Food environment research is in its infancy; although it is growing, valid and reliable methods for assessment are lacking. The methods used in the discussed article have several limitations and as a result compromise the integrity of the findings. Although it may be an efficient method in a large area, using secondary data (ie, government business listing or public directories) to map retailers operate under the assumption that directories have the most complete, up-to-date information on food retailer type and location. Considering the high rates of business turnover in food retailers, these methods may be vulnerable to error. It has been recommended that these methods are accompanied by observational methods or multiple secondary data sources are used to improve validity. Further, measuring access using the density of retailers in a buffer zone involves assuming consumers travel only a limited distance for food, which may not apply to all communities, especially rural communities, where people may have to travel a significant distance for food. More sophisticated methods such as GPS tracking have been used to measure access on an individual level.

Although the authors acknowledge that a correlation exists between access to fast food retailers and gestational diabetes, they neglect to consider all types of retailers as well as the differences between urban and rural communities. To date, limited research has explored the rural food environment. From the research that has been done, we have learned that rural communities face limited geographic access to supermarkets and grocery stores and have a higher density of convenience stores compared to urban communities. This is concerning because of the limited availability of vegetables, fruit, and other healthy food options in convenience stores. When healthy items are available in convenience stores, they and tend to be of lower quality and have higher prices than in larger supermarkets and grocery stores. For many communities, including both urban and rural, a convenience store may be the most accessible and influential source of food, therefore including it in the research would have been valuable. It also would have been interesting if the authors had stratified the results by urban and rural and pursued an investigation into the potential differences in both the food environment and prevalence of gestational diabetes mellitus, as research in this area is needed.