Modifying the food environment for childhood obesity prevention: challenges and opportunities

Abstract

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the home. These external food environments, in restaurants, supermarkets, and in school, or recreation and sports settings, are often characterised by energy dense, nutrient-poor food items that do not reflect the current nutritional guidelines for health. In addition, our understanding of these broader influences on nutritional intake is still limited. Particularly, lacking is a clear understanding of what constitutes the food environment, as well as robust measures of components of the food environment across different contexts. Therefore, this review summarises the literature on food environments of relevance to childhood obesity prevention, with a focus on places where children live, learn and play. Specifically, the paper highlights the approaches and challenges related to defining and measuring the food environment, discusses the aspects of the food environment unique to children and reports on environmental characteristics that are being modified within community, school and recreational settings. Results of the review show the need for a continued focus on understanding the intersection between individual behaviour and external factors; improved instrument development, especially regarding validity and reliability; clearer reported methodology including protocols for instrument use and data management; and considering novel study design approaches that are targeted at measuring the relationship between the individual and their food environment.

Measuring food availability and accessibility among adolescents: Moving beyond the neighbourhood boundary

“…Reviews of studies employing geographic theory and technologies to characterize food environments have been critical of how food environments have been defined (Caspi et al, 2012;Charreire et al, 2010;Giskes et al, 2007;Gustafson et al, 2012;Lytle, 2009), and have called for researchers to devote more empirical thought to the ways that the food environment is conceptualized and measured (Penney et al, 2014). Some researchers have based their definition of residential neighbourhoods on census tracts or postal codes, whereas others have created a predetermined buffer around study participants' homes or schools (Kwan, 2009;Charreire et al, 2010).…”

Biological, environmental, and social influences on childhood obesity

“…In addition, lower obesity levels are observed in areas where the natural environment has high recreational value (43). While evidence suggests that the above environmental factors affect risk behaviors and obesity, there is still a gap in understanding how children interface with the obesogenic environment (44).…”

Individual and food environmental factors: association with diet

“…Whereas making individuals accountable for their own health is central to disease prevention approaches, many of which are heavily affected by the interests of the processed food industry (6) , researchers and policy makers are emphasising the need to understand food choices that result from influences at multiple levels: individual, environmental and policy (7)(8)(9)(10)(11)(12) .…”