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Neighbourhood food environments: food choice, foodscapes and planning for health

Published online by Cambridge University Press:  01 March 2018

Amelia A Lake
Affiliation:
Department of Science, School of Science, Engineering and Design, Teesside University, UK Fuse – UKCRC Centre for Translational Research in Public Health, UK
Corresponding
E-mail address:
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Abstract

The burden of obesity contributes to increasing health inequality, and placing healthcare systems under huge strain. The modern society could broadly be described to support unhealthful eating patterns and sedentary behaviour; also described as obesogenic. Obesity prevention and treatment has focused on educational and behavioural interventions, with limited overall success. A sustainable approach is to address the environments that promote less healthy eating and high energy intake as well as sedentary behaviour. Approaches which modify the environment have the potential to assist in the prevention of this complex condition. The present paper focuses on food environments within the context of obesogenic environments. Takeaway and fast food, a fixture of our diet, is usually nutrient poor and energy dense. A ‘concentration effect’ has been observed, where there is a clustering of fast food and takeaway outlets in more deprived areas. Access to food and intake are associated; however, there are methodological challenges in associating the effect of the food environment on obesity. While there is an imperfect evidence base relating to the role of the food environment in terms of the obesity crisis; policy, practice, civic society and industry must work together and take action now, where current evidence suggests a change. Shaping the environment to better support healthful eating decisions has the potential to be a key aspect of a successful obesity prevention intervention.

Type
Conference on ‘Improving nutrition in metropolitan areas’
Copyright
Copyright © The Author 2018 

Background

Obesogenic environments have been defined as ‘the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations’(Reference Swinburn and Egger1). Ten years ago the Foresight Tackling obesities: future choices (2) report was published. This report described obesity in terms of complex systems(Reference Savona, Rutter and Cummins3). While, 10 years ago, this concept was relatively new, it brought together evidence that linked the built and food environments in novel ways(Reference Lake and Townshend4, Reference Lake, Townshend and Alvanides5). Over 10 years the publications and evidence relating to obesogenic environments have grown exponentially. Most focus on how aspects of the built environment may contribute to current obesity levels, by influencing physical activity and dietary behaviours at the individual and community level(Reference Townshend and Lake6). The 2014 McKinsey report(7) described that overcoming obesity will require multiple solutions, involving many sectors from policy and practice through to industry and consumers. The report describes how we need to ‘reset the default’ in order to normalise and make healthy behaviours easier, relying less on the individual(7). Swinburn et al. have described how ‘dramatic actions’ are needed, globally, to address food environments and thereby impact the on the rise in obesity and diabetes(Reference Swinburn, Kraak and Rutter8). The worldwide rise in obesity has been ‘driven’ by significant changes in the global food system(Reference Swinburn, Sacks and Hall9). This food system produces readily available, processed food which is marketed at populations(Reference Swinburn, Sacks and Hall9). Looking at trends in high-, middle- and low-income countries, research has concluded that increases in the food energy supply, alongside increasing sedentary behaviour, explains the increases in population body weight, particularly in high-income countries(Reference Vandevijvere, Chow and Hall10). The food environment has a role to play in helping to develop obesity, and therefore a role to play in preventing obesity. The present paper focuses on how the environment influences dietary behaviours mediated through the food environment.

Food environments

Food choice and eating behaviours are influenced by a multitude of factors from culture to personal preferences. The relationship between our food choices and the environment in which we make these choices is now widely acknowledged; from nudging and choice architecture(Reference Bucher, Collins and Rollo11) to conceptualising how the local food environment influences eating behaviour(Reference Caspi, Sorensen and Subramanian12). We can define the food environment as any opportunity to obtain food; it includes physical, socio-cultural, economic and policy influences at both micro- and macro-levels(Reference Townshend and Lake13). The broader food environment includes the home food environment, food policies and school food policies in addition to the neighbourhood food environment(Reference Lake, Townshend, Burgoine, Buttriss, Welch, Kearney and Lanham-New14). Story et al. (Reference Story, Kaphingst and Robinson-O'Brien15) have developed an ecological framework to illustrate the influences on dietary behaviours. The present paper focuses on the neighbourhood food environment.

The neighbourhood food environment is defined as a mixture of retail outlets (e.g. small convenience stores to supermarkets) as well as restaurants and take-away (fast food) outlets and is not limited to the residential neighbourhood(Reference Lake, Townshend, Burgoine, Buttriss, Welch, Kearney and Lanham-New14). The neighbourhood food environment influences individual food choice and food intake through the concept of food access. The relatively simple concept of access, in terms of the food environment actually includes five dimensions which are: availability, accessibility, affordability, acceptability and accommodation(Reference Penchansky and Thomas16) (See for more details: Lake et al.Reference Lake, Townshend, Burgoine, Buttriss, Welch, Kearney and Lanham-New14).Research has focused on the availability and accessibility of neighbourhood food outlets. Two recent systematic reviews, one exploring the local food environment in relation to obesity(Reference Cobb, Appel and Franco17) and one exploring the food environment in relation to diet(Reference Caspi, Sorensen and Subramanian12) have been inconclusive in their findings. This is, in part, due to the complexity of the measures and the quality of the studies. However some important patterns emerged; for example, in adults, Cobb et al. (Reference Cobb, Appel and Franco17) found evidence that supermarket availability was negatively associated with obesity and fast food availability was positively associated. The Janssen et al. (Reference Janssen, Davies and Richardson18) review suggested that the strongest determinants of out-of-home food availability are the density of food outlets and deprivation within the built environment.

Our surrounding environment is going to impact on our food choice and ultimately on our eating behaviour and consequently our energy balance, weight gain and obesity(Reference Rosenheck19). Neighbourhood food environments are important and much attention has been paid to fast food and takeaway outlets. We know the food served within these outlets tends to be nutrient poor and energy dense(Reference Jaworowska, Blackham and Davies20, Reference Lachat, Nago and Verstraeten21). Public Health England estimates that in 2014 there were over 50 000 fast food and takeaway outlets, fast food delivery services, and fish and chip shops in England(22) and a greater proportion of these are in deprived areas. Data from the UK National Diet and Nutrition Survey indicates that between a fifth and a quarter of people in the UK eat meals out once per week or more, with one-fifth eating takeaway meals at home once per week or more(Reference Adams, Goffe and Brown23).

Using data from Norfolk (England), researchers report that takeaway food outlet density increased from 1990 to 2008(Reference Maguire, Burgoine and Monsivais24). Takeaway food outlet density was significantly higher in more deprived areas at all time points. Worryingly, over the time period, there were increases in socioeconomic disparities in takeaway food outlet density(Reference Maguire, Burgoine and Monsivais24). This concentration effect has been observed in other studies where takeaway and fast food outlets tend to cluster in more deprived areas(Reference Macdonald, Cummins and Macintyre25).

A recent Danish cross-sectional study reported that fast food access is associated with fast food intake in the capital region of Denmark(Reference Bernsdorf, Lau and Andreasen26). Cross-sectional research in Norfolk, England reported that greater exposure to fast food and a lower educational level is associated with greater fast food consumption, BMI and odds of obesity(Reference Burgoine, Forouhi and Griffin27). However, this finding is not consistent with other studies. An Australian study of disadvantaged women explored the longitudinal associations between the fast food environment around their home and BMI(Reference Lamb, Thornton and Olstad28). Over the 5-year study, they found no association between increases in a major chain fast food outlet availability and increases in BMI over time. There are a number of reasons why fast food outlets around the home are not associated with a change in BMI. People lead complicated lives and do not simply source food from their residential neighbourhood. Focusing on residential address alone excludes other food environment exposure opportunities(Reference Burgoine and Monsivais29). In their study, Burgoine and Monsivais(Reference Burgoine and Monsivais29) explored the difference in food environments between homes, workplaces and along commuting routes between home and work for residents in the East of England. Perhaps unsurprisingly there was a significantly greater density of, and proximity to all food outlet types at work compared with home, particularly restaurants and takeaways. Most recently, Mason et al. (Reference Mason, Pearce and Cummins30) used cross-sectional baseline data from the UK Biobank (project 17380) to explore associations between fast food and physical activity environments and adiposity for adults in mid-life. This large and unique UK study, spanning a geographically diverse area, found a weak association between access to fast food and adiposity. However, they reported high densities of physical activity facilities were associated with lower adiposity for these adults in mid-life. The authors attribute this to limitations in the metric and measurements used in the food environment analysis, an opinion strongly supported by an editorial in the same publication(Reference Monsivais and Burgoine31).

These examples illustrate how reliable measures of the food environment are the foundation of research that will help to inform obesity-related policy(Reference McKinnon, Reedy and Morrissette32). A broad evidence base is required, ranging from spatial analyses to within store audits, alongside individual and neighbourhood level data(Reference Caspi, Sorensen and Subramanian12). In a recent editorial, Cummins et al. (Reference Cummins, Clary and Shareck33) explored the methodological challenges in estimating the effect of the food environment on obesity. While the use of census tracts or postcodes to define exposure to food environments has been used in research, they do not represent the environments an individual is actually exposed to. Rather, an activity-space approach is advised which considers the individual's behaviour in space and time(Reference Perchoux, Chaix and Cummins34).

As well as focusing on exposure to different types of outlets, interventions have also focused on the food served in outlets, promoting healthier ready-to-eat meals (to eat in, to take away or to be delivered). Hillier-Brown et al.(Reference Hillier-Brown, Summerbell and Moore35) conducted a systematic review to assess the impact of such interventions. The majority of the included studies were conducted in the USA (twenty-seven out of thirty), two in Australia and one in the UK. Most studies focused on adults and eighteen were within chain food outlets. The quality of evidence was generally considered to be poor; however, the present study provides useful insight into these types of interventions. Intrusive interventions that restricted or guided choice appeared to have an impact on food-outlet and customer level outcomes, while interventions that enabled choice or provided intervention had little impact.

However, these types of interventions are being delivered by local authorities and rarely get published within the academic literature(Reference Adams, Hillier-Brown and Moore36). In addition to the systematic review, this larger piece of work also explored what interventions were being delivered by local authorities (in England) around providing healthier ready-to-eat meals (to eat in, to take away, or to be delivered)(Reference Hillier-Brown, Summerbell and Moore37). This systematic mapping and evidence synthesis of interventions to promote healthier ready-to-eat-food(Reference Hillier-Brown, Summerbell and Moore37) found seventy-five interventions, of which most were ‘award’ type interventions (defined as those that involved an assessment of food outlet practice(s) targeted by the intervention using pre-defined criteria, together with some sort of accreditation if the food outlet met the criteria). The interventions were delivered by local authority staff, in most cases Environmental Health Officers. Interventions tended to be time-limited and evaluation was limited(Reference Hillier-Brown, Summerbell and Moore37). This research suggested that there was much activity across local authorities in England (as well as elsewhere) and that sharing good practice as well as robust evaluation would be beneficial. The analyses suggested that business owners were generally positive about such interventions. Those that were cost neutral and that were not obvious to their customers were perceived more positively. This programme of research has also explored the perspectives of intervention deliverers(Reference Goffe, Penn and Adams38). Interviews found barriers and facilitators to interventions including lack of funding for interventions and the difficulties of dealing with this sector of the food industry(Reference Goffe, Penn and Adams38).

In the developed world, a sophisticated food supply chain and food system, as well as the domination of a small number of companies, have been noted in the literature(Reference Lang39). While there has been much focus on fast food, there is a lack of clarity about the role of supermarkets in terms of obesity(Reference Burgoine, Mackenbach and Lakerveld40). Using a large UK sample, Burgoine et al. (Reference Burgoine, Mackenbach and Lakerveld40) explored the independent and combined associations of supermarket distance and education with BMI, overweight and obesity. Their results indicated that greater supermarket distance was independently associated with higher BMI and odds of both overweight and obesity(Reference Burgoine, Mackenbach and Lakerveld40).

Food outlets selling low-cost energy-dense food is one aspect of the modern UK high street. Townshend has coined the term ‘toxic high street’ to describe the co-location of money lenders, betting shops and fast food restaurants in more deprived neighbourhoods(Reference Townshend41). Since the economic recession of 2007/2008, Townshend has described how this scenario has become embedded as a feature of the British high street, in contrast to more affluent areas where bistros, delis and boutiques flourish. While some areas have empty boarded up shops, other areas have an unhealthy or ‘toxic’ mix of uses including; takeaways and ‘all you can eat’ buffet style restaurants; sub-prime money lenders (offering instant cash and pay-day loans at high-interest rates); and betting shops; also tanning salons, body piercing parlours, shops selling cut-price (sometimes counterfeit) alcohol and tobacco(Reference Townshend41).

Food environments and eating behaviours

Few studies have explored individual's diets in relation to their food environment, mainly due to the fact it is time-consuming and methodologically challenging. Focusing on young adults (n 86, mean age 17 years), a study by Tyrrell et al. (Reference Tyrrell, Greenhalgh and Hodgson42) provided detailed information regarding where young people obtain food and the nutritional consequences of choosing those food environments. Their respondents completed 4-day self-complete food diaries, recorded what food they consumed and where food was sourced. Sources of food items were coded as home (including friends or relatives homes), and out-of-home. Food items sourced out-of-home were further classified using an updated and a modified version of the Lake et al. food environment classification tool(Reference Lake, Burgoine and Greenhalgh43). The tool contained fifteen out-of-home food outlet categories with eighty-eight detailed sub-categories. With the addition of ‘home’, use of sixteen possible food environments was recorded. Food was obtained by these young adults from a wide range of environments. Over 4 days of observation, all respondents sourced food from home and from an average of 4·3 different out-of-home food environments. Excluding home and school, takeaway and fast food environments were the most commonly used with 53% of respondents sourcing food from these environments; 41% obtained food from convenience stores, at least once over the 4-day period. Food sourced from specialist outlets, convenience outlets, and retail bakers (i.e. national commercial bakers) were the most energy dense. The highest percent energy from fat was from foods sourced from retail bakers, takeaway and fast food and specialist outlets (47%, 43% and 42%, respectively)(Reference Tyrrell, Greenhalgh and Hodgson42). This work highlights the eating behaviours of this transitional age-group and points to the importance of interventions around schools, colleges (the school fringe) and the wider food environment. The importance of the school fringe has been highlighted in a number of studies(Reference Gallo, Barrett and Lake44Reference Walton, Pearce and Day46).

In a larger cross-sectional study of 839 mothers with young children, Vogel et al. (Reference Vogel, Lewis and Ntani47) used a survey including an FFQ, demographic characteristics and frequently visited locations. The authors developed scores for the mother's diet and their food environment. Using Geographical Information Systems alongside demographic information their findings suggested that there is a relationship between health and place as well as educational attainment for these mothers. For example, less healthy food environment scores were associated with better dietary quality in mothers with degrees, but poorer dietary quality in mothers with lower educational attainment. Their findings also suggested that the majority of respondents were exposed to less healthy food environments. These studies(Reference Tyrrell, Greenhalgh and Hodgson42, Reference Vogel, Lewis and Ntani47), both cross-sectional and both with their limitations, link the environment to food behaviours of two population groups and highlights the importance of the environment in relation to eating behaviour.

Urban planning and the food environment

The environment has been acknowledged as a determinant of health(Reference Barton and Grant48). Historically, the urban planning and public health professions originated from the same need to deal with the health inequalities due to both the rapid industrialisation and urbanisation of the 19th century(Reference Northridge and Freeman49). In the 21st century, it is internationally acknowledged that professions need to work together to address our ‘dynamic, complex and interconnected health concerns’(Reference Northridge and Freeman49). Examples of this collaboration include The Healthy Cities movement which, amongst other things links planning and health has raised awareness around healthy urban planning(Reference Barton and Grant48).

An acknowledgment of the potential role of the built environment and planning in creating healthier communities was reflected in the in the 2012 National Planning Policy Framework for England(50). In England, in 2013, many public health responsibilities were moved from the National Health Service to local authorities(Reference Atkins, Kelly and Littleford51). This included responsibility for obesity, community nutrition and increasing physical activity(Reference Lake, Henderson and Townshend52). A recent umbrella literature review(53) assessed the impact of the built and natural environment on health. The review concentrated on five key built environment topics: neighbourhood design, housing, healthier food, natural and sustainable environment, and transport. These are environmental issues that can be shaped by planners and have the potential to influence health.

Policy documents have highlighted the role that local authorities have in tackling obesity(5456). There has been a recent interest in the role of local authorities in shaping the food environment(22), particularly in engaging with small businesses(57) and with planning departments(58).

Planning policy in relation to the food environment has tended to focus on the restriction of hot-food takeaways. Using The Town and Country Planning (Use Class) Order 1987, outlets are classified according to the use class order of the premises they occupy, dependent upon their primary operating model and premise size (The Town and Country Planning (Use Classes) Order 1987 The Secretary of State for the Environment (1987) http://www.legislation.gov.uk/uksi/1987/764/made (as amended) puts uses of land and buildings into various categories known as Use Classes.). However, differences between categories may be unclear. For example, restaurants and cafes (classified as A3), may also sell food to takeaway and hot food takeaways may have small seating areas. Classifications of interest are in Table 1. An increasing number of local authorities are using supplementary planning documents (SPD) to control fast food outlet proliferation (SPD provide detail to support policy in higher level development plan documents. SPD are a material consideration in the assessment and determination of any planning application. (reference from http://www.newcastle.gov.uk/planning-and-buildings/planning-policy/supplementary-planning-documents))(Reference Lake, Townshend, Burgoine, Buttriss, Welch, Kearney and Lanham-New14). It is one of the mechanisms suggested by Public Health England for local government to influence the out-of-home food environment(22), alongside the use of the local plans, joint strategic needs assessments, joint health and wellbeing strategies sustainability and transformation plans and the use of Health in all Policies.

Table 1. The Town and Country Planning order description of land and buildings in categories known as Use Classes

However, not all takeaway outlets are necessarily unhealthy. Moreover, where seating is provided food outlets are classified as restaurants and therefore are exempt from takeaway restrictions. This system of classification, in relation to food outlets, requires an overhaul, but the planning system is probably never going to be nuanced enough to differentiate between healthy and unhealthy outlets.

Barking and Dagenham was one of the first planning authorities to produce an SPD aimed at restricting permission for hot-food takeaways (A5 use)(59). It has been reported that in 7 years, this London borough has reduced fast food outlets by 15% from 187 to 160(Reference Butler60). The mayor of London has recently announced a double-pronged approach to limit new takeaways opening within 400 m of schools and health standard to boost baked or grilled food rather than fried(61).

A review by Dr Foster Intelligence in 2011(62) found four main approaches taken by local planning authorities to curb fast food proliferation:

  1. 1. Only allowing takeaway outlets in specified areas. By defining only certain locations, for example existing shopping areas, where further takeaway outlets are deemed acceptable; however, this may introduce issues of concentration and clustering.

  2. 2. Restricting concentration and clustering. If a location is suitable, local authorities can seek to restrict the number of takeaway outlets in a row (e.g. to two, or three) or the percentage of frontage (ground floor use facing the street) given over to takeaways (e.g. 5% has been used).

  3. 3. Restricting proximity to other uses. This means setting out buffer zones (e.g. 400 m) around land uses such as schools, parks and children's centres, where the development of takeaway outlets is forbidden.

  4. 4. Clamping down on ‘back door’ applications. Fast food outlets have their own classification in UK planning terms, referred to as A5, hot food takeaways. Developers can sometimes try to circumvent takeaway restrictions by opening outlets under different classifications, primarily A3, restaurants and cafes, where the intention is that food will be primarily consumed on the premises. For example, this might be done by adding in a nominal seating area on plans submitted to the local planning authority.

Some planning authorities have sought to charge a levy, or fee, where planning permission is granted for a new takeaway, with funds raised going to initiatives to tackle childhood obesity, for example, improving green spaces to encourage physical activity(Reference Lake, Townshend, Burgoine, Buttriss, Welch, Kearney and Lanham-New14).

Since this review (2011), the number of local authorities producing SPD to tackle fast food outlet proliferation has increased and guidelines have been developed to meet local situations. Estimates are that there are at least twenty SPD in place to tackle hot food takeaways(Reference Butler60). Gateshead Council's SPD(63), prevents new permissions for A5 use in wards where more than 10% of year six pupils are obese. This has effectively barred any new hot food takeaways in the borough.

While authorities may object to food outlets being added to their foodscape, civic society also has a perspective. Also in England, Spence et al.(Reference Spence, Blundred and Chaffer64) analysed local residents’ opposition to a multinational fast food company submitted to the planning enquiry. While there were many health reasons to oppose this particular development, including its close proximity to a school (within 400 m) the main concerns by local residents included traffic, the effect on the environment (littering, etc.) there were also concerns about noise and safety. This research highlights the importance of cross-sectorial working in local governments, and to consider engaging with residents about health impacts of proposed new food outlets(Reference Spence, Blundred and Chaffer64).

Our recent qualitative work(Reference Lake, Henderson and Townshend52) sought to understand the views of individuals working in public health and those working in spatial planning within local government on their respective responsibilities for addressing obesity through spatial planning. One-to-one interviews aimed to explore respondents’ perceptions concerning the wider issue of their role in public health before asking them about tackling issues of obesity, community nutrition and increasing levels of physical activity. Eight interviews were conducted with three Directors of Public Health, one Deputy Director and four planners with a range of seniority from across five local authorities within the North East of England. The findings, from this relatively small study, illustrate what tackling a global problem is like on the front line of local government. It identified a range of barriers to engaging with planners, including an insufficient understanding of the causes of obesity and the primacy of addressing obesity via multiagency approaches, fragmentation in the health system and conflicting priorities. Our research indicates that planners could be better engaged in the obesity agenda via formal incentives (e.g. written within planners’ job descriptions or regulations), and aligning priorities via ‘soft approaches’ (e.g. public health leadership roles)(Reference Lake, Henderson and Townshend52). Since this research, the Local Government Association and Public Health England have published a briefing document about a Whole Systems approach to obesity; this practical guide will be published in 2019(65).

Discussion

Despite our increased knowledge of how the environment, particularly the food environment drives eating behaviours and obesity, there is still a tendency to continue to focus on individual level solutions described as lifestyle drift(Reference Popay, Whitehead and Hunter66). While policy examples in the UK and abroad, for example, The Soft Drinks Industry Levy due to being enforced from April 2018 exist, the focus remains on the indiviudal. There are few upstream approaches that are tackling marketting and the sale of cheap unhealthy food. There is an urgent need to shift our focus to more upstream (or macro-level) strategies. This can be achieved through whole systems approaches to obesity(65) using cross-sector and multi-agency working to consider the multiple factors involved in the aetiology of obesity that influence individual determinants. Examples of upstream approaches could be through use of planning laws(Reference Lake, Henderson and Townshend52) or through the taxation of unhealthy foods(Reference Wright, Smith and Hellowell67). In the 4 years that have followed the first significant nationwide tax on the sugar-sweetened beverage in Mexico (2014), we have seen a global increase in taxes on sugar-sweetened beverage and a trend for this type of intervention to become the norm(Reference Backholer, Blake and Vandevijvere68). Perhaps the London mayor's new announcement will set a global precedent for use of planning restrictions(61). There is need for a systems-wide change in the global food market, for there to be accountability across the private sectors, public sectors and government and commitment to creating healthy food environments(Reference Swinburn, Kraak and Rutter8).

As discussed in the present paper, the present planning laws in this country are not nuanced enough, we know the local government are using SPD and local plans to shape a healthier food environment but this is fragmented and there is a lack of a joined-up approach across local governments. Despite this, there is significant will and movement towards establishing ways of working across disciplines at local and national levels.

While the methodological issues around measuring individual's exposure to food environments remain, there exists convincing international evidence to suggest that exposure to less healthy food results in an increased intake of such foods, which consequently leads to weight gain and ultimately obesity. Our food environment is a sophisticated and complex system, which requires a complex system approach(Reference Rutter, Savona and Glonti69).

The present paper has limitations in that it has only focused on certain aspects within the neighbourhood food environment and has not considered other factors such as the choice architecture of stores or food outlets(Reference Hollands, Shemilt and Marteau70), the cost of food(Reference Darmon and Drewnowski71) and the issues around food insecurity and austerity(Reference Stuckler, Reeves and Loopstra72). While studies described have been from more than one country, the urban planning section has focused on English planning policy. Additionally, future research might also consider the influence of a wider multiagency approach to address the food environment, including education, industry and civic society as the significant actors in addressing obesity.

Conclusions

No country has managed to reverse their obesity trends(Reference Roberto, Swinburn and Hawkes73). Obesity is complex, multifactorial and challenging to address(Reference Townshend and Lake6). What we do know is that takeaway and fast food is, on the whole, nutrient poor and energy dense and that it is a fixture of our diet. There is a concentration effect, with a clustering of these outlets in more deprived areas. Access and intake are associated; however, there are methodological challenges in associating the effect of the food environment on obesity. Tackling obesity requires joined-up approaches from across the professional spectrum, leadership and political will.

The future of interventions in the food environment field is to adopt a systems approach, to encourage professionals in local governments and national governments to work together to develop policies and practices which are championed by the population, supported by all sectors including industry to enable healthier behaviours.

Acknowledgements

I would like to acknowledge my long-term collaborator Professor Tim Townshend and the Nutrition Society for inviting me to present at their Summer Meeting. A. A. L. is an Associate Director of Fuse, The Centre for Translational Research. Funding for Fuse comes from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, and is gratefully acknowledged. The views expressed are those of the author and not necessarily those of the above-named funders.

Financial Support

None.

Conflicts of Interest

None.

Authorship

A. A. L. was the sole author of this paper.

References

1.Swinburn, B & Egger, G (2002) Preventive strategies against weight gain and obesity. Obes Rev 3, 289301.CrossRefGoogle ScholarPubMed
2.Foresight (2007) Scoping the Foresight Project on Tackling Obesities: Future Choices. London: Foresight.Google Scholar
3.Savona, N, Rutter, H & Cummins, S (2017) Tackling obesities: 10 years on. J Epidemiol Community Health [Epublication ahead of print version].Google Scholar
4.Lake, A & Townshend, T (2006) Obesogenic environments: exploring the built and food environments. J R Soc Promot Health 126, 262267.CrossRefGoogle ScholarPubMed
5.Lake, AA, Townshend, TG & Alvanides, A (2010) Obesogenic Environments: Complexities, Perceptions and Objective Measures. Oxford: Wiley-Blackwell.CrossRefGoogle Scholar
6.Townshend, T & Lake, A (2017) Obesogenic Environments: current evidence of the built and food environments. Perspect Public Health 137, 3844.CrossRefGoogle ScholarPubMed
7.McKinsey Global Institute (2014) How the World Could Better Fight Obesity. Available at www.mckinsey.com/mgiGoogle Scholar
8.Swinburn, B, Kraak, V, Rutter, H et al. (2015) Strengthening of accountability systems to create healthy food environments and reduce global obesity. Lancet 385, 25342545.CrossRefGoogle ScholarPubMed
9.Swinburn, BA, Sacks, G, Hall, KD et al. (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378, 804814.CrossRefGoogle ScholarPubMed
10.Vandevijvere, S, Chow, CC, Hall, KD et al. (2015) Increased food energy supply as a major driver of the obesity epidemic: a global analysis. Bull World Health Organ 93, 446456.CrossRefGoogle ScholarPubMed
11.Bucher, T, Collins, C, Rollo, ME et al. (2016) Nudging consumers towards healthier choices: a systematic review of positional influences on food choice. Br J Nutr 115, 22522263.CrossRefGoogle ScholarPubMed
12.Caspi, CE, Sorensen, G, Subramanian, SV et al. (2012) The local food environment and diet: a systematic review. Health Place 18, 11721187.CrossRefGoogle ScholarPubMed
13.Townshend, TG & Lake, AA (2009) Obesogenic urban form: Theory, policy and practice. Health Place 15, 909916.CrossRefGoogle ScholarPubMed
14.Lake, AA, Townshend, TG & Burgoine, T (2017) Obesogenic neighbourhood food environments. In Public Health Nutrition: The Nutrition Society Textbook Series, pp. 327338 [Buttriss, J, Welch, A, Kearney, J and Lanham-New, S, editors]. Oxford: Wiley-Blackwell.Google Scholar
15.Story, M, Kaphingst, KM, Robinson-O'Brien, R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.CrossRefGoogle ScholarPubMed
16.Penchansky, R & Thomas, JW (1981) The concept of access: definition and relationship to consumer satisfaction. Med Care 19, 127140.CrossRefGoogle ScholarPubMed
17.Cobb, LK, Appel, LJ, Franco, M et al. (2015) The relationship of the local food environment with obesity: a systematic review of methods, study quality, and results. Obesity 23, 13311344.CrossRefGoogle ScholarPubMed
18.Janssen, HG, Davies, IG, Richardson, LD et al. (2017) Determinants of takeaway and fast food consumption: a narrative review. Nutr Res Rev, 119.Google ScholarPubMed
19.Rosenheck, R (2008) Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk. Obes Rev 9, 535547.CrossRefGoogle ScholarPubMed
20.Jaworowska, A, Blackham, T, Davies, IG et al. (2013) Nutritional challenges and health implications of takeaway and fast food. Nutr Rev 71, 310318.CrossRefGoogle ScholarPubMed
21.Lachat, C, Nago, E, Verstraeten, R et al. (2012) Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev 13, 329346.CrossRefGoogle Scholar
22.Public Health England (2017) Health Matters: Obesity and the Food Environment. London: Public Health England.Google Scholar
23.Adams, J, Goffe, L, Brown, T et al. (2015) Frequency and socio-demographic correlates of eating meals out and take-away meals at home: cross-sectional analysis of the UK national diet and nutrition survey, waves 1-4 (2008-12). Int J Behav Nutr Phys Act 12, 51.CrossRefGoogle Scholar
24.Maguire, ER, Burgoine, T & Monsivais, P (2015) Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990–2008. Health Place 33, 142147.CrossRefGoogle Scholar
25.Macdonald, L, Cummins, S & Macintyre, S (2007) Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite 49, 251254.CrossRefGoogle ScholarPubMed
26.Bernsdorf, KA, Lau, CJ, Andreasen, AH et al. (2017) Accessibility of fast food outlets is associated with fast food intake. A study in the Capital Region of Denmark. Health Place 48, 102110.CrossRefGoogle ScholarPubMed
27.Burgoine, T, Forouhi, NG, Griffin, SJ et al. (2016) Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study. Am J Clin Nutr 103, 15401547.CrossRefGoogle ScholarPubMed
28.Lamb, KE, Thornton, LE, Olstad, DL et al. (2017) Associations between major chain fast-food outlet availability and change in body mass index: a longitudinal observational study of women from Victoria, Australia. BMJ Open 7, e016594.CrossRefGoogle ScholarPubMed
29.Burgoine, T & Monsivais, P (2013) Characterising food environment exposure at home, at work, and along commuting journeys using data on adults in the UK. Int J Behav Nutr Phys Act 10, 85.CrossRefGoogle ScholarPubMed
30.Mason, KE, Pearce, N & Cummins, S. Associations between fast food and physical activity environments and adiposity in mid-life: cross-sectional, observational evidence from UK Biobank. Lancet Public Health 3, e24e33.CrossRefGoogle Scholar
31.Monsivais, P & Burgoine, T (2017) The built environment and obesity in UK Biobank: right project, wrong data? Lancet Public Health 3, e4e5.CrossRefGoogle ScholarPubMed
32.McKinnon, RA, Reedy, J, Morrissette, MA et al. (2009) Measures of the food environment: a compilation of the literature, 1990-2007. Am J Prev Med 36, S124S133.CrossRefGoogle ScholarPubMed
33.Cummins, S, Clary, C & Shareck, M (2017) Enduring challenges in estimating the effect of the food environment on obesity. Am J Clin Nutr 106, 445446.CrossRefGoogle ScholarPubMed
34.Perchoux, C, Chaix, B, Cummins, S et al. (2013) Conceptualization and measurement of environmental exposure in epidemiology: accounting for activity space related to daily mobility. Health Place 21, 8693.CrossRefGoogle ScholarPubMed
35.Hillier-Brown, FC, Summerbell, CD, Moore, HJ et al. (2017) The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review. Obes Rev 18, 227246.CrossRefGoogle ScholarPubMed
36.Adams, J, Hillier-Brown, FC, Moore, HJ et al. (2016) Searching and synthesising ‘grey literature’ and ‘grey information’ in public health: critical reflections on three case studies. Syst Rev 5, 164.CrossRefGoogle ScholarPubMed
37.Hillier-Brown, FC, Summerbell, CD, Moore, HJ et al. (2017) A description of interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England: a systematic mapping and evidence synthesis. BMC Public Health 17, 93.CrossRefGoogle ScholarPubMed
38.Goffe, L, Penn, L, Adams, J et al. (In Press) The chalenges of interventions to promote healthier food in independent takeaways in England: qualitative study of intervention deliverers' views. BMC Public Health 18, 184.CrossRefGoogle Scholar
39.Lang, T (2003) Food industrialisation and food power: implications for food governance. Dev Policy Rev 21, 555568.CrossRefGoogle Scholar
40.Burgoine, T, Mackenbach, J, Lakerveld, J et al. (2017) Interplay of socioeconomic status and supermarket distance is associated with excess obesity risk: a UK cross-sectional study. Int J Environ Res Public Health 14, 1290.CrossRefGoogle ScholarPubMed
41.Townshend, TG (2017) Toxic high streets. J Urban Des 22, 167186.CrossRefGoogle Scholar
42.Tyrrell, RL, Greenhalgh, F, Hodgson, S et al. (2016) Food environments of young people: linking individual behaviour to environmental context. J Public Health 39, 95104.Google Scholar
43.Lake, AA, Burgoine, T, Greenhalgh, F et al. (2010) The foodscape: classification and field validation of secondary data sources. Health Place 16, 666673.CrossRefGoogle ScholarPubMed
44.Gallo, RG, Barrett, L & Lake, AA (2014) The food environment within the primary school fringe. Br Food J 116, 12591275.CrossRefGoogle Scholar
45.Wills, WJ, Danesi, G & Kapetanaki, AB (2016) Lunchtime food and drink purchasing: young people's practices, preferences and power within and beyond the school gate. Camb J Educ 46, 195210.CrossRefGoogle Scholar
46.Walton, M, Pearce, J & Day, P (2009) Examining the interaction between food outlets and outdoor food advertisements with primary school food environments. Health Place 15, 841848.CrossRefGoogle ScholarPubMed
47.Vogel, C, Lewis, D, Ntani, G et al. (2017) The relationship between dietary quality and the local food environment differs according to level of educational attainment: a cross-sectional study. PLoS ONE 12, e0183700.CrossRefGoogle ScholarPubMed
48.Barton, H & Grant, M (2013) Urban planning for healthy cities. J Urban Health 90, 129141.CrossRefGoogle ScholarPubMed
49.Northridge, ME & Freeman, L (2011) Urban planning and health equity. J Urban Health 88, 582597.CrossRefGoogle ScholarPubMed
50.Department for Communities and Local Government (2012) National Planning Policy Statement. London: Department for Communities and Local Government.Google Scholar
51.Atkins, L, Kelly, MP, Littleford, C et al. (2017) Reversing the pipeline? Implementing public health evidence-based guidance in English local government. Implementation Sci 12, 63.CrossRefGoogle ScholarPubMed
52.Lake, AA, Henderson, EJ & Townshend, TG (2017) Exploring planners and public health practitioners’ views on addressing obesity: lessons from local government in England. Cities Health 19.Google Scholar
53.Public Health England (2017) Spatial Planning for Health an Evidence Resource for planning and Designing Healthier Places. London: Public Health England.Google Scholar
54.HM Government (2010) Healthy lives, Healthy People White Paper: Our Strategy for Public Health in England. London: HM Government.Google Scholar
55.Department of Health (2011) Healthy Lives, Healthy People: A Call to Action on Obesity in England. London: Department of Health.Google Scholar
56.Department of Health (2011) Public Health in Local Government. London: Department of Health.Google Scholar
57.Public Health England (2017) Strategies for Encouraging Healthier ‘Out of Home’ Food Provision A Toolkit for Local Councils Working with Small Food Businesses. London: Public Health England.Google Scholar
58.Public Health England (2017) Planning Document to Limit the Proliferation of Takeaways. London: Public Health England.Google Scholar
59.NHS Barking and Dagenham and London Borough of Barking and Dagenham (2010) Saturation Point Addressing the health impacts of hot food takeaways. Supplementary Planning Document. Barking and Dagenham Local Development Framework. Barking: London Borough of Barking and Dagenham.Google Scholar
60.Butler, P (2017) Fast food England: does putting a cap on takeaways improve people's health? In The Guardian. https://www.theguardian.com/inequality/2017/jul/25/fast-food-england-does-putting-a-cap-on-takeaways-improve-peoples-healthGoogle Scholar
61.Mayor of London (2017) Mayor cracks down on opening of new hot-food takeaways around schools. https://www.london.gov.uk/press-releases/mayoral/mayor-cracks-down-on-new-takeaways-near-schools (accessed November 2017).Google Scholar
62.Dr Foster Intelligence (2011) Tackling the Takeaways: A New Policy to Address Fast-Food Outlets in Tower Hamlets. London: NHS Tower Hamlets.Google Scholar
63.Gateshead Council (2015) Hot Food Takeaway Supplementary Planning Document. Gateshead: Gateshead Council.Google Scholar
64.Spence, S, Blundred, C, Chaffer, A et al. (2017) Local residents’ opposition to a multinational fast food company in England: a qualitative analysis. Lancet 390, S86.CrossRefGoogle Scholar
65.Local Government Association (2017) Making Obesity Everybody's Business. A Whole Systems Approach to Obesity. London: Local Government Association.Google Scholar
66.Popay, J, Whitehead, M & Hunter, DJ (2010) Injustice is killing people on a large scale—but what is to be done about it? Journal of Public Health 32, 148149.CrossRefGoogle Scholar
67.Wright, A, Smith, KE & Hellowell, M (2017) Policy lessons from health taxes: a systematic review of empirical studies. BMC Public Health 17, 583.CrossRefGoogle ScholarPubMed
68.Backholer, K, Blake, M & Vandevijvere, S (2017) Sugar-sweetened beverage taxation: an update on the year that was 2017. Public Health Nutr 20, 32193224.CrossRefGoogle ScholarPubMed
69.Rutter, H, Savona, N, Glonti, K et al. (2017) The need for a complex systems model of evidence for public health. Lancet 390, 26022604.CrossRefGoogle ScholarPubMed
70.Hollands, GJ, Shemilt, I, Marteau, TM et al. (2013) Altering micro-environments to change population health behaviour: towards an evidence base for choice architecture interventions. BMC Public Health 13, 1218.CrossRefGoogle ScholarPubMed
71.Darmon, N & Drewnowski, A (2015) Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 73, 643660.CrossRefGoogle ScholarPubMed
72.Stuckler, D, Reeves, A, Loopstra, R et al. (2017) Austerity and health: the impact in the UK and Europe. Eur J Public Health 27, 1821.CrossRefGoogle ScholarPubMed
73.Roberto, CA, Swinburn, B, Hawkes, C et al. (2015) Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet 385, 24002409.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. The Town and Country Planning order description of land and buildings in categories known as Use Classes

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