Academic journal article International Journal of Child Health and Human Development

Pediatric Obesity and Food Access in Durham, North Carolina

Academic journal article International Journal of Child Health and Human Development

Pediatric Obesity and Food Access in Durham, North Carolina

Article excerpt

Introduction

The problem of childhood obesity is growing in the United States. About 33% of children (ages 2-19 years) are overweight or obese (1) and the percentage of obese children in the US has tripled since the 1980s (2). Childhood obesity has short- and long-term effects, including adult obesity, hypertension, and diabetes (3). Obesity and excess body fat are linked to poor dietary patterns (4), and these patterns may be affected by an individual's food environment. Food environments are characterized by access to different types of food, food prices, and access to nutritional programs (5). Without easily accessible healthy food options, nutritious dietary choices may be difficult.

Living in an area with limited access to healthy food or high access to unhealthy food may impact health. Many studies have shown a connection between access to convenience stores and weight status (6). Epstein looked at data from a behavioral weight treatment program for overweight children and found that children living in areas with fewer convenience stores were more successful in controlling their weight (7). Similarly, Powell et al. examined the availability of food stores and its contribution to obesity among 8th and 10th graders. They saw a positive association between the number of convenience stores and body mass index (BMI) in adolescents (8). Convenience stores tend to have a limited food selection as well as foods that are calorically dense (9).

The evidence on the relationship between supermarket accessibility and health status is mixed. Powell's research showed an association between high density of supermarkets and low BMI levels in children, concluding that an additional supermarket per 1,000 people was statistically associated with a 0.11 percentage decrease in BMI units in children, while Epstein observed a contradictory result. Epstein's research suggested that fewer supermarkets were associated with a greater BMI reduction in children participating in the weight control program (7). Liu et al. found that a greater distance between a child's residence and the nearest large supermarket was associated with a higher risk for being overweight (10).

When looking at adults, Macdonald et al. found that distance to supermarkets was not statistically associated with vegetable and fruit consumption or BMI levels (11), and Stafford et al. had similar results (12). The discrepant findings related to health status and supermarkets may be due to the large variety of food options at these retail stores, including both healthy (fresh produce) and unhealthy (energy-dense processed foods) options.

Multiple studies have shown that food availability differs by the socio-economic status of the community.

In research conducted by Booth, Pinkston, and Poston, neighborhoods with high socio-economic status were shown to have more supermarkets, and the opposite was true for low socio-economic status communities (13). Individuals of low socioeconomic status are at risk of consuming low quality diets low in fresh fruits or vegetables (14). Horowitz et al. looked at the availability of diabetes-healthy food in neighborhoods in East Harlem as well as the Upper East Side of New York City and found that only 18% of stores in East Harlem carried food recommended to individuals with diabetes, while 58% of stores in the Upper East Side stocked the recommended foods (15) .

East Harlem is an area of racial and ethnic minorities whereas the Upper East Side consists mostly of wealthy Caucasians. Despite these neighborhoods being spatially proximate, large disparities exist in food access between the two communities.

Recent consideration of the food retail environment as a possible factor in childhood obesity motivated this analysis of the food retail environment and its relationship to BMI. The purpose of this study was to determine if the presence and distribution of different forms of food outlets contribute to childhood obesity in Durham County, North Carolina, after controlling for socioeconomic factors. …

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