Abstract
U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses to estimate measured BMI (kg/m2), overweight (25 ≥ BMI < 30) and obesity (≥30), across participants’ highest educational attainment (three groups) and tertiles of street network distance (km) from home location to nearest supermarket. Jointly-classified models estimated combined associations of education and supermarket distance, and relative excess risk due to interaction (RERI). Participants farthest away from their nearest supermarket had higher odds of obesity (OR 1.33, 95% CI: 1.11, 1.58), relative to those living closest. Lower education was also associated with higher odds of obesity. Those least-educated and living farthest away had 3.39 (2.46–4.65) times the odds of being obese, compared to those highest-educated and living closest, with an excess obesity risk (RERI = 0.09); results were similar for overweight. Our results suggest that public health can be improved through planning better access to supermarkets, in combination with interventions to address socioeconomic barriers.
Highlights
Overweight and obesity are major and increasingly severe public health problems
We explored the magnitude of overweight and obesity risk associated with lowest education and greatest supermarket distance, relative to those with highest education and lowest supermarket distance, using an adjusted multinomial logistic regression model
We found that greater supermarket distance was independently associated with higher body mass index and odds of both overweight and obesity, with evidence of dose-response relationships throughout
Summary
Overweight and obesity are major and increasingly severe public health problems. By 2050, 60% of men and 50% of women are predicted to be obese in the UK [1]. Obesity is associated with increased risk of type 2 diabetes, coronary heart disease and stroke [2]. These comorbidities and others have substantial social and economic implications. Through lost working hours and healthcare costs for example, overweight and obesity are forecast to cost the UK economy £49.9 billion annually by 2050 [1]. Res. Public Health 2017, 14, 1290; doi:10.3390/ijerph14111290 www.mdpi.com/journal/ijerph
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