Healthy Food Environment Research Articles

Generating the best available science and data to inform healthy food environment policy

Generating the best available science and data to inform healthy food environment policy

Evaluating the application of front-of-package labelling regulations to menu labelling in the Canadian restaurant sector using Menu Food Label Information and Price (Menu-FLIP) 2020 data.

To evaluate the application of front-of-package (FOP) labelling regulations to menu labelling in the Canadian restaurant sector by assessing the proportion of menu items that would be required to display the 'high-in' FOP symbol if the policy were extended to the restaurant sector. Nutrition information of 18,760 menu items were collected from 141 chain restaurants in Canada. Menu items were evaluated using the mandatory FOP labelling regulations promulgated in Canada Gazette II by Health Canada in July of 2022. Chain restaurants with ≥20 establishments in Canada. Canadian chain restaurant menu items including beverages, desserts, entrées, sides, and starters. Overall, 77% of menu items in the Canadian restaurant sector would display a 'high-in' FOP symbol. Among these menu items, 43% would display 'high-in' one nutrient, 54% would display 'high-in' two, and 3% would display 'high-in' all three nutrients-of-concern. By nutrient, 52% were 'high-in' sodium, and 24% and 47% were 'high-in' total sugars and saturated fat, respectively. Given the poor nutritional quality of restaurant foods, the current regulations, if applied to restaurant foods, would result in most menu items displaying a FOP symbol. Therefore, expanding the Canadian FOP labelling regulations to the restaurant sector can be key to ensuring a healthy food environment for Canadians. Furthermore, menu labelling along with other multi-faceted approaches such as reformulation targets are necessary to improve the dietary intake of Canadians from restaurant foods.

Intermediate and secondary school food environment in New Zealand: Food and drink menu assessment.

Nutrition-related obesity is rising among adolescents in New Zealand with an estimated one in eight children being obese. The school environment is an ideal community setting for encouraging a healthy lifestyle as schools contain a diverse population and involve students and parents. However, the healthiness of food available to intermediate and secondary school students (Years 7-13) is unknown. This study assessed how food and drink menus from schools align with policy guidelines for healthy school food environments. A convenience sample of NZ schools' (years 7-13; ages 10-19) menus was collected in 2020. Menus were classified using traffic light criteria. A toolkit was developed by three nutritionists and one dietitian (with trained staff support) to aid with menu classification. Menu quality was evaluated against school characteristics and policy use. Of the school menus assessed (n = 60), 3.3% met the recommendation for the provision of 75% 'green' items. 'Red' items were the main contributors (mean = 53.6%). Schools with high socio-economic status (deciles 8-10; 14.3%; p < 0.05) and small school size (<749 students; 14.1%; p < 0.025) were associated with a higher proportion of 'green' items. Community (19.3%) and in-house (25.9%) food providers provided a lower percentage of 'amber' items than school providers (39.3%; p < 0.001). In-house providers (64.6%) had a greater percentage of 'red' items than school providers (48.2%; p = 0.017). Food available in schools (Years 7-13) tends to be unhealthy. A national nutrition policy could improve the school food environment, especially in schools with large populations and low socio-economic status. SO WHAT?: School demographics have been associated with menu quality but further research within these schools is needed to identify the gaps to improve equitable outcomes within school food environments.

The Universal Neighborhood Effect Averaging in Mobility-Dependent Environmental Exposures.

The neighborhood effect averaging problem (NEAP) is a fundamental statistical phenomenon in mobility-dependent environmental exposures. It suggests that individual environmental exposures tend toward the average exposure in the study area when considering human mobility. However, the universality of the NEAP across various environmental exposures and the mechanisms underlying its occurrence remain unclear. Here, using a large human mobility data set of more than 27 000 individuals in the Chicago Metropolitan Area, we provide robust evidence of the existence of the NEAP in a range of individual environmental exposures, including green spaces, air pollution, healthy food environments, transit accessibility, and crime rates. We also unveil the social and spatial disparities in the NEAP's influence on individual environmental exposure estimates. To further reveal the mechanisms behind the NEAP, we perform multiscenario analyses based on environmental variation and human mobility simulations. The results reveal that the NEAP is a statistical phenomenon of regression to the mean (RTM) under the constraints of spatial autocorrelation in environmental data. Increasing travel distances and out-of-home durations can intensify and promote the NEAP's impact, particularly for highly dynamic environmental factors like air pollution. These findings illuminate the complex interplay between human mobility and environmental factors, guiding more effective public health interventions.

Residential food environment and dietary antioxidant consumption among pregnant women: Modifying effects of socioeconomic factors and ethnic identity

BackgroundResidential food environment influences dietary patterns, however the impact of individuals' perceived social identity on the antioxidant intake, an indicator of healthy dietary patterns, remains underexplored. ObjectiveWe conducted a cross-sectional analysis using data collected in a longitudinal cohort. In the study, we aim to investigate the interactions between the food environment and two indicators of social identity, specifically a subjective ladder measure of socioeconomic status (SES) and the Multigroup Ethnic Identity Measure (MEIM) score, in relation to dietary antioxidant intake (DAI) among n = 512 Boston and NYC-resident pregnant women. MethodsThe modified Retail Food Environment Index (mRFEI) was calculated using the Centers for Disease Control and Prevention's equation, with higher scores indicating a healthier food environment. DAI was estimated by summing standardized data from six micronutrients (magnesium, selenium, zinc, and vitamins A, C, and E) obtained through the Block98 Food Frequency Questionnaires administered during pregnancy, with higher scores indicating increased intake. The mRFEI and DAI were dichotomized based on a median split. Multivariable-adjusted logistic regressions were used to analyze associations, both with and without considering women's subjective SES or MEIM levels as effect modifiers. ResultsWomen were racially/ethnically mixed (19.2 % White, 42.7 % Black, and 33.1 % Hispanic) with 32.2 % reporting more than high school education. In the main effect models, no significant association was observed between mRFEI and DAI. Women with higher MEIM scores exhibited higher DAI [Odds ratio (OR) =1.85, 95 % Confidence interval (CI) = 1.26–2.73]. Exploratory interaction models showed that subjective SES significantly modified the association (p-value for interaction = 0.03), women perceiving themselves to have a lower SES compared to their community (n = 45) exhibited a significantly positive association between mRFEI and DAI. ConclusionThese findings suggest that women perceiving their SES to be lower than their neighborhoods may benefit from better access to healthy food.

Healthy home food environment is associated with usual consumption of free sugar in children

Healthy home food environment is associated with usual consumption of free sugar in children

Intermittent food deserts. Exploring the spatiotemporal dimension of the urban fresh food access in Chilean cities

Food deserts in Chile present a singularity in the context of the Global South. Unlike other countries where food security is mainly achieved through informal trade, in Chile, weekly streets markets is the structural system providing fresh food. Supermarkets complement spatially and functionally street markets. Both systems and their temporal operation makes that the Chilean food deserts main characteristic is their intermittency. The purpose of this research is to analyze the Chilean food deserts to contrast them with the predominant North and Global South discourses and position the Chilean case internationally. Specifically, this article looks to analyze the importance of the spatiotemporal dimension in food access studies where a healthy diet depends on systems other than supermarkets characterized by intermittent operation over week. For this purpose, this article takes the Metropolitan Area of Concepcion as case. First, the research identifies the location and the socioeconomic groups associated with the different degrees of access from a static perspective based on the spatial distribution of supermarkets and street markets. Then, the dynamic analysis introduces the time dimension to reveal the variability of access patterns and the impact on vulnerable groups.The intermittency of the food deserts positions Chile as halfway between the Global South and North models. The particularity of this model is that intermittently and regularly provides a healthy food environment within food deserts. Additionaly, it has the potential to be planned for overcoming structural inequalities in spatial fresh food access.

The change in food service costs associated with increasing the healthiness of ready-to-eat food provision: A systematic scoping review.

Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet-related non-communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready-to-consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.

Built environment and childhood obesity.

Childhood obesity, an escalating global health challenge, is intricately linked to the built environment in which children live, learn, and play. This review and perspective examined the multifaceted relationship between the built environment and childhood obesity, offering insights into potential interventions for prevention. Factors such as urbanization, access to unhealthy food options, sedentary behaviors, and socioeconomic disparities are critical contributors to this complex epidemic. Built environment encompasses the human-modified spaces such as homes, schools, workplaces, and urban areas. These settings can influence children's physical activity levels, dietary habits, and overall health. The built environment can be modified to prevent childhood obesity by enhancing active transportation through the development of safe walking and cycling routes, creating accessible and inviting green spaces and play areas, and promoting healthy food environments by regulating fast-food outlet density. School design is another area for intervention, with a focus on integrating outdoor spaces and facilities that promote physical activity and healthy eating. Community engagement and education in reinforcing healthy behaviors is necessary, alongside the potential of technology and innovation in encouraging physical activity among children. Policy and legislative support are crucial for sustaining these efforts. In conclusion, addressing the built environment in the fight against childhood obesity requires the need for a comprehensive, multipronged approach that leverages the built environment as a tool for promoting healthier lifestyles among children, ultimately paving the way for a healthier, more active future generation.

Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas.

Black neighborhoods in the U.S., historically subjected to redlining, face inequitable access to resources necessary for health, including healthy food options. This study aims to identify the enablers and barriers to promoting equitable healthy food access in small, independently owned carryout restaurants in under-resourced neighborhoods to address health disparities. Thirteen in-depth interviews were conducted with restaurant owners in purposively sampled neighborhoods within Healthy Food Priority Areas (HFPAs) from March to August 2023. The qualitative data were analyzed using inductive coding and thematic analysis with Taguette software (Version 1.4.1). Four key thematic domains emerged: interpersonal, sociocultural, business, and policy drivers. Owners expressed mixed perspectives on customers' preferences for healthy food, with some perceiving a community desire for healthier options, while others did not. Owners' care for the community and their multicultural backgrounds were identified as potential enablers for tailoring culturally diverse menus to meet the dietary needs and preferences of their clientele. Conversely, profit motives and cost-related considerations were identified as barriers to purchasing and promoting healthy food. Additionally, owners voiced concerns about taxation, policy and regulation, information access challenges, and investment disparities affecting small business operations in HFPAs. Small restaurant businesses in under-resourced neighborhoods face both opportunities and challenges in enhancing community health and well-being. Interventions and policies should be culturally sensitive, provide funding, and offer clearer guidance to help these businesses overcome barriers and access resources needed for an equitable, healthy food environment.

P036 INFLUENCE OF FOOD ENVIRONMENT IN AND AROUND SCHOOLS ON FOOD CHOICES AND PRACTICES OF STUDENTS: A MIXED METHODS STUDY – ANTICIPATORY FINDINGS

Background: The health behaviors of adolescents are significantly influenced by their living environments, with schools serving as crucial settings for promoting healthy behaviors. The school food environment, encompassing areas where food is provided and consumed within and around schools, plays a key role in shaping adolescents’ dietary choices. However, there is a notable scarcity of evidence regarding the school food environment in Pakistan. This study aims to examine the school food environment and associated factors, including the availability, accessibility, and affordability of foods within and around schools for adolescents, the facilitators and barriers school vendors face while offering healthy food options, and the perspective of policymakers on the role of food environments. Objectives: • To assess the school lunchtime food practice and sources of adolescents in schools in Karachi • To explore facilitators and barriers to offering healthier food options to adolescents through school vendors both within and outside school premises • To explore the perspectives of adolescents regarding the food choices available to them Methods: A mixed methods concurrent study design i.e. a cross-sectional study, interpretive descriptive qualitative study. Six schools, comprising three government and three private schools from District Central of Karachi, will be recruited. Students from grades 6 and 7 who provide consent and assent will be included, with an anticipated sample size of 430 participants. Descriptive statistics will be utilized to analyze quantitative data and a manual thematic analysis approach will be employed to analyze qualitative data. Results: The anticipated outcome of this study is to understand the school food environment holistically taking into consideration the practices and perspectives of key stakeholders i.e. school-going adolescents, vendors, and policymakers. Conclusion The groundwork done through this research project will help develop evidence-based healthy school food environment programs/interventions that can be feasibly deployed in government and private schools in Pakistan. The research outcomes will foster collaborative efforts among various stakeholders to co-create and implement viable solutions.

Planning healthy food environments: An analysis of local government municipal public health and wellbeing policy in regional Victoria.

While there has been an increased focus on how local governments can support the creation of healthy food environments through healthy public policy, little is known about how this is reflected in public health policy in regional areas. The aim of this study was to understand how improvements to the food environment are prioritised, implemented and evaluated by local governments in regional Victoria. Using a qualitative descriptive approach, content analysis was undertaken of Municipal Public Health and Wellbeing Plans and Council Plans from 10 regional local governments in Victoria, Australia. Seventeen policy documents were analysed including 10 Council Plans, 6 Municipal Public Health and Wellbeing Plans and 1 Food Systems Strategy. Findings highlight regional public health and wellbeing plans have very few concrete actions in place to improve food environments. There is an opportunity for Australian regional local governments to include in their public health and wellbeing plans a greater emphasis on supporting healthy food behaviours, and therefore seeking opportunities to improve food environments through clearly aligned priorities, objectives, actions and measures of success. SO WHAT?: Improving the quality of public health and wellbeing plans can support local government to use policy to drive improvements in food environments leading to improved health and wellbeing for regional communities.

Associations between parent and child latent eating profiles and the role of parental feeding practices

Previous research employing the person-centred approach of Latent Profile Analysis (LPA) with parent-reported data of their child's eating behaviour identified four distinct eating profiles in 3-6-year-old children: typical, avid, happy, and avoidant eating (Pickard et al., 2023). In this follow-up study, the same parents were asked to self-report their own eating behaviour (N = 785) and LPA was conducted to determine the latent eating profiles of the parents/caregivers. The LPA showed that a four-profile solution best represented the sample of parents, termed: typical eating (n = 325, 41.4%), avid eating (n = 293, 37.3%), emotional eating (n = 123, 15.7%) and avoidant eating (n = 44, 5.6%). Multiple mediation analysis was then conducted to examine both the direct associations between parents' eating profiles and the child's probability of eating profile membership, as well as the indirect associations through the mediatory role of specific parental feeding practices. The results suggested direct links between parent and child eating profiles, with the 'avid eating' and 'avoidant eating' profiles in parents predicting similar profiles in their children. Feeding practices, such as using food for emotional regulation, providing balanced and varied food, and promoting a healthy home food environment, mediated associations between parent and child eating profiles. This research provides novel evidence to reinforce the need for interventions to be specifically tailored to both the parent's and child's eating profiles. The work also provides an interesting avenue for future longitudinal examination of whether the parents' provision of a healthy home food environment could protect against intergenerational transmission of less favourable eating behaviours.

Creating a healthy and sustainable food environment to promote plant-based food consumption: clear barriers and a gradual transition

BackgroundA shift away from diets high in animal-based foods towards diets high in plant-based foods is desirable considering human health, environmental sustainability, and animal welfare. As the food environment plays a crucial role in shaping consumption patterns, understanding of how changes in the food environment can facilitate plant-based consumption is crucial for the so-called protein transition. The current study aims to garner insight into barriers and facilitators for food outlet managers to take action to stimulate plant-based consumption within a local food environment.MethodsUsing a maximum-variation sample approach, we examined possible barriers and facilitators to promote plant-based consumption across different types of food outlets located within a geographically shared food environment (a city in the Netherlands). We conducted in-depth semi-structured interviews among food outlet managers and applied multi-stage thematic analysis to the interview transcripts.ResultsMost managers underscored the urgency of shifting towards more plant-based diets, and perceived a growing demand for plant-based products. However, three barriers hindered most of them from taking decisive action: Managers’ perception of low consumer demand for plant-based food options; fear of consumer resistance when stimulating plant-based food options; and limited behavioral agency to offer attractive plant-based food options. The few managers who made changes, or intend to make changes, are individuals with high intrinsic motivation, knowledge and skills.ConclusionsThe present work suggests the key for change towards a food environment stimulating plant-based consumption lies in addressing three (perceived) barriers shared among diverse outlets. These are partly different from barriers for stimulating healthy consumption in general. Furthermore, current changes appear to be driven incidentally by individuals who are motivated and able to stimulate more plant-based purchases among a small targeted group of consumers.

Food environment and obesity: a systematic review and meta-analysis

BackgroundObesity is influenced by a complex, multifaceted system of determinants, including the food environment. Governments need evidence to act on improving the food environment. The aim of this study was...

Rethinking food policy framework to tackle childhood obesity in the Italian context.

Pediatric obesity has been described by the World Health Organization as 1 of the most serious public health challenges of the 21st century. Projections of increasing burdens of pediatric obesity and its related diseases on society highlight the need for urgent and substantial action. Many scientific and public debates about the prevention of childhood obesity are centered around simple dichotomies presenting a single-level solution. In contrast, efficient prevention programs should overcome these overly simplistic dichotomies and proceed in the early years of life within the family environment and the whole society, throughout one's lifetime. Food policies have the potential to counteract pediatric obesity by creating healthy food environments. However, the current food policies approach lacks monitoring indicators to assess short- and long-term impact, and is not well integrated into regional, national, and cross-cutting initiatives. Therefore, redesigning and rethinking food policy strategies and goals is an important opportunity to address childhood obesity, safeguard the planet, and contribute to economic and social prosperity.

Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs.

The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. PROSPERO registration no. CRD42022303255.

The neighborhood food environment modifies the association between infant feeding and childhood obesity

BackgroundThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context.MethodsWIC administrative data, collected from 2013–2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow’s milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2–4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms.ResultsAny infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment.ConclusionsAmong specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.

Food Environment in Burkina Faso: Review of Public Policies and Government Actions Using the Food-EPI Tool.

Governments have a central role to play in creating a food environment that will enable people to have and maintain healthy eating practices. This study analyzes public policies and government actions related to creating healthy food environments in Burkina Faso. The Healthy Food Environment Policy Index tool used for this study has 2 components, 13 domains, and 56 indicators of good practice adapted to the Burkina Faso context. Official policy documents collected from data sources such as government and nongovernment websites, and through interviews with government and nongovernment resource persons, provided evidence of considerations of food environment in public policy documents in Burkina Faso. Policies documents show a lack of revision of old texts and administrative processes for new policies and government practices are very slow. Added to this is the absence of a regulatory document for some implemented actions. The analysis of the documents collected in relation to the indicators of Food-Epi tool shows that there is no evidence of consideration of food environments for the indicators concerning the regulation of nutrition and health claims, labeling, taxes on healthy and unhealthy foods, support systems for training for private structures on healthy diets, implementation of food guidelines, and food trade and investment. This study permits a review of public policies that take into account food environments through the various indicators and constitutes a starting point from which improvements can be made by the government.

Individual and family factors correlated with children's fruit consumption.

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.