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The relationship of the local food environment with obesity: A systematic review of methods, study quality, and results.

ABSTRACT: OBJECTIVE:To examine the relationship between local food environments and obesity and assess the quality of studies reviewed. METHODS:Systematic keyword searches identified studies from US and Canada that assessed the relationship of obesity to local food environments. We applied a quality metric based on design, exposure and outcome measurement, and analysis. RESULTS:We identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross-sectional. Associations between food outlet availability and obesity were predominantly null. Among non-null associations, we saw a trend toward inverse associations between supermarket availability and obesity (22 negative, 4 positive, 67 null) and direct associations between fast food and obesity (29 positive, 6 negative, 71 null) in adults. We saw direct associations between fast food availability and obesity in lower income children (12 positive, 7 null). Indices including multiple food outlets were most consistently associated with obesity in adults (18 expected, 1 not expected, 17 null). Limiting to higher quality studies did not affect results. CONCLUSIONS:Despite the large number of studies, we found limited evidence for associations between local food environments and obesity. The predominantly null associations should be interpreted cautiously due to the low quality of available studies.

SUBMITTER: Cobb LK

PROVIDER: S-EPMC4482774 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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The relationship of the local food environment with obesity: A systematic review of methods, study quality, and results.

Cobb Laura K LK Appel Lawrence J LJ Franco Manuel M Jones-Smith Jessica C JC Nur Alana A Anderson Cheryl A M CA

Obesity (Silver Spring, Md.) 20150612 7

<h4>Objective</h4>To examine the relationship between local food environments and obesity and assess the quality of studies reviewed.<h4>Methods</h4>Systematic keyword searches identified studies from US and Canada that assessed the relationship of obesity to local food environments. We applied a quality metric based on design, exposure and outcome measurement, and analysis.<h4>Results</h4>We identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross-sec ...[more]

PMID: 26096983

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Project description:IntroductionObesity is a global pandemic that affects all socioeconomic strata, however, the highest figures have been observed in the most disadvantaged social groups. Evidence from the USA and Canada showed that specific urban settings encourage obesogenic behaviour in the population living and/or working there. We aim to examine the evidence on the association between local food environments and obesity in the UK, Ireland, Australia and New Zealand.MethodsSix databases from 1990 to 2017 will be searched: MEDLINE (Ovid), Embase (Ovid), Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. Grey literature will also be sought by searching Opengrey Europe, The Grey Literature Report and relevant government websites. Additional studies will be retrieved from the reference lists of the selected articles. It will include cohort, longitudinal, case study and cross-sectional studies that have assessed the relationship between local food environments and obesity in the UK, Ireland, Australia and New Zealand regardless of sex, age and ethnicity of the population. Two researchers will independently select the studies and extract the data. Data items will incorporate: author names, title, study design, year of study, year exposure data collected, country, city, urban/rural, age range, study exclusions, special characteristics of study populations, aims, working definitions of food environments and food outlets, exposure and methods of data collection, outcomes and key findings. A narrative synthesis and a summary of the results will be produced separately for children and adults, according to the type of food exposure-outcome. All the selected studies will be assessed using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.Ethics and disseminationThis study will be based on published literature, and therefore ethical approval has not been sought. Our findings will be presented at relevant national and international scientific conferences and published in a peer-reviewed journal.

Project description:There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children's centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers' food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.

Dataset Information

The relationship of the local food environment with obesity: A systematic review of methods, study quality, and results.

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The relationship of the local food environment with obesity: A systematic review of methods, study quality, and results.

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