Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries

A Mixed-Methods Participatory Intervention Design Process to Develop Intervention Options in Immediate Food and Built Environments to Support Healthy Eating and Active Living among Children and Adolescents in Cameroon and South Africa

“…The term obesogenic has been increasingly used to describe the food and physical activity-built environments in LMICs that have undergone rapid urbanization processes and resulted in the high availability of cheap and convenient ultra-processed foods and reduced opportunities for physical activity through changes in infrastructure, transportation, and occupational activities [ 6 ]. Reviews of the limited literature in LMICs have established the link between obesogenic environments and behavioral and lifestyle-related risk factors of childhood and adolescent obesity and overweight, including unhealthy eating behaviors and physical inactivity [ 7 , 8 , 9 , 10 , 11 ]. Unhealthy eating, consisting of meal skipping, high consumption of ultra-processed foods, and low consumption of vegetables and fruits have been associated with high availability and marketing of cheap, unhealthy ultra-processed food and beverages in school, neighborhood, and home environments; social desirability of and prestige placed upon unhealthy food and beverage brands; peer influence; and limited time, skills, and finances of caregivers at home to prepare fresh foods [ 7 , 8 , 9 , 10 , 11 ].…”

“…Reviews of the limited literature in LMICs have established the link between obesogenic environments and behavioral and lifestyle-related risk factors of childhood and adolescent obesity and overweight, including unhealthy eating behaviors and physical inactivity [ 7 , 8 , 9 , 10 , 11 ]. Unhealthy eating, consisting of meal skipping, high consumption of ultra-processed foods, and low consumption of vegetables and fruits have been associated with high availability and marketing of cheap, unhealthy ultra-processed food and beverages in school, neighborhood, and home environments; social desirability of and prestige placed upon unhealthy food and beverage brands; peer influence; and limited time, skills, and finances of caregivers at home to prepare fresh foods [ 7 , 8 , 9 , 10 , 11 ]. Common drivers of physical inactivity included increased indoor leisure activities and entertainment, such as watching TV, playing video games, using computers and cell phones for social interaction; insecure neighborhoods; lack of open spaces in communities; and competing priorities such as schoolwork [ 8 , 9 ].…”

“…Despite some evidence on food and physical activity-built environments in LMICs, reviews highlighted a scarcity of data from sub-Saharan Africa [ 12 ] and the disproportionate focus on individual and interpersonal level risk factors [ 7 ] as opposed to more granular understanding of the socio-environmental drivers that shape eating and physical activity behaviors [ 10 , 11 ]. While reviews acknowledged global strategies aimed at developing health-promoting food and built environments [ 13 , 14 ], they also emphasized the need for context-specific strategies [ 7 , 10 , 15 ].…”

“…Despite some evidence on food and physical activity-built environments in LMICs, reviews highlighted a scarcity of data from sub-Saharan Africa [ 12 ] and the disproportionate focus on individual and interpersonal level risk factors [ 7 ] as opposed to more granular understanding of the socio-environmental drivers that shape eating and physical activity behaviors [ 10 , 11 ]. While reviews acknowledged global strategies aimed at developing health-promoting food and built environments [ 13 , 14 ], they also emphasized the need for context-specific strategies [ 7 , 10 , 15 ]. A failure to consider contextual differences in values, beliefs, norms, and environmental influences, including local and informal food vendors on eating behavior and physical activity of children and adolescents was perceived as a barrier to successful and effective implementation of global policies in LMICs (often designed for high-income settings) [ 7 , 10 , 11 , 16 ].…”

Characterizing Retail Food Environments in Peri-Urban Pakistan during the COVID-19 Pandemic

“…Although the NEMS tools capture the availability and price of various (mostly healthy) foods, they do not capture nuances observed in informal retail settings and nutrition transition. Further, a comprehensive set of metrics (both objective and subjective) to measure external food environments have yet to be agreed upon [ 21 , 22 ]. Food environments in low- and middle-income countries (LMICs) are dominated by the informal sector (i.e., unregistered, mobile food vendors), as well as midstream micro-, small-, and medium-sized enterprises (MSMEs) [ 23 ].…”