Title : How a participatory process with a low-SEP community in istanbul reshaped priorities for the local food environment: A participatory systems approach from Turkiye

Background: Food environments play a critical role in shaping dietary behaviors and obesity-related health inequities, particularly in socioeconomically disadvantaged settings. Moreover, in low-income urban settings, obesity is often driven not by individual choice but by structurally constrained food environments dominated by “food swamps,” where ultra-processed foods are more accessible and affordable than nutritious options. Improving Equity in Obesity Prevention (IM-EQ), supported by Era4Health and TUBITAK (project number 223N183), applies a participatory systems approach to identify community-driven solutions for healthier environments. This study focuses specifically on insights into the food environment generated through stakeholder workshops in a low-socioeconomic neighborhood in Türkiye.

Methods: A 9-month participatory process engaged community members in mapping local food assets and identifying barriers and enablers across neighborhood settings. Using World Café discussions, asset mapping, and participatory system modeling, participants co-produced insights into the food environment. Priorities were established through structured voting, with qualitative data on feasibility and trust documented by a researcher acting as a participant-facilitator to ensure reflexivity

Results: Findings challenge the standard narrative that physical proximity is the primary barrier to healthy eating. While participants noted that healthy options are often prohibitively expensive, the primary driver of behavior was a profound distrust of the safety of fresh produce, particularly regarding pesticide residues and cold-chain integrity. This distrust reduced stakeholder willingness to promote fresh fruits and vegetables, leading them to favor regulated, healthier packaged items or home-prepared "handmade" traditional alternatives where the source of ingredients was perceived as transparent. Consequently, the community prioritized expanding municipal bread kiosks into affordable "Healthy Food Hubs".

Conclusions: This study highlights that beyond physical access, trust and perceived safety are critical but often overlooked dimensions of food environments. Addressing health equity requires integrating affordability and physical access with trust-building mechanisms. Leveraging municipal infrastructure to provide "public nutrition" offers a promising pathway to reducing obesity-related health inequities in vulnerable urban contexts.

Keywords: Food environment; Health equity; Participatory research.

Elif Ahsen Kalpar is a licensed dietitian and is currently pursuing her MSc in Global Health at Koç University, Istanbul. Serving as a research assistant for the TÜBİTAK-funded IM-EQ (Improving Equity in Obesity Prevention) project, her research centers on public health nutrition, sustainable food systems, and food security dynamics. She specializes in utilizing community-based participatory methodologies to explore urban health disparities and codesign structural, equity-driven solutions for vulnerable populations