NC1033: Local food choices, eating patterns, and population health (NC1001)
Statement of Issues and Justification
IntroductionNumerous concerns over food are reaching epidemic proportions in the US(CDC 2002). The Surgeon General of the United States, for example, describes the problem of obesity as potentially affecting nearly two out of three Americans who are overweight or obese (Carmona 2003). It has been noted by some researchers that increases in obesity rates over the past 15 years have not been accompanied by a related decrease in physical activity suggesting that excessive calories may be the major contributor (Nestle 2003; Putnam et al. 2002). The increased prevalence of obesity and diabetes has occurred at a time when the US food environment has undergone dramatic changes. These changes range from variations in retail food options to shifts in food access and use conditions to consumer perceptions affected by media and cultural values. Consolidation in grocery stores has increased travel distance to stores (and accompanied transportation costs) with implications for an aging population in rural areas and those in poverty. Variations in types and quality of foods available and food prices are reflected in the growth of alternative food sources such as food available at school and work sites (vending machines, fast food places, cafeterias, ethnic and farmer markets, CSAs); changes in personal and community gardening practices; and challenges to safety net organizations such as senior meal sites, food pantries and food banks. Attitudes and values regarding foods also affect the quantity and types of foods consumed. Consumer consumption patterns are influenced by media, local and ethnic cultures, and vested interests in the food production chain. Given all these forms of information and the resources which are mobilized to help shape food choices, there seems to be little evidence of a dominant discourse on food choices. Instead, individuals within the US and many other parts of the world are given numerous options regarding food, and many of these messages are accompanied by statements about good health and/or happiness, regardless of the number of calories consumed.
Some changes in the food environment have increased access to healthier foods. However, many other changes are thought to have increased access and the desirability of high calorie foods and adoption of norms regarding consumption of greater quantities of food. What we do not know is which characteristics of the food environment are detrimental to health and which promote better health. Further, while food systems have undergone global changes, variations among local food environments in prices, access, and retail food options suggest that place matters, not only rural and urban but within neighborhoods and regions. In this project we propose to examine the relationships of food environments to diets, obesity and health. While it is recognized that individuals make food choices, this project assumes that the food environment and foodways are collectively constructed. Thus another aspect of our testing will be the effects of the social organization of food systems including local and regional distribution patterns, alternative food sources, and formal and informal food exchange patterns on diets and health. Our major goal is to determine the impact of food systems on population health including place based populations. Our use of the term "food environment" is a heuristic for our interests in access and use of foods, retail options, and consumer and audience perceptions.
Justification
Many scholars have argued that food is a major component of individual and group identity (e.g., Bell and Valentine 1997; Counihan and Van Esterik 1997; Fischler 1988), as well as the basis for major health concerns (e.g., Ferris 2003; Klaczynski et al. 2004). Given this juxtaposition of a component of culture which is deeply embedded in everyday life for most people, it is important to begin understanding how food patterns are developed. From the perspective that food choices are more than just a matter of taste but involve familiar habits based on socialization (e.g., Bourdieu 1984), agricultural policies (e.g., Goodman and Watts 1997), and availability (e.g., Wrigley et al. 2002), we seek to develop models which highlight the structural and cultural components of the food system and its impact on health.
From everyday experiences, consumers have many choices from which to purchase food. These choices range from internet shopping to large warehouses to neighborhood grocery stores and convenient stores, from roadside stands to farmers' markets to community-supported agriculture, and from fast food restaurants to fine dining. There seems to be ample opportunity to access a range of foods with labels such as organic, fresh, natural, fat-free, and healthy. Access to these various kinds of foods, however, appears to be unequally distributed within the US. One of our goals is to investigate the ways in which access and use conditions within the food environment influence food consumption patterns and obesity rates.
We approach this area of study from a food desert perspective, though we extend our research interests to incorporate a broader scope of food access. Researchers framing food access from the food desert perspective (e.g., Cummins and Mcintyre 2002; Wrigley 2002) seek to measure the density of food stores (and types of food stores) within an area such as a neighborhood, and the average distance someone within that area would need to travel to get to the store. It is often found that in poor areas of cities and rural settings, people must travel further for food, and that the food available may be higher priced, lower in quality and freshness, and less variety. Poverty, obesity and poor health become linked when nutritious foods such as fruits and vegetables are more costly than those high in sugar, fat, and salt. The Food Research and Action Center came to much the same conclusion in their discussions held in November, 2004.
Even when food is readily available, the retail options are often problematic in a number of ways. Schlosser (2001) contends that we have become a fast food nation, consuming hamburgers and fries in record amounts -- two foods which are high in fat and salt. The typical beverages consumed with this meal are carbonated soft drinks or milkshakes, both high in sugar and the latter high in fat. Given our daily caloric needs of 2000-2500 calories (this range varies considerably when taking into account such things as age and level of activity), a meal consisting of a hamburger, fries, and a milkshake accounts for over half those calories (426 calories for a single hamburger, 412 for McDonald's fries, and 720 for an A&W vanilla milkshake -- 1558 total calories).
It is important to understand the food environment in terms of availability of foods such as fruits and vegetables on the one hand, and high fat, salt, and sugar-containing foods on the other. We will gather primary and secondary data in order to assess the availability of foods such as fruits and vegetables and high fat, high sugar foods, taking into account their price, distance from consumers, as well as other difficulties consumers may have in accessing and/or purchasing these foods. And, while there is plenty of information available concerning healthy food choices, Michman and Mazze (1998) have argued that the food industry has become adept at marketing foods which are high in sugar and fat. We propose to investigate further the ways in which retail food stores influence food choices through marketing and promotion. These promotion techniques contribute to how consumers perceive the choices they are given with regards to food.
Based on the work of Hall (1996) and dominant discourses, we seek to map the ways in which food and fitness are discussed in the popular press, experiential knowledge, and community discourse. Within the sociological literature, pathogenic food habits (such as those leading to obesity) are typically framed as a lifestyle outcome (e.g., Smith, Green, and Roberts 2004) or as one end of an eating disorder continuum (with anorexia being on the other) (e.g., Beardsworth and Keil 1997; Klaczynski, Goold, and Mudry 2004). Our study will consist of content analyses of popular media presentations of food choices (and problems associated with food choices) to develop a sense of dominant discources on food, and to help develop survey and interview instruments to measure the ways in which these discourses, if at all, play into values held by individuals with regards to food.
Work on food habits often come to the conclusion that it is the social environment, including the media, educational experiences, and cultural knowledge (or lack thereof), that is important to understand. Much like Gerbner et al.'s (e.g., 1979) work on violence and television, heavy users of television and other forms of mass media are more likely to be obese (Dietz and Gortmaker 2001), as are those of lower educational attainment and few cultural resources. From such a perspective, and coupled with the idea that the US is a mass-mediated society where fast (and fat) food are heavily advertised, one is led to assume that obesity is an unfortunate but unsurprising outcome for many people.
It is hard, though, to simply blame the media given its multivocal nature (Gamson et al. 1992), which seems true concerning food and fitness. Ferris (2003), for example, studied how the media portrayed both Tracie Gold (anorexia) and Carnie Wilson (obesity) as examples of using the star power of these individuals to gain audience attention to the problems of eating disorders. Ten Eyck and Deseran (2004) found that oysters in Louisiana were treated both as a cultural icon and health threat, often in the same issue of local newspapers. A preliminary Lexis-Nexis search on food and fitness shows much the same thing. In August 2005 -- a month chosen at random -- the term "obesity" appeared in 592 articles, while one single food item "ice cream" appeared 691 times. Terms such as "exercise" and "fitness" each appeared more than 4000 times for the same period.
In addition to the media discourse available on these topics, there is also a great deal of public wisdom available, such as cleaning your plate before having dessert, gluttony is a sin, carrying around a few extra pounds can be healthy, heavy people are jolly, sound body -- sound mind, and so forth. We have yet to find an article which says that obesity is appropriate or good, but there seems to be no lack of messages regarding eating (healthy and unhealthy foods), appropriate activities (exercising versus watching television), and normal body types.
At this point it is clear that more work needs to be done on attitudes toward food and fitness, from both individual and societal vantage points. Our approach takes into account culture as argued by DiMaggio (1997) and Swidler (1985), in that knowledge of food and fitness, whether gathered through experiential knowledge, public wisdom, or media discourse (Gamson 1992), are mental schemas/maps which become tools used for navigating through the social landscape. By thinking of this knowledge as cultural tools, and that such tools can be used in a variety of ways, we can make better sense of why individuals who are told one thing by experts think and act in ways which contradict this information.
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