How neighbourhood food shops influence children’s diets in Beirut and Tunis
Most food retailers surrounding schools in the Lebanese and Tunisian capitals sell unhealthy foods, and children in schools whose neighborhoods have a higher density of unhealthy food retailers and advertisements are more likely to be overweight or obese.
Those are some of the findings that emerged from IDRC-supported research undertaken in collaboration with the American University of Beirut and Tunisia’s National Institute of Nutrition and Food Technology. The research is part of an effort to inform interventions targeting childhood obesity in the urban settings of Beirut and Tunis.
The aim of the project is to foster the development of food environments that enable healthy eating among children and their families.
In the last two decades, substantial dietary changes have occurred in the Middle East and North Africa, leading to significant increases in the rates of overweight and obese school-aged children. Although children’s food consumption and eating habits are early risk factors for the development of non-communicable diseases, research on what influences these behaviors remains scant in the region.
What is clear, however, is that school and neighbourhood environments influence children’s dietary habits, including through the availability and promotion of ultra-processed products high in fat, sugar and salt.
“When children constantly consume these types of food, this can affect their energy levels, concentration and overall health,” said Hala Ghattas, who led the study in Lebanon. “Identifying those moments in children’s daily lives that represent threats to and opportunities for healthy eating can serve as levers for future interventions to improve child diets in urban middle-income settings.”
The research aimed to describe the environments in Greater Beirut and Greater Tunis at the level of households, schools and communities where children encounter food, and then identify barriers and enablers to healthy food consumption within those environments.
Wearable cameras help map food environments
The study developed a set of innovative research tools adapted to each context to collect data from 47 schools and neighbourhoods in Lebanon and 50 in Tunisia.
To uncover exposures and cues to food consumption and eating behaviours in children’s daily trajectories to and from schools, the study used wearable cameras as part of a culturally acceptable machine-learning-based data-collection system to objectively capture school children’s exposure to food environments (including food items, advertisements and retailers) and to categorize these by healthiness levels.
In Lebanon, the study collected data from 2,135 children and 1,469 parents. It also collected 190 days of images from wearable cameras, and mapped 3,243 food retailers and 2,000 food advertisements. In Tunisia, the study generated data from 2,465 children and 2,372 parents. It collected 308 days of images from wearable cameras, and mapped 3,621 food retailers and 2,009 food advertisements.
Food environments around school promote ultra-processed foods
The study mapped the community food environments that children were exposed to within a 10-minute walk from their schools. It found that children’s daily trajectories exposed them to large volumes of unhealthy food outside the home, whereas food consumed at home tended to be healthier.
In both Beirut and Tunis, food environments in school neighbourhoods included predominantly unhealthy food retailers. Research showed that around 60 percent of food retailers surrounding schools sold mostly unhealthy ultra-processed foods. Similarly, most food advertisements were promoting solely ultra-processed foods.
While the overall prevalence of overweight and obesity is high in both Beirut and Tunis, children who attended schools with a greater density of unhealthy food retailers in their neighborhoods had higher rates of obesity.
The project used surveys to explore food environments and nutrition-related policies in schools. They showed that although some policies related to food sales in schools existed in Tunisia, none of the 50 schools had a policy regarding types of food sold in school or permission to use food as a reward to students. In Lebanon, there was a mix of policies. However, only a third of schools were fully implementing policies on food and nutrition in school.
“The key elements of the food environment around schools highlighted by this study could contribute to the development, implementation and evaluation of appropriate school food and nutrition policies,” said Jalila El Ati, who led the project in Tunisia. “Effective implementation of such interventions would have the potential to be duplicated in other, similar urban contexts in the region.”
As part of efforts to disseminate the research findings, the project produced infographics and short videos aimed at informing school staff, school-age children and their parents on the importance of healthy diets.