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      Food Systems and Public Health Disparities

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          Abstract

          The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

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          Most cited references118

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          The economics of obesity: dietary energy density and energy cost.

          Highest rates of obesity and diabetes in the United States are found among the lower-income groups. The observed links between obesity and socioeconomic position may be related to dietary energy density and energy cost. Refined grains, added sugars, and added fats are among the lowest-cost sources of dietary energy. They are inexpensive, good tasting, and convenient. In contrast, the more nutrient-dense lean meats, fish, fresh vegetables, and fruit generally cost more. An inverse relationship between energy density of foods (kilojoules per gram) and their energy cost (dollars per megajoule) means that the more energy-dense diets are associated with lower daily food consumption costs and may be an effective way to save money. However, economic decisions affecting food choice may have physiologic consequences. Laboratory studies suggest that energy-dense foods and energy-dense diets have a lower satiating power and may result in passive overeating and therefore weight gain. Epidemiologic analyses suggest that the low-cost energy-dense diets also tend to be nutrient poor. If the rise in obesity rates is related to the growing price disparity between healthy and unhealthy foods, then the current strategies for obesity prevention may need to be revised. Encouraging low-income families to consume healthier but more costly foods to prevent future disease can be construed as an elitist approach to public health. Limiting access to inexpensive foods through taxes on frowned upon fats and sweets is a regressive measure. The broader problem may lie with growing disparities in incomes and wealth, declining value of the minimum wage, food imports, tariffs, and trade. Evidence is emerging that obesity in America is a largely economic issue.
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            Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms.

            Nonnutritive sweeteners (NNS) are ecologically novel chemosensory signaling compounds that influence ingestive processes and behavior. Only about 15% of the US population aged >2 y ingest NNS, but the incidence is increasing. These sweeteners have the potential to moderate sugar and energy intakes while maintaining diet palatability, but their use has increased in concert with BMI in the population. This association may be coincidental or causal, and either mode of directionality is plausible. A critical review of the literature suggests that the addition of NNS to non-energy-yielding products may heighten appetite, but this is not observed under the more common condition in which NNS is ingested in conjunction with other energy sources. Substitution of NNS for a nutritive sweetener generally elicits incomplete energy compensation, but evidence of long-term efficacy for weight management is not available. The addition of NNS to diets poses no benefit for weight loss or reduced weight gain without energy restriction. There are long-standing and recent concerns that inclusion of NNS in the diet promotes energy intake and contributes to obesity. Most of the purported mechanisms by which this occurs are not supported by the available evidence, although some warrant further consideration. Resolution of this important issue will require long-term randomized controlled trials.
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              Fruit and vegetable intake among urban community gardeners.

              To determine the association between household participation in a community garden and fruit and vegetable consumption among urban adults. Data were analyzed from a cross-sectional random phone survey conducted in 2003. A quota sampling strategy was used to ensure that all census tracts within the city were represented. Flint, Michigan. 766 adults. Fruit and vegetable intake was measured using questionnaire items from the Behavioral Risk Factor Surveillance System. Household participation in a community garden was assessed by asking the respondent if he or she, or any member of the household, had participated in a community garden project in the last year. Generalized linear models and logistic regression models assessed the association between household participation in a community garden and fruit and vegetable intake, controlling for demographic, neighborhood participation, and health variables. Adults with a household member who participated in a community garden consumed fruits and vegetables 1.4 more times per day than those who did not participate, and they were 3.5 times more likely to consume fruits and vegetables at least 5 times daily. Household participation in a community garden may improve fruit and vegetable intake among urban adults.
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                Author and article information

                Journal
                J Hunger Environ Nutr
                J Hunger Environ Nutr
                when
                Journal of Hunger & Environmental Nutrition
                Taylor & Francis
                1932-0248
                1932-0256
                11 December 2009
                July 2009
                : 4
                : 3-4
                : 282-314
                Affiliations
                Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health and Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
                Author notes
                Address correspondence to Roni A. Neff, Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Rm. W7010, Baltimore, MD 21205. E-mail: rneff@ 123456jhsph.edu
                Article
                10.1080/19320240903337041
                3489131
                23173027
                6a1c7ac2-1884-4b9b-882d-caf58afa303c
                Copyright © Taylor & Francis Group, LLC

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Research Article

                Nutrition & Dietetics
                health disparities,sustainably produced food,farm bill,access to food,public health,healthy foods,agriculture

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