Can new retailers of healthy foods increase fruit and vegetable consumption?
Public Health Nutrition Editorial Highlight: ‘The Dietary Impact of Introducing New Retailers of Fruits and Vegetables into a Community: Results from a Systematic Review’ Authors: Rebecca Woodruff, Ilana Raskind, Diane Harris, Julie Gazmararian, Michael Kramer, Regine Haardörfer, Michelle Kegler
The quality of the typical American diet is poor, which is an important contributor to the high prevalence of obesity and chronic disease in the United States. Fruit and vegetable consumption in particular remains well below recommended guidelines. Although many health promotion and communications campaigns have sought to educate the American public about the importance of consuming enough fruits and vegetables as part of a healthy diet, consumers with limited access to healthy food options in their communities may be unable to act on these messages.
In response to these disparities, improving community food environments to make them more supportive of healthy eating has become a national public health priority. For example, in 2010, the federal government announced the Healthy Food Financing Initiative, which uses zoning reforms, loans, and grants to encourage new healthy food retailers to open for business in underserved communities, among other activities. Similar initiatives have been implemented at the state and local levels (10-12). However, little is known about the impact these initiatives are likely to have on dietary behavior.
The purpose of this systematic review was to summarize findings from peer-reviewed research articles that have evaluated the impact of opening new retailers of healthy foods on fruit and vegetable intake among adults. Of 3,514 unique references considered, 23 articles representing 15 studies were included in this review. The included studies evaluated the opening of supermarkets, grocery stores, farmers’ markets, fruit and vegetable stands, and mobile markets in communities with limited access to healthy foods in the United States, the United Kingdom, and Australia.
We found that the opening of a new retailer had a positive impact on fruit and vegetable intake, but only among adults who chose to shop there. For example, three out of four studies that used a repeated measures design reported modest, albeit not statistically significant, increases in fruit and vegetable consumption among shoppers (range: 0.23-0.54 daily servings at 6-12 months follow-up). Studies that assessed change in fruit and vegetable consumption among the broader population of people who lived near the new retailer, regardless of whether or not they used it, reported mixed results. Some studies documented increases in intake, while others found no evidence of change or even decreases in intake.
The methods used to evaluate the retailers varied considerably. Generally, evaluations relied heavily on post-test only, repeated cross-sectional and repeated measures designs with limited follow-up intervals and weak outcome measures. For example, fruit and vegetable intake was typically measured using a brief screener or food frequency questionnaires. Evaluations of supermarkets were the most methodologically rigorous and consistent.
Based on these results, we conclude that opening a new retailer of healthy foods in limited-access communities may be an appropriate strategy to improve short-term fruit and vegetable intake among adults who choose to shop there, but the potential impact of this approach on the broader community and/or over longer periods of time warrants additional research.
The full article ‘The Dietary Impact of Introducing New Retailers of Fruits and Vegetables into a Community: Results from a Systematic Review’ in Public Health Nutrition is available to download for free until 1st March 2018.