DESIGNED FOR DISEASE:The Link Between Local Food

Environments and Obesity & Diabetes

Stefan Harvey California Center for Public Health Advocacy

BANPAC, June 4, 2008

Study Partners

The Study: Data Sources

Health and demographic data from the 2005 California Health Interview Survey (CHIS)

Locations of retail food outlets from the 2005 InfoUSA Business File

2000 Census data on community income

Retail Food Environment Index (RFEI)

Fast-Food Restaurants + Convenience Stores

Grocery Stores + Produce Vendors RFEI =

Higher RFEI = Higher Obesity Rates

20%23% 24%

0%

5%

10%

15%

20%

25%

RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+

**

Higher RFEI = Higher Diabetes Rates

6.6%7.8% 8.1%

0%

3%

6%

9%

RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+

**

Higher RFEI = Higher Diabetes Rates

6.6%7.8% 8.1%

0%

3%

6%

9%

RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+

**

23% difference

Higher RFEI in Lower-income Communities

4.9

4.1

0

1

2

3

4

5

6

Lower-income Communities

Higher-income Communities

*

Higher RFEI in Lower-income Communities

4.9

4.1

0

1

2

3

4

5

6

*

20% difference

Lower-income Communities

Higher-income Communities

RFEI & Obesity in Lower-income communities

24%26%

28%

0%

10%

20%

30%

Lower-income Communities RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+

*

RFEI & Obesity in Lower-income communities

24%26%

28%

0%

10%

20%

30%

Lower-income Communities RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+

*

17% difference

RFEI & Diabetes in Lower-income Communities

7.7%8.5%

9.3%

0%

2%

4%

6%

8%

10%

Lower-income Communities

RFEI 3.0 - 4.9 RFEI 5.0+

**

RFEI < 3.0

RFEI & Diabetes in Lower-income Communities

7.7%8.5%

9.3%

0%

2%

4%

6%

8%

10%

Lower-income Communities

RFEI 3.0 - 4.9 RFEI 5.0+

**

RFEI < 3.0

21% difference

Findings hold true after controlling for age, gender, ethnicity, individual income, community income, and

physical activity levels

California adults with an RFEI ≥ 5.0 are 18% more likely to be obese than adults with an RFEI < 3.0

California adults with an RFEI ≥ 5.0 are 24% more likely to have a diagnosis of diabetes than adults with an RFEI < 3.0

Conclusions

Strong and direct link between the local food environment and both obesity and diabetes

Food environment affects communities across California

RFEI, obesity, and diabetes are all highest in lower-income communities

Policy Recommendations

Improve access by incentivizing retail store development and improvement

Promote retail innovations, including smaller-scale markets, selling healthy foods

Require chain restaurants to post nutritional information on menus and menu boards

Policy Recommendations

Establish zoning ordinances to limit fast food outlets in overburdened communities

Maximize the opportunities presented by the changes in the WIC food package

Target obesity and diabetes prevention efforts to lower-income communities

WWW.PublicHealthAdvocacy.Org

DESIGNED FOR DISEASE:The Link Between Local Food

Environments and Obesity & Diabetes

Stefan Harvey California Center for Public Health Advocacy

BANPAC, June 4, 2008