Development and evaluation of a food environment survey in three urban environments of Kunming, China

Abstract

BackgroundGiven the rapid pace of urbanization and Westernization and the increasing prevalence of obesity, there is a need for research to better understand the influence of the built environment on overweight and obesity in world’s developing regions. Culturally-specific food environment survey instruments are important tools for studying changing food availability and pricing. Here, we present findings from an effort to develop and evaluate food environment survey instruments for use in a rapidly developing city in southwest China.MethodsWe developed two survey instruments (for stores and restaurants), each designed to be completed within 10 minutes. Two pairs of researchers surveyed a pre-selected 1-km stretch of street in each of three socio-demographically different neighborhoods to assess inter-rater reliability. Construct validity was assessed by comparing the food environments of the neighborhoods to cross-sectional height and weight data obtained on 575 adolescents in the corresponding regions of the city.Results273 food establishments (163 restaurants and 110 stores) were surveyed. Sit-down, take-out, and fast food restaurants accounted for 40%, 21% and 19% of all restaurants surveyed. Tobacco and alcohol shops, convenience stores and supermarkets accounted for 25%, 12% and 11%, respectively, of all stores surveyed. We found a high percentage of agreement between teams (>75%) for all categorical variables with moderate kappa scores (0.4-0.6), and no statistically significant differences between teams for any of the continuous variables. More developed inner city neighborhoods had a higher number of fast food restaurants and convenience stores than surrounding neighborhoods. Adolescents who lived in the more developed inner neighborhoods also had a higher percentage of overweight, indicating well-founded construct validity. Depending on the cutoff used, 19% to 36% of male and 10% to 22% of female 16-year old adolescents were found to be overweight.ConclusionsThe prevalence of overweight Chinese adolescents, and the food environments they are exposed to, deserve immediate attention. To our knowledge, these are the first food environment surveys developed specifically to assess changing food availability, accessibility, and pricing in China. These instruments may be useful in future systematic longitudinal assessments of the changing food environment and its health impact in China.

A Review of the Growth of the Fast Food Industry in China and Its Potential Impact on Obesity

“…Obesity prevalence increased with frequent eating in FF restaurants among a U.S. study sample, from 24% of those who ate in FF restaurants less than once a week to 33% of those who did it ≥3 times per week [9]. Similar research is growing in China [7,15,16,17,18,19,20,21,22,23,24], showing the fast expansions of FF industry and increased FFC likely have contributed to the increase of obesity in China. Overall, increasing studies in Western countries and China have reported a positive association between FFC and obesity [7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24].…”

“…Most of them reported a positive association, but are predominately cross-sectional studies based on regional data [15,16,17,18,19,20,21,22,23,24]. Eight of these 11 studies only used regional data [15,16,17,18,21,22,23,24]. The other three studies [7,19,20] used data from the China Health and Nutrition Survey (CHNS), which is not a nationally representative study.…”

“…The data recorded from each study include reference, region and year of data collection, sample size, sex and age, study design, outcomes (like obesity or/and overweight), and main results (e.g., measures on the association). Among the 39 identified titles, 11 longitudinal and cross-sectional studies conducted in China met inclusion criteria [7,15,16,17,18,19,20,21,22,23,24]. …”

“…The majority were conducted in Western countries and have demonstrated a positive association [9,10,11,12,13,14]. Similar research is growing in China, but is still limited [7,15,16,17,18,19,20,21,22,23,24]. …”

Association between full service and fast food restaurant density, dietary intake and overweight/obesity among adults in Delhi, India

“…Results of studies conducted in LMICs have been inconclusive. A cross-sectional survey in China found a positive association between number of fast food restaurants and overweight/obesity among adolescents [14]. Another study in China also found a positive association between changes in number of Western fast food restaurants and waist-to-height ratio, but no association with body mass index (BMI) [15].…”