Trust for America’s Health’s (TFAH) report, The State of Obesity 2021: Better Policies for a Healthier America provides an annual analysis of national obesity and overweight trends. In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that while obesity rates in the U.S. have been at epidemic proportion for years, the COVID-19 pandemic changed eating habits, put families at risk for food insecurity, and heightened stress, all worsening the countries’ decades long pattern of obesity.
A major part of a person’s ability to maintain a healthy diet is being able to access and afford quality, nutritious food. This access requires that all communities have local grocery providers, like supermarkets, farmer’s markets, and/or community gardens. In addition to physical proximity, stores need to be accessible via driving, walking, biking, and public transportation. Access to farmer’s markets or full-service grocery stores means that community members have the option to purchase fruits and vegetables, and less processed foods. Without such access, “food deserts” can develop – neighborhoods where grocery stores are largely inaccessible due to their distance or the lack of public transportation. Food desert communities often have fast food outlets or stores that sell processed, packaged foods with low nutritional value. A food environment with limited healthy options can contribute to the likelihood that a person or community struggles with chronic health issues related to diet like obesity, diabetes, hypertension, stroke, and cardiovascular disease.
Transportation and Food Access
The 2017-2018 National Health and Nutrition Examination Survey (NHANES) estimates the 42.4 percent of U.S. adults have obesity. According to the United States Department of Agriculture (USDA) 40 million Americans have poor access to food retailers. This lack of access is heavily concentrated in rural, low-income, and minority neighborhoods. Also contributing to the food deserts problem is that 2.1 million U.S. households do not own an automobile and live 20 miles from a supermarket, burdening mostly low-income and minority communities. According to the U.S. Centers for Disease Control and Prevention, providing public transit is a simple strategy that can improve people’s ability to receive medical care, purchase healthy food, and access opportunities for physical activity, but 45 percent of U.S. households do not have access to public transit and approximately 20 percent have transportation barriers that limit their ability to buy healthy foods. Poor transportation infrastructure is considered the largest and most pressing healthy foods access barrier in rural areas.
A study published in Preventing Chronic Disease evaluated a nationally representative sample of approximately 2,000 U.S. municipalities for their public transit infrastructure: availability of public transit, planning for food access in public transit, and availability of more individualized demand-responsive transit (DRT) as a public transit alternative. DRT offers smaller buses or vans for transportation without a fixed time schedule or route. The study used National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL) data that evaluated municipal government policies and practices that encourage healthy eating and physical activity. It found that approximately one-third of municipalities did not have public transit, most commonly in municipalities that were rural, Southern, had a population of fewer than 2,500 people, had a median educational attainment of high school graduation or less, or had a population that was greater than 50 percent non-Hispanic white. Statistical significance was found for smaller population size, rural status, being in the Southern census region, and greater poverty prevalence relative to the availability of public transit. Approximately one-third of municipalities with public transit reported planning for food accessibility. It was reported more commonly among larger municipalities, urban municipalities, Western municipalities, municipalities with less than 50 percent non-Hispanic white people, and in municipalities that contained food deserts.
Community Examples to Improve Food Access
Although the study results did not find a strong, health-focused public transit infrastructure in many communities, often communities most in need of such services, there are some hopeful examples of community efforts to improve food access. They include the public Grocery Bus line in Austin, Texas that connects a low-income, Latino community that lacks adequate transportation options with supermarkets. It is a city-community-business collaborative that has now been integrated into the regular transit system. Similarly, the Dallas Area Rapid Transit (DART) GoLink program in Dallas, Texas provides transportation for essential needs, including food, that is an on-demand service and has been expanded in partnership with Uber. Community leaders have been able to distribute rider cards to residents and social workers, hoping to partner with community-based organizations, and anecdotally observed users benefit, like being able to purchase their full grocery list with the help of readily available and accessible transportation. As of February 2019, thirty-eight states, Puerto Rico, and the District of Columbia also authorize by statute, public-private transportation partnerships.
Policy Actions and Recommendations
In addition to the encouraged collaborations targeting food access and availability through public transit, TFAH makes additional policy recommendations to encourage healthy behaviors and mitigate obesity risk. These can be especially impactful in affected areas struggling with food insecurity.
- Ensure free, healthy school meals for all students to increase childhood access to healthy foods.
- Expand Supplemental Nutrition Assistance Program (SNAP) benefits and enhance access to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
- Increase funding to allow for the expansion of the Centers for Disease Control and Prevention’s (CDC) National Center for Chronic Disease Prevention and Health Promotion obesity prevention programs in all 50 states. This funding should include allocations for the CDC divisions of Nutrition, Physical Activity and Obesity and Racial and Ethnic Approaches to Community Health.
- Ensure safe and convenient access to walking and biking trails, for leisure as well as school transportation. Furthermore, education agencies should prioritize integrating physical activity and movement regularly throughout the school day.
- Disincentivize unhealthy food choices by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to children and by enacting sugary drink excise taxes where tax revenue is allocated to local efforts to reduce health and socioeconomic disparities.
Read TFAH’s State of Obesity: Policy Recommendations for a Healthier America 2021 report and recommendations.