A report published in the July 11 issue of Archives of Internal Medicine from the JAMA/Archives journals revealed that living in close proximity to fast-food restaurants is apparently associated with increased consumption of fast food by individuals, while dietary behavior has rarely been affected in those living near grocery stores and supermarkets.

Sources of the article were suggestive that one of the priorities of the federal government has been to limit “food deserts” in areas where healthy food is difficult to find.

The authors noted that:

“Such policies stem from limited evidence that food resources are related to obesity and are inequitably allocated according to neighborhood wealth.” “Implicit in these policy initiatives is that reduced access to fast food and increased access to supermarkets will translate into improvements in diet behavior and health.”

This speculation was evaluated by Janne Boone-Heinonen, Ph.D., and colleagues from the University of North Carolina at Chapel Hill by using baseline data collected between 1985 and 2001 from the study entitled, Coronary Artery Risk Development in Young Adults. Fast food consumption, diet quality, adherence to fruit-and-vegetable-consumption guidelines as a function of fast-food chain, and availability of a supermarket or grocery store within distances of less than one kilometer to more than eight kilometers from study participants’ homes were the parameters assessed by the study authors.

The study comprised of 5,115 participants between the ages of 18 to 30 years at baseline from Birmingham, Ala.; Chicago; Minneapolis; and Oakland. The participants were queried regarding their frequency of fast food consumption, and their food consumption during the earlier month. In addition, regular dietary habits were detailed.

An association between fast-food consumption and fast-food availability was observed among participants of the lower-income groups. This relationship was predominantly evident among men whose proximity from their residence to the fast food centre was between one and three kilometers. The results were not suggestive of any significant relationships between supermarkets and diet quality or consumption of fruits and vegetables. A mixed relationship was observed between availability of grocery stores and eating habits.

Researchers documented that:

“These findings have critical implications for existing and proposed policies aimed at improving access to healthy foods. Overall, classification of food stores and restaurants into ‘healthy’ or ‘unhealthy’ according to mode of service (fast food or sit-down) or size (supermarket vs. grocery store) may provide little understanding of how the food environment impacts diet and may overlook innovative policy solutions.”

The authors believe further research is required to determine the effect of neighborhood food environment on diet and consumption.

Jonathan E. Fielding, M.D., M.P.H., and Paul A. Simon, M.D., M.P.H., from the Los Angeles County Department of Public Health and the University of California, Los Angeles have provided their outlook in an accompanying Commentary on the findings by Boone-Heinonen and colleagues. They document that the relationship between fast-food consumption and availability is pertinent to an attempt initiated by Los Angeles to reduce fast-food restaurants in low-income neighborhoods. Fielding and Simon also hypothesize that including data about food quality, pricing, and merchandising may provide more definitive evidence about the association between supermarket availability and dietary behaviors.

They wrote:

“The greatest challenge in this area of research is how to address the complexity of local 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.” Fielding and Simon commented that rather than increasing access to healthy foods, limiting access to fast foods may play a bigger role in curbing obesity. They concluded that “Given the complexity of food environments, it will be important to identify those combinations of interventions that together generate meaningful improvements in dietary practices at the population level and reduce the huge disparities in overweight and obesity.”

“Fast Food Restaurants and Food Stores – Longitudinal Associations With Diet in Young to Middle-aged Adults: The CARDIA Study”
Janne Boone-Heinonen, PhD; Penny Gordon-Larsen, PhD; Catarina I. Kiefe, MD, PhD; James M. Shikany, DrPH; Cora E. Lewis, MD; Barry M. Popkin, PhD
Arch Intern Med. 2011;171(13):1162-1170. doi:10.1001/archinternmed.2011.283

Anne Hudsmith