All ETDs from UAB

Advisory Committee Chair

Kevin R Fontaine

Advisory Committee Members

Thomas Creger

Kathy F Harrington

Virginia Howard

Suzanne E Judd

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Given the growing obesity epidemic in the U.S., modifying current obesogenic food environment, and identifying and promoting an obesity-modifying dietary approach that fits in the food environment context are urgent. Emerging evidence indicates that Mediterranean diet (MD) could be a beneficial dietary pattern to protect against overweight/obesity. However, as a relatively new dietary pattern in the U.S., how the unique food environment influences MD adherence, and whether consuming a MD can mediate the relationship between food environment and obesity among the population remain unknown. This dissertation, applying Geographic Information System (GIS) and path analytical methods using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and government surveillance databases, aimed to extend our understanding of the interplay between community food environment, MD adherence, and obesity among U.S. adults by answering the following research questions: (1) is community food environment related to obesity; (2) is community food environment related to MD adherence; and (3) does consuming a MD mediate the relationship between community food environment and obesity. For the first paper, spatial mapping/modeling were used to examine the relationship between food environment and obesity. The results showed that greater access to healthy food outlets was related to lower BMI, and the relationship varied across regions. For the second paper, the same spatial analytical methods were used to examine the relationship between food environment and MD adherence. However, no significant relationship was found. For the third paper, path analysis was used to test if consuming a MD mediates the relationship between food environment and obesity. The results showed that MD adherence mediated the relationship between food environment and obesity among a subpopulation whose annual household income < $75K. Overall, the findings from this dissertation extend our current understanding of the complex interrelationship between food environment and individuals’ diet pattern and obesity outcome. It further provides strong evidence of the needs for local population- and geographically-tailored interventions and policies to achieve efficacious obesity prevention among the U.S. adult population. Future research is needed to inform policy decisions and intervention development to stop the obesity epidemic in the U.S.

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