|| Checking for direct PDF access through Ovid
Obesity is an important and highly prevalent risk factor for non-communicable diseases in both developed and developing countries. Obesity prevalence is influenced by a complex, multifaceted system of determinants among which the food retailing and advertising environment is pivotal. Current food environments are often characterised by pervasive exposure to unprecedented availability and marketing of energy-rich and nutrient-poor foods. Mexico has one of the highest obesity rates in the world: 70% of the population is overweight or obese. The country has experienced a dietary and food retail transition involving increased high-calorie-dense food and drink availability.The aims of this study were 1) to analyse the associations between total food outlet density and BMI; 2) to examine the association of the retail food environment index (RFEI) and obesity; and 3) to study the association of the density of individual food outlets and obesity in Mexican adults in urban areas.The National Institute of Statistics and Geography in Mexico provided geographical and food outlet data; BMI, calculated from anthropometric measurements, and socio-economic characteristics of a nationally-representative sample of adults aged 18+, came from participants in the National Health and Nutrition Survey in Mexico (ENSANUT) 2012. I calculated densities of supermarkets, restaurants, chain and non-chain convenience stores, and fruit and vegetable stores in total and by individual type per 1000 people per census tract area, using ArcGIS. I calculated RFEI, the ratio of ‘unhealthy’ to ‘healthy’ food outlets. Using multilevel linear regression, I analysed the relationship between density of food outlet types and obesity using complex survey design in STATA14. All analyses were adjusted for sex, age, socioeconomic status and physical activity.Both non-chain convenience store density [β=3.10, 95% CI 0.97 to 5.23, p=0.004] and non-chain combined with chain-type convenience store density [β=2.71, 95% CI 0.63 to 4.80, p=0.011] were significantly associated with obesity. Total food outlet density showed no significant association with obesity. However, the RFEI was associated with higher levels of obesity [β=0.040, 95% CI 0.00049 to 0.02, p=0.040].Convenience stores, which offer a greater availability of energy dense foods with low nutrient content, pose a risk to higher levels of obesity. A balance of healthier food outlets versus non-healthy food outlets could decrease the risk of obesity in urban areas of Mexico.