Research

“If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances in mass life.”
–Rudolph Virchow

“Dietary consumption is driven not only by material constraints but also by immaterial, culturally shaped definitions of what is desirable…. What people eat represents the meeting-point between the desirable and the possible; as the latter changes, so must the former.”
–Mary Weismantel

There is growing concern worldwide with food system sustainability and nutritional health inequities, particularly under the pressures of globalization, climate change, and economic stress. The differing interests of public health systems and food industries add another dimension of complexity to the challenge of securing good nutrition for all.

My core commitment in my work is twofold: to contribute to expanding the life opportunities, health, and well-being of underprivileged communities, with a special interest in Latin America and the Caribbean, and to contribute to advancing local, national, and global food systems sustainability and nutrition security, broadly defined.

My current research interests include mixed-methods analysis of socioeconomic status and nutrition, the influence of “foodscapes” on nutritional health, the sociology of supply-demand interactions for processed and convenience food, the role of FDI and trade in transforming food systems and food access, the politics and prospects of food industry regulation, and migration effects on food behaviors.

Recent projects

Bridle-Fitzpatrick, S. (2015). “Food deserts or food swamps?: A mixed-methods study of local food environments in a Mexican city,” Social Science and Medicine, vol. 142 (Oct.), pp. 212-213, http://dx.doi.org/10.1016/j.socscimed.2015.08.010

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A kaleidoscope of obesogenic snacks

Differential access to healthy foods has been hypothesized to contribute to disparities in eating behaviors and health outcomes. While food deserts have been researched extensively in developed Anglophone countries, evidence from low- and middle-income countries is still scarce.

This mixed-methods study uses a multidimensional approach to analyze four food environments in low-, middle-, and high-income communities in Mazatlán, Sinaloa, Mexico. The study advances understanding of the role that food environments may play in shaping eating patterns by analyzing the density and proximity of food outlet types as well as the variety, quantity, quality, pricing, and promotion of different foods. These measures are combined with in-depth qualitative research with families in the communities, including photo elicitation, to assess perceptions of food access. The central aims of the research were to evaluate physical and economic access and exposure to healthy and unhealthy foods in communities of differing socioeconomic status as well as participants’ subjective perceptions of such access and exposure.

Findings indicate that none of the four analyzed territories is a food desert. However, the three low- and middle-SES areas, I would argue, are food swamps, or areas that have adequate access to healthy foods but are inundated with opportunities to consume calorie-dense foods and drinks. There is a notable difference in the daily neighborhood gauntlet of invitations to buy comida chatarra (junk food) faced by the participating middle- and low-income families compared to the high-income families.

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Coca Cola’s ubiquitous presence

The high-income community can be understood to have a distinct type of food environment, what I call a food oasis. Food oases, in contrast to food deserts, have adequate access to healthy food options. At the same time—in contrast to food swamps—food oases are areas in which stakeholders have managed to limit access to less-healthy options in order to support healthier lifestyles. From the perspective of someone trying to adopt healthier eating habits and avoid high-calorie snacks and drinks in order to maintain a healthy body weight, an environment divested of the usual unhealthy temptations to consume is indeed more like an oasis.

Though most studies of the relationship between food access and obesity have been concerned with food deserts, this study’s findings suggest that food swamps may be a greater concern.

The context in which we make choices often influences our decisions, behavior, and even preferences. Studies of the design of cafeterias have found that different ways of displaying foods influence what customers buy and consume. Placing healthy items at eye-level throughout the cafeteria, placing bowls of fruit instead of high-calorie snacks near check-out counters, and changing the location of the salad bar so that customers must walk around it leads to increased sales of these healthier items. The relative ease of access and frequency of exposure to different types of foods influences food preferences and eating behaviors.

The density and distribution of food outlets within a neighborhood food environment can be seen as a metaphor for a cafeteria. Just as some cafeterias are arranged to make cookies, french fries, and other high-calorie treats especially visible and accessible while other cafeterias emphasize healthier items, local foodscapes differ in their presentation and promotion of different types of foods.

Food swamps are choice environments laden with tempting stimuli and are therefore “hot” decision environments likely to prompt choices for immediate gratification (Yang, et al., 2012). In contrast, food oases, with their reduced exposure and access to—and temptation to consume—unhealthy snacks, drinks, and other foods, are “cooler” decision environments that can support people in making healthier dietary choices.

Because food choice environments so deeply influence dietary behaviors, it may be important to create food environments that not only make healthy choices accessible choices, but also make unhealthy choices less accessible.

Making sure that no community is a food desert is necessary but insufficient. Interventions that “dry out” food swamps—that is, that significantly reduce consumer exposure and access to calorically dense snacks and drinks—may be more efficacious.

Yet drying out food swamps involves more robust interventions than bringing healthy food access to underserved communities. Mexico recently has adopted bold national strategies to address the obesity epidemic through taxing sugar-sweetened beverages and packaged snacks and regulating unhealthy foods in schools. Such policies are an important area for further research into strategies to minimize disparities in dietary behavior and health as well as channel and shape more healthful nutrition transitions in both advanced and developing economies.

Bridle-Fitzpatrick, S. (2016, forthcoming). “Tortillas, pizza, and broccoli: Social class and dietary aspirations in a Mexican city,” Food, Culture, and Society, vol. 19, no. 1

Marked dietary changes are occurring nationwide in Mexico, yet these manifest differently among distinct socioeconomic status (SES) groups. This article examines several complex relationships among: SES; food preferences, norms, and aspirations; and actual dietary practices in a Mexican city.

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Making gorditas

Utilizing data from an in-depth ethnographic study conducted in Mazatlán, Sinaloa, this study takes a multidimensional qualitative approach in order to gain a more nuanced understanding of contemporary dietary changes and nutritional health disparities.

I draw on microeconomic consumer choice theory, which offers some insights into (food) consumption choices but remains largely silent on the rich and complex processes through which tastes and preferences are formed. I also employ Pierre Bourdieu’s model of the mechanisms through which social class shapes lifestyles and cultural tastes (Bourdieu, 1984).

In analyzing the dominant food choices and habits of the participants and the factors that structure them, I argue that consumers navigate a balance between “normative preferences” and “temptation preferences” that is driven by economic constraints but also different kinds of socially structured exposures, access, beliefs, and norms.

This paper contributes to the study of the social structuring of food consumption patterns and preferences by investigating how SES not only influences actual dietary patterns, but also shapes the diets that people aspire to consume in a developing-country setting. Very few studies distinguish actual dietary behaviors from food preferences, interrogate disjunctures between dietary patterns and aspirations, or investigate tensions between normative and temptation food preferences. Understanding the greater vulnerabilities to obesogenic diets that low-SES groups face and addressing them through policy will be important if we wish to reduce the burden that families, communities, and governments bear from the obesity epidemic and speed passage through nutrition transitions to more health-facilitating dietary patterns.

Works in progress

Bridle-Fitzpatrick, S. Foodscapes, Foodways, and Nutrition Transitions in Urban Mexico, book manuscript in preparation

The global surge in obesity and associated degenerative health conditions, such as diabetes and heart disease, have potentially crushing consequences for households, communities, health systems, and national economies. Hunger and malnutrition continue to pose enormous risks to human health worldwide; yet over that past two decades, overweight and obesity have emerged as one of the world’s most important public health problems. Not only are there now more overweight and obese people than undernourished people worldwide, there are more overweight and obese people than undernourished people in developing countries.

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Harvesting poblano chiles in Walamo, Sinaloa

Perhaps the most striking example of a country undergoing a rapid nutritional transformation is Mexico. Mexico has one of the highest prevalence levels of overweight and obesity in the world, yet at a lower income per capita than its peers among highly overweight countries. It has recorded the fastest rate of change in obesity globally as well as a surge in diabetes mortality.

Using a social-ecological approach, I argue that there are a number of broad, global forces driving rising rates of obesity worldwide. However, national and community-level environmental, economic, social, and cultural factors mitigate or reinforce global pressures and risks.

Foodscapes, Foodways, and Nutrition Transitions in Urban Mexico, derived from my dissertation research, presents a nuanced understanding of the obesity-promoting dietary changes that have occurred in Mexico over the past two decades, with particular concern for how social class shapes local food environments, eating patterns, and vulnerability to obesogenic diets.

I combine national-level economic analysis with ethnographic methods used by urban geographers and applied anthropologists to analyze national economic and food system trends as well as local food acquisition, preparation, and consumption environments and practices in urban communities of distinct socioeconomic status. I use a variety of quantitative and qualitative methods to investigate the macrostructures and microprocesses underlying the dietary changes that are occurring, examining factors—risk regulators—that exacerbate or mitigate vulnerability to obseogenic eating patterns.

My work refines Popkin’s general nutrition transition theory by incorporating perspectives from the public health social-ecological framework, health geography, behavioral economics, and sociological theory as well as phenomenological insights gained from in-depth ethnographic research in a middle-income country undergoing astonishingly rapid dietary change.

This research and analysis yield theoretical, substantive, and methodological insights that should be useful in crafting public policies that can channel and shape nutrition transitions to better support human health.

Bridle-Fitzpatrick, S. “Rule-based or goal-based?: Global health security strategies to regulate ‘unhealthy commodities’ to mitigate global obesity and NCD epidemics,” article in development for Global Public Health

“Global health security” rose to prominence at the beginning of the millennium, promoting a new set of international objectives in the arena of public health. Calling attention to ways in which risks to public health have been globalized, the World Health Organization (WHO) has sponsored several influential global response networks and legal frameworks.

The global context that shaped the forging of the global health security agenda has changed. Important shifts include the rise to middle-income status of populous developing economies and the rapidly rising prevalence of diet-related non-communicable diseases (DR-NCDs) in low- and middle-income countries (LMICs). NCDs are now the primary cause of death worldwide, and the vast majority annual global deaths due to DR-NCDs such as cardiovascular disease, diabetes, and some cancers occur in LMICs.

Yet DR-NCDs—and their key risk factors, namely, the global promotion and sale of “unhealthy commodities” such as ultra-processed foods and sugar-sweetened beverages—have been surprisingly under-prioritized in key global health discourse.

This paper argues that the contemporary global health security agenda should prioritize protection against the health risks that take the greatest toll on health and well-being. It takes a “threshold” approach in identifying global health priorities and argues that DR-NCDs should be embedded in the global health security agenda because they pose one of the more serious and pervasive global threats to human health and life. International health and development goals, however, often are shaped by competing considerations, leading to distortions in goal-setting and funding priorities.

Addressing the burgeoning threat of DR-NCDs will require, among other policies, a muscular collaborative effort to combat the global health threat represented by transnational corporations that spread NCD disease risk across national borders. This paper examines the politics and prospects of two approaches to such a coordinated global effort: goal-based and rule-based strategies to regulate unhealthy commodities.

New projects

  • A study that investigates the role of migration on changing food preferences, priorities, and practices. Works with both longer- and shorter-term receiving communities in the US as well as their reciprocal sending communities in Mexico
  • A study that analyzes food access, exposure, and acquisition practices among Hispanic families in Denver, CO. Includes a multidimensional examination of food environments in people’s “activity spaces” (not just residential communities) and the factors shaping food acquisition patterns
  • A study that examines changing access and exposure to “modern” foods in Havana, Cuba. Also analyzes the impact of changing food access on dietary patterns and nutritional health