MODULE 11: FOOD: OBESITY, ACCESS AND ONGOING ISSUES

Food: Obesity, Access and Ongoing Issues

The Food Trust: Case Study

Allison Karpyn, PhD Director, Research and EvaluationThe Food Trust

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Module 11: Food: Obesity, Access and Ongoing Issues

Part 1: Public Health & Environmental Approaches to Obesity Prevention

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The Food Trust

• Working to ensure that everyone has access to affordable, nutritious food.

• Founded in 1992

• 5 Program Areas:- Farmers’ Markets- School Nutrition Education - Healthy Corner Stores Initiative- Farm to School- Supermarket, Grocery Store, and Healthy Food Retail Development

- Consulting

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Food Access

• Nearly 30 million Americans live more than a mile from the nearest grocery store.

Source: United States Department of Agriculture, 2011

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Overweight and Obesity in the U.S.• 2/3 of adults and 1/3 of children are

overweight or obese.

• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.

• Medical care costs associated with obesity were estimated at $190 billion in 2012.Source: Institute of Medicine, 2012

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What are we eating? What the average American consumes in a year.

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Obesity: Part of a Complex System

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Strategies for Obesity Prevention24 recommended strategies by the Centers for Disease Control and Prevention (CDC)

- Improve geographic availability of supermarkets in underserved areas

- Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas

- Improve availability of mechanisms for purchasing foods from farms

Source: Keener, D., Goodman, K., Lowry, A., Zaro, S., & Kettel Khan, L. (2009). Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

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Strategies for Obesity Prevention5 goals from Institute of Medicine (IOM) for implementation by key stakeholders and sectors

- Make physical activity an integral and routine part of life.- Create food and beverage environments that ensure that

healthy food and beverage options are the routine, easy choice.

- Transform messages about physical activity and nutrition.- Expand the role of health care providers, insurers, and

employers in obesity prevention.- Make schools a national focal point for obesity prevention.

Source: IOM (Institute of Medicine). Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, D.C.: The National Academies Press; 2012.

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Strategies for Obesity Prevention4 Global Strategies to Implement AHA Nutrition Guidelines

- Create a healthy food environment- Subsidize good food choices by creating financial and other

incentives for consumption of nutritious food- Market nutrition; use media to counterbalance unhealthy food

messages- Empower consumers by providing more comprehensive labeling of

food and portion size; train professionals in nutrition by improving the skill level of healthcare practitioners and enlarging the pool of individuals qualified to provide nutrition advice

Source: Gidding SS, Lichtenstein AH, Faith MS, Karpyn A, Mennella JA, Popkin B, et al. Implementing American Heart Association Pediatric and Adult Nutrition Guidelines. Circulation. 2009;119:1161-75 doi: 10.1161/CIRCULATIONAHA.109.191856

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Strategies for Obesity PreventionHealthy People provides science-based, 10-year national objectives for improving the health of all Americans.

- NWS-3 Increase the number of States that have State-level policies that incentivize food retail outlets to provide foods that are encouraged by the Dietary Guidelines for Americans

- NWS-4 (Developmental) Increase the proportion of Americans who have access to a food retail outlet that sells a variety of foods that are encouraged by the Dietary Guidelines for Americans

Sources: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx,2013http://www.health.gov/dietaryguidelines/pubs.asp, 2013http://www.health.gov/paguidelines/guidelines/default.aspx, 2013

The Dietary Guidelines for Americans • Published jointly every 5 years since 1980 by the Department of Health and

Human Services (HHS) and the Department of Agriculture (USDA).• Provide information to assist people in making food choices that promote

good health, advocate a healthy weight, and help prevent disease.

Physical Activity Guidelines for Americans • Published in 2008 by the Department of Health and Human Services (HHS)• Provides science-based guidance to help Americans aged 6 and older improve

their health through appropriate physical activity

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• Understand connections between the built environment and health

• Review current recommendations, practices and progress in the field working to provide access to affordable nutritious food

• Examine current research on food access strategies and health promotion

• Describe the process of engaging stakeholders and stimulate policy change

Learning Objectives

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Food System

Preparing

Processing

Source: Michigan State University CS Mott Group for Sustainable Food Systems, 2013

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Community-BasedFood

System

Preparing

Processing

Source: Michigan State University CS Mott Group for Sustainable Food Systems, 2013

Environmental stewardship

Economic development

Jobs

Healthy Individuals

Community &social vitality

Farmlandpreservation

Small- &medium-

scalefarm

viability

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How does the environment influence obesity?

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Scale Energy Intake Energy Expenditure

Macro scale Food Systems Transportation

Commodity chains Communications

Food complexes Mass Media

Meso scale Food Landscapes Exercise Landscapes

Food Sheds Neighborhoods

Food Deserts Facilities

Micro scale Kitchenscapes Rooms

Tablescapes Furniture

Platescapes Clothing

Source: Sobal J, and Wansink B. 2008. Built Environments and Obesity. In EM Blass (Ed), Obesity: Causes, Mechanisms, Prevention, and Treatment. Sunderland, MA: Sinauer Associates.

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What is a food desert?

• Low-income communities where a substantial percent of residents have low access to affordable and healthy food retailers.

• Can be located in rural, urban, or tribal communities

• Food desert locator: www.ers.usda.gov/data/FoodDesert

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Ecological Framework

Ecological Framework for Supermarket Influence on Dietary Intake. (Adapted from: Contento 2000 and Story et al., 2008)

Institutional/Organizational

Public-policy

Community

Individual

Interpersonal

Institutional/Organizational level:• Available healthy options (fair price and

quality)• Supermarket chain policies and standards

(cleanliness, interpersonal)• Informational Environment (In-store

marketing approaches, techniques. advertising, media)

Community level: • Food Availability• Built Environment• Equity• Jobs, Economic Growth• Social, Cultural Norms

Interpersonal level:• Experiences Shopping• Experiences with food• Parenting / Caretaking

Practices• Family and Social Networks

Individual factors• Beliefs, Values, Habits, Perceptions • BMI• Dietary Intake• Demographics/Resources• Shopping Preferences• Time• Biologically Determined (Taste/pleasure;

hunger/satiety)• Knowledge and skills

Public policy level: • Physical/Built Environment: Healthy Food Financing Initiative &

similar State/City incentives for new/expanded stores to reduce disparities

• Economic Environment: product pricing/taxing, production and distribution

• Informational Environment Regulations: labeling , advertising and media