Healthy Food Environment

A food environment is the intersection between an individual and the wider food system. One’s unique food environment is shaped by the physical, political, economic, and sociocultural factors that influence which foods are available, affordable, chosen, and prepared for consumption. [1-4]

Unfortunately in many food environments, unhealthy foods and beverages are often more readily available—and accessible—than healthful items. Their choice is also powered by appealing marketing approaches and ubiquitous placement in vending machines and checkout counters.

A healthy food environment is one in which healthy choices are readily available and promoted, easily accessible, and affordable. To make this shift, change and support must come from all parts of society: governments and schools, businesses and non-profit organizations, neighborhoods and communities, and individuals and families. [5] It is crucial to effect policy changes and create an environment where the default option is the healthy choice.

Beyond the Individual

The food environment often lurks silently in the background going largely unnoticed, but it plays a major role in the food choices people make, even for the most independent-minded consumer. Individuals may choose a food based on factors including taste preferences, beliefs about foods, nutritional knowledge, eating behaviors, and income.

Food choices are also influenced by cultural and ethnic norms and social pressures, and many other influences that extend beyond the individual. [6] Whether it’s small victories on the local level or large shifts on the national level, any positive changes to the food environment can begin to shift momentum away from a world that so readily promotes unhealthy eating.

Sociocultural Influences

Families

Families influence children’s dietary choices, and children develop food preferences at home that can last well into adulthood. [7] The food that families keep at home and how family members share meals can influence what and how much they eat. For example, there is a strong association between children, adolescents, and adults eating more fruits vegetables if they are available at home. [8] Eating family meals together has also been linked with increased intake of fruits and vegetables and other healthy foods. [9] Eating meals together may or may not affect weight as some studies show a positive link while others do not. [10–13] Families also influence what children drink, with children drinking more sugar-sweetened beverages when their parents frequently consumed these beverages, compared with children whose parents did not drink sugar-sweetened beverages. [14]

Families with lower incomes face additional barriers to healthy eating. One roadblock is that healthy foods, such as vegetables, fruits, and whole grains, tend to be more expensive than less healthful foods such as refined grains and sweets. [15] Another is time: It takes longer to prepare meals at home than to buy convenience foods or fast food. People in lower-income households, often single parents working full time and taking care of children, may have less time for meal preparation. [1, 15, 16]

Social networks and norms

Social norms are rules that define beliefs and behaviors of a group. People may change their food preferences and eating behaviors based on health-based social norms. [17] Some research has found that when participants are exposed to healthy social norms, they report lower preferences for unhealthy foods compared with participants who are exposed to unhealthy norms. Increased exposure to social media that endorses images of low-nutrient processed foods may also lead to greater consumption these foods. [18]

Sociocultural interventions

Keep fresh fruit washed and ready-to-eat at home as snacks for the whole family.
Limit or avoid keeping sugary beverages at home. If you enjoy these drinks, consider them as an occasional treat, such as when eating out in a restaurant.
Try to eat at least one meal together daily as a family. Consider getting children involved to help with preparation (chopping vegetables, setting the table) or cleanup.
Implement a meal prep day once weekly, batch-cooking proteins, grains, and vegetables so they can be reheated quickly during the week. Encourage children and teens to participate in meal prep by washing fruits and vegetables, chopping for older kids, and more advanced cooking or baking food ingredients for teenagers.

Community Environments

Throughout the course of life, the environments in which we spend our time can also influence the food we eat. This includes the communities where we live, but also places like schools and workplaces.

Visit the below pages for specific recommendations to improve these spaces:

Early childcare and education (ages 2-5 years old)
Schools and other spaces for youth, such as afterschool programs (ages 5-17 years old)
Workplaces (adults)

Neighborhood food environment

Lack of access to supermarkets

Roughly 2 million U.S. households live more than a mile from a supermarket and don’t have cars or access to cars. [19] Researchers use the term “food desert” to describe neighborhoods with limited access to full-service grocery stores or supermarkets. [20] Living in food deserts is associated with lower quality diets [21-24] and increased risk of obesity. [25–27] There’s evidence that low-income neighborhoods, as well as Black or Hispanic neighborhoods, are less likely to have access to large supermarkets offering high-quality and low-cost food, compared with middle-income neighborhoods and white neighborhoods. [28,29]

Greater access to convenience stores

Having greater access to small food stores may increase the risk of obesity. [25] Convenience stores often offer less variety, higher prices, and lower quality produce than supermarkets. [30] When small stores do stock healthier foods, however, people living nearby eat better. [31] If small stores changed the foods they stock, they could have a positive influence on community members’ diets and obesity risks. Convenience stores selling unhealthy snack foods are more likely to locate in low-income neighborhoods and particularly near schools. [30] They’re also found near schools with more Hispanic and Black students, even after accounting for students’ poverty level. [31]

Fast food

Although eating fast food has been shown to increase caloric intake and the risk of weight gain, it is not as clear that living or working closer to fast-food restaurants has the same effect. [32-34] While some studies have found that living near fast-food restaurants is linked to weight gain, lower intake of vegetables, and less physical activity, other studies have not. [33,35-39] Fast-food restaurants are more likely to locate near schools, and proximity of fast-food restaurants to schools has been linked to weight gain, lower fruit and vegetable intake, and higher soda intake in school children. [40,41]

Improving local healthy food access

Increase availability of fresh fruits and vegetables in neighborhood convenience and corner stores
Ensure that public transportation routes and schedules maximize access to supermarkets
Offer vouchers to farmers markets
Impart zoning regulations to help bring supermarkets to low-income neighborhoods
Change zoning laws and give incentives to lure supermarkets and farmers markets to “food deserts” (areas that lack access to nutritious foods) and underserved communities
Create healthy food zones near schools and recreational areas to ban unhealthy fast-food restaurants
Limit the number of fast-food restaurants in one area through zoning restrictions
Encourage restaurants to reformulate menu items to provide healthier options
Provide permits/incentives to healthy mobile vending carts and food trucks
Promote community gardens through zoning policy and grants or other financial support

Industry Influences

Food marketing

Restaurant, food, and beverage advertising targeted to adolescents almost exclusively promotes energy-dense nutrient-poor products, especially fast food, sugary drinks, candy, and snacks. [42] Exposure to this marketing increases preferences and consumption of these products. Digital marketing through websites, video games, and social media as well as advertising and product placement in supermarkets and schools also contribute to an environment with little uncommercialized space. [43] In 2005, the National Academy of Medicine (formerly called the Institute of Medicine) concluded that food marketing contributes to unhealthy diets and risk of poor health among American children and youth. [44]

Despite this widespread recognition of the negative impact of marketing unhealthy foods, the practice continues unabated. One study found that when children were presented with foods with cartoon characters on the packaging, 73% were more likely to choose the item packaged with these characters compared with the same food without characters. [45] Food marketers are increasingly using sophisticated digital marketing techniques to target youth across a host of platforms, including smartphones, video games, social media, and immersive “virtual worlds,” prompting public health advocates to call for stronger government regulation and industry self-regulation. [46-48] Furthermore, children are less likely to recognize digital advertising techniques as compared with television advertisements. [43,47] One study demonstrates that when children viewed both “advergames” and television commercials, advergames produced more positive attitudes towards brands. [49]

In 2012, the WHO released The WHO NCD Action Plan 2013‐2020, which recommended restrictions on the marketing of unhealthy food and beverage products to children. [50] By 2018, only 63 out of the 193 Member States who originally endorsed these restrictions had enacted federal policy to limit the marketing of unhealthy foods and beverages to children. [50] Instead, some countries relied on industry self-regulatory programs, while many other countries made no changes at all. [50]

In March 2010, the Center for Science in the Public Interest issued a report card grading the strength of the voluntary food marketing policies of 128 food and entertainment companies. [51] Two-thirds of these companies had no policy whatsoever on marketing to children. Of the existing policies, a majority applied only weak nutrition standards to their marketing efforts. Meanwhile, in the U.S., efforts by the Federal Trade Commission (FTC) to develop voluntary, uniform nutrition standards for foods and drinks marketed to children have met strong resistance from industry and have been stymied by Congress. [52] In 2014, the FTC stopped tracking food marketing to children. [53]

Healthy food campaigns

Create education campaigns using various media sources (e.g., television, print, radio) about a specific food or eating pattern
Support policies that increase taxes on unhealthy foods and subsidizing the costs of healthy options
Employ communication policies that restrict advertising to youth about unhealthy foods, or curb stealth marketing to youth through junk food product placements on prime-time television and social media

Industry food marketing

Require food marketed to children to meet nutritional standards
Limit the amount of time per hour of children’s programming that can include food marketing
Restrict food product placement in television shows/movies, and restrict other forms of marketing to children, such as marketing agreements between entertainment brands and food brands
If voluntary efforts to improve the nutritional quality of foods marketed to children on television are not successful, enact federal legislation and monitor compliance with and enforcement of child food marketing regulations at the national level

Public health marketing

Develop public service media and social marketing campaigns to promote healthy eating and drinking
Develop counter-marketing campaigns, such as campaigns that highlight the negative health impact of sugar-sweetened beverages and other unhealthful foods

Restaurants

Encourage the food and restaurant industry to shift marketing efforts toward more healthful foods and beverages for children
Require restaurants to post calorie information on menus and menu boards
Give restaurants incentives to offer healthier items, such as by creating promotional campaigns that highlight or recognize healthy restaurants or by offering other marketing support
Set nutrition requirements for meals that include toys, giveaways, or other incentives aimed at children

Food labeling

Standardize front-of-package health labeling
Require more prominent calorie-per-serving labeling on food packaging
Require additional information on food labeling, such as recommended daily limit on added sugar consumption or caffeine consumption

Agriculture

Support agricultural policies that focus on increased planting and buying of fresh fruits and vegetables.
Use zoning/land use policies to create new space for farmers markets
Provide government subsidies or create public/private partnerships to develop new farmers markets
Provide financial support for marketing of and transportation to farmers markets

Governmental and Global Influences

Government food policy and pricing

In the past 30 years, the price of fruit and vegetables rose much faster than prices of all other consumer goods in the U.S. At the same time, the price of sugar, sweets, and carbonated drinks declined, and people began consuming more sugar and other sweeteners, reaching 151 pounds of caloric sweeteners every year per person by 1999. [54,55] In recent years, per capita sweetener consumption has declined to 142 pounds per year, still significantly higher than the 123 pounds consumed in 1966. A 2014 study offered further evidence that inexpensive food is a key factor in rising obesity rates. [56]

Changes in food prices have been linked to changes in how much we eat and our risk of obesity. One study that followed more than 5,000 young adults for 20 years found that lower prices on soda and pizza were associated with higher caloric intake and increased weight. [57] Another found that higher fruit and vegetable prices were associated with greater weight gain over time in young children. [39]

There has been much debate about why the price of sweeteners has dropped. Some researchers have argued that subsidies to corn growers have led to an oversupply of cheap high-fructose corn syrup, which drives higher sweetener consumption. Economic evaluations of this argument have found that direct subsidies currently play a limited role in lowering sweetener prices, although their historical impact on development of the sweetener market may be more important. [55,58]

Taxing sugar-sweetened beverages

Although economists debate how much government subsidies to corn growers influence the price of sweeteners, the government can set policies that influence the price and availability of foods that, in turn, influence obesity risk. [59] Taxes are related to a greater decrease in consumption and overweight for children who are already overweight or whose families have a low income. Several cities in the U.S. as well as countries such as Mexico and Chile have implemented various taxes on sugar-sweetened beverages. In Philadelphia, the government enacted a $0.15 per ounce tax on all sugary drinks sold within the city. [60] A recent evaluation of this law found that it led to a 51% decrease in sugary drink sales within Philadelphia. [61] However, this decrease was partially offset by a more moderate increase in sugary drink sales (24%) outside of the Philadelphia border. [61]

Case Study: Chile's sugar-sweetened beverage regulations

In 2016, Chile implemented a set of laws regulating food labeling and advertising, taxing sugar-sweetened beverages, and restricting sugary food and beverage sales in schools. Due to these new regulations, purchases of sugary drinks decreased by 27% throughout Chilean households. [62] One recent study noted that Chile’s laws were significantly more impactful than standalone policies taxing sugar-sweetened beverages that have been implemented throughout Latin America. Rather, addressing sugar-sweetened beverage purchases required approaching the problem from all angles, from putting warning labels on junk food packaging, to restricting child-directed food advertisements. [62] One potential caveat in Chile’s food-related laws is that they had more significant effects in high-education households versus low-education households. Therefore, it is possible that these laws increase health gaps between high-education and low-education households. [62]

Healthy food policies

Establish strong nutrition standards and healthy food policies for foods served at public facilities and government buildings, as well as foods purchased with government funds
Make healthy foods more “available and affordable in public facilities and government buildings, and restrict the availability of less-healthy foods
Ensure that smaller portion-size food options are available in public facilities and government buildings
Limit or discourage access to sugar-sweetened beverages, especially in schools and childcare centers, worksites, government buildings, and public facilities
Ensure access to free water in all government buildings
Limit mobile vending of unhealthy foods through legislation or health department regulations

Food pricing and taxes

Tax foods of minimal nutritional value (“junk food”) to decrease consumption such as sugar-sweetened beverages and other high-calorie, low-nutrient foods
Earmark tax revenues from sugar-sweetened beverage taxes or other taxes for obesity prevention efforts
Lower the relative cost of healthy foods through subsidies or other measures

Food assistance programs

Increase enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP), using existing government programs (such as Medicaid and the Children Health Insurance Program)
Change SNAP and WIC guidelines to give people incentives to make healthier food choices, such as providing discounts or rebates for buying fruits and vegetables
Study the impact of changing SNAP guidelines to prohibit benefits from being used to buy sugar-sweetened beverages, or making other changes to improve the quality of foods purchased with SNAP
Remove restrictions on the use of SNAP Education funds for materials or social marketing campaigns that discourage the consumption of unhealthy foods, such as sugar-sweetened beverages
Increase WIC vouchers for fruit and vegetables
Encourage farmers markets and small store owners to accept electronic benefits from food assistance programs
Focus on children’s nutrition by testing healthy food guidelines for children who receive SNAP benefits
Create stronger healthy food stocking standards for SNAP retailers similar to those required of stores that participate in WIC
Require the FDA to collect data on SNAP purchases that can be used to analyze the program’s effect on nutrition and health
Improve nutrition guidelines for Child and Adult Care Food Program and Summer Food Service Program
Increase supply of healthy foods (including produce) in food banks and other emergency food programs

Healthier hospitals and health care

Hospitals are important settings for public health efforts because they reach a large population each year, including employees, patients, and visitors. Emerging evidence also suggests that food and nutrition interventions in coordination with health care settings may be associated with improved health outcomes and decreased health care costs

Learn more

Agricultural policy

Develop government procurement processes that support local farmers
Increase federal funding to support fruit and vegetable production, such as through changing the U.S. Farm Bill
- Remove fruit and vegetable planting restrictions in commodity food programs
- Provide additional training, loans, research, and marketing support to fruit and vegetable farmers
- Increase preservation efforts for farmland devoted to fruit and vegetable production
- Develop a fruit and vegetable subsidy program
Increase local support of production, processing, and distribution of locally grown fruits and vegetables
Increase government procurement of locally grown fruits and vegetables

Global policy

Key global institutions such as the World Health Organization, World Trade Organization, and the World Bank may form teams to implement effective strategies, research translation, and policies that address global food availability and improve healthy food access in low and middle-income countries
Assist policy makers in navigating international trade laws and agreements that make it difficult for governments to restrict access to unhealthy foods
Use statutory powers to promote strategies that improve local, regional, and national food environments
Develop, strengthen and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive and actively engage all sectors
Promote nutrition research that evaluates the associations between agriculture, dietary habits, and health and disease to improve national-level policies

What is globalization?

Globalization is the spread of knowledge, technology, culture, and capital from country to country. [63] It brings both benefits and detriments to health, and is one of the main reasons why the world now has more overweight than underweight people. [64] Globalization is associated with increased wealth and technology that can improve the quality of life for people in developing countries such as job changes from laborious low-paying farming and mining work to manufacturing and service jobs, and increased access to healthy foods. [65] But it also introduces cheap low-nutrient ultraprocessed foods and promotes a sedentary lifestyle. People are spending more time on electronic devices and less time moving and getting outside. [66] They may opt for driving cars or mopeds instead of walking or bicycling. [67] Global free trade agreements create a global agricultural marketplace with access to cheaper foods and the allowance of multinational fast-food companies to expand into new countries, often introducing high-calorie processed foods. [68,69] These include high-calorie oils, meats, refined grains, sugary drinks, and fast food.

These economic changes create predictable dietary shifts, called the “nutrition transition.” [63,70] The earliest nutrition patterns were the “hunter gatherer” in which people were highly active hunting and foraging for food, and ate diets rich in fibrous plants and protein from lean wild animals; followed by the “early agriculture” pattern in which famines were common. Today, low and middle-income countries experience less famines as income rises and nutrition improves, and are moving to a pattern of overeating with associated diseases as people have abundant access to low-nutrient ultraprocessed foods and physical activity declines.

The increased access to technology and lower food prices without a concurrent increase in knowledge about healthy lifestyles and access to health care, as seen in lower-income groups, is associated with increased risk of weight gain and chronic disease. [64] Interestingly, in low-income countries, wealthier, well-educated people are more likely to be overweight than people who have lower incomes or less schooling. The opposite is true in higher-income countries, where wealthier people have lower rates of obesity than those with lower incomes. [71,72]

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