Spatial Patterns of Obesity in the Netherlands, and Its Association with (Un)Healthy Food Store Accessibility

Benjamin Aretz , University of Rostock, University of Groningen
Rafael Costa , Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW/University of Groningen
Gabriele Doblhammer , University of Rostock
Fanny Janssen , Netherlands Interdisciplinary Demographic Institute (NIDI) and University of Groningen

INTRODUCTION Obesity prevalence has almost tripled in Europe since 1980, and the obesogenic (food) environment is suspected to be one of the main drivers. However, empirical evidence is rare for Europe and previous research from the US revealed mixed results. OBJECTIVE To investigate the geographic distributions of obesity in the Netherlands, and its associations with (un)healthy food store accessibility while assessing local differences. METHODS In our ecological study, we used small-area estimated obesity prevalence (adults aged 19+) from 2,836 neighborhoods (six digits zip code, “wijken”) in the Netherlands in 2016 and combined this with measures from Statistics Netherlands on accessibility to (unhealthy) fast food and (healthy) fresh food. Spatial lag of X models were estimated for the entire Netherlands and separately for urban, suburban, and rural neighbourhoods. Total effects were decomposed into a direct and an indirect effect. A geographically weighted regression (GWR) was used to explore local effect variations. RESULTS High obesity clusters were found to be in the North East, the South West and South East. Overall, worse accessibility to (unhealthy) fast food was associated with lower obesity prevalence, mostly due to indirect effects. Better accessibility to (healthy) fresh food was directly and indirectly associated with lower obesity in urban settings only. Effects of unhealthy food accessibility were especially observed in regions with a higher degree of urbanity. CONCLUSION To fight against obesity, reducing the presence of unhealthy food in the wider surrounding of people may be more effective than expanding healthy food supply, especially in urban regions.

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 Presented in Session P1. Postercafe