Objective: To simultaneously identify consumer segments based on individual-level consumption and community-level food retail environment data and to investigate whether the segments are associated with BMI and dietary knowledge in China. Design: A multilevel latent class cluster model was applied to identify consumer segments based not only on their individual preferences for fast food, salty snack foods, and soft drinks and sugared fruit drinks, but also on the food retail environment at the community level. Setting: The data came from the China Health and Nutrition Survey (CHNS) conducted in 2006 and two questionnaires for adults and communities were used. Subjects: A total sample of 9788 adults living in 218 communities participated in the CHNS. Results: We successfully identified four consumer segments. These four segments were embedded in two types of food retail environment: the saturated food retail environment and the deprived food retail environment. A three-factor solution was found for consumers' dietary knowledge. The four consumer segments were highly associated with consumers' dietary knowledge and a number of sociodemographic variables.
Conclusions:The widespread discussion about the relationships between fastfood consumption and overweight/obesity is irrelevant for Chinese segments that do not have access to fast food. Factors that are most associated with segments with a higher BMI are consumers' (incorrect) dietary knowledge, the food retail environment and sociodemographics. The results provide valuable insight for policy interventions on reducing overweight/obesity in China. This study also indicates that despite the breathtaking changes in modern China, the impact of 'obesogenic' environments should not be assessed too strictly from a 'Western' perspective.
KeywordsChina Obesity Food retail environment Multilevel latent class clusterIn recent years, growing scholarly attention (1)(2)(3) has been paid to the relationships between food retail environments (e.g. access, availability and price) and obesity. Fast food is high in energy and low in micronutrient density, and fast-food consumption may contribute to the obesity epidemic (4)(5)(6) . Although research on the possible interactions between obesity and characteristics of the food environment is at an early stage and the evidence is currently too weak to draw firm conclusions (7) , US studies suggest that the food environment influences a healthy diet and obesity levels in North America (8)(9)(10) .The clearly observable presence of processed foods, fast-food restaurants, supermarkets and other food outlets as factors determining the rising prevalence of overweight and obesity is a topic of research that is particularly relevant in the context of developed countries. Similar to the changing food retailing landscape in the postWorld War II era in Western countries (11,12) , the food retailing sector in China is experiencing dramatic changes half a century later. Over the past decade, supermarkets have been spreading faster in China...