Influence of the food environment on obesity risk in a large cohort of US veterans by community type

Abstract

Objective: The aim of this study was to examine relationships between the food environment and obesity by community type.

Methods: Using electronic health record data from the US Veterans Administration Diabetes Risk (VADR) cohort, we examined associations between the percentage of supermarkets and fast-food restaurants with obesity prevalence from 2008 to 2018. We constructed multivariable logistic regression models with random effects and interaction terms for year and food environment variables. We stratified models by community type.

Results: Mean age at baseline was 59.8 (SD = 16.1) years; 93.3% identified as men; and 2,102,542 (41.8%) were classified as having obesity. The association between the percentage of fast-food restaurants and obesity was positive in high-density urban areas (odds ratio [OR] = 1.033; 95% CI: 1.028-1.037), with no interaction by time (p = 0.83). The interaction with year was significant in other community types (p < 0.001), with increasing odds of obesity in each follow-up year. The associations between the percentage of supermarkets and obesity were null in high-density and low-density urban areas and positive in suburban (OR = 1.033; 95% CI: 1.027-1.039) and rural (OR = 1.007; 95% CI: 1.002-1.012) areas, with no interactions by time.

Conclusions: Many healthy eating policies have been passed in urban areas; our results suggest such policies might also mitigate obesity risk in nonurban areas.

Figure 1. Model-based associations^a of the relative availability of fast food restaurants and obesity^b by year and community type

NOTE: p-value reflect statistical significance (α=0.05) of interaction term for time (year since baseline) and food environment exposure variables. ^aAdjusting for baseline age, sex, race/ethnicity, marital status, income/disability flag, land use environment, neighborhood socioeconomic environment quartiles, percentage Hispanic population and percent non-Hispanic Black population of participants’ Census tracts; and interaction with year since baseline (i.e., cohort entry date). ^bObesity defined as body mass index of >30.0 kg/m².

Figure 2. Model-based associations^a of the relative availability of supermarkets and obesity^b by year and community type

NOTE: p-value reflect statistical significance (α=0.05) of interaction term for time (year since baseline) and food environment exposure variables. ^aAdjusting for baseline age, sex, race/ethnicity, marital status, income/disability flag, land use environment, neighborhood socioeconomic environment quartiles, percentage Hispanic population and percent non-Hispanic Black population of participants’ Census tracts; and interaction with year since baseline (i.e., cohort entry date). ^bObesity defined as body mass index of >30.0 kg/m².