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Wednesday, July 13, 2011

No Easy Fix Where Fast Food Reigns


No Easy Fix Where Fast Food Reigns
By Nancy Walsh

Proximity to fast-food restaurants encourages consumption of the typical high-fat, high-calorie offerings of these venues, but increasing access to supermarkets in low-income neighborhoods is not likely to reverse the swelling obesity epidemic, researchers cautioned.

Among low-income men, a 1% increase in the availability of fast food within six-tenths of a mile (1 km) of the home led to an 0.13% increase in consumption of fast food, according to Penny Gordon-Larsen, PhD, of the University of North Carolina at Chapel Hill, and colleagues.

Yet the availability of grocery store and supermarkets -- presumably offering healthier choices -- was not related to local residents' diet quality or consumption of fruits and vegetables (P>0.10 for interaction), the researchers reported in the July 11 issue of theArchives of Internal Medicine.

Targeting neighborhoods lacking access to healthy foods, commonly referred to as "food deserts," has become a popular initiative as policymakers attempt to improve nutrition among lower socioeconomic groups.

But evidence has been lacking as to the efficacy of these efforts, so Gordon-Larsen and colleagues analyzed longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, in which 5,115 participants, ages 18 to 30, were followed for 15 years.

For each participant, they identified all fast-food restaurants within one, three, five, and eight kilometers of the home, as well as the number of grocery stores and supermarkets.

When interviewed at years two, five, seven, ten, and 15, participants reported the number of times each week they ate at establishments such as McDonalds, Burger King, or KFC (formerly known as Kentucky Fried Chicken).

The quality of their diet was assessed with the Diet Quality Index (DQI), which calculates how closely the individual adheres to dietary guidelines.

In general, men's diets were worse when compared with women's diets:
Fast food consumption, 2.1 versus 1.6 times per week
DQI, 46.5 versus 53
Meets recommendations for fruits and vegetables, 5.6% versus 8.7%



The researchers found a dramatic difference in consumption of fast food according to income (P<0.05 for interaction) for men, with a 1% increase in the number of fast-food establishments within a 1-km and 3-km radius of the home being associated with an 0.34% increase in the frequency of consumption.

Other findings were mixed, however. Having a supermarket within a 1-km to 3-km radius led to greater consumption of fruit and vegetables in men (DQI coefficient 2.14 (95% CI 1.19 to 3.83, P=0.01) though not in women (DQI coefficient 0.80, 95% CI 0.59 to 1.08, P=0.15).

In addition, increased grocery store availability with a 1-km to 3-km radius was linked with a lower diet quality in high-income women but a higher diet quality for low-income men (P<0.10 for interaction).

In an accompanying commentary, Jonathan E. Fielding, MD, and Paul A. Simon, MD, of the University of California Los Angeles, emphasized the complexity of low-income food environments.

"In many disadvantaged communities, the food environment is more swamp than desert, with a plethora of fast food; convenience stores selling calorie-dense packaged foods, super-sized sodas, and other sugar-loaded beverages; and other nonfood retail venues selling junk food as a side activity," wrote Fielding and Simon.

Among the factors that may be influencing food choices, according to Gordon-Larsen's group, could be the lack of a car among low-income residents and the fact that supermarkets carry not only healthy foods, but also a wide range of unhealthy products.




And a possible explanation for the inverse correlation between fast food availability and consumption among higher income women could reflect their choice to eat at fast-food establishments other than those specified in the CARDIA questionnaire, such as sandwich shops.




The authors also pointed out that simply classifying restaurants as healthy or unhealthy may be inadequate to explain how the environment influences diet and to help find solutions.




"Alternative or complementary policies include subsidies to small grocery stores for increasing access to specific food such as produce and reduced-fat milk," Gordon-Larson and colleagues observed.

Their study was limited by the possibility of errors in the food database and the lack of information on specific foods consumed.




In addition, no information was provided on food availability and consumption in the work place.

They concluded that simply providing additional supermarkets would have little benefit, "and that alternative policy options such as targeting specific foods or shifting food costs (subsidization or taxation) should be further
considered."

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