Food availability/convenience and obesity.

Neighborhood environments have received considerable attention in recent local, state, and national obesity prevention initiatives, with a particular focus on food deserts, or areas with poor access to healthy foods. Yet, there are inconsistencies in the evidence base, suggesting a nuanced association between neighborhood environment, food availability, diet behaviors, and obesity. There is heterogeneity in associations between environmental exposures and health outcomes across race/ethnicity, gender, region, and urbanicity, which results in complexity in the interpretation of findings. There are several limitations in the literature, including a predominance of cross-sectional studies, reliance on commercial business listings, lack of attention to the process by which diet resources are established and expanded within neighborhoods and the potential for individuals to selectively migrate to locate near such facilities, a predominant focus on residential neighborhoods, and lack of information about the decision-making process underlying purchasing patterns. More research is needed to address the complexity of individual-level residential decision making as well as the purposeful placement of food environment resources across social and geographic space using longitudinal data and complex statistical approaches. In addition, improvements in data quality and depth related to food access and availability are needed, including behavioral data on purchase patterns and interactions with the food environment, and greater attention to heterogeneity across subpopulations. As policy changes to the food environment move forward, it is critical that there is rigorous and scientific evaluation of environmental changes and their impact on individual-level diet choices and behaviors, and their further influence on body weight.