Public Health Nutrition

HOT TOPIC – Food environment

Characterizing the food environment: pitfalls and future directions

Anne Vernez Moudona1 c1, Adam Drewnowskia2, Glen E Duncana2, Philip M Hurvitza3, Brian E Saelensa4 and Eric Scharnhorsta5

a1 Department of Urban Design and Planning, University of Washington, Box 3548002, Seattle, WA 98195, USA

a2 Department of Epidemiology, University of Washington, Seattle, WA, USA

a3 Urban Form Lab, University of Washington, Seattle, WA, USA

a4 Seattle Children's Research Institute, Division of General Pediatrics, University of Washington, Seattle, WA, USA

a5 School of Architecture, Royal Danish Academy of Fine Arts, Copenhagen, Denmark


Objective To assess a county population's exposure to different types of food sources reported to affect both diet quality and obesity rates.

Design Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups.

Setting King County, WA, USA.

Subjects Full census of food sources.

Results According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health.

Conclusions To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.

(Received July 28 2012)

(Revised December 06 2012)

(Accepted February 13 2013)

(Online publication April 10 2013)


  • Census of food sources;
  • Health value;
  • Exposure


c1 Corresponding author: Email