Is Your Neighborhood Making You Fat? Maybe Not

Play deserts, food deserts, food swamps. These are elegant metaphors to sell an appealing narrative. The story they tell is simple. Certain types of neighborhoods might cause obesity. Some researchers have found correlations between fast food outlets and obesity prevalence in some studies. Others have found that neighborhoods with more resources for physical activity have less obesity. It all makes intuitive sense. However, tidy narratives are often misleading. In fact, a new study from Sweden finds that the narrative doesn’t always hold true. In this analysis, fast food and physical activity resources don’t predict a neighborhood’s obesity risk. So maybe our neighborhood is not what makes us fat.

Registry Data from 1.5 Million Adults

Kenta Okuyama and colleagues used national register data from Sweden for 1.5 million adults. They had 11 years of follow-up. Using a Cox regression analysis, they found no meaningful correlation between fast food outlets or physical activity facilities and obesity.

They did, however, find a strong and consistent relationship with neighborhood deprivation.

The story made sense. Too much fast food in a neighborhood could plausibly promote obesity. Too few outlets for physical activity might do the same. But that simple story didn’t hold up, as Okuyama explained:

Although reducing fast food outlets or introducing physical activity facilities might in theory promote healthy eating and exercise, it may not be very effective in all countries and regions. Because the contexts vary by culture and lifestyle. That may affect how often people utilize these facilities in their daily lives.

Wasteful Presumptions

This is just one more example of a how a beautiful metaphor can lead us to a dead end. In the U.S., government programs put money and effort into fixing food deserts. It seemed like a good idea at the time. Food deserts sound like a really bad thing. But unfortunately, all that effort did very little to promote better health. Planting a supermarket doesn’t always yield a healthy foodscape.

Likewise, it seems that plunking down a fitness facility in a deprived neighborhood might not address more fundamental problems.

So we need to look deeper. Forget the pretty stories. Instead of trying to prove a point, we need to look for the truth. That requires genuine objectivity and curiosity. Without it, we’ve been spinning our wheels in obesity prevention.

Click here for the study, here and here for further perspective.

Neighborhoods Khvalynsk, painting by Kuzma Petrov-Vodkin / WikiArt

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May 25, 2020