With the obesity epidemic in full swing and millions of American living in neighborhoods where fruits and vegetables are hard to come by, the Obama administration thought it saw a solution: fund stores that will stock fresh, affordable produce in these deprived areas.
But now, three years and $500 million into the federal Healthy Food Financing Initiative, there's a problem: A study suggests it's not working.
Adding supermarkets to areas with short supplies of fresh produce does not lead to improvements in residents' diets or health outcomes, according to a report published Monday in the February issue of Health Affairs.
Researchers studied two comparable neighborhoods in Philadelphia, a city at the center of the fight against "food deserts"—the wonkish term for the produce-poor areas.
When a grocery store was opened in one Philadelphia food desert, 26.7 percent of residents made it their main grocery store and 51.4 percent indicated using it for any food shopping, the report found. But among the population that used the new supermarket, the researchers saw no significant improvement in BMI, fruit and vegetable intake, or perceptions of food accessibility, although there was a significant improvement in perception of accessibility to fruits and vegetables.
The report was authored by a team of researchers from the London School of Hygiene and Tropical Medicine and Penn State University's departments of sociology, anthropology, and demography. The study was funded by the National Institute of Environmental Health Sciences with support from the Population Research Institute, although neither had a hand in the research design, collection, or analysis.
The researchers compared the Philadelphia neighborhood that would soon receive a new supermarket to a similar community three miles away, hoping to avoid any crossover effect from the opening of the new store. They polled the two communities before and after the store opened to see the effect of the change.
The study needs to be replicated in other neighborhoods and other parts of the United States to confirm or refute these findings, said lead researcher Steven Cummins, professor of population health at the London School of Hygiene and Tropical Medicine. The results do, however, mirror findings in the U.K., where researchers created a similar comparison of two neighborhoods in Scotland and observed no net effect on fruit and vegetable intake.
And if the conclusion is borne out, it would suggest that policymakers rethink the Healthy Food Financing Initiative if they want to promote healthier eating and healthier citizens.
There's some evidence already to support the conclusion that access to healthy food needs to be paired with education about consumption. The Philadelphia Department of Public Health studied some 120,000 schoolchildren ages 5 to 18 and found that obesity rates declined 5 percent between 2006 and 2010. When evaluating by race and gender, African-American boys dropped 8 percent and Hispanic girls 7 percent.
Those results came after the city implemented nutrition education in 1999 for all children eligible for food stamps, removed sugary drinks from school vending machines, switched from 2 percent to 1 percent milk in the cafeteria, and created wellness councils made up of teachers and students in 171 schools.
Some 23.5 million people in the U.S. live in a food desert, according to data from the USDA.
The Healthy Food Financing Initiative is the most aggressive of the White House's programs to fight obesity. But other programs also work to incentivize the consumption of fresh produce, including providing subsidies to existing bodegas and mom-and-pop corner stores to increase the presence of fresh produce; encouraging the acceptance of food stamps and vouchers at farmer's markets; and instituting fresh-fruit and vegetable programs in low-income schools. It's too early into the HFFI program to see results, an official at USDA said, but White House representatives will meet Tuesday with representatives from six healthy food access projects across the country to discuss their progress.
Communities with less access to healthy foods are at an increased risk of obesity, diabetes, and cardiovascular disease. But, Cummins said, there's little evidence to support that installing a supermarket improves population health, and his study would indicate that the converse is true.
Cummins said in an email that lawmakers ought to consider policies that will change community behavior to incorporate healthy food into everyday diets.
"These might include economic initiatives such as taxes on unhealthy foods and subsidies on healthy foods, marketing initiatives that focus on in-store promotion of healthy food, and programs that focus on skills related to buying and cooking components of a balanced diet," Cummins said.
Cummins isn't alone. Food-policy expert and former Hartford Food System executive director Mark Winne said the movement toward improving access to healthy food started in the mid-1980s, when researchers first uncovered the connection between poverty, diet, and poor health outcomes.
"Our health policy is not connected to our agriculture policy," Winne said. "The level of subsidy that we provide to corn, rice, wheat, and sugar producers outpaces what we're countering with those programs to incentivize consumption of fruits and vegetables. You see almost nothing in terms of actual subsidy for fresh fruits and vegetables."
Billions of dollars of corn subsidies help lower the price of packaged foods that contain high amounts of high fructose corn syrup, and the price of fruits and vegetables just can't compete, Winne said. Keeping the price of fruits and vegetables down is one intervention the government can consider, in addition to making them readily available.
"Access, affordability, education would probably be the three legs of the stool," Winne said, describing how policymakers can approach efforts to improving health outcomes through food. "Regulation of the food industry would be a fourth leg, particularly in advertising to children and in location of fast-food restaurants so that they're not close to schools."
These complementary policies, he said, could spur behavior change as lawmakers look to bring grocery stores to underserved communities.