Abstract
Background/ObjectiveMexico has one of the highest rates of obesity and overweight worldwide, affecting 75% of the population. The country has experienced a dietary and food retail transition involving increased availability of high-calorie-dense foods and beverages. This study aimed to assess the relationship between the retail food environment and body mass index (BMI) in Mexico.Subjects/MethodsGeographical and food outlet data were obtained from official statistics; anthropometric measurements and socioeconomic characteristics of adult participants (N = 22,219) came from the nationally representative 2012 National Health and Nutrition Survey (ENSANUT). Densities (store count/census tract area (CTA)) of convenience stores, restaurants, fast-food restaurants, supermarkets and fruit and vegetable stores were calculated. The association of retail food environment variables, sociodemographic data and BMI was tested using multilevel linear regression models.ResultsConvenience store density was high (mean (SD) = 50.0 (36.9)/CTA) compared with other food outlets in Mexico. A unit increase in density of convenience stores was associated with a 0.003 kg/m2 (95% CI: 0.0006, 0.005, p = 0.011) increase in BMI, equivalent to 0.34 kg extra weight for an adult 1.60 m tall for every additional 10% store density increase (number of convenience stores per CTA (km2)). Metropolitan areas showed the highest density of food outlet concentration and the highest associations with BMI (β = 0.01, 95% CI: 0.004–0.01, p < 0.001). A 10% store density increase in these areas would represent a 1 kg increase in weight for an adult 1.60 m tall.ConclusionsConvenience store density was associated with higher mean BMI in Mexican adults. An excessive convenience store availability, that offers unhealthy food options, coupled with low access to healthy food resources or stores retailing healthy food, including fruits and vegetables, may increase the risk of higher BMI. This is the first study to assess the association of the retail food environment and BMI at a national level in Mexico.
Highlights
The food environment—the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status—is recognised as a major determinant of health [1, 2] which can exert a major influence on obesity [3,4,5,6,7]
Retail food environment studies have mainly focused on high-income countries; there are a number of studies that have been conducted in low and middle-income countries (LMICs) [12,13,14], very few have tested associations with obesity [15,16,17,18,19,20]
The majority (39%) of the studied sample lived in the south of the country, in a census tract area (CTA) with a high deprivation level (37%) and in urban or metropolitan areas (64%)
Summary
The food environment—the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status—is recognised as a major determinant of health [1, 2] which can exert a major influence on obesity [3,4,5,6,7]. The community nutrition environment [8], or what we refer to as the retail food environment [9,10,11], encompasses the type, location and accessibility of food outlets. NAFTA influenced the retail food environment by the introduction into Mexico of global fast-food outlet chains and an increased import of low-cost and ultra-processed foods [22,23,24]. The rise in obesity prevalence has accelerated worldwide in the last 30 years [25], in Mexico, where measurement data from the 1988, 1999 and 2000 Nutrition and Health Surveys indicate a steep increase in obesity [26, 27], coinciding with the period when NAFTA was introduced [24]. In Mexico, 75% of the population is affected by overweight or obesity [28]
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