Systematic review of local food environment and diet related health outcomes

Introduction. Research on contributions of the food environment to obesity and other diet-related health problems has grown rapidly over the past several years. Policymakers are pressing for evidence to guide interventions to reverse the obesity epidemic and improve population health. Methods. This systematic review assessed peer-reviewed U.S. studies through 2012 that tested associations between the community or consumer food environment and body weight, diabetes, or indicators of cardiovascular health (e.g., blood pressure) in adults and children. A systematic keyword search yielded 5,340 titles, of which 61 met full inclusion criteria. Results. Among the findings, over half of adult studies (58%; n=11/19) that examined supermarkets found that better access was associated with healthier weights. Of the studies that examined convenience stores in children, 63.6% (n=7/11) found that better access was associated with less healthy weights. Evidence linking fast food outlets to weight was equivocal (n=10/20 studies in adults; n=3/13 studies in children). Of the 20% of studies that included a direct measure of the consumer food environment (e.g., food availability), few found relationships with body weight. Few associations were found with other health outcomes. Conclusions. There remains no consensus on the importance of the local food environment in Americans' health. While research to date supports some limited interventions (e.g., improving supermarket access, possibly improving product mix and marketing at convenience stores), additional research is needed to identify the most promising targets of policies and programs. Our review points to multiple ways to strengthen evidence on the local food environment and health.