From Food Deserts to Food Swamps: Interventions to Improve Patient Health

By Sheri Vettel, MPH, RD, LDN

We each make over 200 decisions about food daily. Many of these decisions are strongly influenced by our food environment and may contribute to health status based on what is available. Limited access to nutritious foods, as well as overwhelming access to nutrient-poor foods, can be addressed by health professionals through motivational interviewing with tailored education and knowledge of community resources.

“Food Deserts” are defined as residential areas with reduced access to affordable, nutrient-dense food. More specifically, they are census tracts with high poverty rates, low median incomes, and two-thirds of residents living more than one mile from a grocery store (more than 10 miles in a rural area). Living in a food desert puts citizens at risk for obesity and chronic disease. According to the USDA Food Access Research Atlas, it is estimated that there are at least 349 food deserts with over 1.5 million residents across North Carolina.

On the other hand, many of these same communities may have abundant access to food, however, the foods that are accessible are highly processed, of poor nutritional value,  or contain disease-promoting ingredients. Research reveals that living in these “Food Swamps” may be a stronger predictor of adult obesity than living in a food desert. Typically, food swamps are saturated with fast food establishments where the cost of food is low and the risk of overconsumption is high. It is estimated that for every one healthy food option there are four unhealthy food options available in a food swamp. When healthier choices are available, they may be overpriced in corner stores or simply unfamiliar to the neighborhood’s customers. These factors are likely to unfavorably sway the food-related decisions patients are making.

With key interventions, health professionals have the power to stem the tide of obesity and chronic disease related to food choices and environment. First, health professionals must start the conversation about food access and availability with their patients. This conversation should lead to education, meeting patients where they are financially and motivationally. Secondly, by sharing community food resources (listed below), barriers to making healthy food choices while living in a food desert or a food swamp may be reduced.

Related: The Role of Medical Nutrition Therapy in Addressing Food Insecurity and Disease Prevention

Conversations with patients may include questions about food access and transportation, grocery shopping patterns, food preferences/dietary intake, and most importantly, readiness to change. Many of the patients I work with identify family food preference, convenience (access), and cost as primary factors in the food choices that they make. Education on nutritious yet low-cost meals may prove helpful for some, while discussion around barriers and building supports for making healthier food choices may work best for others. Taking the next step and linking the patient to community resources will enhance education provided. Identifying those resources will require some research and may include:

·         Cooperative Extension (gardening education, nutrition classes)

·         Farmers Markets (EBT or “Food Stamp” benefit matching programs)

·         Food Pantries

·         Free Community Meals

·         Hospitals/Medical Centers (support groups, nutrition education)

·         Local Food Councils

·         Online resources, such as the USDA Food Access Research Atlas, to identify food deserts in your own community

·         Registered Dietitians (individualized medical nutrition therapy to meet a patient’s specific health needs)

·         Hospitals/Medical Centers (support groups, nutrition education)

While not an exhaustive list, seeking out the resources above will likely lead to identifying additional resources or the need for additional resources in your community.

With these resources at hand, health professionals are in a unique position to identify at-risk patients, intervene with concrete alternatives, and ultimately, improve patients’ quality of life as it relates to food decisions.



Cooksey-Stowers, K., Schwartz, M.B., Brownell, K.D. (2017). Food Swamps Predict Obesity Rates Better than Food Deserts in the United States. Int J Environmental Research and Public Health, 1-20.

Curley, B. (2018). How to Combat ‘Food Deserts’ and ‘Food Swamps.’ Healthline.

Brea Neri