Ubiquity of energy-dense snack foods: A national multi-city study

Background: The obesity epidemic has risen in parallel with increased snacking and increases in consumption of energy-dense snack foods. The mere availability of these foods can promote consumption. We assessed the availability of these foods in retail outlets.

Methods: Pairs of observers visited retail stores that were not food stores or restaurants in 20 U.S. cities. In each city, ten consecutive stores meeting inclusion criteria were observed in each of six commercial areas. Observers noted the availability, location, and “for-free” accessibility of sweetened beverages, coffee, salty snacks, candy, baked sweets, and frozen sweets.

Results: Data are currently available for six cities. In these cities, 36% of outlets that sold goods and 37% of those that sold services offered some snack foods or beverages. Seventeen percent offered carbonated beverages, 11% other sweetened beverages, and 9% coffee; 28% offered candy, 16% salty snacks, 11% baked sweets, and 6% frozen sweets. For 61% of outlets offering salty snacks and 46% of outlets offering candy the items were within arm's length of the cash register queues. Among those with candy it was free in 24%. Among the types of outlets most frequently observed, those most likely to have any snack foods or beverages were banks (47%) and beauty salons, nail salons, and barber shops (38%).

Discussion: Foods closely linked to obesity are widely sold in stores that are not licensed food retailers. To combat the obesity epidemic health departments, which have legal authority to regulate food sales, should consider restrictions on sales in non-food stores.