Comparing food environment and food purchase in areas with low and high prevalence of obesity: data from a mapping, in-store audit, and population-based survey

Mapping food and physical activity environments in low- and middle-income countries: A systematised review

This systematised literature review synthesised evidence on approaches to mapping food and physical activity (PA) environments in low- and middle-income countries (LMICs). Of the 60 articles included, 25 and 35 mapped food and PA environments respectively. All studies were cross-sectional with researcher-led data collection. Three types of mapping tools were identified - maps (n = 18), GPS (n = 10), and GIS (n = 37). Our findings point to a paucity of research mapping food and PA environments, overall and particularly subjective domains. We highlight a need for future studies that utilise innovative, inexpensive and participatory research methods to understand dynamic exposures to obesogenic environment features in resource-constrained contexts undergoing rapid urbanisation.

The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review

INTRODUCTION

Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.

METHODS

We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively.

RESULTS

74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap.

CONCLUSION

'Zoning' or 'healthy food cart' interventions to alter food availability may be appropriate in urban LMIC.

PROSPERO REGISTRATION NUMBER

CRD42020207475.

Acting against obesity: a cross-cultural analysis of prevention models in Spain, Argentina and Brazil

This article analyses and compares preventive models for obesity in Spain, Argentina and Brazil through an examination of the respective measures adopted to counter it in those countries. Based on a qualitative study of the main actions carried out since 2004, the aim is to delineate the conceptual framework and reflect on the reasons for their relative effectiveness. The results show that in contexts where prevalence has increased rapidly, sociocultural causes acquire greater explanatory power as opposed to biological and/or behavioral factors. These models premise worsening diets and sedentary lifestyles as being the main culprits, and assume that contemporary societies generate obesogenic and toxic environments. The international health bodies have developed specific strategies to control and prevent obesity based on this diagnosis, and these have been supported by member states such as Spain, Argentina and Brazil. Although the measures reflect certain particularities, they conform to a common pattern organized from platforms promoting so-called "healthy lifestyles" and articulated mainly around the twin axes of a balanced diet and regular physical exercise. The discussion suggests that the excessive emphasis on individual responsibility and the underplaying of the role of food as a complex practice, as well as changing structural factors and the differential distribution of this disease, might largely explain the limited impact of these strategies.

[Preventing obesity in precarious contexts: local responses to global strategies]

The aim of this article is to analyze the conceptual structure underlying the models of obesity prevention implemented in Argentina, Brazil, and Spain. In their culturally distinct but epidemiologically similar contexts, the three countries have devised strategies that reproduce global diagnoses of the causes of obesity and replicate some of the measures proposed at the global level. While so-called "obesogenic environments" are considered primarily responsible for these tendencies, efforts to raise awareness about food and nutrition tend to promote self-monitoring and behavior rationalization as the main tools for achieving changes in diet and physical activity. Although a variety of measures have been proposed at the local level, they have been less diverse in terms of their nature and scope, barely taking into account the constraints that hinder the adoption of healthy lifestyles. In contexts of social and food precarity, this has meant neglecting the social groups with the highest prevalence of obesity.

An Italian Innovative Small-Scale Approach to Promote the Conscious Consumption of Healthy Food

An unhealthy diet is considered to be one of the main causes for increases in obesity and chronic diseases. Food choices are frequently influenced by food systems and environments along with the availability and affordability of healthy and sustainable food. In this context, a major contemporary challenge lies in improving these aspects in order to support healthy dietary choices. Hence, to address this issue, here, we propose a small-scale approach called SANI (Italian for “healthy”) which involves experts in science and marketing. Two typical agri-foods of the Abruzzo area (center of Italy), tomato sauce and extra virgin olive oil, are characterized as high-quality products in terms of their nutrient content, absence of chemical contaminants (chromatographic, spectrophotometric, and magnetic resonance techniques), and ecological footprint (lifecycle assessment and carbon footprint). Hence, their consumption is promoted, with strict attention being paid to several aspects of the food system, such as production, processing, distribution, labeling, and promotion, as well as marketing strategies and dissemination activities. Overall, these SANI actions, especially labeling and dissemination, have proven to be a valuable learning tool for consumers moving toward more conscious consumption, which can be extended and applied to additional food products. Future applications of similar research strategies in a wider context could positively affect human and environmental health.

Sociodemographic Differences in the Dietary Quality of Food-at-Home Acquisitions and Purchases among Participants in the U.S. Nationally Representative Food Acquisition and Purchase Survey (FoodAPS)

Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.