An Ecological Study of Neighborhood Food Retail Environment and Obesity Prevalence in Urban Slums of Bhopal, India.

Neighborhood food retail environments influence dietary behaviors and obesity, yet evidence from urban slums in low- and middle-income countries remains limited. This ecological cross-sectional study examined the association between neighborhood food retail environment density and cluster-level obesity prevalence among adults residing in urban slums of Bhopal, India. Thirty-two slum clusters were randomly selected from 389 recognized slums and 6,134 adults aged ≥ 30 years were enrolled. neighborhoods were defined as 400-m road-network service areas surrounding each cluster. Geographic Information System (GIS)-based mapping was used to determine the density of fresh fruit and vegetable shops, fresh animal-source food shops, chips and chocolate shops and ready-to-eat food shops. Cluster-level obesity prevalence (BMI ≥ 30 kg/m2) was examined using bivariate and multivariable linear regression after adjustment for neighborhood wealth, participants with formal education, mean age and proportion of male participants. neighborhoods were characterized by considerably higher densities of ready-to-eat food outlets and chips and chocolate shops than fresh fruit and vegetable shops. Higher fruit and vegetable shop density was associated with lower obesity prevalence in the unadjusted analysis, while the adjusted association remained inverse but was not statistically significant. No meaningful associations were observed for the other food outlet categories. These findings highlight the limited availability of healthy food outlets in urban slums and suggest that improving access to fresh fruits and vegetables warrants further investigation as a potential strategy for obesity prevention in low- and middle-income countries.