Key Words ecological framework, environmental and policy change, healthy eating environments.
Abstract
Food and eating environments likely contribute to the increasing epidemic of obesity and chronic diseases, over and above individual factors such as knowledge, skills, and motivation. Environmental and policy interventions may be among the most effective strategies for creating population-wide improvements in eating. This reviewdescribesanecologicalframeworkforconceptualizingthemany foodenvironmentsandconditionsthatinfluencefoodchoices,with an emphasis on current knowledge regarding the home, child care, school, work site, retail store, and restaurant settings. Important issuesofdisparitiesinfoodaccessforlow-incomeandminoritygroups andmacrolevelissuesarealsoreviewed.Thestatusofmeasurement andevaluationofnutritionenvironmentsandtheneedforactionto improve health are highlighted.
INTRODUCTION
Substantialresearchclearlyindicatesthatdiet plays an important role in prevention of chronic diseases and obesity (96, 98, 106). Nutrition has come to the fore as one of themajormodifiabledeterminantsofchronic diseases (106). Changes in Americans’ dietaryandlifestylepatternscouldproducesubstantial gains in the population’s health (96). Specifically, increasing consumption of fruits and vegetables, whole grains, and calciumrichfoods,whilereducingsaturatedfats,trans fats,sodium,addedsugars,andexcesscalories and reducing obesity could dramatically improve Americans’ health and well-being (98). Major changes in our food system and food and eating environments over the past decadeshavebeendrivenbytechnologicaladvances; U.S. food and agricultural policies; and economic, social, and lifestyle changes. Food is now readily available and accessible in multiple settings throughout the day. More processed and convenience foods are available in larger portion sizes and at relatively low prices. Parents are working longer hours,therearefewerfamilymeals,andmore meals are eaten away from home (51). The school food environment is remarkably different than a few decades ago: High-calorie, low-nutrition foods are available in multiple venues throughout the school day (91). Food marketing aimed at children has drastically increased over the past 30 years (50). We have seen an exodus of grocery’s to res and an influx of fast-food outlets in low-income urban areas, which has contributed to the income and racial/ethnic disparities in access to healthy
foods (66, 75). Collectively, these environmental changes have influenced what, where, and how much we eat and are believed to have played as substantial role in the current obesity epidemic (50, 51). Individual behavior to make healthy choices can occur only in a supportive environment with accessible and affordable healthy food choices (97). This article presents an overview of food environments and strategies for creating healthy eating environments. A conceptual framework is presented first, followed by a description of key environmental factors organized by specific settings: home, child care, schools, work sites, retail food stores, restaurants, and broader macrolevel issues such as food and agriculture policy and food marketing. Issues of disparities in food access for low-income and minority groups are highlighted. The aim is to advance readers’ understanding of how the environment influences food choices and to highlight promising intervention and policy strategies to promote population-wide healthy eating. Measurement and evaluation issues in conducting environmental and policy research and surveillance is also discussed.
SETTINGS AND PLACES FOR HEALTHY EATING
Homes
National survey data indicate that Americans consume roughly two thirds (68%) of their total calories from foods prepared within the home (43). A variety of factors within the home environment have been associated with healthful dietary behaviors; among the strongest factors are availability and accessibility of healthy foods, the frequency of family meals, and parental in take and parenting practices (for children’s diets).
Child Care
Child care facilities provide a valuable opportunity to promote healthy eating and energy balance in children. Although much has been written on creating healthy food environments in schools, surprisingly little has beenwrittenregardingchildcaresettings.Research examining the nutritional quality of foods and beverages served in child care settings has been extremely limited, and the few studies suggest that nutritional quality needs to be improved (90). Furthermore, little intervention research has been done on changing the food environment. This is a missed opportunity because the majority of children under age five (60%) spend an average of 29 hoursaweekinsomeformofchildcaresetting and 41% spend 35 or more hours per week.
CONCLUSIONS
Improving dietary and lifestyle patterns and reducingobesitywillrequireasustainedpublic health effort, which addresses not only individual behaviors but also the environmental context and conditions in which people live and make choices. Individual behavior changeisdifficulttoachievewithoutaddressing the context in which people make decisions. Initial, significant steps are needed to make healthful food choices available, identifiable,andaffordabletopeopleofallracesand incomelevelsandinalltypesofgeographiclocations(e.g.,urban,suburban,rural).Ourultimategoalsshouldbetostructureneighborhoods,homes,andinstitutionalenvironments so that healthy behaviors are the optimal defaults.
healthyfoods 