Pineda, Ana Elisa; (2018) Examining relationships between food environments and adult obesity in Mexico using geographical information systems. Doctoral thesis (Ph.D), UCL (University College London).

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Text Examining Relationships Between Food Environments and Adult Obesity in Mexico - PhD Thesis - FINAL-PRINT-corrected.pdf - Accepted Version Download (13MB) | Preview

Abstract

Mexico has one of the highest rates of obesity and overweight worldwide: 73% of the population is overweight or obese. The country has experienced a dietary and food retail transition involving increased high-calorie-dense food and beverage availability: 163 L of sugar-sweetened beverages (SSB) were consumed on average per person in 2012. The obesity epidemic in Mexico increased significantly which suggests that the contributing risk factors are likely to be influenced by the environment. Therefore, this study aimed to assess the relationship between the food environment and obesity in Mexico. Food outlet geolocation was obtained from the National Institute of Statistics and Geography in Mexico; anthropometric measurements and socio-economic characteristics of adult participants came from the National Survey on Health and Nutrition in Mexico (ENSANUT) 2012. I calculated the density of supermarkets, restaurants, fast-food outlets, chain convenience stores (CCS) and non-chain convenience stores (NCCS), and fruit and vegetable stores separately and overall. The retail food environment index (RFEI), and the density of ‘unhealthy’ and ‘healthy’ food outlets were also calculated per CTA using ArcGIS. I then analysed the relationship between food outlet density types and obesity through five models which controlled for different covariates including gender, age, socioeconomic status and physical activity, using multilevel linear regression in STATA 14. Results indicated that density of NCCS [β=3.10, 95% CI: 0.97-5.23, p=0.004] and CCS [β=19.11, 95% CI: 1.59-36.63, p=0.003] and the RFEI [β=0.015, 95%CI: 0.049-0.0001, p<0.05] were significantly directly associated with obesity whilst total, healthy and unhealthy food outlet density showed no significant associations. This study showed strong associations between both high densities of convenience stores and a higher proportion of unhealthy food outlets with higher levels of BMI in Mexican adults living in urban areas. Policy makers in Mexico should consider interventions aimed at tackling the obesogenic food environment in the country.

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