More and healthier food choices in a neighborhood, when done right (whatever that means), should be a good thing, no?
We have long known that some low-income neighborhoods have few options than for accessing healthy foods, like fresh fruits and vegetables. It has been suggested that this likely contributes to unhealthy diets and, in turn, to obesity and its associated medical problems, such as Type 2 diabetes.
Encouraging supermarkets and grocery stores to open in these neighborhoods has been proposed as a way to improve access to healthier foods and reduce diet-related illnesses. Although this supposition makes intuitive sense, there is not much evidence to support that this type of intervention actually works.
That is why a recent paper, “New Neighborhood Grocery Store Increased Awareness of Food Access But Did Not Alter Dietary Habits or Obesity,” in the February 9, 2014 issues of the journal Health Affairs is so interesting. London-based researchers Steven Cummins and Ellen Flint (from the London School of Hygiene and Tropical Medicine) collaborated with Stephen Matthews, associate professor of Sociology, Anthropology, and Demography at Penn State on a “controlled pre-post quasi-experimental longitudinal design” to assess the impact of a adding a new supermarket to a neighborhood considered a food desert.
The logistics of this study were formidable—including weathering a three-year delay in the supermarket’s construction. Baseline data collection took place in June-September 2006, but the supermarket did not open until December 2009. A thousand four hundred and forty people participated in the initial data collection. At follow-up 6 months after the store opened, that number was reduced to 650. Attrition was the same in the intervention neighborhood—the one that got the supermarket—as in the control neighborhood. The make-up of the neighborhoods was similar.
The study looked at three main outcomes:
- Was there a change in Body Mass Index (BMI)? Did people lose or gain weight?
- Was there a change in mean fruit and vegetable intake (assessed by the Block Food Frequency Questionnaire?
- Did perceptions of food access change (assessed by a five-item questionnaire)?
Did the supermarket make a difference?
First of all, according to the article, “few residents adopted the new supermarket as their main food store.” And secondly, “exposure to the new supermarket had no statistically significant impact on BMI and daily fruit and vegetable intake at six months.” The new store did, however, positively impact perceptions of food accessibility.
What does it mean?
This study raises many more questions than it answers—but that is a good thing. It will force proponents of this type of intervention to dig deeper to figure out what is really going on.
There are some hints from the discussion section of the paper. Proposed reasons why the residents didn’t use the new store include preference for existing food stores (why?), increased cost, and access to informal credit in existing stores. The authors also note that previous studies have suggested community resistance to new food supermarket development could impact its use. But we are told the community owned and operated the site the new supermarket was built on and that it supported its development. Other questions that come to my mind include:
- Was the supermarket owned and run by members of the community or by outsiders?
- Did the supermarket stock culturally preferred types of produce? And, other types culturally preferred foods?
- Did the new market threaten the existence of the existing markets and/or was there a strong loyalty to the operators of the existing markets?
- Were there geographic barriers to accessing the market (e.g., not on a bus line, area perceived as dangerous, hours open not convenient)?
I am sure there are many other possible reasons that you, my dear readers, can suggest. I only hope that before holders of the purse strings deem this experiment to be a failure, an attempt is made to understand why, really, the supermarket wasn’t used more and whether there are simple fixes that can improve its uptake. More and healthier food choices in a neighborhood, when done right (whatever that means), should be a good thing, no?
I congratulate the authors for taking on this difficult research question and hope that they are energized, and not discouraged, by the results of their first attempt to answer it.
Want to learn more about the impact of living in a food desert—check out this first hand account:
Featured photo credit: Freepik