March, 2015

Research Perspective and Comments & Analysis

Study Reveals Produce Consumption Depends On Food Businesses Located Near Home

By Chistelle M. Clary & Yan Kestens, Université De Montréal’s Department Of Social & Preventive Medicine

A research team from the Université de Montréal has recently looked at whether the actual consumption of fruits and vegetables was related to the presence of certain types of food outlets and restaurants around home.

Types of businesses in question were: supermarkets, grocery stores, fruit and vegetable shops, fast-food restaurants and convenience stores. The survey has been based on data from about 49,000 Canadians over the age of 18, living in Toronto, Montreal, Vancouver, Calgary and Ottawa between 2007 and 2010. Those data were extracted from the Canadian Community Health Survey (CCHS) that collects each year information related to health status and health determinants for the Canadian population.

Meals Depend On Local Food

The study revealed that, for both men and women, a greater number of fruit and vegetable shops in the residential area was associated with a higher consumption of fruits and vegetables. Inversely, the consumption of fruits and vegetables decreased with the number of fast-food restaurants available around home.

Those findings highlight that procurement strategies for foods are partly related to the type of food businesses around the home. Easy access to food is often reported as a strong influence on food purchase in health research. Proximity from home may therefore be a purchase incentive.

Gender Variations In Procurement

The study has also shown that, for men only, the consumption of fruits and vegetables was further associated with the percentage of businesses selling a wide range of fresh fruits and vegetables around home. In short, the higher the overall number of supermarkets, fruit and vegetable stores and grocery stores compared to the overall number of fast-food restaurants and convenience stores, the higher the fruit and vegetable consumption of men. Why? This may have to do with conformity to consumption norms. A predominance of a certain type of businesses in the environment may represent an authoritative judgment as to what one ought to purchase and eat. Thus, an area with a bountifulness of shops selling fruits and vegetables may unconsciously encourage men to purchase fruits and vegetables in order to adhere to the underlying consumption norms.

Why men and not women? Women are often reported to be more nutritionally knowledgeable, more sensitive to health-concerns, and more attentive to price and quality of products when food shopping. They may therefore use other criteria than a normative benchmark to decide what to buy. This is a possible hypothesis, which remains to be validated, though.

Future Perspectives

Fruit and vegetables are important components of a healthy diet, and may help prevent a wide range of diseases, from obesity to cardiovascular diseases to certain types of cancers. A growing number of people are concerned with their health, and health authorities tend to encourage populations to eat more fruits and vegetables. Yet, there is still room for reaching the national recommendations from Health Canada, which suggest a daily intake of 7 to 10 portions of fruits and vegetables every day for an adult.

In this study, women and men reported eating on average 4.4 and 3.5 portions of fruits and vegetables per day respectively, well below those recommendations. Reinforcing local offerings in fruits and vegetables may be an interesting avenue for encouraging individuals to purchase and eat more of this nutritious food, especially for men.

The Method

Self-reported fruit and vegetable intake from participants of four cycles (2007–2010) of the repeated cross-sectional Canadian Community Health Survey living in the five largest metropolitan areas of Canada (n = 49,403) was analyzed. Measures of exposure to the food environment around home were computed at participants’ residential postal codes. Linear regression models, both in the whole sample and in gender- and city-stratified samples, were used to explore the associations between exposure measures and fruit and vegetable intakes

The Study

The study, Should We Use Absolute or Relative Measures When Assessing Foodscape Exposure in Relation to Fruit and Vegetable Intake? Evidence from a Wide-Scale Canadian Study, was published in Preventive Medicine in December 2014. It was conducted at the Quebec Interuniversity Centre for Social Statistics which is part of the Canadian Research Data Centre Network (CRDCN). The services and activities provided by the QICSS are made possible by the financial or in-kind support of the SSHRC, the CIHR, the CFI, Statistics Canada, the FRQSC and the Quebec universities.


Will Changing Food ‘Ecosystem’ Make A Difference?

The issue of food deserts has gone so far as to engage the First Lady of the United States, Michelle Obama. The thought is relatively simple: an important reason why people don’t eat more produce is because they live in neighborhoods in which fruits and vegetables are not widely sold, are of poor selection or quality, or available only at high prices.

If, through manipulation of public policy incentives, we can get more venues selling produce in these food-desert neighborhoods, then produce consumption would increase, the health of people in these “underserved” neighborhoods would increase, and the cost of any necessary public policy incentives to make this all possible would be paid for by healthcare savings the government realizes from a healthier population.

It sounds great, but it is more a vision than a thought. There is precious little evidence that any of this actually happens.

The problem is obvious: in a free-market economy, if there is demand for something — say more fruit and vegetable purchasing opportunities — usually retailers will move to capitalize on that opportunity. Existing venues will alter their assortment and new banners will open. The fact that this doesn’t happen implies strongly that the demand isn’t there — even if we wish it were. So simply saying we will build fruit- and veg-selling stores in these areas may not do much to increase demand. To the extent sales increase, it might be transfers from purchases that had been made near work or on weekend visits to the suburbs where supermarkets may be in more abundance.

This research by the Université de Montréal’s Department of Social and Preventive Medicine is interesting because it starts to suggest a more sophisticated course of study. The researchers suggest that the thing to look at is not just an absolute count (how many sources of healthy food are available in a given area) but, instead, a relative count (the ratio of healthy to unhealthy food options in a given area).

This idea, if true — and the research weighs in that direction — seems to imply that the whole food-desert thought process might be misguided. Though many neighborhoods may seem in absolute terms to offer plenty of options for healthy eating, these neighborhoods may not be conducive “ecosystems” for healthy eating as the ratio of healthy food retailers to fast food restaurants is disproportionate. This would imply a major redirection of public policy efforts.

The problem though is that, of course, correlation is not causality. It is not really surprising that purchasing and consumption statistics should track what is sold in a community. What is unclear is what this research tells us about people’s consumption habits.

If you were to travel the country and find communities where the local mall has upscale stores, such as Neiman Marcus and Saks Fifth Avenue, you would almost certainly find that in surrounding areas people buy more expensive clothing items than in those areas where the local mall features Sears or J.C. Penney.

There is surely a bit of “push-me, pull-you” to this phenomenon. These stores identify which neighborhoods to locate in based on demographics and existing purchase patterns. Then the presence of these stores attracts people who already are predisposed to shopping in these upscale venues.

So this phenomenon — basically that people are influenced by the options available when purchasing — is not surprising. Indeed for a long time, looking at higher per capita produce consumption in other countries, analysts theorized that less availability of fast food outlets and processed snack food has led people to consume more fruits and vegetables.

The question is what to do with this insight? To some whose only interest is improving diet, the answer is obvious: Use the power of the state to reduce the availability of less healthy options and to encourage more healthy options. The question then becomes how intrusive we want the state to be.

Some would say altering welfare policies is fair game. We are giving people food stamp money, because we want them to buy food — not other things. It is a small journey to say we want them to buy fruits and vegetables, not cupcakes, but this would increase demand for fruits and vegetables and thus encourage retailers to offer broader options. Yet even here, it is complicated. Many people receiving welfare are parents, and they know better than the government what their children will eat and what best serves their family. Restricting welfare recipients so as to increase the purchase of fruits and vegetables is not unthinkable, but it is problematic.

When we get beyond welfare and move to restricting the options of the general populous, things become more troubling. As the contretemps over Mayor Michael Bloomberg’s efforts to restrict soda size indicated, there is something deep in the American spirit that rejects this attempt to intrude on our freedom. The offer of fast foods is part of the cornucopia of food choices Americans have on hand. The evidence that most Americans want their choices restricted is sparse indeed.