Grocery store access and social factors impact dietary health

Greater access to grocery stores, lower access to fast food, a higher income and higher educational attainment were independently associated with a greater likelihood of eating healthier and a lower likelihood of overweight or obesity, data show.

However, the associations differed greatly across predominately Black, Hispanic or white communities, according to researchers.

The findings were from a 5-year study published in Nature Communications.

"When assessing patient diets and giving recommendations, we need to understand that environmental factors such as fast food and grocery store access, income and education likely impact diet health outcomes,” Tim Althoff, MS, PhD, an assistant professor in the Paul G. Allen School of Computer Science and Engineering at the University of Washington, told Healio.

In a nationwide observational study, Althoff and colleagues tracked diet health among 1,164,926 U.S. adults across 9,822 ZIP codes who used the MyFitnessPal app between 2010 and 2016. The researchers compiled data on users’ self-reported dietary outcomes for fresh fruit and vegetable consumption, fast food and soda consumption and incidence of overweight or obese BMI classification.

Dietary health and food environment

Overall, 78.4% of the ZIP codes analyzed had predominantly white populations. When comparing data above or below median values, Althoff and colleagues reported that in ZIP codes with above median grocery store access, participants consumed 3.4% more fruits and vegetables, 7.6% less fast food, 6.4% less soda and were 2.4% less likely to be overweight or obese (P < .001). In ZIP codes with below median fast-food access, participants consumed 5.3% more fruits and vegetables, 6.2% less fast food, 13.3% less soda and were 1.5% less likely to be overweight or obese (P < .001). In ZIP codes with above median educational attainment, participants consumed 9.2% more fruits and vegetables, 8.5% less fast food, 13.8% less soda and were 13.1% less likely to be overweight or obese (P < .001), according to the researchers. In ZIP codes with above median household income, participants consumed 3.3% more fruits and vegetables, 6.8% less fast food and 8.6% less soda (P < .001) but had a 0.6% higher likelihood of being overweight or obese (P = .006).

The findings differed significantly among ZIP codes with predominantly Black and Hispanic populations.

Associations among Black populations

Among predominantly Black populations, Althoff and colleagues found that higher income was associated with 6.5% lower fruit and vegetable consumption, 5.5% higher fast-food consumption and an 8.1% higher likelihood of being overweight or obese. Conversely, lower fast-food access and high educational attainment access were associated with better diet health, with low fast-food access associated with 12% less fast-food consumption and high educational attainment associated with 11.2% greater fruit and vegetable consumption.

However, lower fast-food access was associated with a 3.1% higher likelihood of overweight or obesity (3.1%). Higher grocery store access was associated with 10.2% higher fruit and vegetable consumption, 12.6% lower fast-food consumption and a 9% lower likelihood of being overweight or obese, according to the researchers.

Associations among Hispanic populations

Among predominantly Hispanic populations, above median income was associated with 5.7% higher fruit and vegetable consumption. Also, higher educational attainment was associated with 8.9% higher fruit and vegetable consumption, 11.9% lower fast-food consumption, 16.5% lower soda consumption and a 13.7% lower likelihood of overweight or obesity.

“People assume that if we eliminate food deserts, that will automatically lead to healthier eating, and that a higher income and a higher degree lead to a higher quality diet,” Jenna Hua, PhD, an environmental health scientist and founder of Million Marker, a health and wellness company, said in a press release.

The findings indicate that interventions must be tailored to communities, according to Althoff.

“It is important to realize that all patients do not have equally easy access to healthy foods,” Hua told Healio. “Working with patients to overcome their individual access barriers is important to improve diets.”

References:

Althoff T, et al. Nat Commun. 2022;doi:10.1038/s41467-021-27522-y.

Deserts, demographics and diet: UW and Stanford researchers reveal findings of nationwide study of the relationship between food environment and healthy eating. https://news.cs.washington.edu/2022/01/18/deserts-demographics-and-diet-uw-and-stanford-researchers-reveal-findings-of-nationwide-study-of-the-relationship-between-food-environment-and-healthy-eating/. Published Jan. 18, 2022. Accessed Jan. 24, 2022.