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      FOOD SHOPPING BEHAVIORS AND SOCIOECONOMIC STATUS INFLUENCE OBESITY RATES IN SEATTLE AND IN PARIS

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          Abstract

          Objective

          To compare the associations between food environment at the individual level, socioeconomic status (SES) and obesity rates in two cities: Seattle and Paris.

          Methods

          Analyses of the SOS (Seattle Obesity Study) were based on a representative sample of 1340 adults in metropolitan Seattle and King County. The RECORD (Residential Environment and Coronary Heart Disease) cohort analyses were based on 7,131 adults in central Paris and suburbs. Data on socio-demographics, health and weight were obtained from a telephone survey (SOS) and from in-person interviews (RECORD). Both studies collected data on and geocoded home addresses and food shopping locations. Both studies calculated GIS network distances between home and the supermarket that study respondents listed as their primary food source. Supermarkets were further stratified into three categories by price. Modified Poisson regression models were used to test the associations among food environment variables, SES and obesity.

          Results

          Physical distance to supermarkets was unrelated to obesity risk. By contrast, lower education and incomes, lower surrounding property values, and shopping at lower-cost stores were consistently associated with higher obesity risk.

          Conclusion

          Lower SES was linked to higher obesity risk in both Paris and Seattle, despite differences in urban form, the food environments, and in the respective systems of health care. Cross-country comparisons can provide new insights into the social determinants of weight and health.

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          Most cited references55

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          U.S. disparities in health: descriptions, causes, and mechanisms.

          Eliminating health disparities is a fundamental, though not always explicit, goal of public health research and practice. There is a burgeoning literature in this area, but a number of unresolved issues remain. These include the definition of what constitutes a disparity, the relationship of different bases of disadvantage, the ability to attribute cause from association, and the establishment of the mechanisms by which social disadvantage affects biological processes that get into the body, resulting in disease. We examine current definitions and empirical research on health disparities, particularly disparities associated with race/ethnicity and socioeconomic status, and discuss data structures and analytic strategies that allow causal inference about the health impacts of these and associated factors. We show that although health is consistently worse for individuals with few resources and for blacks as compared with whites, the extent of health disparities varies by outcome, time, and geographic location within the United States. Empirical work also demonstrates the importance of a joint consideration of race/ethnicity and social class. Finally, we discuss potential pathways, including exposure to chronic stress and resulting psychosocial and physiological responses to stress, that serve as mechanisms by which social disadvantage results in health disparities.
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            Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.

            Obesity is a leading public health concern, and although environmental factors have been hypothesized to play a role in the prevention of obesity, little empirical data exist to document their effects. The purpose of this study was to examine whether characteristics of the local food environment are associated with the prevalence of cardiovascular disease risk factors. A cross-sectional study of men and women participating in the third visit (1993-1995) of the Atherosclerosis Risk in Communities (ARIC) Study was conducted in 2004. The analyses included 10,763 ARIC participants residing in one of the 207 eligible census tracts located in the four ARIC-defined geographic areas. Names and addresses of food stores located in Mississippi, North Carolina, Maryland, and Minnesota were obtained from departments of agriculture. Multilevel modeling was used to calculate prevalence ratios of the associations between the presence of specific types of food stores and cardiovascular disease risk factors. The presence of supermarkets was associated with a lower prevalence of obesity and overweight (obesity prevalence ratio [PR] = 0.83, 95% confidence interval [CI] = 0.75-0.92; overweight PR = 0.94, 95% CI = 0.90-0.98), and the presence of convenience stores was associated with a higher prevalence of obesity and overweight (obesity PR = 1.16, 95% CI = 1.05-1.27; overweight PR = 1.06, 95% CI = 1.02-1.10). Associations for diabetes, high serum cholesterol, and hypertension were not consistently observed. Results from this study suggest that characteristics of local food environments may play a role in the prevention of overweight and obesity.
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              The economics of obesity: dietary energy density and energy cost.

              Highest rates of obesity and diabetes in the United States are found among the lower-income groups. The observed links between obesity and socioeconomic position may be related to dietary energy density and energy cost. Refined grains, added sugars, and added fats are among the lowest-cost sources of dietary energy. They are inexpensive, good tasting, and convenient. In contrast, the more nutrient-dense lean meats, fish, fresh vegetables, and fruit generally cost more. An inverse relationship between energy density of foods (kilojoules per gram) and their energy cost (dollars per megajoule) means that the more energy-dense diets are associated with lower daily food consumption costs and may be an effective way to save money. However, economic decisions affecting food choice may have physiologic consequences. Laboratory studies suggest that energy-dense foods and energy-dense diets have a lower satiating power and may result in passive overeating and therefore weight gain. Epidemiologic analyses suggest that the low-cost energy-dense diets also tend to be nutrient poor. If the rise in obesity rates is related to the growing price disparity between healthy and unhealthy foods, then the current strategies for obesity prevention may need to be revised. Encouraging low-income families to consume healthier but more costly foods to prevent future disease can be construed as an elitist approach to public health. Limiting access to inexpensive foods through taxes on frowned upon fats and sweets is a regressive measure. The broader problem may lie with growing disparities in incomes and wealth, declining value of the minimum wage, food imports, tariffs, and trade. Evidence is emerging that obesity in America is a largely economic issue.
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                Author and article information

                Journal
                101256108
                32579
                Int J Obes (Lond)
                Int J Obes (Lond)
                International journal of obesity (2005)
                0307-0565
                1476-5497
                4 March 2014
                27 May 2013
                February 2014
                01 August 2014
                : 38
                : 2
                : 306-314
                Affiliations
                [1 ]Center for Public Health Nutrition, University of Washington, Seattle, WA
                [2 ]Urban Form Lab, College of Built Environments, University of Washington, Seattle, WA
                [3 ]Department of Urban Planning, Ball State University, Indiana
                [4 ]UMR Inserm U557; Inra U1125; Cnam; University Paris 13-Sorbonne Paris Cité, CRNH Ile-de-France, Bobigny, France
                [5 ]University Paris-Est, Department of Geography, Lab-Urba, Urbanism Institute of Paris, France
                [6 ]Inserm, U707, Paris, France
                [7 ]Université Pierre et Marie Curie-Paris 6, UMR-S 707, Paris, France
                Author notes
                Corresponding author: Adam Drewnowski, 305 Raitt Hall # 353410, University of Washington, Seattle, WA 98195-3410, adamdrew@ 123456uw.edu , Phone 206 543 8016

                Details for each author

                AD. Professor and Director, Center for Public Health Nutrition, University of Washington

                A VM. Professor and Director, Urban Form Lab, College of Built Environments, University of Washington

                AA. Research Associate, Center for Public Health Nutrition, University of Washington

                JJ. Assistant Professor, Department of Urban Planning, Ball State University

                HC. Assistant Professor, Department of Geography, University of Paris Est

                BC. Research team co-leader, UMR-S 707, Inserm – Université Pierre et Marie Curie,

                Article
                NIHMS560187
                10.1038/ijo.2013.97
                3955164
                23736365
                e554ece2-e4c2-401a-8bcd-ffcaf5a21df2
                History
                Categories
                Article

                Nutrition & Dietetics
                obesity,socioeconomic status (ses),access to supermarket,food environment,food shopping

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