Availability and price of healthier food choices and association with obesity prevalence in New Zealand Maori

Background and Objectives: Examine availability and price of healthier foods-vs-regular counterparts and their association with obesity. Methods and Study Design: A cross-sectional survey of weight and height among Māori in 2 urban and 96 rural areas in the Waikato/Lakes Districts-NZ (year 2004-06) was undertaken. Concurrently, availability of 11 'healthier' food in fast-food-outlets was examined by location (urban vs rural) and median income (high-low). In supermarkets, five-specific 'regular' foods were scored against 'healthier' counterparts (white-vs-wholemeal bread, with-skin-vs-skinless chicken, regular-vs-trim meat, standard-vs-trim milk, sugarsweetened- beverages vs-water) for in-store availability and price according to the Nutrition Environment Measures Survey. Results: Overall, 3,817 Māori (BMI: women: 32.9±7.8 kg/m ² ; men: 33.1±6.7 kg/m ² ) were included with 451 food-outlets in two urban-clusters and 698 food-outlets in 96 rural-clusters. Fast-foods: The availability of healthier food choices was higher for 8/11 items in rural and low-income areas than urban and high-income areas. Multivariate analysis considered location and income as cofactors. No association between number of fast-food-outlets/cluster and healthier foods/cluster with obesity prevalence (General/Māori BMI cutoffs) was observed. Supermarkets: Water was cheaper than sugar-sweetened-beverages and negatively associated with obesity prevalence (General r=-0.53, p=0.03; Māori r=-0.53, p=0.03); high availability scores for trim milk compared to standard milk correlated with higher obesity prevalence (General r=0.49, p=0.04; Māori r=0.57, p=0.01). Conclusions: Bottled water vs sugar-sweetened-beverages prices were inversely associated with obesity. This supports the argument to regulate the availability and price of sugar-sweetened-beverages in NZ. The positive association of the availability of trim milk with the prevalence of obesity warrants investigation into individual's dietary and food-purchase behaviour.