Public Health Nutrition

HOT TOPIC – Local community nutrition

Healthy food availability and the association with BMI in Baltimore, Maryland

Sarah Stark Casagrandea1 p1 c1, Manuel Francoa1a2, Joel Gittelsohna1, Alan B Zondermana3, Michele K Evansa3, Marie Fanelli Kuczmarskia4 and Tiffany L Gary-Webba1 p2

a1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

a2 Centro Nacional Investigación Cardiovascular, Calle de Melchor Fernandex Almagro, Madrid, Spain

a3 National Institute on Aging, Baltimore, MD, USA

a4 College of Health Sciences, University of Delaware, Newark, DE, USA


Objective To study the association between the availability of healthy foods and BMI by neighbourhood race and socio-economic status (SES).

Design Trained staff collected demographic information, height, weight and 24 h dietary recalls between 2004 and 2008. Healthy food availability was determined in thirty-four census tracts of varying racial and SES composition using the Nutrition Environment Measures Survey–Stores in 2007. Multilevel linear regression was used to estimate associations between healthy food availability and BMI.

Setting Baltimore City, Maryland, USA.

Subjects Adults aged 30–64 years (n 2616) who participated in the Healthy Aging in Neighborhoods of Diversity across the Life Span study.

Results Among individuals living in predominantly white neighbourhoods, high availability of healthy foods was associated with significantly higher BMI compared with individuals living in neighbourhoods with low availability of healthy food after adjustment for demographic variables (β = 3·22, P = 0·001). Associations were attenuated but remained significant after controlling for dietary quality (β = 2·81, P = 0·012).

Conclusions Contrary to expectations, there was a positive association between the availability of healthy food and higher BMI among individuals living in predominantly white neighbourhoods. This result could be due to individuals in neighbourhoods with low healthy food availability travelling outside their neighbourhood to obtain healthy food.

(Received September 09 2010)

(Accepted December 16 2010)

(Online publication January 28 2011)


c1 Corresponding author: Email

p1 Present affiliation and address for correspondence: Social and Scientific Systems, 8757 Georgia Avenue, Silver Spring, MD 20910, USA

p2 Present affiliation: Columbia Mailman School of Public Health, 722 168th Street, New York, NY 10032, USA