Consistent with treatment recommendations to reduce fat intake and remove food cues, participants completing a 6-month behavioral weight loss program reported reducing the availability of high-fat foods in their homes and storing fewer foods in visible locations. There were no significant changes in the number of low-fat foods they reported available in their homes. Changes in high-fat food availability in the home found in the current study were similar in magnitude to those reported in previous research using the same measure . In the two available studies that similarly examined changes in availability [10, 11], a significant reduction in the availability of high-fat foods was also reported among participants in behavioral weight control programs (mean decrease of approximately 0.8 high-fat foods in both studies). In contrast to one of these previous studies , home food environment changes were not associated with weight changes in the current study. A significant correlation between changes in food availability and weight loss was reported over the 12-month period they studied . It may be that home food environment changes require a longer period of time to influence weight loss than the 6 month period examined in the current study or the 8-week period examined in Gorin and colleagues in their earlier study . On the other hand, a greater magnitude of change to the home environment, as was demonstrated when home grocery delivery was provided in the earlier Gorin et al. study , may be required to influence weight loss. Alternatively, the absence of a correspondence between self-reported changes in home food environment and weight change may reflect social desirability (i.e., a reporting bias). All participants in the study were in an intervention that counseled reductions in high-fat foods; therefore, some biases toward reporting decreased high-fat foods in the house might be expected. However, the lack of evidence of changes in the presence of low-fat foods in the home offers some evidence that the impact of a social desirability bias was modest since participants were also counseled to increase their consumption of low-fat, low-calorie foods and a similar effect would therefore have been expected with this variable.
The assessment of home food environment clearly warrants further examination in the context of supporting behavioral weight control efforts. Such research efforts would likely benefit from refined methods to measure the home food environment since current measures are fairly limited and fail to reflect the complicated, multi-factorial nature of the overall home food environment. This concern has been raised about measures of the built environment in general  and likely applies to the home food environment in particular. There are likely other crucial factors in the home food environment that may be associated with weight loss which are not captured in the currently available assessment methods . Indeed, it may be important to take a step back and actively work on developing and evaluating standardized measures tailored to evaluating the home food environment prior to undertaking further research in the arena of weight management and home food environment. At this point, the lack of standardized home food availability measures and methodology limits the ability to compare research on home food environments [4–8, 10, 11, 32].
Continued research exploring race/ethnicity and regional elements of the home food environment associated with weight management offers potential for significantly enhancing the understanding of obesity development and treatment. Differences in environmental factors may be contributing to observed differences in the prevalence of obesity [16, 17, 33] and in obesity treatment outcomes [12–15]. It may be important to take a broader approach to the study of the home environment, as food intake and household food availability are influenced by other spheres including the food environment of the community .
A greater understanding racial/ethnic and regional differences in food availability in the home would be advantageous given that studies suggest that household availability may impact obesity prevalence and food consumption for multiple household members [10, 34]. Furthermore, modifications to the micro-level food environment (i.e., the home) may be more feasible for individuals interested in addressing obesity rather than re-structuring the larger macro-level food environment (i.e., restaurants, supermarkets). The potential for enhancing the success of behavioral weight control approaches by more directly and robustly targeting modifications to the household food environment is intriguing and worthy of further exploration as it offers a promising direction for refining available obesity treatment methods. Thus, a greater focus on the micro-level food environments may be useful for both obesity treatment and understanding patterns of obesity prevalence.
Some researchers have suggested that cultural factors play an important and often ignored role in the development of obesity , and the current study would suggest that regional factors might also be considered. The overlap between the cultural factors that characterize the southern region of the United States and those that are common among African American groups has been noted [36, 37]. Future considerations of cultural factors associated with obesity might benefit from attention to meaningful regional variations in the cultural meanings and salience of home food environment.
This study has some limitations, including the small sample size, the limited regional representation and the focus on individuals who are engaged in a weight control program. Further, there was racial diversity in only one research center, precluding analyses of a true interaction between race and region. In addition, the lack of information on household composition precluded examining whether the number of individuals in the home made a difference in the home food environment or in the ability to change the home environment as part of a behavioral weight control program. However, the findings are suggestive of potentially important environmental factors that may be salient for understanding the higher dietary fat intake among southerners [18, 19] as well as the higher rates of obesity in the south [16, 17] and among African Americans .