Healthy Eating Intervention in Restaurants and Food Stores

Healthy Eating Intervention in Restaurants and Food Stores

Background

Obesity is a complex public health problem with serious health and economic consequences. In the US, over two thirds of adults are overweight or obese. The problem is even more acute in rural areas where obesity rates tend to be higher and resources for obesity prevention efforts are typically scarcer. Research indicates that a healthy diet plays a critical role in preventing obesity and chronic diseases, however almost all Americans fail to adhere to dietary recommendations.

Growing evidence indicates that the nutrition environment, encompassing food access, availability, pricing, quality, and promotion, is linked to individual dietary behaviors and obesity rates. Restaurants and food stores are two main domains of the community nutrition environment and represent suitable settings for interventions aimed to promote healthier dietary practices and curb the obesity epidemic at a population level.

Previous research on community-based interventions promoting healthy eating in restaurants and stores has provided some evidence of feasibility, but data on their effectiveness to positively alter the nutrition environment and patrons' purchasing behaviors is still inconclusive. While evidence supporting these interventions is growing, gaps remain in the literature. For instance, although 19% of Americans live in rural areas and 40% of rural adults are obese, few studies have evaluated restaurant or store interventions in rural or semi-rural areas. Additionally, almost all interventions have focused exclusively on either restaurants or food stores, missing the opportunity for synergy between these two domains. Furthermore, there is a need for stronger and more comprehensive evaluation designs using baseline measures, comparison groups, and data beyond efficacy or effectiveness to better assess the public health impact of these interventions.

The purpose of this study is to pilot test a community-level intervention to improve the nutrition environment and promote healthy eating in restaurants and food stores of a rural community. The evaluation emphasized acceptability and feasibility and was guided by the RE-AIM framework, a model that considers the public health impact of an intervention as determined not only by its effectiveness or efficacy, but also by the ability to reach the intended audience (Reach), the likelihood of being adopted by the intended organizations or settings (Adoption), the extent and fidelity of implementation (Implementation), and the likelihood of being sustained over time (Maintenance). By attending to these multiple dimensions for an intervention designed to meet the needs of a rural community, our study was designed to inform a future effectiveness trial aimed to expand the evidence base related to community-based approaches to promote healthy eating and curb the obesity epidemic in rural U.S. communities.