Food Environment and Eating Behaviour NDT 2126 PDF

Food Environment and Eating Behaviour NDT 2126 : Overview of Food Environment in Urban & Rural Settings...

Food Environment and Eating Behaviour NDT 2126 : Overview of Food Environment in Urban & Rural Settings April 23, 2024 Copyright (C) 2020. IMU Inspire Empower Elevate Limitations: For internal circulation in the International Medical University ONLY Lesson outcomes Define food environment and its concept Describe the characteristics of the food environment Access Availability Affordability Quality The Concept of Food Environment & its Relevance to Health 3 Food Environment Food environments are the physical, social, economic, cultural and political factors that impact the accessibility, affordability, availability, and adequacy of food within a community or region. 4 Food Environment The food environment plays a role in what people choose to eat. The food environment is defined by: The physical presence of food that affects a person’s diet A person’s proximity to food store locations The distribution of food stores, food service, and other spaces from which food may be obtained A connected system/network that allows access to food Food environments are created by the human-built and social environments. 5  Dimensions of Food Environment Turner et al., Concepts and critical perspectives for food environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security. 2018; 18:93–101 6 Aspects of Food Environment Community food environments are measured by people’s proximity to different kinds of food outlets or the density or variety of different types of food outlets within a specific geographic area. Consumer food environments are characterized by the accessibility, variety, price, and quality of foods, and of consumer information such as promotional signs, as well as relative prominence of healthier versus less healthy food options. Organizational food environments are shaped by features such as food preparation, retailing, or food growing facilities in institutional settings. Food information may be in the form of advertising, labelling, or educational curricula. 7 Food Environment Affects Health Outcomes Turner et al., Concepts and critical perspectives for food environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security. 2018; 18:93–101 8  Food Environments Affect Health Outcomes (cont…) Multiple community settings identified significant associations between the availability (measured as density) of food vendors and BMI, though vendor type was found to have variable associations. The availability of unhealthy foods in and around schools is positively associated with the regular intake of these foods amongst adolescents. SSB consumption correlated with sedentary behavior, frequency of purchasing lunch from school cafeterias and frequency of purchasing snacks from vending machines. However, evidence associating school food environment and student BMI is not conclusive. 9 Healthy Food Environments Healthy food environments provide equitable access to healthy foods. They provide/ make available: opportunities for food production and food distribution networks fresh fruits and vegetables and whole foods in a variety of retail and food service outlets healthier options for prepared and pre-packaged foods community programs and infrastructure All of these enable healthy food consumption and to support healthy eating. 10  Methodological Framework: maps geospatial and observational approaches to food environment domains GIS: Geographic Information System GPS: Global Positioning System Turner et al., Concepts and critical perspectives for food environment research: a global framework 11 with implications for action in low- and middle-income countries.. Global Food Security. 2018; 18:93– 101 Food Environments in Low- or Middle-Income Country (LMIC) 12 Community Food Environments in LMIC Small- and medium-sized market-based vendors dominate LMICs. For example, in Cape Town, South Africa, formal supermarkets did not cater to the needs of the poor, whereas informal vendors provided sources of cheaper, lower-quality foods available on credit. Nonmarket-based food sources were also important in some settings. In communities vulnerable to food insecurity, wild food harvesting may also be important e.g. Brazilian rainforest cities. 13 Community Food Environments in LMIC (cont…) Food deserts: characterized by insufficient availability and accessibility of healthy foods, particularly fruits and vegetables, were widespread in urban communities in Brazil. Food swamps: typified by the inundation of unhealthy foods and drinks, were common in low- and middle-income communities in Mexico. Food oases: identified amongst high-income communities with limited availability of less-healthy options in Mexico. Turner et al., Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review, Advances in Nutrition, 2019; https://doi.org/10.1093/advances/nmz031 14 School Food Environment in the LMIC Multiple settings consistently found school food environments to be saturated with vendors selling unhealthy foods and beverages. Targeted marketing of SSBs to children was also evident. Unhealthy foods and beverages were readily available, affordable, and desirable, whereas healthier options were found to be limited in many school settings. 15 School Food Environment in the LMIC (cont…) Concerns around misleading marketing messages, food safety, and the importance of peer influence in school canteens, the role of food prestige placed upon non-traditional, foods from roadside vendors, restaurants, and small grocery stalls around schools. School policies were found to be highly contested amongst a wide array of actors. For example, proposed policies to regulate the sale of unhealthy foods in schools, had support amongst academics, health professionals, citizens, and parents while food industry concerned about a negative public image, loss of income, and reduced employment opportunities. Guatemala, South Africa, Swaziland, India, Mexico, Mauritius 16 Household Food Environment in the LMIC Traditional family structures and complex eating patterns in Brazil. Perceived low efficacy of low-income mothers to provide their children with nutritious foods in Indonesia. Targeted television marketing and promotion of unhealthy foods to children during school holidays in Malaysia. 17 Rural and Urban Food Environments  Rural and Urban Food Environments – Eg from Nevada Tested the hypotheses of difference in venue density, the availability and quality of produce, and the price difference between standard and healthy items between rural and urban Nevada geographies. Primary data show a greater per-capita density of grocery and convenience venues in the rural area than the urban. A greater per capita density of fast-food venues was found in the urban sample area. 19  Rural and Urban Food Environments – Eg from Nevada (cont…) The variety and quality of produce in the rural grocer venues were lower than the urban supermarkets. No significant or functional price difference was found between the standard and healthier versions of select items within commonly purchased food groups, between rural and urban geographies. 20 Rural and Urban Food Environments - E.g. Texas Fruit and vegetable (FV) intake in urban and rural contexts was studied. Rural sample had more large grocers & convenience stores vs urban sample per 1,000 persons (unexpected!). Density of fast-food venues in rural sample was less but not significantly different from the urban geographies. Distance to supermarket or supercenter: did not affect fruit and vegetable intake in urban areas decreased the FV intake in rural areas 21 Rural and Urban Food Environments - E.g. Texas (cont…) Retail food environments Lower variety and quality have different impacts on scores of produce in the rural FV intake in urban and rural settings. areas. Interventions to improve FV intake in these settings No significant price difference should account for the importance of distance to between rural and urban the retail food environment geographies for non-produce in rural settings. food items. Nickelson, J. "A Rural and Urban Study of the Food Environment in Select Nevada Geographies" (2017). UNLV Theses, Dissertations, Professional Papers, and Capstones. 3019. 22 https://digitalscholarship.unlv.edu/thesesdissertations/3019 Food Intake in Rural and Urban Malaysia Energy intake and Distribution: Energy intake (EI) Males : Rural EI was significantly lower than urban EI (2024 kcal vs 2275 kcal) Females: No difference in mean energy between rural and urban EI (1711 vs 1718 kcal) Energy Distribution Urban males and females: Protein - 14%, Carbohydrate - 55% Fat - 30% Rural : Protein - 13% both males and females Carbohydrate - 65% in males and 66% in females Fat - 19% in males and 21% for females 23 Food Intake in Rural and Urban Malaysia (cont…) Micronutrients: Rural areas = poorer mean intake of vitamins and minerals compared to urban areas. Rural males were deficient, less than two-third RNI in calcium, riboflavin and niacin. Rural women had a poor intake of vitamin A and niacin. Calcium and iron intakes were less than two-third RDA in both the rural and urban women. Overall, only protein and vitamin C intake met the RDA in most subjects from rural and urban areas. Chee SS et al., 1997, Malaysian Journal of Nutrition 24 Recommendations to Improve the Food Environment 25 26 Identifying Gaps in Nutrition and Health - Malaysian Opinions MANS 2014 found MY adults had inadequate intake of fruits, vegetables and wholegrains. Sugar, soy sauce and condiments were staple household items. My Breakfast study (2013) - only a minority of children and adolescents consumed whole grains, at insufficient levels. “Government spending on managing existing cases in the public healthcare system and the predominantly curative approach cannot be sustained.” https://www.thestar.com.my/opinion/letters/2019/10/02/time-to-change-how-we-look-at-nutrition 27 Bridging the Gaps Rice School Food Urgent Need? Programmes fortification with To incentivize and facilitate micronutrient health prevention behaviours, such as: making healthier food choices Minimum taking supplements to nutritional address nutritional Food standards for innovation to cafeteria at deficiencies schools and incorporate adopting healthy lifestyles. workplaces whole grains  Malaysian Food – EPI Recommendations for Food Environment Restrict promotion of unhealthy food and beverage directed at children’s settings and media Set mandatory nutritional labelling (sodium, total sugar and added sugars) on products and to require calorie menu board labelling for all fast-food chains and other food outlets Set sodium targets and investigate food composition standards for added sugar and saturated fat for selected food groups Investigate restriction on opening hours of fast-food restaurants and seek opportunities to restrict the opening of new outlets near schools and residential areas 29  Malaysian Food – EPI Recommendations for Food Environment (cont…) Introduce taxes on sugary drinks with revenues applied to healthy diets for children and investigate price rise in fruits and vegetables Optimise usage of existing monitoring system and provide appropriate feedback and referral mechanism Strengthen access to information and discussion Continue to fund research and nutrition promotion and strengthen sustainable funding for the Malaysian Health Promotion Board 30 References & Acknowledgement: Centre for disease control and prevention (CDC), Atlanta: https://www.cdc.gov/healthyplaces/healthtopics/healthyfood/general.htm University of Wisconsin Population Health Institute: County Health Rankings & Roadmaps program https://www.countyhealthrankings.org/explore-health-rankings/measures- data-sources/county-health-rankings-model/health-factors/health-behaviors/diet-exercise/food- environment-index Harvard School of Public Health: https://www.hsph.harvard.edu/obesity-prevention- source/obesity-prevention/food-environment/ Lytle, L. Myers, A. Measures Registry User Guide: Food Environment. Washington (DC): National Collaborative on Childhood Obesity Research, January 2017. http://nccor.org/tools- mruserguides/wp-content/uploads/2017/NCCOR_MR_User_Guide_Food_Environment- FINAL.pdf. 31 References & Acknowledgement: The World Health Organization: https://www.who.int/bulletin/volumes/93/5/14-145540/en/ Block J Seawrd M, and James P. 2018 Food environment and health In: Neighbourhoods and Health. https://www-oxfordscholarship- com.ezp2.imu.edu.my/view/10.1093/oso/9780190843496.001.0001/oso-9780190843496- chapter-9 INFORMAS: Food-Environment Policy Index (Food-EPI) Malaysia 2019: https://www.informas.org/2019/03/18/food-epi-malaysia/ New Strait Times. March 20, 2019. Malaysia launches first Food-EPI to curb rising NCDs, obesity. https://www.nst.com.my/news/nation/2018/07/393531/malaysia-launches-first-food- epi-curb-rising-ncds-obesity Dr Sangeetha Shyam 32 Lesson outcomes Define food environment and its concept Describe the characteristics of the food environment Access Availability Affordability Quality  Thank you. For more information please contact: Dr Tan Siew Tin Lecturer [email protected] IMU Education Sdn Bhd No. 126, Jalan Jalil Perkasa 19 199201005893 (237397-W) Bukit Jalil, 57000 Kuala Lumpur, Malaysia 603 8656 7228 Copyright (C) 2020. IMU Limitations: For internal circulation in the International Medical University ONLY Formerly known as International Medical University. imu.edu.my