The association between the obesogenic environment and 6-month and 24-month weight change in a rural weight loss intervention trial in the United States.

The unique obesogenic environment may influence the ability to effectively maintain weight loss in rural areas. The aim of this study was to examine the contextual relationship of neighborhood disadvantage, distance to supermarkets and supercenters, and fast food, dollar store, and exercise facility environments on weight loss following a weight-loss intervention in the United States. This analysis (n = 1177) linked weight loss outcomes from a rural, primary care-based randomized controlled trial to contextual data collected from residential addresses. Outcomes include 6-month and 24-month percent weight loss. These outcomes were compared across contextual variables, including tract level disadvantage, food accessibility, and food/exercise availability. Covariates were included in ordinary least squares (OLS) multivariable regression models for 6-month and 24-month weight loss measures, across three weight loss interventions. Contextual variables were not significantly related to percent weight loss overall across treatment arms. Participants living in a 5-mile buffer to dollar stores experienced approximately a 2% (p < 0.05) lower weight loss, but only in the least effective counseling arm (individual clinic visits), while controlling for both individual and contextual factors. Our results suggest that specific contextual variables in rural populations may play an important role in moderating weight loss outcomes especially under the conditions of less effective interventions.

Availability of Foods and Beverages in Supplemental Nutrition Assistance Program-Authorized Dollar Stores in a Region of North Carolina.

BACKGROUND: There are >25,000 Supplemental Nutrition Assistance Program (SNAP)-authorized dollar stores throughout the United States; many are located in lower-income neighborhoods and provide an accessible food and beverage source for area residents. OBJECTIVE: The purpose of this research was to determine the percent of food deserts within 16 counties in North Carolina that include a SNAP dollar store; examine the types of foods and beverages at SNAP dollar stores in these counties; test whether the foods and beverages offered vary by SNAP dollar store chain; and test whether the foods and beverages available differ by rural and urban location. DESIGN: This cross-sectional study used a combination of publicly available data and primary data to investigate the research questions. Secondary data sources were obtained from the US Department of Agriculture's SNAP retailer locator, the US Census, and the US Department of Agriculture's Food Access Research Atlas. Availability of foods and beverages was assessed among a sample of 90 SNAP dollar stores in 16 counties in southern and western sections of North Carolina. Data were collected in June 2014. RESULTS: About half (52%) of the food deserts in the research area included a SNAP dollar store. Most of the sampled stores sold healthier food staples, such as frozen meats, brown rice, 100% whole-wheat bread, and dried beans. None of the stores sold fresh fruits or vegetables. Some of the foods and beverages offered (eg, frozen fruit, frozen unseasoned vegetables, nonfat or low-fat milk, frozen ground beef) varied by SNAP dollar store chain. The foods and beverages offered did not differ by rural or urban county location. CONCLUSIONS: SNAP dollar stores offer a number of healthy food staples; however, they do not sell fresh fruits or vegetables. Further food environment research should include dollar stores.