Buying In to Nutritious Eating

Until recently, Sun Grocery in East Baltimore was like most other "corner stores" that dot Baltimore's inner city neighborhoods, its shelves lined with high-calorie snacks, sodas and convenience foods, with no low-fat milk and few fruits and vegetables or other healthy foods to choose from. But lately the Korean-American-owned store has gone on a health kick.

Today, colorful in-store posters read, "Stay Lean! Use Smoked Turkey in your greens and beans" and "Make food less greasy! Cooking with spray is easy!" Shelf cards now highlight low salt, low sugar or high fiber foods. They draw attention to Grape Nuts, Cheerios and Special K. Other shelf cards tout low-fat cooking spray over oil. In addition to promotional pieces around the store, a bowl with apples and bananas sits by the register.

"Many of our customers are overweight and eat greasy food," says Sun Grocery owner Soon J. Kim. "Good food is better for life."

Sun Grocery is just one participant in Baltimore Healthy Stores, a program launched by associate professor Joel Gittelsohn, PhD, International Health and Center for Human Nutrition, as a series of store-based interventions in low-income areas where healthy foods are often unavailable. The program strives to curb diet-related chronic diseases in ethnic-minority populations by increasing the supply of more nutritious foods, promoting them at the point of purchase, and educating store employees and customers alike about the benefits of healthier diets.

According to the American Obesity Association (AOA), obesity in the United States is a critical public health problem among ethnic-minority populations, many of whom make their home in urban areas. Among African Americans, obesity prevalence in adults is nearly 70 percent, and in Latino-American adults that figure is 73 percent, according to the AOA. By contrast, 62 percent of white Americans are considered obese.

"The problem is reduced availability, as well as reduced accessibility, to healthy food selections," says Gittelsohn. "In Baltimore, certain neighborhoods don't have local supermarkets, or people don't have transportation to get to markets."

Gittelsohn started the Healthy Stores projects in 2000 in the Marshall Islands and on two Apache reservations in Arizona. Three years later, he shifted his efforts closer to home, establishing Baltimore Healthy Stores at nine stores in East Baltimore.

Baltimore Healthy Stores project members work with store managers to stock healthier food items and conduct in-store taste tests, give away free bottles of water or pieces of fruit to people ordering carryout, hand out flyers recommending alternative snacks to typical junk food and teach employees to suggest healthier types of bread or to ask, "Easy on the mayo?" Since many shoppers in these stores are repeat customers, project members quickly form a bond, which helps reinforce their educational efforts over time, Gittelsohn says.

"Interaction is so important," Gittelsohn says. "Our interventionists go out into each of the nine stores two or three times a month to offer informal, point of purchase education to customers."

Initial feedback from questionnaires aimed at measuring customer impact and from interviews with store managers shows that the program is being accepted by the stores and the community, says Gittelsohn. At the end of the feasibility study this fall, project members will look for trends in impact on healthy food purchasing and consumption, and hopefully see positive results.

Next spring, Baltimore Healthy Stores will expand to nine more stores in West Baltimore.