Researchers blame c-stores, QSRs for higher risk of obesity and diabetes

People living in neighborhoods crowded with fast-food and convenience stores but relatively few grocery or produce outlets are at significantly higher risk of suffering from obesity and diabetes, according to a study by health researchers in California. The study, titled Designed for Disease: the Link Between Local Food Environments and Obesity and Diabetes, was released April 29. It examines the correlation between the health of nearly 40,000 Californians and the mix of retail food outlets near their homes.

“Whether we realize it or not, we are affected by the food choices around us,” said Dr. Harold Goldstein of the California Center for Public Health Advocacy (CCPHA), one of the study’s authors. In a press release announcing the release of the report, Goldstein said, “Maybe it’s time to consider adding the fast-food joints and convenience stores around every corner to the Environmental Protection Agency’s list of known environmental toxins. This study suggests that they may quite literally be making us sick.”

To examine the effect of “the food landscape” on health, CCPHA, PolicyLink and the UCLA Center for Health Policy Research matched the prevalence of obesity and diabetes from the 2005 California Health Interview Survey (CHIS) to nearly 40,000 respondents’ Retail Food Environment Index (RFEI) scores. The RFEI is the number of fast-food and convenience stores divided by the number of grocery and produce stores around one’s home.

“The relationship was striking in both its consistency and implications,” said Dr. Susan Babey of the UCLA Center for Health Policy Research. “Throughout the state, adults living in high RFEI areas (RFEI of five or higher) had a 20 percent higher prevalence of obesity, and a 23 percent higher prevalence of diabetes than their counterparts living in low RFEI areas (RFEI below three). This is some of the most powerful evidence yet of how the foods available in our communities are shaping the obesity and diabetes epidemics.”

Though low-income communities are often hit hardest by this phenomenon, the health correlation is seen across all geographic regions, income levels and ethnicities, according to the researchers. Statewide in California, the average RFEI of all study participants is 4.5, meaning that they find four times more fast-food and convenience stores than grocery stores and produce vendors when they step out their door. California is home to 14,826 fast-food restaurants and 6,659 convenience stores. By contrast, the state has 3,853 grocery stores and 1,292 produce stands (including farmers’ markets). This disproportionate access to less nutritious foods is, according to the study’s authors, especially alarming in light of the growing obesity and diabetes epidemics, which cost California $6 billion and $18 billion per year, respectively.

California counties where survey respondents had on average more than five times the number of unhealthy retail food options as healthy options include San Bernardino (5.60), Stanislaus (5.48), Kern (5.23), Solano (5.11) and Fresno (5.01). All of these counties have higher rates of obesity and diabetes than counties with average RFEIs below three. In fact, Marin and Santa Cruz Counties, which had the lowest RFEI scores (2.06 and 2.24, respectively), had both the lowest obesity and diabetes prevalence in the state, according to the researchers.

“Clearly the obesity crisis in California can no longer be seen only as a fight over personal choices,” said Dr. Victor Rubin of PolicyLink. “Public policies drive the universe of food options from which we can choose. Families who live in communities with choices limited to high-calorie foods and beverages face substantially greater health risks.” Rubin called on policy makers at the state and local level to provide healthier food options.

The full text of the study is available on the CCPHA Web site at: http://www.publichealthadvocacy.com/designedfordisease.html.