Multiplicity and complexity of food environment in China: full-scale field census of food outlets in a typical district

Objectives Community food environment is closely associated with residents' health status, and it has received substantial research attention in recent years. However, such studies are sparse in China. This study aims to reveal the characteristics of food environment in China. Subjects A ground-truthing field census of food outlets was conducted in Xi Hu district, Hangzhou. A novel categorizing system was developed to better characterize food outlets in the study area. Geocoding and food environment analysis were performed by Arc-GIS software. Results A total of 9274 food outlets were identified, of these, 6161 (66.43%) were food service places and 3113 (33.57%) were food stores. Fast-food restaurants (2692) and convenience stores (1764) were the two most numerous outlet types. The density of food outlets was 29.72/km(2) and 113.97/10,000 people. Availability of BMI-unhealthy food outlets was four times greater than that of BMI-healthy ones. Further, 41.86% of total food outlets provided food-delivery services; among them, fast-food restaurants were the highest (65.53%) providers. In the urban area, the average density of food outlets was 104/km(2). While, it was only 29/km(2) in the rural area. Conclusions Availability of food outlets was excellent in our study area, though it showed regional imbalance. Food environment tends to be obesogenic and high prevalence of food delivery service might increase this trend. Thus, policy makers should guarantee the smooth development of catering industry in China, so as to ensure a balanced nutrition environment.