Healthy food availability and the association with BMI in Baltimore, Maryland

Objective: To study the association between the availability of healthy foods and BMI by neighbourhood race and socio-economic status (SES). Design: Trained staff collected demographic information, height, weight and 24 h dietary recalls between 2004 and 2008. Healthy food availability was determined in thirty-four census tracts of varying racial and SES composition using the Nutrition Environment Measures Survey-Stores in 2007. Multilevel linear regression was used to estimate associations between healthy food availability and BMI. Setting: Baltimore City, Maryland, USA. Subjects: Adults aged 30-64 years (n 2616) who participated in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Results: Among individuals living in predominantly white neighbourhoods, high availability of healthy foods was associated with significantly higher BMI compared with individuals living in neighbourhoods with low availability of healthy food after adjustment for demographic variables (beta = 3.22, P = 0.001). Associations were attenuated but remained significant after controlling for dietary quality (beta = 2.81, P = 0.012). Conclusions: Contrary to expectations, there was a positive association between the availability of healthy food and higher BMI among individuals living in predominantly white neighbourhoods. This result could be due to individuals in neighbourhoods with low healthy food availability travelling outside their neighbourhood to obtain healthy food.