A Better Way to Fight Obesity: New, Smarter Supermarkets

One entrepreneur's quest to make America healthier by redesigning the spaces where we buy our groceries

If high rates of obesity are correlated with poverty and limited access to fresh, healthy food, it's logical that building more supermarkets should improve public health outcomes. This is the conclusion the Obama administration has drawn, and barring further cuts, the current federal budget designates more than $400 million toward an item called the Healthy Food Financing Initiative, which will help fund new markets in low-income neighborhoods. It's a progressive move based on sound research and reasoning—but according to public health expert Rupal Sanghvi, the initiative has the potential to be a lost opportunity at a grand scale.

"Standard supermarkets are designed to promote consumption of foods that are high in sugar and preservatives," explains Sanghvi, "because those are the high-margin items that maximize profit." According to current guidelines, in an average 10,000-square-foot supermarket, only 500 square feet must be utilized for fresh produce. If the U.S. spends millions to build supermarkets according to the conventional mold, she argues, we may see some improvement in public health simply as a result of increased access to food, but we stand to achieve far better outcomes if we first reconsider supermarket design itself.

Sanghvi is the founder of HealthxDesign ("Healthy By Design"), an initiative she launched in 2010 after a decade of work with the International Planned Parenthood Federation. During her years in the field, Sanghvi observed numerous instances in which people developing public health solutions overlooked contextual factors that were contributing to the problem. In clinics, for example, she saw how redesigning ventilation systems, retrofitting inefficient lighting, or choosing different building materials could improve treatment conditions and accessibility, but these things were rarely addressed. Likewise, in supermarkets, features like store layout and air temperature can influence purchasing decisions, but food access initiatives often stop short of such nuances of structural design.

So Sanghvi took it upon herself to start connecting the dots between architecture, environmental design, and public health. In the year since establishing HealthxDesign, she has partnered with design professionals to investigate solutions ranging from sustainable building strategies for Bolivia's health care infrastructure to product design interventions for preventing infant mortality in impoverished communities. Now she has set her sights on the federal government's supermarket spending plan, with a proposal to rethink the store design template.

"The current supermarket template is not behavior neutral," Sanghvi explains. "The more times you bump into something at eye level, the more likely you are to purchase it, and store owners are aware of this. There's a lot of product placement and they're all about having the candy in front of the cash register for kids."

Trying to encourage impulse buys may be obvious, but some factors driving shopping behaviors are more subtle. Bakeries are located toward the back of the store so the aroma will draw shoppers past items that might not be on their list, but which are likely to end up in the cart if spotted. Likewise dairy cases—where almost every shopper goes on every visit—tend to be in the rear. And for anyone who has ever wondered why supermarkets tend to be chilly, Sanghvi reports that heavy A/C actually triggers a basic human instinct: when we're cold, we want to accumulate more food.

Of course, keeping the air cool in order fill carts also increases the store's energy expenditure. Add to that the fact that most supermarkets are windowless and brightly lit with fluorescent bulbs, and the environmental inefficiencies become glaring. The US Green Building Council recently released a set of LEED energy efficiency guidelines geared toward retail, but supermarkets have such a specific and high level of energy demands that the general retail checklist doesn't cover all the bases.

To develop a viable alternative to the current template, Sanghvi breaks the challenge down into several key areas: community access, behavior change, environmental sustainability, and financial feasibility. The latter two are fairly straightforward—efficiency and profitability are both essential, and demonstrating them is relatively easy. Much of Sanghvi's focus goes toward the first two areas, as she asks how a supermarket can be more than simply a place to buy food.

"If public money is being spent on this," she reflects, "then in a sense we need to view the supermarket as an intervention. If you want to influence behavior and health on a population level, what would that experience need to be?"

The answer, in short, is that the supermarket becomes a platform for community engagement and social cohesion. She calls it "outcomes-based healthy supermarket design," and it could entail anything from microenterprise incubation to nutrition education to open space for recreation and entertainment. Her plan is to involve local communities in designing their own markets in order to ensure that their specific needs are met. Ultimately she hopes new supermarkets can act as anchors for small-scale commercial development that will catalyze local economic growth.

While Sanghvi's long-term vision for this endeavor could be viewed as idealistic, her approach is not. As a public health practitioner, she is metrics-obsessed. Her crusade for nationwide supermarket redesign begins with a microcosmic case study in her own Brooklyn community, where she plans to conduct quantitative and qualitative analysis leading to the planning and development of a fully operational pilot model that could ultimately be scaled up. "The scale of a supermarket is important in terms of access and profitability," she says. "We're talking about lots of people who don't have access, and farmers' markets alone cannot deliver the volume needed. So there has to be a large-scale solution."

In Brooklyn, the process starts with the establishment of a local food policy council. In collaboration with the Oakland-based Public Health Institute, HealthxDesign plans to spend a year assessing the specific food access needs of central Brooklyn residents, and inviting the community to participate in rethinking the supermarket's role.

This won't be the first food access assessment conducted in New York City—a program called FRESH (Food Retail Expansion to Support Health) was established in 2009 by the Departments of Health and City Planning and the city's Economic Development Corporation to provide zoning and financial incentives for grocery stores. The planning department created a Supermarket Need Index for New York, tracking incidence of diet-related disease against the presence of grocery stores on a series of maps.

"This is when the idea really crystallized for me," Sanghvi says. Seeing an exact correlation between obesity and supermarket need was no surprise, but when she added a layer to the map showing the presence of health department clinics, a light went on. There was no shortage of clinics in the high supermarket need areas, but, she observed, the clinics seemed like a solution delivered several steps too late to address the root problem. "People go to clinics once they already have diabetes and hypertension, but people go to supermarkets every day." So how can the supermarket become a venue for thinking and talking about health?

This is where design thinking comes in and distinguishes the HealthxDesign approach from previous studies. Sanghvi plans to investigate a range of structural and operational models, from public, open-air markets to privately managed cooperatives, gathering a collection of best practices. The hope is to use good design as a strategy for bringing people in and getting them interested in managing their own health through their food choices.

In addition to inviting local residents to envision a better supermarket, Sanghvi has asked students from the transdisciplinary design department at Parsons to think about how game dynamics and technology products could transform the grocery shopping experience. The possibilities are endless and the potential to influence purchasing behaviors is perhaps strongest when framed as a game.

One could imagine, for example, a tech-enabled shopping cart that calculates the nutritional quality of its contents and spurs real-time competition among shoppers to select healthy food. In the process, shoppers would gain information and knowledge about what they're eating, and at checkout they would be rewarded with discounts and coupons.

Better yet, says Colleen Macklin, an Associate Professor in the Department of Communication Design and Technology at Parsons, "we could build a fictional future self, an avatar that would develop according to our choices in the supermarket." Macklin directs research in the Parsons Prototyping Evaluation, Teaching and Learning Lab, creating games in the social interest. In Macklin's opinion, games are most powerful when applied as tools for understanding and challenging cultural systems in a context where failure is safe and feedback is immediate. "If we could travel in time and see our future selves, we might be able to see how choices we make now effect our health and finances in the future," she explains. "Your food purchases would feed your avatar, and you could then visit your avatar in a mobile game, a social (Facebook) game, as your Xbox/Wii/PS3 avatar and/or a representation in the supermarket itself."

The concept may be hard to envision in a typical supermarket, but the technology and design are already well within reach, and because of the prevalence of mobile gaming, many people are already familiar with the experience of integrating games into daily life. "I've talked to a lot of different people and organizations and nobody is doing anything like this," Sanghvi says. She likens the HealthxDesign approach to Apple's attitude when they conceived the iPhone. "They stripped it down to the most fundamental question: What is a phone? Then they conducted extensive user research to find out what a phone could be. We're doing the same thing."

As with all potentially disruptive innovations, the user research phase could last quite a while. A truly viable supermarket redesign will have to suit not only daily shoppers and local communities but also real estate developers, retailers, and policymakers from the borough level all the way up to the federal government. But Sanghvi is undaunted and she's ready to activate her plan. "At the minimum my goal is to establish some design guidelines as a first step for city planning to test new models. I'm literally going to go door to door and talk to supermarket owners about participating as neighborhood pilots," she says. "The money is in the budget. These supermarkets are coming."

Image: Mike Kline/flickr