Exploring the Relationship between the Built Food Environment and Obesity Among African Americans: A Systematic Review

Background: Nearly 50% of African Americans have obesity, compared to 42% of Non-Hispanic, white adults (Hales, Carroll, Fryar, & Ogden, 2020). Obesity is associated with numerous co-morbid health conditions. Previous research has established the importance of the built food environment, defined as the physical access to food in a neighborhood or community (Glanz, Sallis, Saelens, & Frank, 2005), in shaping weight-related behaviors and influencing risk for obesity. An understanding of this relationship in African Americans, however, remains limited. Thus, the purpose of this systematic review is to explore the relationship between the built food environment and obesity among African Americans. This review expands Casagrande and colleagues' (2009) earlier systematic review of the relationship between the built environment and health behaviors among African Americans by reviewing the literature published beginning January 1, 2008 to February 1, 2020.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible and included studies were: written in English, published after January 1, 2008, had data collected in the United States, comprised of participants who were >18 years, had a sample that was predominately (greatest percentage of sample) African American, and examined associations between the built food environment and obesity. We conducted a literature search in PubMed, CINAHL, PsychInfo via EBSCO and Web of Science. The search included both peer-reviewed articles and grey literature. Boolean search terms included: neighborhood AND built environment AND food insecurity AND obesity AND body mass index (BMI) AND African American. The protocol was developed with the assistance of a research librarian.

Results: A total of 2,054 titles were identified in the initial search. After screening the title and abstract, a full-text review of 126 studies were conducted, and 11 studies met the inclusion criteria. Various study designs were used among the included articles: qualitative (n=1), cross-sectional (n=6), mixed method (n=1), secondary data analysis (n=1), and longitudinal cohort (n=2). The median sample size was 11,462 (83 to 97,366). A majority of studies reported a positive relationship between the built food environment and obesity among African Americans (n=8). Specific built food environment factors associated with obesity include: distance to store (n=2), type of grocery store frequented (e.g., supermarket, warehouse store) (n=2), distance traveled to store (n=2), amount of money spent on food (n=2), neighborhood composition (n=1) and proximity to fast food restaurants (n=2).

Conclusions and Implications: Similar to the results found in Casagrande et al., (2009), the current systematic review highlights the importance of the built food environment and its impact on obesity in African Americans. In fact, African Americans who shop at certain types of grocery stores may increase their risk for obesity. Social workers have opportunities to improve food policy initiatives and encourage the presence of supermarkets in neighborhoods to mitigate the rising rates of obesity. Future studies should investigate the relationship between specific elements of the built food environment, including store type and distance to food access, and their relationship to obesity in African Americans.