Bad News for Obama’s Antiobesity Effort

A new study suggests that giving consumers greater access to healthy food doesn’t change eating habits.

LEIPZIG, GERMANY - MAY 23: A man with a large belly eats junk food on May 23, 2013 in Leipzig, Germany. According to statistics a majority of Germans are overweight and are comparatively heavier than people in most other countries in Europe.
National Journal
Clara Ritger
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Clara Ritger
Feb. 3, 2014, 11:01 a.m.

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.

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