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Despite 2 decades of effort by the public health community to combat obesity, obesity rates in the United States continue to rise. This lack of progress raises fundamental questions about the adequacy of our current approaches. Although the causes of population-wide obesity are multifactorial, attention to food systems as potential drivers of obesity has been prominent. However, the relationships between broader food systems and obesity are not always well understood. Our efforts to address obesity can be advanced and improved by the use of systems approaches that consider outcomes of the interconnected global food system, including undernutrition, climate change, the environmental sustainability of agriculture, and other social and economic concerns. By implementing innovative local and state programs, taking new approaches to overcome political obstacles to effect policy, and reconceptualizing research needs, we can improve obesity prevention efforts that target the food systems, maximize positive outcomes, and minimize adverse consequences. We recommend strengthening innovative local policies and programs, particularly those that involve community members in identifying problems and potential solutions and that embrace a broad set of goals beyond making eating patterns healthier. We also recommend undertaking interdisciplinary research projects that go beyond testing targeted interventions in specific populations and aim to build an understanding of the broader social, political, and economic context. [ABSTRACT FROM AUTHOR]

Food policy councils (FPCs) are collaboratives that work to strengthen food systems. Over 300 FPCs exist in the United States, Canada, and Tribal Nations. In 2015, we surveyed the types of initiatives FPCs undertook and identified food sector targets and domains of potential impact in an effort to inform comprehensive FPC impact assessments. FPCs (N=66) reported 317 policy, systems, and environmental initiatives. At least half of these were focused on food production, and many were focused on institutional food service and the food assistance sectors. Commercial food service, food processing, and food waste were less often the focus. Potential impacts of their initiatives were classified into six domains: supporting resilient food systems (235, 74%); increasing access to healthy foods (171, 54%); supporting economic development (115, 36%); promoting equity in the food system (94, 30%); promoting environmental sustainability (82, 26%); and increasing knowledge of or demand for healthy foods (27, 9%). Many initiatives were likely to impact multiple domains. [ABSTRACT FROM AUTHOR]

Supermarket-based interventions are one approach to improving the local food environment and reducing obesity and chronic disease in low-income populations. We implemented a multicomponent intervention that aimed to reduce environmental barriers to healthy food purchasing in a supermarket in Southwest Baltimore. The intervention, Eat Right-Live Well! used: shelf labels and in-store displays promoting healthy foods, sales and promotions on healthy foods, in-store taste tests, increasing healthy food products, community outreach events to promote the intervention, and employee training. We evaluated program implementation through store environment, taste test session, and community event evaluation forms as well as an Employee Impact Questionnaire. The stocking, labeling, and advertising of promoted foods were implemented with high and moderate fidelity. Taste test sessions were implemented with moderate reach and low dose. Community outreach events were implemented with high reach and dose. Supermarket employee training had no significant impact on employees’ knowledge, self-efficacy, or behavioral intention for helping customers with healthy purchasing or related topics of nutrition and food safety. In summary, components of this intervention to promote healthy eating were implemented with varying success within a large supermarket. Greater participation from management and employees could improve implementation. [ABSTRACT FROM AUTHOR]

To discover how organic food factors into low-income consumers' overall understanding of healthy eating, we analyzed 36 in-depth interviews with adults in Baltimore, Maryland. We asked participants to discuss their understanding of healthy eating. Unprompted, many participants discussed organic food or attributes commonly understood to define organic food. Some participants believed health issues including cancer, weight gain, and allergies can arise from consuming nonorganic foods. Participants expressed that organic competes with other food attributes such as nutrient content in informing their perception of whether a food is healthy. Several voiced concern that nonorganic foods are responsible for weight gain and abnormal development. Our results show that despite limited access, organic is an important factor in some consumers' understanding of healthy food. Consumers' perceptions of organic can swamp or compete with other messages about healthy eating. Therefore, consumers' understanding of organic should be considered in developing diet-related messages and programs. [ABSTRACT FROM AUTHOR]

Objective To evaluate a multifaceted supermarket intervention promoting healthier alternatives to commonly purchased foods. Design Sales of 385 foods promoted between July and October, 2012 in the Eat Right–Live Well! intervention supermarket were compared with sales in a control supermarket. Setting Two supermarkets in geographically separate, low-income, urban neighborhoods. Participants One control and 1 intervention supermarket. Intervention Product labeling, employee training, community outreach, and in-store promotions, including taste tests. Main Outcome Measures Number of items sold; absolute and percent differences in sales. Analysis Difference-in-difference analyses compared absolute and percent changes between stores and over time within stores. Sub-analyses examined taste-tested items and specific food categories, and promoted items labeled with high fidelity. Results Comparing pre- and postintervention periods, within-store difference-in-differences for promoted products in the intervention store (25,776 items; 23.1%) was more favorable than the control (9,429 items; 6.6%). The decrease in taste-tested items' sales was smaller in the intervention store (946 items; 5.5%) than the control store (14,666 items; 26.6%). Increased sales of foods labeled with high fidelity were greater in the intervention store (25,414 items; 28.0%) than the control store (7,306 items; 6.3%). Conclusions and Implications Store-based interventions, particularly high-fidelity labeling, can increase promoted food sales. [ABSTRACT FROM AUTHOR]