Food environments and obesity: Household diet expenditure versus food deserts

Objectives. To examine the associations between obesity and multiple aspects of the food environments, at home and in the neighborhood. Methods. Our study included 38 650 individuals nested in 18 381 households located in 2104 US counties. Our novel home food environment measure, USDA Score, evaluated the adherence of a household's monthly expenditure shares of 24 aggregated food categories to the recommended values based on US Department of Agriculture food plans. The US Census Bureau's County Business Patterns (2008), the detailed food purchase information in the IRi Consumer Panel scanner data (2008-2012), and its associated MedProfiler data set (2012) constituted the main sources for neighborhood-, household-, and individual-level data, respectively. Results. After we controlled for a number of confounders at the individual, household, and neighborhood levels, USDA Score was negatively linked with obesity status, and a census tract-level indicator of food desert status was positively associated with obesity status. Conclusions. Neighborhood food environment factors, such as food desert status, were associated with obesity status even after we controlled for home food environment factors.