Measuring Progress in Obesity Prevention Workshop Report (2012) / Chapter Skim
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3 The Food and Nutrition Environment
3 The Food and Nutrition Environment
Pages 21-38
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. • Although a primary focus has been on individual consumption, many ongoing efforts to collect data, as well as newer research designs and data collection tools, have expanded knowledge of food environments and policies.
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KrebsSmith, chief of the Risk Factor Monitoring and Methods Branch in the Division of Cancer Control and Population Sciences at the National Cancer Institute, focused on surveillance in this area and the potential for expanding the focus of dietary surveillance from individual-level behaviors to the community- or national-level food environment. UNDERSTANDING FOOD ENVIRONMENTS AND POLICIES Presenter: Karen Glanz As with physical activity, food choices are influenced by many factors.
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• Self-efficacy • Social support • Friends • Demographics (e.g., • Behavioral capability • Social norms • Peers income, race/ethnicity) FIGURE 3-1 An ecological framework depicting the multiple influences on food choices.
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Work Other Government Psychosocial Eating and Factors Patterns Industry Policy Consumer Nutrition Environment • Available healthy options • Price, promotion, placement Perceived • Nutrition Information Nutrition Environments Information Environment (Media, Advertising) FIGURE 3-2 Model of community nutrition environments.
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The food environment also can evolve in the absence of policies, she added, because commercial enterprises do not necessarily look to government's goals as they make marketing decisions. Measures Given this complex picture of influences on food choices, Glanz explained, there are five reasons for the measurement of food and nutrition environments: • Observation, or simply observing what is available and what peo ple eat and why they eat the way they do in the different environ ments to which they are exposed • Explanation of the reasons for people's choices • Evaluation of the results of programs and strategies • Support for advocacy or other actions • Surveillance, or ongoing monitoring to identify trends and problems A variety of data sources support these goals.
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The researchers collected self-report data and found an association between interventions designed to alter food choices and changes in workers' choices. An Australian study of a number of aspects of the workplace included a nutrition component, collecting data on such features as availability of nutrition information, cafeteria options, and food in vending machines (Oldenburg et al., 2002)
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The foodrelated measures included whether communities had a plan for applying the Dietary Guidelines for Americans2 in their government facilities and largest school district, the numbers of full-service grocery stores (per 10,000 people) in their three largest underserved census tracts, and the availability of government incentives to retailers for offering healthy food and beverages.
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Researchers also lack common metrics for many of the features they want to measure, and not all measures 3 Glanz suggested several resources for further information: a web compilation of measures and articles, at https://riskfactor.cancer.gov/mfe/; the Healthy Eating Research website, at www.healthyeatingresearch.org; Your Food Environment Atlas, at http://www.ers.usda.gov/ foodatlas/; and the NCCOR Catalogue of Surveillance Systems, at http://tools.nccor.org/css/ (accessed July 27, 2011)
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SURVEILLANCE OF FOOD ENVIRONMENTS Presenter: Susan M Krebs-Smith Currently, national surveys related to food and obesity focus mainly on the behavior of individuals, Krebs-Smith noted, but she believes a national surveillance system is needed to track nutrition-related environmental and policy changes and their effects.
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30 Away-from-Home Household Influential Food Acquired Food Acquired Factors Exports Nutrient Imports Requirements Storage Nutrition and Consumption Nutrient Nutrient Related Health Food Supply by Individuals Intake Utilization Measurements Food Production Supplement Use Food Knowledge, Composition Attitudes, and Behavior FIGURE 3-3 Diagram of the relationships between food and health. 3-3.eps NOTE: Shaded boxes indicate that data have traditionally been collected for these factors.
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Grocery Stores and Markets Exports Household Imports Food Acquired Storage Food Consumption Food Supply Manufacturers by Individuals Food Production Away-from-Home Food Outlets: Food Acquired • Fast Food and Other Restaurants • Daycare • Schools • Worksites • Hospitals FIGURE 3-4 Flow of foods from the food supply to individual consumption. 3-4.eps SOURCE: Krebs-Smith, 2011.
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Similarly, a finding that all individuals consumed an average of 88 grams of mixtures, mainly meat, poultry, and fish, was of somewhat limited value because there were no dietary recommendations for how many grams of such mixtures individuals should eat. Responding to these difficulties, nutritionists devised improved ways to capture the intake of specific foods of interest, to estimate usual intake distributions, and to relate this information to caloric density.
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Department of Agriculture's Center for Nutrition Policy and Promotion to monitor the quality of diets in the United States) to assess the nutritional quality of specific menu items at fastfood restaurants and determine relative diet quality, for example.8 7 For more information on the dietary guidelines and the committee that developed them, see http://www.cnpp.usda.gov/dietaryguidelines.htm.
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More complete food-linked data also would allow for a more detailed assessment of the progress of such initiatives as the Healthy Weight Commitment Foundation, an effort in which food manufacturers and other food-related businesses have pledged to support consumers in reducing obesity by changing their products, packaging, and labeling and reducing the calories in the food supply by 1.5 trillion by the end of 2015.9 It would be valuable, Krebs-Smith explained, to look at whether the calorie reduction goal was achieved through limits on empty calories, as opposed to the more valuable calories supplied by fruits, vegetables, and whole grains. Workshop participants pointed out that each sort of measure entails complications, observing that individuals make errors when responding to surveys in recalling and recording what they have eaten, while imprecise estimates regarding food waste may introduce error in food supply data.
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Agricultural Some unprepared foods: commodities: databases needed databases available Grocery Stores and Markets Exports Household Imports Food Acquired Storage Food Consumption Food Supply Manufacturers by Individuals Away-from-Home Food Production Food Outlets: Food Acquired • Fast Food and Other Restaurants • Daycare • Schools • Worksites • Hospitals Ready-to-eat foods: databases available FIGURE 3-5 Diagram showing what an ideal national surveillance system for tracking nutrition-related environmental and policy 3-5.eps changes might examine. landscape NOTE: Shaded boxes indicate what would ideally be measured.
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2005. Healthy nutrition environments: Concepts and measures.
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2006. The neighborhood food environment: Sources of historical data on retail food stores.
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