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insidE

Highlights

Introduction

List of Exhibits

Exhibits and Findings

Discussion

Conclusions and Implications

Appendix 7.A Research Methodology

References

autHors

Jane Y. Polsky

Jonathan T. Weyman

Maria I. Creatore

Anne-Marie Tynan

Peter Gozdyra

Richard H. Glazier

Gillian L. Booth

Chapter7

The Local Retail Food EnvironmEnt and Diabetes

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HigHligHtsissue Healthyeatingisessentialtomaintaininggood

healthandpreventingmanychronicdiseases,includingtype2diabetes.

Foodchoicesareshapednotonlybyindividualcharacteristics,butalsobytheenvironmentinwhichthosechoicestakeplace.

Inthischapter,geographicaccesstocommonretailfoodoutletsacrossPeelandratesoffruitandvegetableintakeamongresidentsareexamined.LevelsofeconomicdisadvantageandratesofdiabetesamongPeelresidentsarealsoassessedrelativetoaccesstofoodretail.

Key Findings

InPeel,sourcesofhealthyfood(i.e.,super-marketsandgrocerystores)andlesshealthyfood(i.e.,fast-food/take-outrestaurantsandconveniencestores)weregenerallylocatedinthesameareas.Inallareas,sourcesoflesshealthyfoodgreatlyoutnumberedsourcescontainingmorehealthyfoodbyafactorofatleastfivetoone.

AccesstobothhealthyandlesshealthyfoodoutletswasverygoodnearBolton,throughoutcentralBramptonandinmanypartsofMississauga.LimitedaccessexistedinCaledon,northeastBramptonandinsouthMississauga.Thispatternoffoodoutletdistributioncoincidedwithlocationsofothercommercialandretailservicesandwithpat-ternsofpopulationdensityinPeel.

UnlikemanycitiesintheUnitedStates,economicallydisadvantagedareasofPeelgen-erallyhadbetteraccesstosourcesofhealthyfoodcomparedwiththewealthiestareas.However,theseareasalsohadbetteraccesstosourcesoflesshealthyfood.

Areashometoahighproportionofresidentslivingwithdiabetesweregenerallywellservedbybothsourcesofhealthyandlesshealthyfood.Incontrast,lowerdiabetesareashadreducedaccesstofoodretailofanytype.

InmostareasofPeel,only40%45%ofresidentsreportedconsumingfruitsand/orvegetablesatleastfivetimesaday.TheseratesweresimilartoOntarioandCanada,overall.

Ratesoffruitand/orvegetableintakevariedlittleacrossPeel.Therewasnoapparentassociationbetweenratesoffruitandvegetableintakeandratesofdiabetes.

implications Accesstobothhealthyandlesshealthyfood

shapesindividualseatingbehaviours.

Whilemanyforcesthatshapethefoodenvi-ronmentareoutsidethelocalsetting,manyimportantinitiativescanbeundertakenatthecommunityleveltoencourageandbettersupporthealthyeating.

Giventherisingratesofoverweight/obesityandtype2diabetesinPeelandacrossCanada,publichealthmeasurestoencourageandsup-porthealthyeatingmustbeconsideredmajorpriorities.

introductionHealthanddiet(i.e.,whatweeatanddrink)areinextricablylinked.Individualswhoconsumeahealthydiet(e.g.,onethatishighinfreshfruits,vegetablesandwholegrains)havealowerriskofdevelopingchronicdiseasessuchastype2diabetes,cardiovasculardiseaseandsomecan-cers.1Inaddition,forpeoplelivingwithdiabetesorcardiovasculardisease,eatingahealthydietisamongthekeystrategiestobettermanagetheircondition.1Unfortunately,majortechnologicalandeconomicchangesinthefoodsystemoverpastdecadeshaveresultedinafoodsupplythatishigherinsugarandmoreenergy-dense,andrepletewithhighly-processedfoods.2ThesechangeshaveverymuchshapedtheWesterndiet,whichischaracterizedbyfrequentconsumptionofhighly-processedenergy-densefoodsthatarelowinfibreandhighinfat,addedsugars,refinedgrainsandsodium.IndividualswhoconsumetheWesterndietareathigherriskofdevelopingchronicdiseases,includingtype2diabetes.1

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What are canadians eating? AlthoughfoodavailabilitydatasuggestthatCanadianshavebeenconsumingmorefruitsandvegetablesoverthepasttwodecadesandfewercaloriesperdaybetween2001and2009,3theoverallqualityofmostpeoplesdietscontinuestobeofgreatconcern.ArecentnationalsurveyofCanadianseatinghabitsshowedthatsevenoutof10Canadianchildrenandhalfofadultsatelessthanthehistoricallyrecommendedfiveserv-ingsofvegetablesandfruiteachday.4Thistrendisworrisomeconsideringthatin2007CanadasFoodGuideincreasedtherecommendeddailyintakeoffruitsandvegetablestoarangeofsevento10servingsforteensandadults.5TheoveralldietqualityoftheaverageCanadianhasbeenclassifiedaspoor,withlessthan1%ofCanadiansfollowingadietconsistentwithCanadasFoodGuide.6

OneconcernisthatCanadiansareconsumingtoomanyotherfoods(eg.sweetenedbeveragesandfoodssuchassaladdressingsandpotatochipsthatarenotpartofthefourmajorfoodgroups)foodsthatarehighincaloriesandverylowinnutrients.4ThesefoodscomprisedaquarteroftotaldailycaloriesamongCanadianteenagers.4Furthermore,reflectingthegrowingavailabilityandpopularityofready-to-eatconveniencefoods,oneinfourCanadiansreportedeatingatleastonefast-fooditemonthepreviousday.4Teenagersandyoungmenweremostlikelytohaveeatensomethingfromafast-foodrestaurant(30%and39%,respectively).Thisisatroublingtrendbecausecommonfastfoodslikepizza,hotdogsandsoftdrinkstendtobehighincalories,salt,andlowinnutrients.Frequentconsumptionoffastfoodshasbeenassociatedwithlowerintakeofhealthyfoodsandincreasedriskofbecomingobeseanddevelopingtype2diabetes.7-9

What shapes a persons diet?Individualsdietarypreferencesandchoicesarehighlycomplexandareshapedbymanydiffer-entfactors.Attheindividuallevel,thesefactorsincludeage,sex,familycompositionandsocio-culturalfactors(e.g.,socioeconomicstatus,

ethnoculturalorreligiousbackground).10-13Householdincomeisparticularlyimportantbecauseadiethighinfreshfruitandvegetables,leanmeatsandfishtendstocostmorethanaless-healthydiethighincaloriesandhighly-pro-cessedfoods.14Canadianhouseholdswithhigherlevelsofincomeandeducationconsistentlypurchasemorenutritiousfoodsandhaveabetterqualitydiet.15-17Purchasingfruitandvegetablesisparticularlysensitivetofinancialconstraints:Canadianswithlowerlevelsofeducationorthoselivinginlowerincomehouseholdstendtobuyandeatfewerfruitandvegetablescomparedwithindividualswithhigherlevelsofeducationorincome.13,16Limitedtimeforgroceryshop-pingandcookingisoftenanotherimportantinfluenceonfoodintakeamonglow-incomeindividualsworkinglonghoursormultiplejobs,andparticularlyforsingle-parenthouseholds.18Highersocioeconomic(SES)groupstendtobemoreresponsivetodietaryrecommendations,havemoreknowledgeaboutnutritionandmaybemoreawareoftherelationshipbetweendietandhealthcomparedtolowerSESgroups.16,19

Apersonsethnoculturalcharacteristicsalsoplayanimportantroleinfoodchoices.CanadiansbelongingtoAboriginal,SoutheastAsianandChineseethnicgroupswerelesslikelytoreporteatingfruitandvegetablesatleastfivetimesadaycomparedwithotherethnicgroupsincludingLatinAmerican,White,SouthAsianandBlack.11

Individualsfoodchoicesareguidednotonlybypersonalfactors,butalsobythechoicesavailabletothemwithindifferentsettings(e.g.,work,school,community).Messagesthatencouragethesechoicesfromotherindividuals,themediaandinstitutionsarealsoveryinfluential.Tobetterunderstandtheseinfluences,researchersareincreasinglystudyingtherolethatthefoodenvironment(i.e.,thefoodchoicesavailabletoindividualsinvarioussettingsofdailylife)playsinpromotingorhinderinghealthyeating.20Thesesettingsincludetheorganizationalfoodenvironment(e.g.,school,work,home),theconsumerenvironment(i.e.,availability,quality,portionsizeandpriceoffoodsinstoresandeatingplaces),thecommunityenvironment(i.e.,

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availabilityandaccessibilityofvarioustypesofstoresandeatingplacesincommunities)andtheinformationenvironment(i.e.,mediaandadvertising).21Theconsumerandcommunityenvironmentsareparticularlyimportantbe-causeanychangesinthesedomainswillhavebroad-reachingeffectsonthepopulation.Forthisreasonandbecausedataonvarioustypesofsettingsaredifficulttoobtain,theanalysesinthisatlasfocusonlyonthecommunityorlocalfoodenvironment.Inthischapter,thetermlo-calfoodenvironmentisusedinterchangeablywiththetermcommunityfoodenvironment.

the local food environment and diet Sourcesoffresh,healthyandaffordablefoodareessentialresourcesforhealthyeatingincom-munities.Ifanareadoesnothavegoodaccesstohealthyaffordablefood,residentsmusttravelsomedistanceoutsidetheirneighbourhoodtoobtainthesefoods,orrelyonmorereadilyavail-ableandoftenlesshealthyoptionssoldinnearbyconveniencestoresoreatingplaces.Inmanyurbansettings,convenientaccesstobothhealthyandless-healthyfoodinneighbourhoodscanbeparticularlyimportantforlowerincomegroupsandindividualswithlimitedaccesstoaprivatevehicleforfoodshoppingpurposes.22

Todate,thereisalackofCanadianresearchthatexaminestheeffectsofthelocalfoodenviron-mentonindividualsdiets.ThemajorityofpublishedstudiesonthistopicwereconductedintheUnitedStates(U.S.),EuropeandAustralia,andpresentconflictingevidenceontheextenttowhichthelocalretailfoodenvironmentshapesdietarypatterns.Whilesomestudiesdidnotfindthathavingbetteraccesstohealthyfoodwasrelatedtohealthiereating,othersshowedthatresidentslivingnearsupermarketsorlargegrocerystoreshadbetterqualitydiets.20,23,24

Researchersarealsoincreasinglypayingattentiontoretailsourcesoflesshealthyfood,suchasconveniencestoresandfast-foodoutlets.Althoughtheyprovideconvenientlocationsandextendedoperatinghours,conveniencestoresconsistentlystockfewhealthieroptionsandsellfoodsatsignificantlyhigherprices

thanlargergrocers.25,26Canadiansarealsoincreasinglypatronizingfast-foodandtake-outrestaurants(outletsthatlacktableserviceandwherecustomersgenerallypaybeforereceivingtheirmeal).4Suchoutletsareeasilyaccessibleinmostcommunities,provideasourceofrelativelyinexpensivemealsandcommonlyofferlargeportionsofhighly-processedandnutrient-poorfoodsanddrinks.

Accesstofast-foodrestaurantsandconveniencestoresmayplayaroleinshapingthedietsoflocalresidents.23,27U.S.residentswholivednearmorefast-foodrestaurantsweremorelikelytoconsumefastfoodneartheirhomeandwerelesslikelytohaveahealthydietoverall.28InAustraliaandEngland,childrenwithbetteraccesstofast-foodoutletsandconveniencestoresneartheirhomeatefewerfruitsandvegetablesandmoresnackfoodsthanthosewithlessaccesst