Supermarkets are spreading across parts of Asia, global beverage companies are expanding into once isolated areas in Africa, and processed foods are arriving in towns where people live on $2 a day. These are just a few examples of how food environments are changing around the world.

Current research on food environments tend to focus on high-income countries, such as the United States, as a response to rising obesity rates. A new collaboration between the University of Washington School of Public Health and the London School of Hygiene & Tropical Medicine outlines innovative ways to accelerate food environment research in low- and middle-income countries (LMICs) to address food insecurity and malnutrition. This has become increasingly important given the rapidly transitioning food environment in LMICs today.

“Food environment is a very critical interface between food supply and nutrition,” says Anju Aggarwal, acting assistant professor of epidemiology at SPH. “Greater availability of energy-dense convenient foods might be one of the key drivers of unhealthy food choices and the dual burden of malnutrition in LMICs, yet this domain is under-funded.”

Aggarwal is a key technical member of the Agriculture, Nutrition and Health (ANH) Food Environment Working Group alongside Adam Drewnowski, professor of epidemiology at SPH. The group recently published a report summarizing current knowledge and concepts of food environment. They also put forward a novel framework to be applied in LMICs.

The framework suggests food environments consist of two domains: external food environment and personal food environment. External food environment refers to food availability, prices, marketing and regulation, while personal food environment refers to food accessibility, affordability and desirability.

“Food environment is not just about availability of healthy foods in the neighborhood or community,” Aggarwal says. “There is a continuous interaction between what is available out there and how one accesses it, depending on their economic barriers and food-related preferences. Aligning the food system with nutrition and health requires a closer look at these interactions.”

Washington’s Seattle Obesity Study, led by Drewnowski and funded by the National Institutes of Health, developed a toolbox of metrics to capture external and personal food environment. The toolbox is currently being deployed in rural, semi-urban and urban counties in Washington state. The next step is to scale up these metrics to study food environments in LMICs.

To conduct food environment research in LMICs effectively, the ANH working group highlights four key points:

• Researchers need to consider the range of market and non-market food sources from which people get their food.
• Research must account for the full spectrum of healthy and unhealthy food products available.
• Static conceptualizations of community are problematic. What constitutes a community boundary on a map may not be relevant to people’s daily activities in real life.
• Researchers need to disentangle the numerous environmental and personal dimensions that are commonly conflated within the community and consumer concepts and terminology.
• Research must place more emphasis on personal perceptions that are known to be influential in shaping people’s decisions about what to eat.

Co-authors of the report include Jennifer Coates, Tufts University; Corinna Hawkes, City University of London; Anna Herforth, Columbia University; Suneetha Kadiya, London School of Hygiene and Tropical Medicine (LSHTM); Sofia Kalamatianou, LSHTM, Christopher Turner, LSHTM; and Helen Walls, LSHTM.