Perceived neighbourhood food environment and overweight and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) participants in the Midwest US

Objective: To evaluate the relationship between neighborhood food environment perceptions and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) or Expanded Food and Nutrition Education Program (EFNEP) participants. Design: A cross-sectional study conducted during SNAP-Ed or EFNEP program participation in six states in the Midwest US between May 2016 and November 2017.Setting: Community centers, food pantries and other SNAP-Ed or EFNEP recruitment locations. Participants: Convenience sample of 1743 low-income, adult nutrition education program participants. Results: Controlling for participant location and other demographic variables, those who perceived that a large selection of fruits and vegetables were available to them were 22 % less likely to be obese (adjusted odds ratio 0·78, 95 % CI 0·63, 0·97). In addition, participants who perceived the distance to the grocery store where they purchased most of their groceries to be greater than 5 miles were 1·36 times more likely to be overweight or obese than those who travelled shorter distances for their groceries. Conclusions: SNAP-Ed or EFNEP participants' weight status may be associated with their perceptions of their neighborhood food environments. Programs incorporating nutrition education and food access initiatives should attempt to better understand participant perceptions in order to address barriers in their efforts and to ensure that healthy food is accessible to low-income residents. © The Authors 2020.