Access to healthy food and adult obesity: A secondary evidence synthesis with clinical implications for endocrinology

Background: Obesity is highly prevalent and determined, in addition to individual factors, by characteristics of the food environment. Understanding how the availability of healthy foods affects obesity risk is important for endocrinology practice. Objective: Summarize the relationship between access to healthy food and obesity in adults and highlight the clinical and public health implications. Methods: Focused secondary synthesis based on contemporary systematic review and meta-analysis, supplemented by representative observational studies. Exposures are operationalized as proximity, density and composite indices (eg RFEI). Pooled odds ratios (ORs) with 95% confidence intervals were extracted; no new re-meta-analysis was performed. Quality and bias were considered within the framework of PRISMA and the ROBINS-I domain. Results: Closer availability of fast food was consistently observed to be associated with higher odds of obesity (≈OR 1.15), while proximity to supermarkets and greater density of fresh food stores were associated with lower odds (≈OR 0.90 and ≈OR 0.93). Composite indices are more often close to the neutral effect. Heterogeneity depends on the definition of the exposure zone (signal clearer in wider buffers, EG 1.5-3 km) and socioeconomic conditions. Although the effects are moderate at the individual level, they may be clinically significant in the population. Conclusion: The spatial availability of healthy food is measurably related to the risk of obesity. Endocrinological practice should combine individual counseling with "mapping" of local sources of fresh food and referral to realistically available resources. Public policies that reduce the dominance of unhealthy offerings AND encourage the opening/ sustainability of healthier food outlets have the potential for significant population benefit. Standardization of exposure metrics and evaluation of interventions in a real environment is needed.