How Our Surroundings Influence What We Eat

What we choose to eat plays a large role in determining our risk of gaining too much weight. But our
choices are shaped by the complex world in which we live-by the kinds of food our parents make
available at home, by how far we live from the nearest supermarket or fast food restaurant, even by the
ways that governments support farmers. In the U.S. and many parts of the world, the so-called food
environment-the physical and social surroundings that influence what we eat-makes it far too hard to
choose healthy foods, and all too easy to choose unhealthy foods. Some even call this food environment
“toxic” because of the way it corrodes healthy lifestyles and promotes obesity.

View The Forum at Harvard School of Public Health’s webcast, “Why We Overeat: The Toxic Food
Environment and Obesity.”

Understanding how the food environment influences our weight can help policymakers identify ways to
change the environment-and in turn, reduce obesity risk for everyone. And it may help address one of
the more troubling trends in the obesity epidemic: the higher rates of obesity found in low-income and
racial/ethnic minority groups in the U.S. Environmental barriers to healthy eating are often greater for
people who have lower incomes, less education, and language barriers, and traditional healthy diet
education campaigns often fail to reach them.

Over the past 20 years, research on our “obesogenic” food environment has grown, and scientists have
approached the topic from a number of angles. They have looked at how the settings in which we live-
from homes and neighborhoods to worksites and schools-influence which foods are available, how
much they cost, and whether the people in those settings are eating healthy diets. They have also
examined broader societal influences on individual food choices, from food marketing to government
policies. This article offers a brief and selective overview of the research on both the settings and
societal factors that shape what we eat.

Food Environment Research by Setting

Families

Families influence children’s dietary choices and risk of obesity in a number of ways, and children
develop food preferences at home that can last well into adulthood.

The food that families keep at home and how family members share meals influences what and how
much they eat. Not surprisingly, a recent review of published studies found a strong association
between the availability of fruits and vegetables at home and whether children, adolescents, and adults
eat these foods. Eating meals as a family has also been linked with increased child and adolescent intake
of fruit and vegetables and other healthy foods. Increased frequency of family meals has been linked
with lower BMI in some studies but not in others.

Low-income families face additional barriers to healthy eating that may contribute to the higher rates of
obesity seen in lower-income groups. One roadblock is that healthy foods, such as vegetables, fruits, and
whole grains, are more expensive than less healthful foods, such as refined grains and sweets, and may
be too expensive for low-income families. Another is time: It takes longer to prepare healthful meals
than to buy convenience foods or fast food. But people in lower-income households, often single
parents working full time and taking care of children, may have less time for meal preparation and other
household chores.

Worksites

Employed adults in the U.S. spend about one-quarter of all of their time at work. Worksites often
provide easy access to unhealthy foods in vending machines and limited access to healthier options,
such as fruits and vegetables. A number of studies have shown that making changes to the workplace
food environment, such as offering more healthy foods in company cafeterias, results in improved diet
quality.

Work environments can also increase the risk of obesity arising from job stress and work-related fatigue,
which are linked to poor diets and reduced physical activity. Time at work also plays a role: Shift workers
and employees working longer-than-usual hours every week have a higher risk of obesity.

Schools

Just as employed adults spend most of their day at work, children spend much of their day at school. In
the U.S., the National School Lunch Program and related federal school meal programs, administered by
the U.S. Department of Agriculture, serve more than 30 million children every day, including breakfast,
lunch, and after-school snacks. Researchers have found that participating in the School Breakfast
Program is associated with lower BMI in children, while participating in the lunch program did not affect
obesity. Students participating in the School Breakfast Program were also less likely to skip breakfast,
which may reduce risk of overweight by spreading food intake more evenly across the day.

Most schools sell foods to students outside of the school meal programs. These so-called “competitive
foods” are widely available in the cafeteria, vending machines, and school stores. In 2004-2005, 40
percent of all U.S. students ate competitive foods on a given school day, mostly foods high in calories
and low in nutritional value, otherwise known as junk food. Eating competitive foods has been linked
with poorer quality diets and increased risk of obesity in several studies.

In addition to unhealthy foods, schools have long provided a ready supply of sugar-sweetened
beverages, which are linked to increased risk of obesity and diabetes. Although recent agreements
between Alliance for a Healthier Generation and the American Beverage Association have substantially
reduced the supply of sugary beverages, schools continue to offer students unhealthy sugar-sweetened
beverages. But policies that curb access to sugary drinks on school property could be a promising
strategy for helping children cut back: Boston banned sugary drinks in public schools in 2004, and
researchers found that after the policy change took place, city students cut back, overall, on sugary
drinks.

Neighborhoods

People will have a hard time eating healthfully if healthy foods just aren’t available where they live.
Several aspects of the neighborhood food environment have drawn research attention, chief among
them, how the presence or lack of nearby supermarkets, convenience stores, and fast-food restaurants
relates to obesity risk. Researchers have also looked at whether economic and racial/ethnic disparities in
neighborhood food environments may, in part, explain the higher rates of obesity found in individuals
who have lower socioeconomic status (lower incomes, education, and job status) (15), and in Blacks and
Hispanics (29) in the U.S.

Lack of Access to Supermarkets

Roughly 2 million U.S. households live more than a mile from a supermarket and don’t have cars or
access to cars. (30) Researchers have used the term “food desert” to refer to neighborhoods with
limited access to full-service grocery stores or supermarkets. (31) Living in food deserts has been
associated with lower quality diets (32–35) and increased risk of obesity (35–38) in some studies. But
not all studies have found a relationship between supermarket access, diet, and obesity, among them,
two recent studies in U.S. children. (39,40) There’s evidence that low-income neighborhoods, as well as
Black or Hispanic neighborhoods, are less likely to have access to large supermarkets offering high-
quality and low-cost food, compared to middle-income neighborhoods and white neighborhoods.
(41,42)

Greater Access to Convenience Stores

Not only does lack of access to supermarkets seem to be associated with an increased risk of obesity;
simply having greater access to small food stores may increase the risk, too, (36) though again, not all
studies find this relationship. (40) Convenience stores often offer less variety, higher prices, and lower
quality produce than supermarkets. (45) When small stores do stock healthier foods, however, people
living nearby eat better. (46) If small stores changed the food that they stock, they could have a positive
influence on community members’ diets and obesity risks.

Convenience stores and other small stores selling unhealthy snack foods are more likely to locate in
poor neighborhoods and particularly near schools. (45) They are also more likely to locate near schools
with more Hispanic and Black students, even after accounting for students’ poverty level. (46

Fast Food

Although eating fast food has been shown to increase caloric intake and the risk of becoming obese,
(47–49) it is not as clear that living or working closer to fast-food restaurants has the same effect. While
some studies have found that living near fast-food restaurants is linked to increased risk of obesity, (50–
52) a number of studies have found no relationship. (40,48,53,54) Fast-food restaurants are more likely
to locate near schools, (55) however, and close proximity of fast-food restaurants to schools has been
linked to increased risk of obesity in schoolchildren. (56)

Societal Influences that Shape Food Choices and Obesity Risk

Food Marketing

In 2008, the Federal Trade Commission (FTC) reported that the food industry spends almost $10 billion
per year marketing food and beverages in the U.S. that appeal to children and adolescents, including
$1.6 billion to target children and adolescents directly with soft drinks, fast-food, and cereal promotions.
(57) In 2005, the Institute of Medicine (IOM) concluded that food marketing contributes to unhealthy
diets and risk of poor health among American children and youth. (58)

Despite this widespread recognition of the negative impact of marketing unhealthy foods, the practice
continues unabated. One recent study found that, from 2006 to 2008, food companies increased the use
of licensed cartoon and other entertainment characters targeting young children, and that most foods
marketed with such characters failed to meet IOM standards for snack food suitable for school children.
(59) Food marketers are increasingly using sophisticated digital marketing techniques to target youth
across a host of platforms, including cell phones, video games, social media, and immersive “virtual
worlds,” prompting public health advocates to call for stronger government regulation and industry self-
regulation. (60)

In March 2010, the Center for Science in the Public Interest issued a report card grading the strength of
the voluntary food marketing policies of 128 food and entertainment companies. ( 61) Two-thirds of
these companies had no policy whatsoever on marketing to children. Of the existing policies, a majority
applied only weak nutrition standards to their marketing efforts. Even companies that have pledged to
self-regulate advertising during children’s television shows have been using other means to market
unhealthful foods and drinks, such as product placements during prime-time television shows. (62)
Meanwhile, in the U.S., FTC efforts to develop voluntary, uniform nutrition standards for foods and
drinks marketed to children have met strong resistance from industry and have been stymied by
Congress.

Government Food Policy and Pricing

In the past 30 years, the price of fruit and vegetables rose much faster than the prices of all other
consumer goods in the U.S. At the same time, the price of sugar, sweets, and carbonated drinks declined
relative to other products, (64) and people began consuming more sugar and other sweeteners,
reaching 151 pounds of caloric sweeteners every year per person by 1999. (65) In recent years, per
capita sweetener consumption has declined to 142 pounds per year, still significantly higher than the
123 pounds consumed in 1966. A 2014 study offered further evidence that inexpensive food is a key
factor in rising obesity rates.

Changes in food prices have been linked to changes in how much we eat and our risk of obesity. One
study that followed more than 5,000 young adults for 20 years found that lower prices on soda and pizza
were associated with higher caloric intake and increased weight. (66) Another found that higher fruit
and vegetable prices were associated with greater weight gain over time in young children. (54)

There has been much debate about why the price of sweeteners has dropped. Some researchers have
argued that subsidies to corn growers have led to an oversupply of cheap high-fructose corn syrup,
which drives higher sweetener consumption. Economic evaluations of this argument have found that
direct subsidies currently play a limited role in lowering sweetener prices, although their historical
impact on development of the sweetener market may be more important. (65,67)

Taxing Sugar-Sweetened Beverages

Although economists debate how much government subsidies to corn growers influence the price of
sweeteners, (1) the government can set policies that influence the price and availability of foods that, in
turn, influence the risk of obesity. For example, existing small taxes on soft drinks are associated with
slightly lower BMI and lower consumption of these beverages. (68) The taxes are related to a greater
decrease in consumption and overweight for children who are already overweight or whose families
have a low income. More recently, researchers have estimated that in the U.S., adding a nationwide
penny-per-ounce tax on sugar sweetened beverages would reduce consumption by 24 percent-and
would raise nearly $80 billion in revenue over a five-year period. (69)

Social Networks and Norms

Some researchers argue that recent shifts in cultural norms have led to eating and physical activity
habits that promote overweight.

Researchers who analyzed social networks among participants in the Framingham Heart Study, for
example, found that when someone’s friends gained weight, that person, too, was more likely to gain
weight in the future. (70) The effect of social relationships turned out to be a stronger predictor of
shared weight gain than living in the same neighborhood. More recently, other researchers analyzed
changes in weight perception in national survey data from the late 1980s to the early 2000s and found
that those who were overweight or obese had become more likely to consider their own weight “about
right” instead of “overweight.” (71)

Social Networks and Norms

Some researchers argue that recent shifts in cultural norms have led to eating and physical activity
habits that promote overweight.

Researchers who analyzed social networks among participants in the Framingham Heart Study, for
example, found that when someone’s friends gained weight, that person, too, was more likely to gain
weight in the future. (70) The effect of social relationships turned out to be a stronger predictor of
shared weight gain than living in the same neighborhood. More recently, other researchers analyzed
changes in weight perception in national survey data from the late 1980s to the early 2000s and found
that those who were overweight or obese had become more likely to consider their own weight “about
right” instead of “overweight.” (71)

Some work is already underway. In the U.S., for example, the White House Childhood Obesity Task Force
in 2010 outlined an ambitious public policy agenda aimed at fixing the toxic food environment. (73) The
task force recommendations include a number of steps to improve the food environment, such as a call
for a national program to finance supermarket development in disadvantaged communities. Several
areas require stronger policy recommendations, however, such as the need to eliminate the aggressive
marketing of unhealthy foods to children.

Internationally, meanwhile, the United Nations Special Rapporteur on the Right to Food has declared
that “our food systems are making people sick,” and he has outlined five ways for governments to
improve the food environment in developed and developing countries, among them, taxing unhealthful
foods and drinks, curbing junk food marketing to all groups (not just children), and realigning agricultural
subsidies with health. (74) Only with such comprehensive efforts will we be able to move away from a
world that so easily promotes unhealthy eating, and toward a world where healthy eating is the default
choice.