A Direct Assessment of the External Domain of Food Environments in the National Capital Region of India

Abstract

Data on food environments in India and other low- and middle-income countries are scarce. The objective of this study was to assess the four dimensions of the external domain of food environments (availability, price, vendor and product properties, and marketing) in food establishments in the National Capital Region of India. The assessment focused on fruits, vegetables, and ultra-processed foods. The 60 food establishments surveyed were categorized as stores, restaurants, or mobile food vendors. Only 13.3% of food establishments sold fruits and vegetables. Stores were more likely to sell vegetables than mobile food vendors (14.8 vs. 6.2%, respectively) and sold a greater variety of both fruits and vegetables as compared to mobile food vendors [mean (SD) of 8.6 (3.2) fruits and 18.6 (9.2) vegetables available at stores vs. 5.5 (5.7) fruits and 25 vegetables available at the one mobile food vendor who sold vegetables]. However, these healthy food items were more expensive at stores. The availability (100% of stores, 12.5% of mobile food vendors, and 12.5% of restaurants) and variety (156 types) of ultra-processed foods across food establishments were higher than fruits and vegetables. A greater percentage of food establishments displayed advertisements for ultra-processed foods as compared to unprocessed or minimally processed foods such as fruits and vegetables. The National Capital Region of India has an unhealthy food environment. Regulations that limit the availability of ultra-processed foods and improve the availability and affordability of fruits and vegetables are needed to reverse the rising tide of chronic non-communicable diseases in this setting.

Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review

“…Two studies ( n = 2) were developed to be used in multiple countries [ 76 , 77 ]. Additional countries examined included China ( n = 1), [ 78 ], India ( n = 1), [ 79 ], South Africa ( n = 1), [ 80 ], and Spain ( n = 1) [ 81 ].…”

“…The most common assessment method was a checklist or similar format ( n = 36), [ 25 , 26 , 28 , 32 – 37 , 39 – 41 , 44 – 49 , 51 , 52 , 56 – 59 , 61 , 66 – 70 , 72 – 74 , 78 , 79 , 81 , 82 ]. Additional assessment methods included the use of a market basket approach which aims to measure foods commonly consumed ( n = 1), [ 50 ], use of an observational form or tool, [ 29 , 71 ], and assessment of shelf space ( n = 5) [ 29 , 31 , 53 , 64 , 65 , 83 ].…”

“…Among studies conducted in the US ( n = 37), [ 25 – 30 , 32 , 34 – 37 , 39 – 42 , 44 , 46 , 47 , 51 – 53 , 56 , 59 , 62 , 65 – 69 , 71 – 73 , 78 , 79 , 81 – 83 ], eight studies collected information on whether or not stores accepted Supplemental Nutrition Accessibility Program (SNAP) [ 25 , 26 , 28 , 32 , 40 , 42 , 48 , 50 , 55 ], and seven collected information on whether or not stores accepted Special Supplemental Nutrition Program for Women, Infants and Children (WIC) [ 25 , 26 , 28 , 32 , 40 , 48 , 50 ]. Few studies ( n = 2) looked at other aspects of accessibility such as physical accessibility [ 27 , 39 ].…”

“…Thirty-six studies in the review presented measures that were adaptations of other, existing measures ( n = 36) [ 25 – 30 , 32 , 34 – 37 , 39 – 42 , 44 , 46 , 47 , 51 – 53 , 56 , 59 , 62 , 65 – 69 , 71 – 73 , 78 , 79 , 81 – 83 ]. For example, some studies would modify or adapt an existing measure to fit a new geographic context or food retailer stores type.…”

“…For example, some studies would modify or adapt an existing measure to fit a new geographic context or food retailer stores type. The most commonly adapted measure is the Nutrition Environment Measures Survey for stores (NEMS-S) developed by Glanz et al, (2007) ( n = 20) [ 25 , 26 , 28 , 34 , 35 , 37 , 40 , 46 , 52 , 53 , 56 , 66 – 68 , 71 , 78 , 79 , 81 – 83 ]. Some measures modified or combined several measures; for example, the FoodNest measure created by Glickman et al, 2021 [ 34 ] modified the Nutrition Environment Measurement Score in Corner Stores (NEMS-CS) and the Bridging the Gap Community Obesity Measures Program.…”