Food away from home and body mass outcomes: taking heterogeneity into account enhances quality of results

Restaurant outlet density and the healthfulness of food purchases: evidence from FoodAPS

Introduction

The average American household's diet and food purchasing patterns are out of sync with federal recommendations. Researchers have connected this with the large and growing rates of obesity, diabetes, and other diet-related ailments in the U.S. Restaurant food has been discussed a potential contributor to unhealthful diets, as it is often calorically dense. We investigate the association between household access to restaurants and diet quality using USDA FoodAPS data and NPD ReCount data.

Methods

We define radii around households to measure restaurant outlet counts and apply a regression analysis incorporating household characteristics.

Results

We find that neither restaurant counts nor openings share many statistically or economically significant associations with average dietary quality. Household characteristics and demographics are far more powerful in explaining variation in diet quality.

Discussion

Our findings align with the large and growing body of empirical research that suggests that personal preferences and other household characteristics are more important than the food environment in explaining food choices and diet quality. Given the extant research on the importance of access to large supermarkets, our results suggest that access to food retailers is more important in explaining diet quality than access to restaurants.

Poverty, Household Structure and Consumption of Foods Away from Home in Peru in 2019: A Cross-Sectional Study

The aim of this study was to evaluate the probability of buying food away from home according to the type of household using the logit model, as well as the sociodemographic characteristics of the heads of household, and how much income expenditure represents. A cross-sectional study was carried out using the National Household Survey (ENAHO) 2019 database. After joining the database, the household type variables were created. To calculate the probability with the “logit” model of purchase, the variables—family size, income, types of household, and total expenditure—were selected as a measure of the purchasing power of the family. A statistically significant association (p < 0.05) was found between the probability of consumption and the variables: age of household members, predominance, nuclear without children−married, nuclear with children−cohabitant, nuclear with children−widowed, nuclear with children−separated, extended, compounded, poor not extreme, and not poor. The bulk of families was represented by nuclear families (61.97%). The highest expenditure in the CFAH was for families defined as composite with a yearly average of USD 1652.89 (equivalent to PEN 5520.67). Observing the expenditure on food consumed outside the home through the composition of households can allow a better approach to offer educational measures. This information can be helpful to developers of educational issues.

Eating out of Home: Influence on Nutrition, Health, and Policies: A Scoping Review

Eating out of home (EOH) is a common practice worldwide but research gaps have been identified. The aims of this review were (a) to find a common definition for EOH, (b) to determine the nutritional contribution of EOH, and (c) to analyze the relationship of EOH with health parameters in adults. Fifty-seven articles were finally selected. The definition of EOH was not harmonized between researchers and the comparison between studies was quite difficult. Restaurant and fast food were the terms most used, followed by chain restaurant, à la carte, sit-down restaurant, eating at table, full service, ready to eat, takeaway, buffet and buffet by weight, bar, cafes, and cafeterias, either alone or attached to at least one of the above. The profile of the main EOH participant was a highly educated, high-income, and unmarried young man. EOH was related to a body mass index (BMI) or being overweight in a different way depending on age, sex, or EOH frequency. A high rate of EOH led to poorer diet quality, characterized by higher intakes of energy, total and saturated fats, sugar, and sodium, as well as lower intakes of fiber, dairy, fruit, vegetables, and micronutrients. Regarding beverages, a higher intake of soft drinks, sugar-sweetened beverages, fruit juices, beer, and other alcohol was observed when EOH. There is a need for a methodological consensus for analyzing the impact of EOH on dietary intake and health to avoid bias. Additionally, measures and policies should be utilized to help consumers to make healthier choices when EOH is compatible with business regarding those running EOH establishments.

Obesity and food away from home: What drives the socioeconomic gradient in excess body weight?

Rising obesity rates are one of the most challenging public health issues in many emerging economies. To what extent food away from home (FAFH) and its nutritional components are behind this rise is not yet well understood. To address the issue, this paper combines a representative restaurant survey that includes detailed information on the diet quality of the most widely consumed meals and their nutritional components from 1605 restaurants and a representative household survey with anthropometric measures of adult women living in 40 neighborhoods in the Lima Metropolitan Area. One important advantage of the dataset is the fact that nutrition professionals observed the preparation of the meals and that they were subject to a detailed laboratory analysis. Exploiting this data, we examine the differences in nutritional quality of FAFH among 40 neighborhoods of various socioeconomic groups and explore whether these differences can explain part of the observed socioeconomic gradient in excess body weight. The findings indicate that less healthy food in restaurants located in the food environment of the households is significantly associated with higher rates of obesity and overweight. In particular, the high supply and intake of sodium potentially drives higher excess body weight. The study also finds that up to 15 percent of the socioeconomic gradient in obesity is attributable to the restaurant food quality in the food environment of the households.

The Association Between Food-Away-From-Home Frequency and a Higher BMI Varies by Food Security Status in US Adults

BACKGROUND

For decades, Americans have increasingly relied on food away from home (FAFH) despite its association with negative health outcomes. Little is known about FAFH frequency and expenditures of adults with lower food security (FS) and their association with health outcomes, such as BMI.

OBJECTIVES

We evaluated patterns of adults' FAFH purchases by FS status and other demographic characteristics, and examined the association between FAFH frequency and BMI in adults of varying levels of FS.

METHODS

This cross-sectional study used data from the Consumer Behavior Survey, Food Security Survey, and anthropometric measurements to assess FAFH frequency and expenditures, FS, and calculated BMI of adults (≥18 y) who participated in the NHANES 2007-2014 (n = 20,733). We used multinomial logistic regression to examine the association between FAFH frequency quartiles (quartile 1: 0 n/wk; quartile 2: 1-2 n/wk; quartile 3: 3-4 n/wk; quartile 4: ≥5 n/wk) and BMI by FS category.

RESULTS

Although FAFH frequency was similar across FS levels, adults with high FS spent more dollars (${\$}$213.60) and a greater proportion (29.4%) of their food budget on FAFH compared with adults with marginal, low, and very low FS (${\$}$133.00, ${\$}$116.20, ${\$}$103.30 and 21.4%, 19.7%, 20.0%, respectively). Obesity prevalence was highest in adults with low FS (42.9%) and very low FS (41.5%), and lowest in adults with high FS (33.7%). FAFH frequency and BMI were positively associated in adults with high (P < 0.001), marginal (P = 0.025), and low (P = 0.024) FS, but not in adults with very low FS (P = 0.589).

CONCLUSIONS

FAFH is frequent in adults regardless of FS status. The positive association between FAFH and BMI is the strongest in adults with high FS, the group with the lowest prevalence of obesity. Conversely, BMI was not associated with FAFH in adults with very low FS, despite their higher prevalence of obesity.

Eating Out and Consumers' Health: Evidence on Obesity and Balanced Nutrition Intakes

Changes in demographic and socioeconomic characteristics have contributed to an increase in away-from-home food consumption. Although consumers are increasingly demanding higher quality food, unbalanced nutrition intakes and health issues such as obesity remain prominent predicaments. This paper investigates the relationship between the frequency of having Food Away From Home (FAFH), balanced dietary intakes, and obesity (controlling for covariates) among Korean adults aged 19 to 64. Whether there exists a linear relationship between the number of having FAFH and health outcome is investigated and the optimal number of having FAFH that leads to the best health outcome is identified in the study. The results suggest that Food Away From Home generally increases deviations of dietary intakes from the reference intakes and high-frequency FAFH consumers have an elevated chance of being obese (36.22%). However, having FAFH 1-7 times per week is associated with decreased body mass index (BMI) and a lower chance of being obese in comparison to the outcomes of having food at home. The optimal level of consuming FAFH is identified to be 5-7 times per week in terms of BMI and obesity. However, consuming no FAFH is suggested to be the best in terms of balanced nutrition intake.

Relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions toward healthy menu selection

BACKGROUND/OBJECTIVES

Obesity is a serious concern worldwide, for which the restaurant industry holds partial responsibility. This study was conducted to estimate restaurant consumers' intention to select healthy menu items and to examine the relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions, which are known to be major determinants of consumer behaviors.

SUBJECTS/METHODS

An online, self-administered survey was distributed for data collection. The study sample consisted of customers who reported having visited casual dining restaurants in the last three months at the time of the survey. Structural equation modeling was used to verify the fit of the proposed research model.

RESULTS

Structural equation modeling revealed that the proposed model supports the sequential, mediated (indirect) relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions toward healthy menu selection.

CONCLUSION

This study contributes to the available literature regarding obesity by adding past behaviors, one of the most influential variables involved in prediction of future behaviors of consumers, to the TPB model, enabling a better understanding of restaurant consumers' rational decision process regarding healthy menu choices. The results of this study provide practical implications for restaurant practitioners and government agencies regarding ways to promote healthy menus.

Using Gamma and Quantile Regressions to Explore the Association between Job Strain and Adiposity in the ELSA-Brasil Study: Does Gender Matter?

This paper explores the association between job strain and adiposity, using two statistical analysis approaches and considering the role of gender. The research evaluated 11,960 active baseline participants (2008-2010) in the ELSA-Brasil study. Job strain was evaluated through a demand-control questionnaire, while body mass index (BMI) and waist circumference (WC) were evaluated in continuous form. The associations were estimated using gamma regression models with an identity link function. Quantile regression models were also estimated from the final set of co-variables established by gamma regression. The relationship that was found varied by analytical approach and gender. Among the women, no association was observed between job strain and adiposity in the fitted gamma models. In the quantile models, a pattern of increasing effects of high strain was observed at higher BMI and WC distribution quantiles. Among the men, high strain was associated with adiposity in the gamma regression models. However, when quantile regression was used, that association was found not to be homogeneous across outcome distributions. In addition, in the quantile models an association was observed between active jobs and BMI. Our results point to an association between job strain and adiposity, which follows a heterogeneous pattern. Modelling strategies can produce different results and should, accordingly, be used to complement one another.

BODY MASS INDEX AND SELF-EMPLOYMENT IN SOUTH KOREA

This study assesses differential labour performance by body mass index (BMI), focusing on heterogeneity across three distinct employment statuses: unemployed, self-employed and salaried. Data were drawn from the Korean Labor and Income Panel Study. The final sample included 15,180 person-year observations (9645 men and 5535 women) between 20 and 65 years of age. The findings show that (i) overweight/obese women are less likely to have salaried jobs than underweight/normal weight women, whereas overweight/obese men are more likely to be employed in both the salaried and self-employed sectors than underweight/normal men, (ii) overweight/obese women have lower wages only in permanent salaried jobs than underweight/normal weight women, whereas overweight/obese men earn higher wages only in salaried temporary jobs than underweight/normal weight women, (iii) overweight/obese women earn lower wages only in service, sales, semi-professional and blue-collar jobs in the salaried sector than underweight/normal weight women, whereas overweight/obese men have lower wages only in sales jobs in the self-employed sector than underweight/normal weight women. The statistically significant BMI penalty in labour market outcomes, which occurs only in the salaried sector for women, implies that there is an employers' distaste for workers with a high BMI status and that it is a plausible mechanism for job market penalty related to BMI status. Thus, heterogeneous job characteristics across and within salaried versus self-employed sectors need to be accounted for when assessing the impact of BMI status on labour market outcomes.

Mortality outcomes associated with intake of fast-food items and sugar-sweetened drinks among older adults in the Vitamins and Lifestyle (VITAL) study

Objective

To evaluate associations of fast-food items (FFI) and sugar-sweetened drinks (SSD) with mortality outcomes including deaths due to any cause, CVD and total cancers among a large sample of adults.

Design

Using a prospective design, risk of death was compared across baseline dietary exposures. Intakes of FFI and SSD were quantified using a semi-quantitative FFQ (baseline data collected 2000–2002). Deaths (n4187) were obtained via the Washington State death file through 2008, excluding deaths in the first year of follow-up. Causes of death were categorized as due to CVD (I00–I99) or cancer (C00–D48). Cox models were used to estimated hazard ratios (HR) and 95 % CI.

Setting

The Vitamins and Lifestyle (VITAL) study among adults living in Western Washington State.

Subjects

Men and women (n69 582) between 50 and 76 years of age at baseline.

Results

Intakes of FFI and SSD were higher among individuals who were younger, female, African-American, American Indian or Alaska Native, Asian-American or Pacific Islander, of lower educational attainment, and of lower income (P<0·0001 for all). Higher risk of total mortality was associated with greater intake of FFI (HR=1·16; 95 % CI 1·04, 1·29;P=0·004; comparing highestv. lowest quartile) and SSD (HR=1·19; 95 % CI 1·08, 1·30;P<0·0001; comparing highestv. lowest quartile). Higher intake of FFI was associated with greater cancer-specific mortality while an association with CVD-specific mortality was suggested. Associations between intake of SSD and cause-specific mortality were less clear.

Conclusions

Intake of FFI and SSD has a detrimental effect on future mortality risk. These findings may be salient to socially patterned disparities in mortality.

Gender difference in the association between food away-from-home consumption and body weight outcomes among Chinese adults

Objective

The present study aimed to explore the associations between food away-from-home (FAFH) consumption and body weight outcomes among Chinese adults.

Design

FAFH was defined as food prepared at restaurants and the percentage of energy from FAFH was calculated. Measured BMI and waist circumference (WC) were used as body weight outcomes. Quantile regression models for BMI and WC were performed separately by gender.

Setting

Information on demographic, socio-economic, diet and health parameters at individual, household and community levels was collected in twelve provinces of China.

Subjects

A cross-sectional sample of 7738 non-pregnant individuals aged 18–60 years from the China Health and Nutrition Survey 2011 was analysed.

Results

For males, quantile regression models showed that percentage of energy from FAFH was associated with an increase in BMI of 0·01, 0·01, 0·01, 0·02, 0·02 and 0·03 kg/m2 at the 5th, 25th, 50th, 75th, 90th and 95th quantile, and an increase in WC of 0·04, 0·06, 0·06, 0·04, 0·06, 0·05 and 0·07 cm at the 5th, 10th, 25th, 50th, 75th, 90th and 95th quantile. For females, percentage of energy from FAFH was associated with 0·01, 0·01, 0·01 and 0·02 kg/m2 increase in BMI at the 10th, 25th, 90th and 95th quantile, and with 0·05, 0·04, 0·03 and 0·03 cm increase in WC at the 5th, 10th, 25th and 75th quantile.

Conclusions

Our findings suggest that FAFH consumption is relatively more important for BMI and WC among males rather than females in China. Public health initiatives are needed to encourage Chinese adults to make healthy food choices when eating out.

A restaurant-based intervention to promote sales of healthy children's menu items: the Kids' Choice Restaurant Program cluster randomized trial

BACKGROUND

Away-from-home eating is an important dietary behavior with implications on diet quality. Thus, it is an important behavior to target to prevent and control childhood obesity and other chronic health conditions. Numerous studies have been conducted to improve children's dietary intake at home, in early care and education, and in schools; however, few studies have sought to modify the restaurant food environment for children. This study adds to this body of research by describing the development and launch of an innovative intervention to promote sales of healthy children's menu items in independent restaurants in Southern California, United States.

METHODS

This is a cluster randomized trial with eight pair-matched restaurants in San Diego, California. Restaurants were randomized to a menu-only versus menu-plus intervention condition. The menu-only intervention condition involves manager/owner collaboration on the addition of pre-determined healthy children's menu items and kitchen manager/owner collaboration to prepare and plate these items and train kitchen staff. The menu-plus intervention condition involves more extensive manager/owner collaboration and kitchen staff training to select, prepare, and plate new healthy children's menu items, and a healthy children's menu campaign that includes marketing materials and server training to promote the items. The primary outcome is sales of healthy children's menu items over an 18-week period. In addition, dining parties consisting of adults with children under 18 years of age are being observed unobtrusively while ordering and then interviewed throughout the 18-week study period to determine the impact of the intervention on ordering behaviors. Manager/owner interviews and restaurant audits provide additional evidence of impact on customers, employees, and the restaurant environment. Our process evaluation assesses dose delivered, dose received, and intervention fidelity.

DISCUSSION

Successful recruitment of the restaurants has been completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children's menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge.

TRIAL REGISTRATION

NCT02511938.

Menu label accuracy at a university's foodservices. An exploratory recipe nutrition analysis

The increase in the weight of American adults and children has been positively associated with the prevalence of the consumption of food-away-from-home. The objective was to assess the accuracy of claimed nutritional information of foods purchased in contracted foodservices located on the campus of an institution of higher education. Fifty popular food items were randomly collected from five main dining outlets located on a selected campus in the northeastern United States. The sampling was repeated three times on separate occasions for an aggregate total of 150 food samples. The samples were then weighed and assessed for nutrient composition (protein, cholesterol, fiber, carbohydrates, total fat, calories, sugar, and sodium) using nutrient analysis software. Results were compared with foodservices' published nutrition information. Two group comparisons, claimed and measured, were performed using the paired-sample t-test. Descriptive statistics were used as well. Among the nine nutritional values, six nutrients (total fat, sodium, protein, fiber, cholesterol, and weight) had more than 10% positive average discrepancies between measured and claimed values. Statistical significance of the variance was obtained in four of the eight categories of nutrient content: total fat, sodium, protein, and cholesterol (P < .05). Significance was also reached in the variance of actual portion weight compared to the published claims (P < .001). Significant differences of portion size (weight), total fat, sodium, protein, and cholesterol were found among the sampled values and the foodservices' published claims. The findings from this study raise the concern that if the actual nutritional information does not accurately reflect the declared values on menus, conclusions, decisions and actions based on posted information may not be valid.

Impact of body mass on job quality

The current study explores the association between body mass and job quality, a composite measurement of job characteristics, for adults. We use nationally representative data from the Korean Labor and Income Panel Study for the years 2005, 2007, and 2008 with 7282 person-year observations for men and 4611 for women. A Quality of Work Index (QWI) is calculated based on work content, job security, the possibilities for improvement, compensation, work conditions, and interpersonal relationships at work. The key independent variable is the body mass index (kg/m(2)) splined at 18.5, 25, and 30. For men, BMI is positively associated with the QWI only in the normal weight segment (+0.19 percentage points at the 10th, +0.28 at the 50th, +0.32 at the 75th, +0.34 at the 90th, and +0.48 at the 95th quantiles). A unit increase in the BMI for women is associated with a lower QWI at the lower quantiles in the normal weight segment (-0.28 at the 5th, -0.19 at the 10th, and -0.25 percentage points at the 25th quantiles) and at the upper quantiles in the overweight segment (-1.15 at the 90th and -1.66 percentage points at the 95th quantiles). The results imply a spill-over cost of overweight or obesity beyond its impact on health in terms of success in the labor market.

Impact of dining out on nutritional intake and metabolic syndrome risk factors: data from the 2011 Korean National Health and Nutrition Examination Survey

The frequency of dining out has rapidly increased; however, the independent associations between dining out, metabolic syndrome risk factors and nutritional status have not been well characterised. The aim of the present study was to investigate the associations between dining out, nutritional intakes and metabolic syndrome risk factors among Korean adults, using data from the 2011 Korean National Health and Nutrition Examination Survey. Frequency of dining out was significantly associated with intake of nutrients such as energy, water, protein, fat, carbohydrate, Ca, Na, vitamin A and carotene. Especially, the result revealed that Korean adults had insufficient Ca intake compared with the Korean reference intake (700 mg). As the frequency of dining out increased, so did energy intake. In addition, individuals who dined out seven or more times per week experienced a 64 % higher likelihood of blood pressure abnormalities, an 88 % higher likelihood of waist circumference abnormalities, and a 32 % higher likelihood of low HDL-cholesterol levels than those who dined out less than once per week. BMI was not associated with the frequency of dining out. Our findings suggest that strategies to modify dining-out behaviour could reduce metabolic syndrome risk factors via improved nutrition.