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Key Words environmental change, obesity preventions Abstract Obesity has increased dramatically over the past two decades and currently about 50% of US adults and 25% of US children are overweight. The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. This chapter reviews what is known about environmental influences on physical activity and eating behaviors. Recent trends in food supply, eating out, physical activity, and inactivity are reviewed, as are the effects of advertising, promotion, and pricing on eating and physical activity. Public health interventions, opportunities, and potential strategies to combat the obesity epidemic by promoting an environment that supports healthy eating and physical activity are discussed.

OBJECTIVE:To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students. DESIGN: A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured. SUBJECTS: Students in grades 7 -12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection. MEASUREMENTS: Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured. RESULTS: FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students' own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status. CONCLUSIONS: FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

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OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN: A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS: Women (n 891) aged 20 ± 45 y who enrolled in the Pound of Prevention study. MEASUREMENTS: Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS: Twenty-one percent of the sample reported eating 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of ®ber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION: Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.

Mary Story, Karen Kaphingst, and Simone French argue that U.S. schools offer many opportunities for developing obesity-prevention strategies by providing more nutritious food, offering greater opportunities for physical activity, and providing obesity-related health services. Meals at school are available both through the U.S. Department of Agriculture's school breakfast and lunch programs and through "competitive foods" sold à la carte in cafeterias, vending machines, and snack bars. School breakfasts and school lunches must meet federal nutrition standards, but competitive foods are exempt from such requirements. And budget pressures force schools to sell the popular but nutritionally poor foods à la carte. Public discomfort with the school food environment is growing. But can schools provide more healthful food options without losing money? Limited evidence shows that they can. Although federal nutrition regulations are inadequate, they permit state and local authorities to impose additional restrictions. And many are doing so. Some states limit sales of nonnutritious foods, and many large school districts restrict competitive foods. Several interventions have changed school food environments, for example, by reducing fat content of food in vending machines and making more fruits and vegetables available. Interventions are just beginning to target the availability of competitive foods. Other pressures can also compromise schools' efforts to encourage physical activity. As states use standardized tests to hold schools and students academically accountable, physical education and recess have become a lower priority. But some states are now mandating and promoting more physical activity in schools. School health services can also help address obesity by providing screening, health information, and referrals to students, especially low-income students, who are at high risk of obesity, tend to be underinsured, and may not receive health services elsewhere.

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Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.