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.