Abstract An unhealthy diet is a major risk factor for chronic diseases including cardiovascular disease, type 2 diabetes, and cancer 1–4 . Limited access to healthy food options may contribute to unhealthy diets 5,6 . Studying diets is challenging, typically restricted to small sample sizes, single locations, and non-uniform design across studies, and has led to mixed results on the impact of the food environment 7–23 . Here we leverage smartphones to track diet health, operationalized through the self-reported consumption of fresh fruits and vegetables, fast food and soda, as well as body-mass index status in a country-wide observational study of 1,164,926 U.S. participants (MyFitnessPal app users) and 2.3 billion food entries to study the independent contributions of fast food and grocery store access, income and education to diet health outcomes. This study constitutes the largest nationwide study examining the relationship between the food environment and diet to date. We find that higher access to grocery stores, lower access to fast food, higher income and college education are independently associated with higher consumption of fresh fruits and vegetables, lower consumption of fast food and soda, and lower likelihood of being affected by overweight and obesity. However, these associations vary significantly across zip codes with predominantly Black, Hispanic or white populations. For instance, high grocery store access has a significantly larger association with higher fruit and vegetable consumption in zip codes with predominantly Hispanic populations (7.4% difference) and Black populations (10.2% difference) in contrast to zip codes with predominantly white populations (1.7% difference). Policy targeted at improving food access, income and education may increase healthy eating, but intervention allocation may need to be optimized for specific subpopulations and locations.
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This content will become publicly available on January 6, 2026
How does delivery service change food accessibility: A modified 2-step floating catchment area method
Existing methodology on food accessibility predominately focuses on on-premise services, that is, dine-in and shopping at stores, which assumes a linear distance decay property (the closer, the higher accessibility). Access to delivery services is fundamentally different from that to on-premise stores. Stores with close proximity (within an inner boundary) are less desirable for delivery due to delivery fees, and there is an outer boundary beyond which deliveries are unavailable, both challenging the assumption of increasing impediment with distance. These two boundaries form a donut shape for delivery services. We propose a modified 2-step floating catchment area method that incorporates the donut shape, accounts for both demand and supply, and examines the diversity of food options. Using Seattle as a case study, our results show that delivery services increase restaurant and fast-food accessibility in areas where there is already good accessibility (e.g., downtown Seattle for restaurants and South Seattle for fast-food). Given South Seattle is where low-income and low-access households concentrate, the increase in accessibility to fast-food may not be desired. Interestingly, with delivery services, more low-income or low-access households (those who live far from grocery stores) have better accessibility to fresh produce from grocery stores compared to the rest of the population. And the newly created Supplemental Nutrition Assistance Program (SNAP) online program appears to miss low-access households. These findings have important implications for policymakers and stakeholders seeking to improve food accessibility in urban areas through delivery services.
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- Award ID(s):
- 2053373
- PAR ID:
- 10565116
- Publisher / Repository:
- SAGE Publications
- Date Published:
- Journal Name:
- Environment and Planning B: Urban Analytics and City Science
- ISSN:
- 2399-8083
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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