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Int. J. Environ. Res. Public Health 2017, 14(11), 1366; doi:10.3390/ijerph14111366

Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States

1
Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT 06103, USA
2
Sanford School of Public Policy, Duke University, Durham, NC 27708, USA
*
Author to whom correspondence should be addressed.
Received: 30 June 2017 / Revised: 10 October 2017 / Accepted: 21 October 2017 / Published: 14 November 2017
(This article belongs to the Special Issue Food Environment, Diet, and Health)
View Full-Text   |   Download PDF [343 KB, uploaded 14 November 2017]

Abstract

This paper investigates the effect of food environments, characterized as food swamps, on adult obesity rates. Food swamps have been described as areas with a high-density of establishments selling high-calorie fast food and junk food, relative to healthier food options. This study examines multiple ways of categorizing food environments as food swamps and food deserts, including alternate versions of the Retail Food Environment Index. We merged food outlet, sociodemographic and obesity data from the United States Department of Agriculture (USDA) Food Environment Atlas, the American Community Survey, and a commercial street reference dataset. We employed an instrumental variables (IV) strategy to correct for the endogeneity of food environments (i.e., that individuals self-select into neighborhoods and may consider food availability in their decision). Our results suggest that the presence of a food swamp is a stronger predictor of obesity rates than the absence of full-service grocery stores. We found, even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates. All three food swamp measures indicated the same positive association, but reflected different magnitudes of the food swamp effect on rates of adult obesity (p values ranged from 0.00 to 0.16). Our adjustment for reverse causality, using an IV approach, revealed a stronger effect of food swamps than would have been obtained by naïve ordinary least squares (OLS) estimates. The food swamp effect was stronger in counties with greater income inequality (p < 0.05) and where residents are less mobile (p < 0.01). Based on these findings, local government policies such as zoning laws simultaneously restricting access to unhealthy food outlets and incentivizing healthy food retailers to locate in underserved neighborhoods warrant consideration as strategies to increase health equity. View Full-Text
Keywords: food swamps; fast food retail; food deserts; food environments; obesity; instrumental variables; zoning food swamps; fast food retail; food deserts; food environments; obesity; instrumental variables; zoning
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Cooksey-Stowers, K.; Schwartz, M.B.; Brownell, K.D. Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. Int. J. Environ. Res. Public Health 2017, 14, 1366.

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