Association for Public Policy Analysis & Management

The Healthy Food Financing Initiative is a federal policy effort to increase access to healthy, affordable food across communities in the United States that currently lack these options. Placing full-service supermarkets (FSS) in food deserts (areas with limited access to healthy foods) is one example of this, and has been proposed as a strategy to improve diet among residents. In theory, if residents had greater access to fresh fruits, vegetables and other healthy items, they could improve their diets, which could lead to lower obesity rates.

Our team embarked upon the most rigorous study to date to assess the extent to which opening a FSS in a food desert may change dietary intake, food purchasing behaviors, and neighborhood satisfaction of residents. Capitalizing on a natural experiment, we enrolled n=1,372 randomly selected households from two comparable neighborhoods, one of which received a full-service supermarket in 2013. Baseline data, including extensive self-reported socio-demographic data, food purchasing behaviors, and 24-hour dietary recall, as well as measured body mass index (BMI) were collected in-person by trained data collectors in May through December of 2011.  Follow up interviews were completed in May through December of 2014 with 831 panel participants.  Attrition weights were used to adjust for nonresponse.

In a difference in difference analysis, we found large statistically significant improvements in neighborhood satisfaction; and very large (and statistically significant) improvements in perceived access to healthy food options including whole grains and fruits and vegetables in the FSS neighborhood compared to the “control” neighborhood. We also found significantly greater reductions in daily total kilocalorie intake (about 171 kcals less), total fat (7.2 grams less), added sugars (3.3 teaspoons less), discretionary fat (4.4 grams less), and percent of caloric intake from Solid Fats, Alcohol Beverages and Added Sugars (SOFAAS) (3.1% less) in the FSS neighborhood compared to the control. However, we did not observe differential improvement in fruit and vegetable intake, whole grain consumption or reduction in measured BMI. However, differences were not statistically significantly associated with use of the new supermarket.

Although these findings provide the first positive findings to date of dietary change in a neighborhood with a newly located full service supermarket, the mechanism by which dietary change occurred is still unclear.