Unhealthy food environments that promote overweight and food insecurity in a brazilian metropolitan area: A case of a syndemic?

Abstract

Obesity has been characterized as an ongoing pandemic. This swift and continuous weight increase cannot be explained solely by individual factors. High availability of Ultra Processed Food (UPF) and reduced supply or absence of unprocessed/minimally processed foods in food environments can influence food choices and promote a syndemic process involving overweight and food insecurity. We evaluate the association between overweight and food community and consumer environment among adults in the Metropolitan Region of Recife, Brazil and discuss within syndemic theory. Data was collected at individual and environment levels in 2019. Information on 446 individuals and 231 food stores was gathered. Logistic multi-level regression models assessed the association between overweight and neighborhood and food environment measurements which have been adjusted by individual characteristics and census track data. Prevalence of overweight and food insecurity was high, 70.9 % and 72 % respectively. Each participant had, on average, 20.64 ± 5.78 food stores in their food environment. Stores that sell UPF had the highest density rates. People living within a milieu with the highest density of stores predominantly selling UPF (OR = 1.92; p < 0.05), with the highest average UPF sold at check-out (OR = 2.19; p < 0.05), with the highest average of soft drinks available in the stores (OR = 1.68; p < 0.05), and availability of filled cookies within the intermediate category (OR = 2.26; p < 0.01), had the highest probability of being overweight. Food environment is associated with overweight, after controlling for individual factors, and it is suggested that there is a food syndemic involving overweight and food insecurity, which is influenced by the food environment.