Changes in retail food environments around schools over 12 years and associations with overweight and obesity among children and adolescents in Flanders, Belgium.

BACKGROUND: Children are susceptible to the food environment. This research assessed changes in retail food environments near schools in Flanders between 2008 and 2020 and associations with children's and adolescents' weight status. METHODS: The food environment within a 500 m and 1000 m road network distance to all primary and secondary schools was mapped using spatial indicators. The commercial Locatus database, including addresses of all food retailers in Flanders, was used to calculate the density of different types of food retailers near the school perimeter, the percentage of schools with at least one food retailer of a certain type near the school perimeter and the shortest distance from the school entrance to the nearest food retailer of a certain type. A generalized linear model was used to explore associations between these indicators and the percentage of children and adolescents with overweight at the school level. RESULTS: Food environments near schools in Flanders were found to be unhealthy in 2020, with a significant increase in fast food restaurants and convenience stores between 2008 and 2020. The density of fast food restaurants within a 1000 m walking distance from primary and secondary schools increased from 5.3 ±0.3 to 6.3 ±0.4 and from 10.2 ±0.7 to 12.7 ±0.9 respectively between 2008 and 2020, while the density of convenience stores increased from 3.2 ±0.3 to 3.8 ±0.4 and from 6.2 ±0.6 to 7.6 ±0.8 respectively. Food environments near schools with a higher proportion of children from a poor socio-economic background were found unhealthier, regardless of the urbanization level. A significant positive association was found between the density of fast food restaurants as well as the density of convenience stores around primary schools and the percentage of children aged < 6 years and 6-12 years with overweight. A positive, not significant association was found between the density of fast food restaurants as well as the density of convenience stores around secondary schools and the percentage of adolescents, aged 13-14 and 15-18 years with overweight. CONCLUSION: Food environments around schools in Flanders became unhealthier over time and were associated with children's weight status.

Unhealthy food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium): a detailed assessment.

INTRODUCTION: The supermarket food environment is a key setting for potential public health interventions. This study assessed food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium). METHODS: A sample of 55 supermarkets across five chains and 16 Flemish municipalities was selected in 2022, about 64% in the most deprived socioeconomic areas. Healthiness indicators related to food availability (ratio of cumulative linear shelf length for healthy versus unhealthy foods), prominence (proportion of unhealthy foods at check-outs and end-of-aisle endcaps), and promotion (food marketing on food packages) were measured. RESULTS: Overall, the average ratio of healthy/unhealthy foods in supermarkets in Flanders was 0.36, meaning that for every 10m of shelf length of unhealthy foods there was 3.6m of healthy foods. There was a large variation in ratio's across supermarket chains. Of all foods available, 97.5% were ultra-processed at the check outs, while 72.2% and 58.5% were ultra-processed at the front and back end-of-aisle end-caps, respectively. Confectionery and sweet biscuits were the food categories with on average the highest number of marketing messages on pack per 10m of shelf length. CONCLUSION: Supermarket in-store food environments in Flanders were found generally unhealthy, with those located in low income areas having unhealthier in-store food environments than supermarkets located in medium and high income areas. Despite commitments of all large supermarket chains in Flanders to promote and create healthier in-store food environments, our findings indicate that currently consumers are incentivized to buy unhealthy rather than healthy food products.

The Changing Landscape of Food Deserts and Swamps over More than a Decade in Flanders, Belgium.

Food deserts and swamps have previously been mostly studied in Anglo-Saxon countries such as the USA and Great Britain. This research is one of the first studies to map food deserts and swamps in a mainland European, densely populated but heavily fragmented region such as Flanders. The evolution of food deserts and swamps between 2008 and 2020 was assessed. Special focus was given to areas where high numbers of elderly, young people and/or families with low income live. Food deserts were calculated based on supermarket access within 1000 m and bus stop availability, while food swamps were calculated using the Modified Food Environment Retail Index. The main cause behind the formation of food deserts in Flanders is its rapidly aging population. Food deserts with a higher number of older people increased from 2.5% to 3.1% of the residential area between 2008 and 2020, housing 2.2% and 2.8% of the population, respectively. Although the area that could become a food desert in the future due to these sociospatial and demographic evolutions is large, food deserts are currently a relatively small problem in Flanders in comparison to the widespread existence of food swamps. Unhealthy retailers outnumbered healthy retailers in 74% of residential areas in 2020, housing 88.2% of the population. These food swamps create an environment where unhealthy food choices predominate. Residential areas with a higher number of elderly people, young people and families with low incomes had healthier food environments than Flanders as a whole, because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher. This research showed that food deserts and swamps could be a growing problem in European regions with a high population density that experience the high pressures of competing land uses.