Sep. 29 2014

Around the world, New York City is known as a beacon for foodies. Tourists and locals line up to taste the trend du jour, whether it’s cronuts or ramen burgers, or simply to savor the offerings of some 20,000 restaurants serving up a United Nations of cuisines.

urban_foodsm.jpgIt’s not just the astonishing diversity of food options that makes food in the city so special, but the ability of cities to shape what and how we eat, observed Mailman School obesity researcher Claire Wang in the leadoff lecture of this fall’s Urban Health Conversations series.

“Cities should be provocative and proactive in shaping the food environment,” said Wang, an associate professor of Health Policy and Management and co-director of the School’s Obesity Prevention Initiative, adding that diet is the single most modifiable risk factor for premature deaths and disability around the world. In the face of the obesity epidemic, municipalities have an obligation to go well beyond restaurant safety inspections and to use food as a lever to improve health. 

For decades, scientists have wrestled with how to identify what aspects of the urban food environment are healthy and unhealthy. According to Wang, the popular concern over “food deserts”— areas lacking access to healthy foods—may be overstated; research by the U.S. Department of Agriculture showed that nearly 98 percent of Americans are able to walk or drive to a supermarket.

An emerging alternative known as the “food swamp”—an area saturated in unhealthy options—is just as problematic.  So far researchers have struggled to demonstrate consistent associations between obesity and food environments, consumptions patterns, or diet quality. Poor neighborhoods in California have twice as many fast food restaurants and convenience stores; at the same time, they have twice as many supermarkets. In an intentionally provocative statement, Wang called the state of research an “exciting and confusing mess,” adding, “The field is evolving.”

Sampling Urban Food Interventions

Wang and others have made better headway evaluating the effectiveness of various food-related policy interventions.

To comply with the Affordable Care Act, chain restaurants must list calorie information. But does the knowledge that, say, a double bacon cheeseburger is over 900 calories, necessarily change how people eat? According to Wang, the answer is unclear.  Labeling worked in Philadelphia, but showed mixed results in New York; some younger consumers even sought out calorie-dense items because they gave more for their dollar.  Yet it turns out menu labeling has been successful, albeit in a roundabout way. While consumers often tune out the information, some restaurants were prodded to take their biggest calorie bombs off the menu. Listing calories “is a supply side intervention,” said Wang.

Another popular urban intervention gives monetary incentives to food stamp recipients to purchase fresh fruit and vegetables. A USDA study in Hampden, Massachusetts, found a 25 percent increase in the consumption of fruits and vegetables after the intervention was put in place.

Perhaps the easiest way for cities to modify dietary behavior is by changing their procurement policies. When Chicago mandated that three-quarters of vending machines on city property serve healthy food, consumers were happy and sales went up. Said Wang, “It is not a money-losing business to provide healthy options.”

Then there’s the soda size debacle. In a published analysis, Wang concluded that New York City’s proposed legislation of a 16-ounce soda cap would have disproportionally affected the overweight as intended, but not low-income groups, as a number of critics contended.

Though the law was struck down, the high-profile debate furthered the cause of those seeking to reduce soda consumption, and opened the door for other policy options. “All of a sudden, taxes on sugary drinks seem reasonable and moderate and not as draconian,” said Wang, adding that San Francisco and Berkeley will vote on a soda tax in November. A national soda tax was proposed in Congress in July.

As Wang’s presentation made clear, New York and other cities are more than a beacon for foodies. Food policies and the debate around them have a “lighthouse effect,” she said, shining a light on what’s possible.

The next in the series of Urban Health Conversations, led by Peter Muennig, takes place on November 25.