Weight loss maintainers sustain high diet quality in diverse residential retail food environments

Introduction The relationship between the retail food environment and diet quality has received minimal investigation among weight loss maintainers. Objective To investigate the association between the residential retail food environment and diet quality in weight loss maintainers from WeightWatchers (WW) in the US. Design Cross-sectional data were collected between January 2018 and February 2020. The Retail Food Environment Index (RFEI), based on geocoded home addresses, classified the environment: RFEI < 1.6= healthiest; RFEI 1.6- <2.5, = moderately healthy; RFEI 2.5 - <4.0 = moderately unhealthy; RFEI ≥4.0= least healthy. Dietary data was obtained using a food frequency questionnaire. Participants /setting: Adult participants (n=1,159) who had lost weight using WW and maintained >9.1 kg weight loss for > 1 year (mean 24.7 kg loss for 3.4 years). Outcome Measures HEI-2015 component and total scores (0-100; higher scores indicate better alignment with the Dietary Guidelines for Americans 2015-2020). Statistical Methods Regression models included RFEI category, the independent variable, and HEI-2015 and component scores (outcomes) controlling for age, sex, race and ethnicity, educational attainment, and household income. Results Compared to individuals living in the healthiest food environments (mean HEI-2015 score = 71.5) those in the unhealthiest environments had a mean HEI-2015 score of 70.1 (95% CI = 68.8, 71.3), those in moderately unhealthy environments had a score of 71.3 (95% CI = 70.3, 73.1) and those in moderately healthy environments had a score of 70.3 (95% CI=68.9, 71.2), indicating a non-linear relationship. Compared to those in the healthiest environments, those in the least healthy had approximately a 0.47 lower added sugar HEI-2015 component score (95% CI = -0.86, -0.08), indicating approximately 5% higher added sugar intake. Conclusions Weight loss maintainers maintained high diet quality in diverse retail food environments. Compared to those in healthiest food environments, those in the least healthy had a higher consumption of added sugars.