Better Grocery Stores Alone Can’t Improve Kids’ Diets, Study Finds

There’s been a lot of talk lately about food deserts and lack of access to healthy, nutritious food for many families living in rural and lower-income urban areas. So the solution seems to be to increase the availability of healthier fare, and what better way than to build a full service supermarket in the neighborhoods without one?

That’s what a government-sponsored program called Health Food Financing Initiative does, enticing supermarket chains to build stores in lower income areas with favorable tax credits. These stores are also required to meet some criteria meant to make the most of their presence in areas where fresh and nutritious foods are harder to come by. In New York, for example, the state program requires that at least 30% of a store’s floor space be devoted to perishable foods like produce and fruit, with at least 500 square feet dedicated specifically to fresh produce.

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A new study published in journal Public Health Nutrition looked at whether the supermarkets are actually making a difference. Brian Elbel, associate professor of population health and health policy at New York University School of Medicine, and his colleagues compared eating habits in families in a part of the Bronx with a new supermarket and in a close by neighborhood without one.

To capture any change in the families’ food-buying habits over time, the researchers stopped parents on the street in these neighborhoods and asked them questions about their eating and food buying patterns, and then called the participants around six months later, and again a year after that first encounter.

The results were sobering. While there was an increase in those who said they shopped at the supermarket between the first and second rounds of questioning, that difference disappeared a year later. What the families were buying also didn’t change much, despite the supermarket selling fresh and healthy foods. At the start of the study 77% of those living in the neighborhood with the new supermarket said they had fresh fruits and vegetables in their homes, which dropped to 68% by the second follow up. The other neighborhood, however, showed a similar decline, from 78% to 65%.

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In fact, both neighborhoods showed similar changes in food-buying trends, including positive ones such as a decrease in the availability of cookies, cakes, pastries and salty snacks in the home, so Elbel says it’s not possible to attribute them to the presence of the supermarket in the one community.

“It’s very clear that a supermarket alone does bring access to healthy food,” says Elbel. “But at the same time, does it bring unhealthy stuff, and introduce new products to the neighborhood that weren’t there before? Potentially.”

While healthy foods were available at the store, for example, they were not always the most affordable items, or the ones that the store promoted with special discounts or deals. Cost, it seems, overrules nutrition for many families making food-buying decisions.

While programs to increase the availability of full service food stores are laudable, Elbel says his results highlight the fact that access isn’t the only answer. “We can definitely imagine criteria that would make it more stringent for stores to qualify for these programs, and provide more detail on how the store is structured, what products are promoted or which products are available and how they are priced,” he says. “The question is, if we provide the tax credits and these constraints, will stores still be interested in opening in [food desert] neighborhoods? I don’t know.”

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It’s also possible that the supermarket didn’t have the impact public health officials anticipated because the neighborhoods already had reasonable access — a train or bus ride away — to full service stores, before the new store opened. Almost 90% of the participants said they shopped at a supermarket, not convenience stores, for meals they made at home, so the new store likely didn’t do much to change that pattern. That suggests, says Elbel, that policy makers may also need stricter definitions of food deserts or areas that need nutritional attention.

“Just building a supermarket is not enough,” he says. “We need more data on what exactly a food desert is, and exactly where to place a supermarket. We have to look at access more broadly, and make clear that improving health is not just about access.” That’s a bigger challenge, but as the study shows, needs to be addressed if healthier fare is going to find its way onto more dinner plates.