When My Lovely Wife and I embarked on the hunt that led us to our current abode, our short list of criteria did not include its proximity to a convenience store or a fast-food joint. It’s not that we disdained convenience or avoided Big Macs, but we were more concerned with the number of bedrooms (our fledglings had not yet flown the coop), the potential for gardens, and the general neighborhood vibe.
And while we’re pleased with the choice we made 13 years ago, new research suggests our due diligence may not have been quite diligent enough. We could be living in a stroke-producing “food swamp.”
In a paper presented last month at the American Stroke Association’s International Stroke Conference, a research team led by Dixon Yang, MD, a postdoctoral fellow at Columbia University Irving Medical Center, found that older adults residing in communities harboring an overabundance of fast-food outlets, cafés, and convenience stores were more likely to suffer a stroke than their peers who are surrounded by grocery stores and other purveyors of healthier fare.
“An unhealthy diet negatively impacts blood pressure, blood glucose, and cholesterol levels that increases the risk of stroke,” Yang explains. “Independent of one’s own demographics or socioeconomic status, living in a neighborhood with an abundance of poor food choices may be an important factor to consider for many people.”
Cross-referencing data from the University of Michigan’s Health and Retirement Study (HRC) with food environment information from the U.S. Department of Agriculture, Yang and his team developed a retail food environment index. They based this metric on the ratio of unhealthy food sources (fast-food outlets, full-service restaurants, and convenience stores) to sources of more nutritious foods (grocery stores, farmers’ markets). A 5-to-1 mix, they determined, describes a food swamp.
Yang’s team garnered data from 17,875 HRC participants (average age of 64) surveyed between 2010 and 2016 and extrapolated the results to represent more than 84 million Americans. They calculated that 3.8 percent of study participants — representing about 3.2 million people — reported suffering a stroke. Those living in food swamps were 13 percent more likely to suffer one than their counterparts residing in neighborhoods with more access to healthy food.
“Our research highlights the potential importance of an area’s retail food options as a structural factor affecting stroke,” says Yang, “especially since most participants resided in areas with six times the amount of relative unhealthy to healthy food choices.”
Only about three in 10 HRC participants lived in a healthy-food zone — a testament, one might argue, to America’s debilitating culinary culture. Or is it more likely the result of random supply and demand? Just as most of us don’t choose a home solely based on its proximity to a supermarket, businesses — including convenience stores and fast-food outlets — will put down roots anywhere they perceive there’s a market to serve.
When MLW and I bought our first house back in the mid-1980s, the only property we could afford was mired in what Yang would describe as a food swamp: no grocery stores within a couple of miles, plenty of convenience stores, and a smattering of low-budget restaurants and fast-food joints. The fact that it was a predominately Black neighborhood was probably not coincidental. But, if we’re to believe Yang’s conclusions, it’s not just hardscrabble communities that are lacking healthy food sources and thus exposing their older residents to a greater risk of stroke.
Because the study has not yet been published, however, it’s difficult to evaluate its results. Yang admits, for instance, that its cross-sectional design is simply a snapshot of a single period of time and can’t prove cause and effect. Also, the incidences of stroke were self-reported, raising additional questions of accuracy. We’re left to wonder, as well, how exactly the researchers adjusted for demographic, lifestyle, and other factors.
Part of me is curious about how our current neighborhood, with its plethora of bistros, paucity of convenience stores, and scattered fast-food outlets, would rank in Yang’s calculations. We’re not lacking in grocery stores; our farmers’ markets are popular destinations. But I’m guessing there are too many restaurants to suit his stroke calculus.
Still, I have a hard time conceding that our robust mix of food establishments will have much of an effect on my cardiovascular function. After all, you get to choose what you eat, regardless of the source. Put another way, a swamp presents some dangers when you’re wading mindlessly among the reeds near the shoreline, but it offers few threats when you’re paddling in a canoe.