Supermarkets: Components of Causality for Healthy Diets—Reply

In reply

Like Lehmann et al, our goal is to improve diets of low-income individuals, particularly those residing in dense urban and sparsely populated rural areas. The ultimate question is how to best achieve this goal.

Two other pieces of evidence bolster our reservations about the focus on supermarket access, without consideration of other driving factors. First, a natural experiment in the United Kingdom compared diet behavior before and after introduction of a supermarket in a food desert.¹ Compared with a control community, no significant increases in fruit and vegetable consumption occurred. Second, a joint Institute of Medicine–National Academy of Sciences task force workshop (chaired by B.M.P.) on the public health impact of food deserts found limited evidence that placing supermarkets in food deserts alone would improve the diets of poor individuals.² It is possible that providing supermarkets in isolation of other efforts may not change consumer behavior or improve health.