recalls were used to assess dietary intake of vegetables and fruit, and sugar-sweetened beverages. Questionnaires were used to determine the frequency of eating/snacking out and consumption of delivered/take-out foods. We characterized residential and school neighbourhood food environments by means of a Geographic Information System. Variables included distance to the nearest supermarket, fast-food restaurant and convenience store, and densities of each food establishment type computed for 1 km network buffers around each child's residence and school. Retail Food Environment indices were also computed. Multivariable logistic regressions (residential access) and generalized estimating equations (school access) were used for analysis.

RESULTS

Residential and school neighbourhood access to supermarkets was not associated with children's diets. Residing in neighbourhoods with lower access to fast-food restaurants and convenience stores was associated with a lower likelihood of eating and snacking out. Children attending schools in neighbourhoods with a higher number of unhealthful relative to healthful food establishments scored most poorly on dietary outcomes.

CONCLUSIONS

Further investigations are needed to inform policies aimed at shaping neighbourhood-level food purchasing opportunities, particularly for access to fast-food restaurants and convenience stores.

Neighborhood deprivation, supermarket availability, and BMI in low-income women: a multilevel analysis

High levels of neighborhood deprivation and lack of access to supermarkets have been associated with increased risk of obesity in women. This multilevel study used a statewide dataset (n = 21,166) of low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children to determine whether the association between neighborhood deprivation and BMI is mediated by the availability of retail food stores, and whether this relationship varied across the urban rural continuum. Residence in a high deprivation neighborhood was associated with a 0.94 unit increase in BMI among women in metropolitan areas. The relationship between tract deprivation and BMI was not linear among women in micropolitan areas, and no association was observed in rural areas. The presence of supermarkets or other retail food stores did not mediate the association between deprivation and BMI among women residing in any of the study areas. These results suggest that level of urbanity influences the effect of neighborhood condition on BMI among low-income women, and that the availability of supermarkets and other food stores does not directly influence BMI among low-income populations.

Impact of neighbourhood food environment on food consumption in children aged 9-10 years in the UK SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study

OBJECTIVE

Poor diet in childhood increases risk of obesity but the relationship between access to food and children's food choice is underexplored. We determined relationships between distance to and density of food outlets on children's food choice.

DESIGN

Children (n 1721) aged 9-10 years who participated in a cross-sectional study from a sample of state and private schools across urban and rural areas. Food consumption was reported using a short validated FFQ. A Geographic Information System was used to determine proximity to local food outlets. Multivariable regression analyses were performed to determine associations between food consumption and distance to and density of local food outlets.

SETTING

Norfolk, England.

SUBJECTS

Boys (n 754) and girls (n 967) aged 9-10 years.

RESULTS

The impact of distance to or density of food outlets on food choice was small after adjustment. Living further away from a supermarket increased portions of fruit (0.11 portions/week per 1 km increase in distance to nearest supermarket, P < 0.05) and vegetables (0.11 portions/week, P < 0.05) consumed. Living closer to convenience stores was also associated with an increased consumption of crisps, chocolate and white bread. Density of supermarkets was associated with both an increase in vegetable intake (0.31 portions/week, P < 0.05) and unhealthy foods.

CONCLUSIONS

Distance to and density of food outlets are both associated with children's food choice, although the impact appears to be small and the relationship is complex. However, the effects of individual foods combined could be important, particularly as even small differences in intake can impact on body weight over time.

Childhood obesity and the built environment

PURPOSE OF REVIEW

Neighborhood factors are increasingly examined for their role in the childhood obesity epidemic. Whereas studies on the impacts of neighborhood factors on adult obesity are relatively common, studies examining these same factors on childhood obesity are far fewer.

RECENT FINDINGS

Using the Ecological Systems Theory (EST) as a model, we sought to examine the strength of the literature with respect to neighborhood factors as outlined in EST. This includes factors related to the family and the school, which are embedded in larger social contexts of the community and society. These factors are often referred to in the literature as the 'built environment' which encompasses the entire range of structural elements in a residential setting including, for example, housing mix, transportation networks, public resources, and presence of sidewalks or trails.

SUMMARY

Whereas progress has been made with respect to the body of evidence supporting the role of neighborhood factors on childhood obesity and obesity-related behaviors, much work remains to be done to enhance our understanding of neighborhood level factors. As the body of evidence grows, these studies will inform multilevel interventions which are urgently needed to tackle the growing epidemic of childhood obesity in the US.

Examining the interaction between food outlets and outdoor food advertisements with primary school food environments

Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students' exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.