Associations between the objective and perceived food environment and eating behavior in relation to socioeconomic status among adults in peri-urban settings: results from the CIVISANO study in Flanders, Belgium.

Obesity, a significant public health concern, disproportionately affects people with lower socioeconomic status (SES). Food environments have been identified as part of the causal chain of this disparity. This study investigated variations in the food environment across groups with different SES profiles residing in peri-urban municipal settings. In addition, it examined the association of the perceived and objective food environments with eating behaviour and assessed if these associations were moderated by SES. Utilizing GIS and survey data (n = 497, aged 25-65), results showed differences in the objective and perceived food environments based on SES. Respondents with higher SES perceived their food environments as better but resided farther from all food outlets compared to respondents with lower SES. However, there was no difference in outlet density or mRFEI between SES groups. SES moderated associations between the objective and perceived food environments and most eating behavior outcomes except fast food consumption frequency. For fruits and vegetables, SES moderated the association between neighborhood availability and consumption frequency (β0.23,CI0.03;0.49). Stratified analysis revealed a positive association for both lower (β0.15, CI0.03;0.27) and higher (β0.37, CI 0.12;0.63) SES groups. For snack foods, SES moderated the association between healthy outlet density and consumption frequency (β-0.60, CI-0.94; -0.23), showing statistical significance only for respondents with higher SES (β0.36,CI 0.18;0.55). Similarly, for sugar-sweetened beverages, a statistically significant interaction was observed between unhealthy outlet density in the 1000m buffer and consumption frequency (β 0.06, CI 0.02; 0.11). However, this association was only statistically significant for respondents with higher SES (β-0.02,CI -0.05;-0.0002). These results emphasize the significance of SES as a crucial element in comprehending the connection between the food environment and eating behaviour. Indicating the need for policymakers to take SES into account when implementing food environment interventions, particularly when focusing on the neighborhood food environment without considering residents' SES and their perceptions.