The Cummins et al article “New Neighborhood Grocery Store Increased Awareness of Food Access but Did Not Alter Dietary Habits or Obesity,” published in the February issue of Health Affairs, generated considerable media attention, with headlines claiming that grocery stores do not contribute to healthy diets or reductions in obesity. However, the study offered no conclusive proof showing that access to grocery stores is not a part of the solution to preventing obesity.
In fact, the study showed clear signs of promise that the intervention was working in key aspects during the short time the researchers collected data. Within just a few months after the new supermarket opened, for example, researchers documented significant improvement in residents’ perceptions about the choice and quality of fresh fruits and vegetables, along with improvements in their perception of healthy food accessibility.
The subject of the study, the Fresh Grocer in North Philadelphia, is a beautiful store with a bountiful fresh produce section. The supermarket, which is now thriving in one of the poorest neighborhoods in the country, was built from the ground up after a 15-year hiatus in which the surrounding community had no grocery store. Its opening has revitalized a historic African-American owned shopping plaza and reinvigorated the local neighborhood’s retail economy.
Has the store reduced the rate of obesity among local residents? This is a crucial question, but one that cannot be adequately deduced from the present study. All we know from this study’s findings is that obesity rates did not change significantly during the first six to nine months after the store’s opening – not surprising, given the many decades of gradual changes in eating habits that have led to the obesity epidemic.
The authors point out this limitation and several others. Their sample size was very small and surveys were conducted only using land-line phones. Despite a large initial sample that was relatively robust (1,400 people), by the time the Fresh Grocer had opened for business (after construction delays), the researchers had fewer than half of those people left in the study. Of this group, only 83 had started to shop at the store, and those that were left were significantly older (by 30 years, on average) than the general population in the area. Many of those surveyed had never shopped at the new store, yet their answers about weight were tallied along with those who had.
It’s worth noting that, despite these limitations, the study found a “significant improvement” in residents’ perception of choice and quality of fresh fruits and vegetables, and a “moderate improvement” in their perception in food accessibility. “Why wasn’t that the headline?” asked Ann Palmer, program director of the Center for a Livable Future’s Food Communities & Public Health Programs.
The Institute of Medicine and others have been clear that having access to affordable and nutritious food is part of a comprehensive approach to obesity prevention. This goal has been at the heart of the Pennsylvania Fresh Food Financing Initiative, the public policy that made possible the construction of this Fresh Grocer. By 2010, with close to 90 fresh food retail projects completed and 5,000 jobs created in Pennsylvania, the Fresh Food Financing Initiative has been deemed a resounding success and named by Harvard as a model policy.
As for the Fresh Grocer, skeptics once said that no grocery store would ever be located where it now stands. Today, the store is profitable, and in terms of selection, it rivals any grocery store to be found in wealthier suburban communities. Moreover, the Fresh Grocer sells $50,000 of produce a week—robust revenue that most grocers consider a great success and a clear sign that residents are buying large amounts of healthy food.
No one involved in the Fresh Food Financing Initiative ever thought that grocery stores alone could solve the obesity epidemic. That’s why, in Philadelphia, obesity-prevention efforts are based on a comprehensive approach, with collaborative support from city and state government agencies and a host of nonprofit and university partners. As part of this multi-pronged effort, grocery stores have been opened or expanded citywide through the Fresh Food Financing Initiative; a Healthy Corner Store Network was expanded with more than 600 participating stores; community farmers’ markets opened in high-poverty neighborhoods; and public schools provide robust nutrition education and ban sugar-sweetened beverages on their premises.
The impact of these integrated efforts to combat obesity has been among the best in the country.
In Philadelphia, rates of obesity among school children fell by nearly 5 percent between 2006 and 2010, during a time when national obesity rates remained unchanged. Even bigger declines were reported for African-American boys and Hispanic girls (7.6 percent and 7.4 percent, respectively), groups that have historically had some of the highest rates of obesity. Of note, the Cummins et al study did not mention that Philadelphia’s comprehensive approach may have impacted their control neighborhood. Although those living in the study’s control neighborhood lacked a new grocery store, they likely benefitted from the wide variety of other interventions that were being implemented to improve healthy food access during the overall timeframe.
No one believes that reducing obesity rates will be easy or quick. As most people who have tried to change their own eating habits and lose weight can attest, the process takes time. Yet, if you read the media coverage of this study, you may be led to believe that, based on this one study, we need to stop efforts to increase healthy food access and find some other way to prevent an obesity epidemic that is bankrupting our health care system and shortening our children’s lives. But do we really believe that people will be able to eat healthfully if they can’t buy healthy food in their communities?
Around the country, strong momentum is building to improve healthy food access in low-income communities, and these efforts are improving health and creating economic opportunity in the communities that need it most. Indeed, many would argue that access to healthy food is a right that every American should enjoy. To make the leap from one small study that policymakers should not be aggressively working to improve access to healthy food for all Americans is a mistake. While we agree with Cummins et al that “complementary” approaches, such as nutrition education, are needed as part of a comprehensive approach to obesity prevention, these approaches can only work if residents have access to healthy food.
While this study provides some interesting new data, it should not deter efforts to bring healthier, affordable food to low-income communities that need it most. Healthy foodfinancing initiatives, such as those in Pennsylvania, New York, New Orleans, California, New Jersey, and at the federal level with the Healthy Food Financing Initiative, need to be expanded and accelerated to reach more communities that deserve better food access than what they currently have. More research also is needed to better capture the complex nature of the obesity epidemic and examine how a variety of approaches can best be implemented to prevent obesity and diet-related disease.