Exploring Cross-Sector Approaches to Promote Healthy Eating and Prevent Obesity

Abstract

Obesity impacts two-thirds of adults and one-third of children in the United States. This dissertation explores approaches to promote healthy eating and prevent obesity in primary care and grocery retail settings. In Chapter 1, I evaluated how primary care physicians (PCPs) reported managing patients with obesity and whether there were differences between Democratic and Republican PCPs. This was a secondary analysis of a survey of 225 PCPs registered to vote as Democrats or Republicans. PCPs were least likely to say they would prescribe medication (3.9%) or refer the patient to counseling (24.0%). Republicans were more likely to report that they would inquire about the time course of obesity (73.4% v. 56.2%, p= 0.012) and discuss the health risks of obesity (91.0% v. 78.3%, p=0.018). In Chapter 2, I compared the sociodemographic characteristics of households who grocery shopped online with curbside pickup versus those who only shopped in-store. The study population was 863 adults enrolled in fruit and vegetable incentive trials in Maine supermarkets. Online shoppers had higher incomes (p<.0001), were less likely to participate in WIC or SNAP (p<.0001), and were more likely to be female (p=0.04). Most online shoppers were 30 to 39 years old (p=0.003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income, and SNAP participation, female gender (OR=2.75, p=0.003), number of children (OR=1.27, p=.04), and higher income (p<.0001) were significantly associated with shopping online. In Chapter 3, I described the grocery shopping patterns of 137 primary household shoppers who shopped both online (with curbside pick-up) and in-store. The study population was 137 primary household shoppers who shopped in two Maine supermarkets over 44 weeks. Online and in-store transactions were compared using paired t-tests and descriptive analyses with respect to frequency, total spending, number of items purchased, and spending on food groups and subgroups. Mixed effects regression models estimated differences in spending on five unhealthy, impulse-sensitive subgroups. When shopping online, participants spent 44% more per transaction (p<.0001), purchased more items (p<.0001), and spent less per transaction on candy (-$0.57, p<.0001), cold or frozen desserts (-$0.27, p=0.005), and grain-based desserts (-$1.09, p<.0001).