Fighting Obesity and Diabetes One Corner Store at a Time —by Mohan Kumar and Joel Gittelson

Nakisa, a 32-year old single mother of two, goes to the local supermarket weekly to get her groceries—a trip that involves paying for a taxi or hack in the cold of winter. On other days, she walks to the corner-store for some quick carryout food or a bottle of soda. Often as she walks back home, she thinks of her health and her latest visit with the doctor, who recently added diabetes to her ever-growing list of health problems including high blood pressure and obesity.

Nakisa could be any one of the thousands of low income residents of Baltimore who suffer from chronic diseases including diabetes, heart disease and their complications. According to a study published in Ethnic Discrimination, in West Baltimore, 60 percent of adults are overweight with over 30 percent considered obese (1). According to Baltimore City Health Department statistics, heart disease was the leading cause of death in Baltimore in 1998 accounting for 28 percent of all deaths, while diabetes was responsible for 4 percent of the deaths. Diabetes rates doubled in African-Americans in Baltimore between 1990 and 1999. These numbers just scratch the surface of the issue and foretell of increasing problems in public health with one in five health care dollars spent on chronic diseases in 1998 alone.

Any one person’s risk for these chronic diseases includes a combination of social, economic, genetic and environmental factors. Environmental factors like access to affordable, healthy food and physical activity clearly play a critical role. According to the Baltimore Sun (5/21/02), 15 percent of supermarkets—which are often a source of fresh produce and high quality meat and fish—closed shop between 2000 and 2003 leaving less than 60 supermarkets to serve more than 635,000 residents (2). As a result, low-income residents, with limited means of transportation to faraway supermarkets, rely on small local stores (3). While local stores provide convenience, they offer a limited selection of foods at higher prices than supermarkets. Often urban residents pay over 37 percent more for groceries compared to suburbanites. More importantly, many of the small stores are filled with unhealthy high-fat, high-sugar foods.

Against this backdrop, the Baltimore Healthy Stores (BHS) project was initiated in 2005 by the Johns Hopkins Center for Human Nutrition with the leadership of Dr. Joel Gittelsohn (co-author of this article). Baltimore Healthy Stores was designed as a partnership with select supermarkets, corner stores, and community organizations in an attempt to increase access and availability of healthy foods to the inner-city population of Baltimore. The project is funded by the US Department of Agriculture, and the Johns Hopkins Centers for a Livable Future and Adolescent Health.

Baltimore possesses several characteristics which warranted initial research and assessment and the eventual tailoring of the program to the community. Significant is the role played by Korean-American corner-stores, which fill the void created by the lack of supermarkets. There are over 240 Korean-American stores in Baltimore with a predominantly African-American clientele. Many of these corner-stores agreed to collaborate with the BHS program in an attempt to increase healthy food options. In addition, the Stop Shop and Save supermarket chain agreed to participate.

The BHS program goals include increasing availability and access to healthy foods to residents of the city by working with local merchants to offer healthier, affordable foods together with the promotion of specific healthy foods at the point of purchase. Another aim is to communicate alternative healthy food preparation methods to inner-city residents.

The Baltimore Healthy Stores program is being implemented in several phases. The first phase took place in East Baltimore between January and October 2006. The next phase will begin in West Baltimore in May 2007. Over a period of ten months, the East Baltimore project targeted specific issues of nutrition and access to healthy foods, including healthy eating for kids, healthy cooking at home, healthy snacks, carryout foods alternatives and low-calorie foods. Hee-Jung Song, a doctoral student at at Johns Hopkins Bloomberg School of Public Health (JHSPH), led with the recruitment of the Korean-American stores, trained graduate students as interventionists, and implemented the program among the communities.

Baltimore Healthy Stores promoted specific healthy foods using print materials and taste tests to deliver messages about healthy foods. Interventionists used shelf labels, posters, educational displays, recipe cards, brochures and flyers to promote the messages about healthy foods. Many of the posters and flyers were developed by local artists. Also, incentive cards and coupons were used to promote the healthy food items. Children and their nutrition were specifically targeted in one phase using promotions, cooking demonstrations and taste tests.

Several Korean-American stores lent store space to stock specific promoted healthy food items and carryout taste tests. The Stop Shop and Save supermarket also played a role by disseminating program information and hosting cooking demonstrations and taste tests in stores.

The second phase of the BHS program will reach out to the West Baltimore communities in 2007 with similar approaches using Korean-American stores. In addition, some African-American and Hispanic stores will be involved. Greater emphasis will be placed on community organizations, including Kids on the Hill, and churches in West Baltimore with involvement in disseminating information, recruitment of stores and hosting of specific activities of the program.

BHS findings will be used to develop a city-wide program for all of Baltimore in an attempt to increase accessibility to and availability of healthy foods, which could eventually serve as a model of store-based nutrition intervention at corner-stores in other urban settings.

1) Clark JM, Bone LR, Stallings R, Gelber AC, Barker A, Zeger S, et al. Obesity and approaches to weight in urban African-American community. Ethnic Discrimination, 2001 Fall; 21(4):676-86.
2) Klein A. Baltimoreans are hungry for supermarkets. Baltimore Sun, 05/21/2002.
3) Morland K, Wing S, Diex-Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J of Prev Med 2002;22(1):23-9.