Tuesday, May 3, 2016

Why we focus on food deserts and not food swamps

Most people have heard the term food desert. A food desert is a place where people live and do not have reasonable access to whole foods, or fresh produce. Often this is measured by some distance to a grocery store. For example, in some places people live close to convenience stores and fast food restaurants, but would have to travel several miles, sometimes 10 or 20, to get to a grocery store. In these same areas, there may be high rates of obesity - however, there are high rates of overweight and obesity across the USA. Some speculate that not living close to a grocery store where one can access produce is a 'cause' of obesity (i.e., they associate food deserts with obesity). And it is not just availability, it's affordability, too. If the fresh produce costs more than processed foods, they are less accessible. If children have to try foods several times to like them, and a parent is on budget, it makes it hard to buy more expensive items that might not be eaten.

Access and affordability are things that public health advocates work to change AND that the electorate/society supports. Right? Of course we should make sure everyone has access to nutritious foods that are often low in calories. YAY! Let's do it.

Research has not always supported the intuitive, however, and sometimes people who have access to fruits and vegetables still don't purchase or consume them. Why not? Well, my educated/informed opinion is because a good many people live in food swamps. I am not sure where I first heard or read the phrase, but I describe a food swamp as an area where high calorie foods - often low in nutrients - are in abundance, are cheap, easy to locate, highly advertised, branded (e.g., KFC, Doritos, Pepsi) and popular among children, adolescents and adults. Actually, these foods and their promotions (e.g., all you can eat buffets, $1 hamburgers, 3 for 1 honeybuns, 32 ounce sodas) are hard to avoid.  

As noted above, the popular strategy for dealing with a food desert is to bring more fresh foods in - build a grocery store or a farmers market, add produce to the convenience store checkout, send in a mobile produce truck - and hope people will purchase, prepare wisely and eat more nutritious foods. Oh and here is the most important part... eat them instead of the high calorie non-nutritious foods they have been eating. Every one agrees, yes - those are all good strategies... yay, lets fund them! [They don't work so well, but they seem smart and non-paternalistic, therefore, it must be right.]

The strategy for food swamps (which is as unpopular as the food desert strategy is popular) is policy and regulation. I believe that food swamps are the bigger problem and that regulation and policy are our best bet at trying to reduce over consumption of calories (often occurring passively, i.e., not intentionally eating extra calories). Examples include, limiting the number of fast food/quick casual restaurants that can surround neighborhoods, schools, and worksites (zoning laws), putting a sales tax on high calorie, low nutrient items, like sugar sweetened beverages (specifically I say a sales tax because consumers are more likely to notice a sales tax than an excise tax and sales taxes cannot be 'eaten' by the manufacturer unless they literally lower the prices of their products), putting calorie counts out in front on everything, everywhere (menu boards, front of packages, sodas) and educating people on what is considered a 'high' amount of calories (e.g, a dinner entree over 500 calories is high, if it is part of a days worth of meals), portion caps - like suggested in NYC might work, and limiting ads for high calorie foods or ad space (e.g., TV, public transit, magazines, websites, social media). I think our grocery stores should have makeovers as well. The cheap, high calorie foods should not get prominence and promotion. This is one of the main reasons I believe that strategies to add fruits and vegetables to neighborhood stores or whole grocery stores to neighborhoods, fail. It is hard to get through the mire of junk - physically, emotionally, socially, parentally - to the better for you items. 

And before anyone points out that the food swamp policies I mentioned are regressive (i.e., they will have a bigger impact on persons of lower income) I say YES, and obesity and its related disease conditions is also regressive and has a greater impact on persons of lower income. 

My point is, that though it might sound good (especially politically) to make fruits and vegetables and other nutritious foods available and accessible, what we really need is to make low nutrient (junk) foods and drinks LESS available and accessible (less cheap, less popular, less in our face).  And as that annoying prince on the TV show Outlander says, "mark me" I am right about this.

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