Abstract
Data on food environments in India and other low- and middle-income countries are scarce. The objective of this study was to assess the four dimensions of the external domain of food environments (availability, price, vendor and product properties, and marketing) in food establishments in the National Capital Region of India. The assessment focused on fruits, vegetables, and ultra-processed foods. The 60 food establishments surveyed were categorized as stores, restaurants, or mobile food vendors. Only 13.3% of food establishments sold fruits and vegetables. Stores were more likely to sell vegetables than mobile food vendors (14.8 vs. 6.2%, respectively) and sold a greater variety of both fruits and vegetables as compared to mobile food vendors [mean (SD) of 8.6 (3.2) fruits and 18.6 (9.2) vegetables available at stores vs. 5.5 (5.7) fruits and 25 vegetables available at the one mobile food vendor who sold vegetables]. However, these healthy food items were more expensive at stores. The availability (100% of stores, 12.5% of mobile food vendors, and 12.5% of restaurants) and variety (156 types) of ultra-processed foods across food establishments were higher than fruits and vegetables. A greater percentage of food establishments displayed advertisements for ultra-processed foods as compared to unprocessed or minimally processed foods such as fruits and vegetables. The National Capital Region of India has an unhealthy food environment. Regulations that limit the availability of ultra-processed foods and improve the availability and affordability of fruits and vegetables are needed to reverse the rising tide of chronic non-communicable diseases in this setting.
Highlights
Healthy dietary changes, including increasing consumption of fruits, vegetables, legumes, and nuts, and reducing consumption of added sugars and red meat, could prevent an estimated 19% of deaths globally (EAT-Lancet Commission on Healthy Diets From Sustainable Food Systems, 2019)
The study was conducted in Delhi National Capital Region (NCR) India, which is an inter-state region comprised of the entire National Capital Territory of Delhi and adjoining districts from the surrounding states of Haryana, Rajasthan, and Uttar Pradesh (National Capital Regional Planning Board, 2014)
The NCR’s total population is about 46 million which is spread over an area of 53,817 km2 (National Capital Region Planning Board Government of India, 2017)
Summary
Healthy dietary changes, including increasing consumption of fruits, vegetables, legumes, and nuts, and reducing consumption of added sugars and red meat, could prevent an estimated 19% of deaths globally (EAT-Lancet Commission on Healthy Diets From Sustainable Food Systems, 2019). As a result of these unhealthy dietary patterns, while undernutrition has declined over the past decade in India, overweight has increased and is emerging as a significant public health challenge (Ministry of Health and Family Welfare Government of India, 2017). Nationally representative dietary intake data in India and elsewhere are scarce (Green et al, 2016). Available data suggest that the Indian diet is becoming more calorically dense with a larger share of calories coming from unhealthy foods high in fat and sugar (Shetty, 2002; Green et al, 2016). There has been an increase in dietary salt intake to an average of 11 g per day, far exceeding the World Health Organization’s 5 g per day upper limit (Johnson et al, 2017)
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