President Obama proclaimed September 2010 the first Childhood Obesity Awareness Month, but some low-income and minority parents who want to improve their children's diet may find buying healthier foods a challenge. That's because supermarkets — which typically offer a healthier selection of foods at better prices than corner stores — can be far away. According to one study, low-income neighborhoods have 25 percent fewer chain supermarkets and 1.3 times as many convenience stores, compared to middle-income neighborhoods. The same study found that predominantly black neighborhoods have about half and predominantly Latino areas only a third as many supermarkets compared to white neighborhoods.
Communities without convenient access to affordable and healthy food are called “food deserts.” Last year the U.S. Department of Agriculture (USDA) estimated that 23.5 million people, or just under 8 percent of Americans, live in low-income areas that are more than one mile from a supermarket or large grocery store.
While that percentage may seem small, the consequences are not. Studies show that people living in food deserts don't eat as healthily as others, consuming fewer fruits and vegetables and less low-fat milk. In addition, some studies have found that access to healthy foods is associated with lower rates of obesity and diabetes.
The White House Task Force on Childhood Obesity wants to eliminate food deserts within seven years and is urging local governments to create incentives to attract supermarkets to underserved neighborhoods and expand the number of farmers' markets. Pennsylvania has already begun.
The Pennsylvania Fresh Food Financing Initiative, started in 2004, provides financing to grocery stores willing to locate in underserved low-to-moderate-income areas. So far 85 stores have been funded. “That is everything from a full-service 70,000-square-foot supermarket to small mom and pop grocery stores to farmers' markets,” says John Weidman, deputy executive director of The Food Trust in Philadelphia, a nonprofit that helps administer the state program.
The funding is a one-time grant meant to overcome the often high costs of opening a grocery business in low-income communities. “Assembling a large piece of land in an urban area is one example of the kinds of barriers these businesses face,” says Weidman. Others are workforce development and environmental remediation if an industrial site is being reused.
Only five of the operations funded so far have failed. “That is a higher success rate than the grocery store average,” says Weidman, “breaking down the myth that these stores cannot be profitable.”
Illinois, New York state and New Orleans are launching similar programs, and President Obama's fiscal 2011 budget includes $400 million for a national initiative.
But no one knows — at least not yet — how the new stores in Pennsylvania have influenced the buying habits, weight and health of nearby residents. Researchers at Pennsylvania State University are conducting a study, and the results should be out next year.
It's one thing to document that existing food deserts are associated with less healthy diets and higher obesity rates. It's quite another to show that an intervention like the Fresh Food Financing Initiative can have a positive impact. “You cannot assume that,” says Joel Gittelsohn, a medical anthropologist at the Bloomberg School of Public Health at Johns Hopkins University, “because human behavior and weight is affected by a multitude of factors — not just access to healthy food — factors like people's knowledge about using healthy foods.”
Eating healthy foods like fresh fruit and vegetables instead of high-calorie junk food is a challenge in low-income neighborhoods, which have far fewer chain supermarkets and more convenience stores than upscale neighborhoods. (Getty Images/Joe Raedle)
While bringing supermarkets to low-income communities may be a long-term solution, Gittelsohn says it makes sense in the short term to work with what's already there. “If you go to Baltimore city, there may be 30 or 40 supermarkets, but there may be as many as 1,000 corner stores and as many carry-out restaurants, and then there are fast-food restaurants,” he says.
The Food Trust and the Philadelphia health department have such a program, called the Healthy Corner Store Initiative. So far about 40 corner stores have signed up, with a goal of 1,000 by the end of 2011. Stores agree to carry water and 100 percent fruit juice, baked chips and fruit salad. “We know anecdotally that the fruit salad is selling,” says Weidman. “Kids tend to buy what is in front of them, and when you combine that with our nutrition education in the schools, you can really have an impact.”
Gittelsohn has conducted several corner-store studies to try and assess more scientifically whether these programs lead to healthier eating. Like the Philadelphia program's nutrition-education component, Gittelsohn's interventions also tried to increase demand for healthy foods as well as supply, using strategies like in-store promotions. The majority of his studies show an impact on healthy-food purchases, and where diet has been assessed, “less fatty food consumption and more fruit and vegetable consumption.”
But Gittelsohn's studies did not show an improvement in weight and health. “I've looked at it, but I didn't see an impact,” he says. One problem may be that his studies were small; another is that it can take years to reduce obesity and diabetes rates. Or it could be that shoppers are compensating by purchasing less healthy foods from other stores. The USDA is currently accepting applications for a much larger, longer-term study.
— Barbara Mantel