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Experts say children in communities without larger grocery stores tend to eat less healthy and gain more weight. Inti St Clair/Getty Images
  • A new study concludes that children who live in communities with limited grocery options are more likely to develop obesity.
  • Researchers say families with limited time and money can make unhealthy choices when it comes to food purchases.
  • Experts say small grocery stores and convenience stores should be encouraged to sell more fresh fruit and vegetables.

Low-income communities pay a steep price in health for cheap, convenient food.

But efforts to make healthier food available in these communities can help improve health outcomes, according to a study published today in the Journal of the Academy of Nutrition and Dietetics.

Children who live in low-income minority neighborhoods with a lot of convenience stores selling unhealthy food are more likely to develop obesity, researchers reported.

However, children in communities with small grocery stores that stock more healthy items tend to have a healthier weight over time, said Punam Ohri-Vachaspati, PhD, RD, a professor in the College of Health Solutions at Arizona State University and lead author of the study.

“We found that community food environment, particularly small neighborhood stores, can significantly influence children’s weight status,” Ohri-Vachaspati wrote in the study.

Dr. Ilan Shapiro, medical director of health education and wellness at AltaMed Health Services in Los Angeles, told Healthline that the study findings “are a reflection of the social determinants of health and barriers that attribute to obesity in underserved communities.”

“Access can be one of the largest contributors to a healthy lifestyle,” said Shapiro. “Communities with more purchasing power will have more grocery store options available to them.”

Researchers followed two groups of children ages 3–15 in four communities in New Jersey (Camden, New Brunswick, Newark, and Trenton) that have undertaken policy and environmental programs to combat childhood obesity.

The study tracked changes in the number and type of food outlets in close proximity to the homes of the children in the study and how that changed over time.

Changes included store openings and closings, families moving between communities, and existing food stores responding to community initiatives by improving their healthy food offerings.

Researchers also looked at the mix of food outlets in communities, including supermarkets, small grocery stores, convenience stores, pharmacies, full-service restaurants, and limited service restaurants.

Particular attention was paid to small grocery stores and convenience stores, which are ubiquitous in many low-income communities.

Stores were classified as small grocery stores if they sold a specific selection of healthy items such as five different types of fruits, five different types of vegetables, lower fat milk, and fresh or frozen meat.

Convenience stores participating in “healthy corner store” initiatives were classified as “upgraded convenience stores.”

Children who had a non-upgraded convenience store within a mile of their home over 24 months had an 11 percent greater likelihood of having a higher body mass index (BMI) range than other children their age.

“When thinking about the ‘two hot dog and a soda’ deal at a local convenience store, it’s easy to see how many calories can be consumed at a very low cost,” Dr. Alexander Lightstone Borsand, a physician with Scottsdale Lifestyle Medicine in Arizona, told Healthline.

“Low-fiber foods, which constitutes the vast majority of available options at a convenience store, are a leading cause of obesity,” Borsand said.

Exposure to an additional small grocery store within a mile over 24 months resulted in a 37 percent decrease in the likelihood that a child would have a high BMI score.

No consistent patterns were found for changes in exposure to supermarkets, restaurants, or pharmacies.

“Our research design allowed us to examine the patterns of relationship between changes in children’s weight status and changes in the food environment over several meaningful distances and lengths of exposure,” said Michael Yedidia, PhD, co-director of the study and a professor in the Institute for Health, Health Care Policy, and Aging Research at Rutgers University in New Jersey.

Cara Harbstreet, RD, LD, a dietitian with Street Smart Nutrition, told Healthline that while the majority of people in poor communities shop in supermarkets, “the more food insecure and low-income a household is, the more likely they are to shop at convenience stores.”

There are many reasons why people in low-income communities choose to shop at convenience stores despite those stores’ limited food options and higher prices, experts said.

“Transportation barriers combined with food deserts [lack of other shopping choices] are substantial reasons why some low-income families are more likely to shop at a convenience store for their groceries,” said Shapiro.

“Parents in working-class families may be working multiple jobs, which doesn’t allow time to get to a grocery store, especially if it’s not located nearby and transportation is an issue,” he said.

Children who are unsupervised while parents work may be free to visit convenience stores and make unhealthy food purchases, Shapiro added.

“If the child is doing this on a regular basis, it can build poor eating habits and has a cumulative effect on their health,” he said. “When it’s the parents purchasing junk food for children, it can be an unhealthy emotional purchase.”

“Low-income families may not have the means to buy their child trending toys and technology, but a bag of chips or a candy bar that costs two dollars might bring a smile to the child’s face,” he added.

“Other factors are at play here, including store hours, SNAP participation or other benefit program options, loyalty programs or couponing options, and ability to one-stop-shop,” added Harbstreet.

The study researchers concluded that initiatives that raise the healthfulness of food offered in convenience stores to the levels offered at small grocery stores could improve the weight status of children.

They note that this is especially important during the COVID-19 pandemic, which has increased food insecurity in low-income communities.

“Start a dialogue with your corner store owner and ask what it would take to stock fresh fruit and vegetables,” said Shapiro. “Asking a convenience store to stock healthier foods could require a multi-organization effort.”

“Working with underserved areas of Southern California, we were seeing a large number of children struggling with obesity,” he recalled. “We reached out to our local public health department and worked with them to identify food deserts and worked with convenience stores to supply fresh fruits and vegetables to be displayed near the registers.”

Families also need to be educated about reading food labels and making good nutritional choices, said Shapiro.

“Ultimately, if there’s no demand for perishable foods, the store is less inclined to continue to stock them,” he said.

“A lack of time may be addressed by teaching or demonstrating skills for using canned or shelf-stable foods that require minimal preparation, cooking time, or clean up time,” said Harbstreet.

“Culinary knowledge and confidence can be bolstered by assessing which cooking tools and appliances are available, and offering support with recipes that don’t exceed those limitations,” she said. “For example, stove top cooking may not be an option in some households, but hot plates or microwave cooking is.”

“Finally, simplicity and cultural sensitivity can ease the burden of cooking for some families,” Harbstreet said. “The cumulative stress of working multiple jobs, finding reliable and affordable childcare, transportation, etc., leaves little capacity for some families to meet what others would define as a healthy diet.”

“Simple, approachable recipes and guidance around the preparation and storage of certain foods can be helpful… as well as reminders that culturally significant foods, while they may not appear as nutritious as staples of a westernized American diet, can still be included for overall nutrition, satisfaction, and enjoyment during meals,” Harbstreet added.

Harbstreet said that broader societal issues also play a role in food shopping behaviors.

“There is a known association between income level, access to affordable and healthy food, and built environments,” she said. “The communities who lack access to affordable, healthy food are often described as ‘food deserts’ but a more accurate term is ‘communities impacted by food apartheid.’”

“The lack of grocery stores, farmers markets, public transportation, walkable neighborhoods, and public safety net programs are all the result of organized, planned exclusion,” she explained. “This ties into the history of neighborhood covenants and red-lining, as many of these communities have been cut off from the same opportunities as wealthy, white neighborhoods for generations.”

Harbstreet said that access to healthy food is another aspect of the struggle against systemic racism.

“We are quick to blame packaged, processed foods for rising body sizes, particularly among children, and think addressing this through soda or sugar taxes is a solution,” she said.

“In reality, we must address the underlying systems that marginalize these communities and the longstanding, harmful beliefs that economically depressed neighborhoods are full of people who are uneducated or do not care about their health,” she added.