Heading straight to the source — the grocery store — can help improve and sustain access to healthy foods among poor people, found a new study conducted in the Marshall Islands. By learning about shop owners' business needs and shoppers' eating habits, the researchers were able to foster an increase in the supply of and demand for nutritious foods.
"Diet-related chronic diseases are at epidemic proportions, particularly among low-income ethnic populations," said lead researcher Joel Gittelsohn, Ph.D., of the department of international health at Johns Hopkins University. "Studies have shown that where there is less healthy food available there are higher rates of heart disease and other diet-related chronic diseases."
The Republic of the Marshall Islands lies about 2,000 miles west of Hawaii in the mid-Pacific. Like many other native populations, Gittelsohn said, people there have undergone a conversion from a subsisting on a diet of local staples, such as fish and breadfruit, to one based largely on imported processed food. Obesity and diabetes are rampant. Thus the researchers found it "a prime location in which to pilot a food-store based program."
For the study in the October issue of the journal Health Promotion Practice, the researchers gathered preliminary data about local economic and cultural factors. They conducted surveys and interviews with store managers, customers and community leaders, in some cases asking community members to review their findings and make suggestions.
The team took two main approaches to improving the food environment: through in-store activities, such as cooking demonstrations, and through radio and print advertising.
"Increased exposure was associated with increased purchasing of certain promoted foods," such as oatmeal and turkey, the researchers found, and the interventions were "also associated with improvements in the healthiness of cooking methods."
Gittelsohn's team has undertaken a series of "healthy store" projects worldwide, starting with the pilot program in the Republic of the Marshall Islands in 2001 and now with Apache tribe members in Arizona and poor residents of Baltimore. Analyses are under way to determine the impact of the Apache Healthy Stores program on diet.
Interventions that modify the availability and promotion of healthy foods within stores are not enough by themselves, said Gittelsohn: "Efforts should be made to increase demand for these foods so that the intervention will be sustainable. That's the purpose of the healthy stores programs, to increase supply and demand for healthy foods" permanently.
Robert Jeffery, Ph.D., director of the University of Minnesota Obesity Prevention Center, calls this work "congruent with growing sentiment among researchers that the obesity epidemic is largely driven by the food environment."
"Research on promoting healthier diets has had mixed results," Jeffrey said. "For 40 years there has been a consistent emphasis on reducing fat intake by health professionals with some support from the industry, and our fat intake as a percentage of calories has dropped — by about 25 percent. We still continue to eat too many calories overall, however, and to grow fatter at an alarming rate."
"I believe that a healthier food supply is essential to reversing this trend," Jeffery added. "The challenge is to get health professionals, food producers, food merchandisers and food consumers to work together to make this happen."