This paper reviews studies on the interactions between weight loss and food environments in several high-income countries. It finds that unsupportive food environments can undermine people’s efforts to lose weight or maintain weight loss in many ways, especially for people on a low income.
As the paper notes, most people who have successfully met their desired weight loss goals regain the lost weight (over 95% over the course of three years) and sometimes gain more weight than they lost while dieting. The aim of this paper is to explore the external influences that shape people’s food and drink options - i.e. the food environment.
26 papers were included in the review, covering 12 high-income countries and 679 people, published between 2011 and 2020. The authors identified four common themes from these studies:
- Constant effort is required to navigate the food environment. People have to frequently plan around food options that they perceive as being unhealthy, for example by bringing meals to work to avoid eating from a vending machine (and hence having to set aside time to prepare those meals), by only shopping from a pre-prepared list, by buying smaller (but proportionally more expensive) portions of food, or by avoiding shopping when hungry. One solution that people found helpful in the studies was workshop-style education sessions covering recipes, portion guidance and label reading.
- People’s efforts are undermined by the availability of less nutritious options. Widespread fast food advertising was seen by study participants as making healthier options less tempting, while fast food outlets are more likely than healthier options to be near homes and workplaces. Reaching outlets for healthier options can require more travel or higher delivery costs, with deprived areas being particularly affected by the expense and time of reaching larger supermarkets. People trying to manage their weight found it easier to follow healthier diets when those foods were easier to access, for example through the food options available on university campuses or affordable fruit and vegetable boxes being sold at a weekly farmers’ market at the workplace.
- The higher cost, both real and perceived, of healthier produce is challenging for people on low incomes. Many study participants saw healthy foods as more expensive than less healthy options, and hence people engaged in weight management often deprioritised it when buying food on a low budget, particularly when they also have a family to buy for. Cut-price items in the supermarket are often appealing as a way to save money even when they are for items not in line with a person’s diet plan or shopping list.
- Social situations can present a particular challenge to weight management. For example, eating out at restaurants or cafes can “trigger” eating foods high in fat, salt or sugar; meanwhile, friends and colleagues are likely to bring less nutritious foods to social events. Participants reported social pressure to eat highly calorific foods or drink alcohol, with both women and men experiencing critical remarks about weight management from acquaintances. People used a variety of strategies for these occasions, including: skipping desserts in restaurants; accepting food at work events but not eating it all; or bringing their own food to social occasions. Nevertheless, people found that social pressures around food consumption made social occasions uncomfortable.
The review concludes that reshaping the food environment is essential for supporting people who wish to manage their weight, for example by encouraging supermarkets to offer promotions on healthier foods, supporting workplaces in providing healthier options, providing clearer food labelling about portion sizes and nutritional information, restricting marketing of foods high in fat, sugar or salt, incentivising fast food outlets to offer healthier options, and providing ongoing financial support for people on lower incomes.
People engaged in weight loss or weight loss maintenance (weight management) often regain weight long term. Unsupportive food environments are one of the myriad challenges people face when working towards a healthier weight. This systematic review explores how the food environment influences people engaged in weight management and the policy implications. Nine electronic databases (CINAHL, Medline, PsycINFO, Academic Search Complete, Embase, Ovid Emcare, PubMed, Open Grey, and BASE) were searched systematically in May 2020 to synthesize the qualitative evidence. Eligible studies were conducted with adults (18+) in high-income countries, available in English and published 2010–2020 with a substantial qualitative element and reference to food environments. Data were analyzed using a thematic synthesis approach. Quality assessment using the Critical Appraisal Skills Programme was undertaken. We identified 26 studies of 679 individuals reporting on weight management experiences with reference to the food environment. Limitations of the included studies included a lack of detail regarding socioeconomic status and ethnicity in many studies. The analysis revealed that food environments undermine efforts at weight management, consistently making purchasing and consumption of healthier food more difficult, particularly for those on a low income. For weight management to be more successful, concurrent actions to reshape food environments are necessary.
Neve, K.L. and Isaacs, A., 2021. How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature. Obesity Reviews, p.e13398.