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Overweight and obesity are growing health problems in many developing countries. Rising obesity rates are the result of changes in people’s diets and lifestyles. Income growth and urbanization are factors that contribute to these changes. Modernizing food retail environments may also play a certain role. For instance, the rapid spread of supermarkets in many developing countries could affect consumer food choices and thus nutritional outcomes. However, concrete evidence about the effects of supermarkets on consumer diets and nutrition is thin. A few existing studies have analyzed related linkages with cross-sectional survey data. We add to this literature by using panel data from households and individuals in urban Kenya. Employing panel regression models with individual fixed effects and controlling for other factors we show that shopping in supermarkets significantly increases body mass index (BMI). We also analyze impact pathways. Shopping in supermarkets contributes to higher consumption of processed and highly processed foods and lower consumption of unprocessed foods. These results confirm that the retail environment affects people’s food choices and nutrition. However, the effects depend on the types of foods offered. Rather than thwarting modernization in the retail sector, policies that incentivize the sale of more healthy foods—such as fruits and vegetables—in supermarkets may be more promising to promote desirable nutritional outcomes

BackgroundWhile undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people’s health have not been analyzed up till now.ObjectiveThis study investigates the effects of purchasing food in supermarkets on people’s BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome.DesignThis study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality.ResultsPurchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed.ConclusionsSupermarkets and their food sales strategies seem to have direct effects on people’s health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people’s food choices.

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The Global Alliance for Improved Nutrition (GAIN) is a Swiss-based foundation launched at the UN in 2002 to tackle the human suffering caused by malnutrition. Working with governments, businesses and civil society, we aim to transform food systems so that they deliver more nutritious food for all people, especially the most vulnerable.