Current Obesity Reports

, Volume 3, Issue 4, pp 451–458 | Cite as

Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions

  • Elizabeth Anderson SteevesEmail author
  • Paula Andrea Martins
  • Joel Gittelsohn
Economy and Environment (LM Powell, Section Editor)


The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment prior to implementation. In addition, we outline the need for strategies for addressing these issues including conducting pilot interventions, developing additional methodologies, and embracing the use of simulation models.


Food environment Obesity Food dessert Stores Intervention Nutrition Food access 



The project described was supported by Grant Number U54HD070725 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD). The project is co-funded by the NICHD and the Office of Behavioral and Social Sciences Research (OBSSR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or OBSSR.

Compliance with Ethics Guidelines

Conflict of Interest

Elizabeth Anderson Steeves, Paula Andrea Martins, and Joel Gittelsohn declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009;87(1):123–54.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Glanz K, Sallis JF, Saelens BE, Frank LD. Healthy nutrition environments: concepts and measures. Am J Health Promot. 2005;19(5):330–3. ii.PubMedCrossRefGoogle Scholar
  5. 5.
    Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Cummins S, Flint E, Matthews SA. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Aff (Millwood). 2014;33(2):283–91.CrossRefGoogle Scholar
  7. 7.
    Morland KB, Evenson KR. Obesity prevalence and the local food environment. Health Place. 2009;15(2):491–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006;30(4):333–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Powell LM, Auld MC, Chaloupka FJ, et al. Associations between access to food stores and adolescent body mass index. Am J Prev Med. 2007;33(4 Suppl):S301–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Gibson DM. The neighborhood food environment and adult weight status: estimates from longitudinal data. Am J Public Health. 2011;101(1):71–8.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Powell LM, Slater S, Mirtcheva D, et al. Food store availability and neighborhood characteristics in the United States. Prev Med (Baltim). 2007;44(3):189–95.CrossRefGoogle Scholar
  12. 12.
    Franco M, Diez Roux AV, Glas TA, et al. Neighborhood characteristics and availability of healthy foods in Baltimore. Am J Prev Med. 2008;35(6):561–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Gordon C, Purciel-Hill M, Ghai NR, et al. Measuring food deserts in New York City’s low-income neighborhoods. Health Place. 2011;17(2):696–700.PubMedCrossRefGoogle Scholar
  14. 14.
    Gittelsohn J, Rowan M, Gadhoke P. Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease. Prev Chronic Dis. 2012;9(September 2010):E59.PubMedCentralPubMedGoogle Scholar
  15. 15.•
    Gittelsohn J, Lee-Kwan SH, Batorsky B. Community-based interventions in prepared-food sources: a systematic review. Prev Chronic Dis. 2013;10(8):E180. This is one of the first review papers of food environment interventions focusing on prepared food sources. Prepared food sources are not often the target of food environment interventions, despite the high percent of caloric intake consumed at this type of food source.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Escaron AL, Meinen AM, Nitzke SA, Martinez-Donate AP. Supermarket and grocery store-based interventions to promote healthful food choices and eating practices: a systematic review. Prev Chronic Dis. 2013;10(2):E50.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Bentley ME, Johnson SL, Wasser H, et al. Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: an overview. Ann N Y Acad Sci. 2014;1308:54–67.PubMedCrossRefGoogle Scholar
  18. 18.
    Wilson MG, Goetzel RZ, Ozminkowski RJ, et al. Using formative research to develop environmental and ecological interventions to address overweight and obesity. Obesity (Silver Spring). 2007;15 Suppl 1:37S–47S.CrossRefGoogle Scholar
  19. 19.
    Pitts SBJ, Bringolf KR, Lloyd CL, et al. Formative evaluation for a healthy corner store initiative in Pitt County, North Carolina: engaging stakeholders for a healthy corner store initiative, part 2. Prev Chronic Dis. 2013;10:E120.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Cavanaugh E, Mallya G, Brensinger C, et al. Nutrition environments in corner stores in Philadelphia. Prev Med (Baltim). 2013;56(2):149–51.CrossRefGoogle Scholar
  21. 21.
    Dodson JL, Hsiao Y-C, Kasat-Shors M et al. Formative research for a healthy diet intervention among inner-city adolescents: the importance of family, school and neighborhood environment. Ecol Food Nutr; 48(1):39–58.Google Scholar
  22. 22.
    Cortes LM, Gittelsohn J, Alfred J, Palafox NA. Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands. Health Educ Behav. 2001;28(6):696–715.PubMedCrossRefGoogle Scholar
  23. 23.
    Christiansen KMH, Qureshi F, Schaible A et al. Environmental factors that impact the eating behaviors of low-income African American adolescents in Baltimore City. J Nutr Educ Behav; 45(6):652–60.Google Scholar
  24. 24.
    Lee SH, Rowan MT, Powell LM et al. Characteristics of prepared food sources in low-income neighborhoods of Baltimore City. Ecol Food Nutr; 49(6):409–30.Google Scholar
  25. 25.
    Pereira RF, Sidebottom AC, Boucher JL, et al. Assessing the food environment of a rural community: baseline findings from the heart of New Ulm project, Minnesota, 2010-2011. Prev Chronic Dis. 2014;11:E36.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Ayala GX, Elder JP. Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. J Public Health Dent. 2011;71:S69–79.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Freimuth VS, Mettger W. Is there a hard-to-reach audience? Public Health Rep;105(3):232–8.Google Scholar
  28. 28.•
    Gittelsohn J, Laska MN, Karpyn A, et al. Lessons learned from small store programs to increase healthy food access. Am J Health Behav. 2014;38(2):307–15. The paper uses a case study approach to highlight the food environment work that have been conducted in four American cities: Minneapolis, MN; Philadelphia, PA; Baltimore, MD; and Burlington, NC. This article describes effective strategies and lessons learned across each of the cities.PubMedCrossRefGoogle Scholar
  29. 29.
    Gittelsohn J, Evans M, Story M, et al. Multisite formative assessment for the Pathways study to prevent obesity in American Indian schoolchildren. Am J Clin Nutr. 1999;69(4 Suppl):767S–72S.PubMedGoogle Scholar
  30. 30.
    Strolla LO, Gans KM, Risica PM. Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low-income audience. Health Educ Res. 2006;21(4):465–76.PubMedCrossRefGoogle Scholar
  31. 31.
    Liese AD, Weis KE, Pluto D, et al. Food store types, availability, and cost of foods in a rural environment. J Am Diet Assoc. 2007;107(11):1916–23.PubMedCrossRefGoogle Scholar
  32. 32.
    Fleischhacker SE, Evenson KR, Sharkey J, et al. Validity of secondary retail food outlet data: a systematic review. Am J Prev Med. 2013;45(4):462–73.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Martins PA, Cremm EC, Leite FHM, et al. Validation of an adapted version of the nutrition environment measurement tool for stores (NEMS-S) in an urban area of Brazil. J Nutr Educ Behav. 2013;45(6):785–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Glanz K, Sallis JF, Saelens BE, Frank LD. Nutrition Environment Measures Survey in stores (NEMS-S): development and evaluation. Am J Prev Med. 2007;32(4):282–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Beebe J. Rapid Assessment Process: An Introduction. Walnut Creek, CA: Rowman & Littlefield; 2001.Google Scholar
  36. 36.
    Scrimshaw SC, Carballo M, Ramos L, Blair BA. The AIDS Rapid Anthropological Assessment Procedures: a tool for health education planning and evaluation. Health Educ Q. 1991;18(1):111–23.PubMedCrossRefGoogle Scholar
  37. 37.
    Community Economic Development Healthy Food Financing Initiative. [].
  38. 38.
    Ayala GX, Baquero B, Laraia BA et al. Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers’ intake of fruits and vegetables. Public Health Nutr. 2013:1–8.Google Scholar
  39. 39.
    Cavanaugh E, Green S, Mallya G, et al. Changes in food and beverage environments after an urban corner store intervention. Prev Med (Baltim). 2014. doi: 10.1016/j.ypmed.2014.04.009.Google Scholar
  40. 40.
    Gittelsohn J, Kim EM, He S, Pardilla M. A food store-based environmental intervention is associated with reduced BMI and improved psychosocial factors and food-related behaviors on the Navajo nation. J Nutr. 2013;143(9):1494–500.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Song H-J, Gittelsohn J, Kim M, et al. A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods. Public Health Nutr. 2009;12(11):2060–7.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    McCormack LA, Laska MN, Larson NI, Story M. Review of the nutritional implications of farmers’ markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc. 2010;110(3):399–408.PubMedCrossRefGoogle Scholar
  43. 43.
    Young CR, Aquilante JL, Solomon S, et al. Improving fruit and vegetable consumption among low-income customers at farmers markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011. Prev Chronic Dis. 2013;10:E166.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Lindsay S, Lambert J, Penn T, et al. Monetary matched incentives to encourage the purchase of fresh fruits and vegetables at farmers markets in underserved communities. Prev Chronic Dis. 2013;10:E188.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Food Expenditures: Table 10 - Food Away from Home as a share of Food Expenditures. [].
  46. 46.
    Stewart H, Blisard N, Jolliffe D. Let’s Eat Out: Americans Weigh Taste, Convenience, and Nutrition, District of Columbia: 2006.Google Scholar
  47. 47.
    Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health Place. 2010;16(5):876–84.PubMedCrossRefGoogle Scholar
  48. 48.
    Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966-2007. Prev Chronic Dis. 2009;6(3):A105.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Hawkes C. Identifying Innovative Interventions to Promote Healthy Eating Using Consumption-Oriented Food Supply Chain Analysis. J Hunger Environ Nutr. 2009;4(3–4):336–56.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Novotny R, Vijayadeva V, Ramirez V, et al. Development and implementation of a food system intervention to prevent childhood obesity in rural Hawai’i. Hawaii Med J. 2011;70(7 Suppl 1):42–6.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Song H-J, Gittelsohn J, Kim M, et al. Korean American storeowners’ perceived barriers and motivators for implementing a corner store-based program. Health Promot Pract. 2011;12(3):472–82.PubMedCrossRefGoogle Scholar
  52. 52.
    Bodor JN, Ulmer VM, Dunaway LF, et al. The rationale behind small food store interventions in low-income urban neighborhoods: insights from New Orleans. J Nutr. 2010;140(6):1185–8.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Bleich SN. Generating better evidence to engage local food outlets in obesity prevention research. Prev Med (Baltim). 2013;57(4):265–7.CrossRefGoogle Scholar
  54. 54.
    Lee SH, Bleich S, Kim H, Gittelsohn J. Environmental intervention in carry-out restaurants increases sales of healthy menu items in a low-income urban setting. Am J Heal Promot. 2014 Jun 26. [Epub ahead of print].Google Scholar
  55. 55.
    Sigurdsson V, Saevarsson H, Foxall G. Brand placement and consumer choice: an in-store experiment. J Appl Behav Anal. 2009;42(3):741–5.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Rose D, Bodor JN, Hutchinson PL, Swalm CM. The importance of a multi-dimensional approach for studying the links between food access and consumption. J Nutr. 2010;140(6):1170–4.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    D’Angelo H, Suratkar S, Song H-J, et al. Access to food source and food source use are associated with healthy and unhealthy food-purchasing behaviours among low-income African-American adults in Baltimore City. Public Health Nutr. 2011;14(9):1632–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Seymour JD, Yaroch AL, Serdula M, et al. Impact of nutrition environmental interventions on point-of-purchase behavior in adults: a review. Prev Med (Baltim). 2004;39 Suppl 2:S108–36.CrossRefGoogle Scholar
  59. 59.
    Novak NL, Brownell KD. Role of policy and government in the obesity epidemic. Circulation. 2012;126(19):2345–52.PubMedCrossRefGoogle Scholar
  60. 60.
    U.S. Department of Health and Human Services. The Surgeon General’s call to action to prevent and decrease overweight and obesity, Rockville, MD: 2001.Google Scholar
  61. 61.
    Mello M. Legal and policy approaches to the obesity epidemic. Surg Obes Relat Dis. 2012;8(5):507–13.PubMedCrossRefGoogle Scholar
  62. 62.
    Silberfarb LO, Savre S, Geber G. An approach to assessing multicity implementation of healthful food access policy, systems, and environmental changes. Prev Chronic Dis. 2014;11:E64.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Mayo ML, Pitts SBJ, Chriqui JF. Associations between county and municipality zoning ordinances and access to fruit and vegetable outlets in rural North Carolina, 2012. Prev Chronic Dis. 2013;10(8):E203.PubMedCentralPubMedGoogle Scholar
  64. 64.
    Powell LM, Chriqui JF, Khan T, et al. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14(2):110–28.PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Bedore M. The convening power of food as growth machine politics: A study of food policymaking and partnership formation in Baltimore. Urban Stud. 2014. doi: 10.1177/0042098013516685.Google Scholar
  66. 66.
  67. 67.
    Giang T, Karpyn A, Laurison HB et al. Closing the grocery gap in underserved communities: the creation of the Pennsylvania Fresh Food Financing Initiative. J Public Health Manag Pract;14(3):272–9.Google Scholar
  68. 68.
    Park S, Choi BY, Wang Y, et al. School and neighborhood nutrition environment and their association with students’ nutrition behaviors and weight status in Seoul, South Korea. J Adolesc Health. 2013;53(5):655–662.e12.PubMedCrossRefGoogle Scholar
  69. 69.
    Leite FHM, de MA O, Cremm EC, et al. Availability of processed foods in the perimeter of public schools in urban areas. J Pediatr (Rio J). 2012;88(4):328–34.CrossRefGoogle Scholar
  70. 70.
    Du W, Su C, Wang H, et al. Is density of neighbourhood restaurants associated with BMI in rural Chinese adults? A longitudinal study from the China Health and Nutrition Survey. BMJ Open. 2014;4(4):e004528.PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Ho LS, Gittelsohn J, Rimal R, et al. An integrated multi-institutional diabetes prevention program improves knowledge and healthy food acquisition in northwestern Ontario First Nations. Health Educ Behav. 2008;35(4):561–73.PubMedCrossRefGoogle Scholar
  72. 72.
    Gittelsohn J, Dyckman W, Frick KD, et al. A pilot food store intervention in the Republic of the Marshall Islands. Pac Health Dialog. 2007;14(2):43–53.PubMedGoogle Scholar
  73. 73.
    Gittelsohn J, Vijayadeva V, Davison N, et al. A food store intervention trial improves caregiver psychosocial factors and children’s dietary intake in Hawaii. Obesity (Silver Spring). 2010;18 Suppl 1:S84–90.CrossRefGoogle Scholar
  74. 74.
    Bustillos B, Sharkey JR, Anding J, McIntosh A. Availability of more healthful food alternatives in traditional, convenience, and nontraditional types of food stores in two rural Texas counties. J Am Diet Assoc. 2009;109(5):883–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Sharkey JR, Dean WR, Nalty CC, Xu J. Convenience stores are the key food environment influence on nutrients available from household food supplies in Texas Border Colonias. BMC Public Health. 2013;13:45.PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    De Carvalho CE, Marrocos Leite FH, de Abreu DSC, et al. Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr. 2012;15(6):1056–64.CrossRefGoogle Scholar
  77. 77.
    Vedovato G, Gittelsohn J, Trude A, et al. Community engagement process used to develop a food store intervention for a low-income Brazilian urban area. FASEB J. 2014;28:1019.Google Scholar
  78. 78.
    Hammond RA. Complex systems modeling for obesity research. Prev Chronic Dis. 2009;6(3):A97.PubMedCentralPubMedGoogle Scholar
  79. 79.
    Cockrell Skinner A, Foster EM. Systems science and childhood obesity: a systematic review and new directions. J Obes. 2013;2013:129193.PubMedGoogle Scholar
  80. 80.
    Yang Y, Diez-Roux AV. Using an agent-based model to simulate children’s active travel to school. Int J Behav Nutr Phys Act. 2013;10:67.PubMedCentralPubMedCrossRefGoogle Scholar
  81. 81.
    Hammond RA, Ornstein JT. A model of social influence on body mass index. Ann N Y Acad Sci. 2014. doi: 10.1111/nyas.12344.PubMedGoogle Scholar
  82. 82.
    Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.PubMedCrossRefGoogle Scholar
  83. 83.
    Dennisuk LA, Coutinho AJ, Suratkar S, et al. Food expenditures and food purchasing among low-income, urban, African-American youth. Am J Prev Med. 2011;40(6):625–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23–9.PubMedCrossRefGoogle Scholar
  85. 85.
    Inagami S, Cohen DA, Finch BK, Asch SM. You are where you shop: grocery store locations, weight, and neighborhoods. Am J Prev Med. 2006;31(1):10–7.PubMedCrossRefGoogle Scholar
  86. 86.
    Gittelsohn J, Kumar MB. Preventing childhood obesity and diabetes: is it time to move out of the school? Pediatr. Diabetes. 2007;8 Suppl 9:55–69.Google Scholar
  87. 87.
    Budd GM, Volpe SL. School-based obesity prevention: Research, challenges, and recommendations. J Sch Health. 2006;76(10):485–95.PubMedCrossRefGoogle Scholar
  88. 88.
    Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009;37(5):418–27.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Elizabeth Anderson Steeves
    • 1
    Email author
  • Paula Andrea Martins
    • 2
  • Joel Gittelsohn
    • 1
  1. 1.Johns Hopkins Global Obesity Prevention Center and Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Departamento de Ciências do Movimento HumanoUniversidade Federal de São PauloSantosBrasil

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