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Modifying Food Environments for Better Health

cartoon neighborhoodFrom markets to vending machines, there is growing evidence that the food choices around us make a difference in what people eat, weigh and ultimately, cancer risk.

Research involving the food environment is a fast-growing area of study. Findings related to how environment affects healthier eating can have important public health significance, as two thirds of the United States is overweight or obese. Obesity increases the risk of seven cancers, along with heart disease and type 2 diabetes.

"In the last ten years, research related to the food environment has really exploded," said Sharon Kirkpatrick, PhD, an Assistant Professor at University of Waterloo who spoke at the AICR annual research conference. "There's now a huge number of studies documenting communities' nutrition environments... and a growing number of studies examining the influence of the food environment on diet and health."

And it’s not only researchers who are interested in this topic, policymakers are hungry for evidence on how modifying the food environment might improve nutrition and health outcomes among the population."

A person's food environment includes grocery stores, restaurants, corner markets, and work places. And there are numerous reasons why a consumer purchases one item over another, at the market or the restaurant.

Where do people get their food, what do they buy, where do they eat it? Research to shed light on these questions is complex, says Kirkpatrick. Researchers needs to think about what types of food outlets are most relevant, what foods to consider in our examinations of what is offered in different environments, and how to capture the varied ways in which people interact with their food environments.

Strategies that Work

Years of research in minority and ethnic communities suggest that certain strategies to modify the food environment can break consumer patterns and lead to healthier eating behaviors, said Joel Gittelsohn, PhD, MSc, a medical anthropologist at Johns Hopkins University and a leading researcher in grocery store-based intervention programs.

Many of Gittelsohn's studies take place in areas of Baltimore with little access to healthy foods, where carryout corner stores are the mainstay and "deep fryer is king." Customers are predominantly African Americans. The first step is working with the store owners, who were resistant about stocking other kinds of foods, said Gittelsohn.

In one study, owners were given $50 to start buying healthier inventory, such as fresh fruit. The research team replaced the store's hand-scrawled menu boards with new boards, highlighting the healthier options with a green leaf beside the healthier choices.

Even figuring out that leaf was a learning experience. “We did a lot of work to figure out that leaf - something to imply healthy that wouldn't have negative connotations to the clientele," said Sonja Goedkoop, MSPH, RD, a former research program coordinator on the project who is now a clinical dietitian at the Massachusetts General Hospital. "The word 'healthy' really didn't go over well so we stuck more with the idea of 'fresh.'"

The stores soon featured meals that were healthier than previous options. For example, a ham sandwich on whole-grain bread with lettuce and tomato was promoted.

It took six months to build the trust to the point where changes started to be made. After four to five months, sales of healthier foods increased and the owners were happy to consider reducing the prices of healthier meals, said Gittelsohn. Overall, there was an increase in total revenue for the stores after introducing the healthier meals.

Another recent study of Gittelsohn's that took place in Navajo Nation found that adding new varieties of healthful foods to grocery shelves, brief interactive sessions, simple signage and educational posters helped customers choose healthier foods and lose weight.

The 14-month study divided the area into 10 regions that included markets and convenience stores then implemented changes at half. Changes to the regions included: Navaho health workers leading taste tests with shoppers, shelf labels promoting healthy food choices, and stocking new fruits. Radio ads highlighted the link between obesity and type 2 diabetes, a disease prevalent among American Indians. A sample of shoppers answered a series of questions at the start and end of the study, and were measured for BMI.

“We know that people are more likely to eat healthier foods if these foods are more accessible,” said Gittelsohn. “But accessibility includes many things, including availability, cost, location within stores and transportation to get to stores. In addition to increasing supply, you also need to increase demand for these foods, by promotions and education.”

Community engagement is necessary in all these projects, said Gittelsohn. “The goal is to promote healthy food choices to reduce risk for diet related chronic diseases and there are many strategies that we have seen work.”

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