Neighbourhood fast food outlets and obesity in children and adults: the CLAN Study

BMI and the Food Retail Environment in Melbourne, Australia: Associations and Temporal Trends

Research into the link between food environments and health is scarce. Research in this field has progressed, and new comprehensive methods (i.e., incorporating all food retail outlets) for classifying food retail environments have been developed and are yet to be examined alongside measures of obesity. In this study, we examine the association and temporal trends between the food environment and BMI of a repeated cross-sectional sample of the adult population between 2008 and 2016. Methods: Food retail data for 264 postal areas of Greater Melbourne was collected for the years 2008, 2012, 2014, and 2016, and a container-based approach was used to estimate accessibility to supermarkets, healthy and unhealthy outlets. Data on BMI for postal areas was obtained from the Victorian Population Health Survey (n = 47,245). We estimated the association between the food environment and BMI using linear mixed models. Results indicated that BMI increased as accessibility to healthy outlets decreased by up to -0.69 kg/m2 (95%CI: -0.95, -0.44). BMI was lower with high and moderate access to supermarkets compared to low access by -0.33 kg/m2 (-0.63, -0.04) and -0.32 kg/m2 (-0.56, -0.07), and with high access to unhealthy outlets compared to low access (-0.38 kg/m2: -0.64, -0.12) and moderate access (-0.54 kg/m2: -0.78, -0.30). Conclusion: Our results show that increasing access and availability to a diverse range of food outlets, particularly healthy food outlets, should be an important consideration for efforts to support good health. This research provides evidence that Australia needs to follow suit with other countries that have adopted policies giving local governments the power to encourage healthier food environments.

Association of fast-food restaurants with overweight and obesity in school-aged children and adolescents: A systematic review and meta-analysis

We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.

The community food environment and its association with diet, health or weight status in Australia: A systematic review with recommendations for future research

ISSUE ADDRESSED

This study systematically reviewed Australian literature to determine if an association exists between geospatial exposure to food outlets and diet, health or weight status. Recommendations for future research are provided.

METHODS

A systematic literature search was conducted in December 2021 using CINAHL Plus, PubMed and Web of Science databases. Data were extracted, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using an eight-item checklist. A descriptive synthesis of study characteristics and findings was carried out, stratified via study outcomes.

RESULTS

Of the 36 included articles, the majority were from Victoria (n = 19), involving adult participants (n = 30) and cross-sectional in design (n = 27). Overall, associations were mainly null (nonsignificant) for diet (80%), weight status (75%) and health outcomes (90%). Significant findings were mixed with no positive trend with study quality.

CONCLUSIONS

Six recommendations are suggested to address current knowledge gaps and limitations in the Australian evidence base: (1) Conduct research on different populations; (2) Employ robust study designs that can test the impact of change over time; (3) Improve the accuracy of food outlet data sources; (4) Improve food outlet geospatial exposure measures; (5) Improve measurement of outcome variables; and (6) Incorporate theoretical models into study design and data analysis. SO WHAT?: Improving the quality and consistency of research will be critical to informing locally relevant policy. Despite the present limitations in the evidence base, it is reasonable to assume that decisions to purchase and consume food are driven by availability and access. Thus, policy and planning aimed at improving the overall "healthiness" of the community food environment by increasing access to healthy food outlets is warranted to ensure that healthy options are easier choice for all.

Assessment of food environment at work and its association with cardiometabolic health among employed adults in Delhi, India

BACKGROUND AND AIMS

Unhealthy food environment at work is believed to be playing a role in the burgeoning obesity, cardiometabolic risk, diabetes and cardiovascular diseases in India. Therefore, food environment assessment at work is crucial to understand the effect of food environment and to find its association with cardiometabolic risk among adults in Delhi, India.

METHODOLOGY

Mix-methods study to find association between worksite food environment on the food choices, dietary behavior, and cardio-metabolic health of 455 apparently healthy adults (both males and females) aged 25-55 years was done in urban India.

RESULTS

Unhealthy food environment, poor eating pattern and sedentary lifestyle at work resulted in clustering of CMR factors among the study participants. Work environment assessment revealed that worksites with canteens had higher overall CHEW score for all its domains (Physical, nutritional, and information environment), in comparison to worksites without or no canteens. Four out of ten apparently healthy adults had metabolic syndrome indicating poor cardiometabolic health. The odds of CMR in subjects with access to canteen (unhealthy food) were estimated to be 0.74 (CI: 0.51 to 1.07; p = 0.11) times the odds of CMR in subjects without canteen (limited access to food). Females (β:0.34; 95% CI:0.23, 0.44; p = 0.00) had high CMR factors in comparison to males. Overall cardiometabolic risk factors increased with age (β:0.01; 95% CI:0.01,0.01; p = 0.00).

CONCLUSION

Findings of the present study urge the need for dietary and lifestyle intervention along with longitudinal studies to further disentangle the association of the food and work environment on the prevalence of CMR among adults.

Spatial spillovers, living environment and obesity in France: Evidence from a spatial econometric framework

In 2019, obesity affected 17% of French adults. In this article, we use a unique data set that combines individual-level health and consumption data with living environment data (food, sports and health amenities). We develop a spatial econometric framework to address French health disparities in obesity prevalence across space. We find that regulations on fast food restaurant locations could be a policy instrument to counter the prevalence of obesity. We also establish the existence of spatial spillovers of sports and medical amenities on obesity. This new evidence points to the need to consider a wider context than just the immediate local environment in the fight against the obesity pandemic.

Associations between supermarket availability and body size in Australia: a cross-sectional observational study comparing state and territory capital cities

Background

Residential environment features such as availability of supermarkets may shape dietary behaviour and thus overweight and obesity. This relationship may not be consistent between cities. This Australian national-level study examined: 1) the relationship between supermarket availability and body size; and 2) whether this relationship varied by capital city.

Methods

This study used 2017–18 Australian National Health Survey data including individual-level socio-demographic information (age, sex, country of birth, education, occupation, household income), and measured body size (height and weight to derive body mass index [BMI], and waist circumference [WC]). Objectively-expressed measures of residential environments included: counts of supermarkets (major chain outlets), counts of amenities (representing walkable destinations including essential services, recreation, and entertainment), and area of public open space - each expressed within road-network buffers at 1000 m and 1500 m; population density (1km² grid cells); and neighbourhood disadvantage (Index of Relative Socioeconomic Disadvantage) expressed within Statistical Area Level 1 units. Data for adult respondents ≥18 years residing in each of Australia’s state and territory capital cities (n = 9649) were used in multilevel models to estimate associations between supermarket availability and body size sequentially accounting for individual and other environment measures. An interaction term estimated city-specific differences in associations between supermarket availability and body size. Models were consequently repeated stratified by city.

Results

Body size (BMI and WC) and supermarket availability varied between cities. Initial inverse associations between supermarket availability and body size (BMI and WC) were attenuated to null with inclusion of all covariates, except for BMI in the 1000 m buffer model (beta = − 0.148, 95%CI -0.27, − 0.01, p = 0.025). In stratified analyses, the strengths of associations varied between cities, remaining statistically significant only for some cities (BMI: Melbourne, Brisbane Hobart; WC: Brisbane, Hobart) in fully adjusted models. Different patterns of attenuation of associations with inclusion of covariates were evident for different cities.

Conclusions

For Australian capital cities, greater availability of supermarkets is associated with healthful body size. Marked between-city variations in body size, supermarket availability, and relationships between supermarket availability and body size do not, however, support universal, “one-size-fits-all” solutions to change built environments to support healthful body size.

Fast-food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta-analysis

Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.

A longitudinal analysis of fast-food exposure on child weight outcomes: Identifying causality through school transitions

This article investigates the effect of fast-food availability on childhood weight outcomes by gender, race, and location. We use a novel identification strategy based on changes in fast-food exposure along the route between the home and school that occur as students progress through the public school system and transition to different types of schools, e.g. from elementary school to intermediate school or from intermediate school to high school. Using a longitudinal census of height and weight for public school students in Arkansas, we find no evidence that changes in fast-food exposure are associated with changes in body mass index z-score for any student subpopulation.

Food Retail Environments in Greater Melbourne 2008-2016: Longitudinal Analysis of Intra-City Variation in Density and Healthiness of Food Outlets

Obesity prevalence is inequitably distributed across geographic areas. Food environments may contribute to health disparities, yet little is known about how food environments are evolving over time and how this may influence dietary intake and weight. This study aimed to analyse intra-city variation in density and healthiness of food outlets between 2008 and 2016 in Melbourne, Australia. Food outlet data were classified by location, type and healthiness. Local government areas (LGAs) were classified into four groups representing distance from the central business district. Residential population estimates for each LGA were used to calculate the density of food outlets per 10,000 residents. Linear mixed models were fitted to estimate the mean density and ratio of ‘healthy’ to ‘unhealthy’ food outlets and food outlet ‘types’ by LGA group over time. The number of food outlets increased at a faster rate than the residential population, driven by an increasing density of both ‘unhealthy’ and ‘healthy’ outlets. Across all years, ratios of ‘unhealthy’ to ‘healthy’ outlets were highest in LGAs located in designated Growth Areas. Melbourne’s metropolitan food environment is saturated by ‘unhealthy’ and ‘less healthy’ food outlets, relative to ‘healthy’ ones. Melbourne’s urban growth areas had the least healthy food environments.

A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity

There is strong support across multiple sectors for the implementation of policies to create healthier food environments as part of comprehensive strategies to address obesity and improve population diets. The existing evidence base describing food retail environments and their relationship with health outcomes is limited in several respects. This systematic review examines the current evidence regarding food retail environments in Australia, including associations with diet and people with obesity, and socioeconomic and geographic disparities. Three databases were searched and independently screened. Studies were included if they were undertaken in Australia and objectively measured the food retail environment. Sixty papers were included. The broad range of methodological approaches used across studies limited the ability to synthesize the evidence and draw conclusions. Results indicated that there is some evidence that disparities exist in food retail environments across measures of socioeconomic position and geographic area in parts of Australia. Overall, there were inconsistent findings regarding the association between the healthiness of food retail environments and diet or people with obesity. Findings support previous calls for standardized tools and measures for monitoring the healthiness of food retail environments. This is imperative to inform evidence-based policy and evaluation in this critical component of recommended obesity prevention strategies.

Association between Availability of Neighborhood Fast Food Outlets and Overweight Among 5⁻18 Year-Old Children in Peninsular Malaysia: A Cross-Sectional Study

A growing number of fast-food outlets in close proximity to residential areas raises a question as to its impact on childhood overweight and obesity. This study aimed at determining the relationship between the availability of fast-food outlets that were in close proximity to residential areas and overweight among Malaysian children aged 5 to 18 years. Measurement data on the weight and height of 5544 children (2797 boys, 2747 girls) were obtained from the National Health and Morbidity Survey 2011. Overweight (including obesity) is defined as BMI-for-age z-score > +1 SD based on the WHO growth reference. Geographic information system geospatial analysis was performed to determine the number of fast-food outlets within 1000 m radius from the children’s residential address. Multiple logistic regression was conducted to examine the association between the availability of fast-food outlets (none or more than one outlet) and overweight with adjustment for age, sex, ethnicity, monthly household income, parental educational level, residential area and supermarket density. Our results showed that the prevalence of overweight was 25.0% and there was a statistically significant association between the density of fast-food outlets and overweight (odds ratio: 1.23, 95% confidence interval: 1.03, 1.47). Our study suggested that the availability of fast-food outlets with close proximity in residential areas was significantly associated with being overweight among children. Limiting the number of fast-food outlets in residential areas could have a significant effect in reducing the prevalence of overweight among Malaysian children.

The prevalence of obesity among adult population and its association with food outlet density in a hilly area of Uttarakhand

Background

The rising burden of obesity is a threat to both developed and developing countries. Obesity is a killer lifestyle disease. Different aspects of the local environment play a key role in the occurrence of obesity. The present study was conducted to determine the prevalence of obesity among adult, its associated factors, and its relationship with retail food outlet density in Srikot, Uttarakhand.

Materials and Methods

This study was a community-based cross-sectional study, carried out in Srikot, Uttarakhand, in 2016 among 155 adults systematically sampled, aged above 20 years. A semi-structured pretested questionnaire was used to interview the participants, and anthropometry measurements were done. The details regarding the geographic location and count of outlets were carried out. Obesity was considered body mass index ≥25 kg/m².

Results

In the present study, 61.3% were females. The mean age of the study participants was 38.3 (±13.6) years. The prevalence of overweight was 14.8% and obesity was 55.5%. A total of 92.9% of the study participants reported consumption of junk food. On mapping the study area, it was found that the total number of food outlets were 116. It was found that density of any food outlet per study participant was 0.7.

Conclusion

The Srikot in Uttarakhand is in an early stage of urbanization as evident from the burden of obesity, and this might worsen by prevalent outlet density of food in the environment.

Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review

Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.

Associations between major chain fast-food outlet availability and change in body mass index: a longitudinal observational study of women from Victoria, Australia

OBJECTIVES

The residential neighbourhood fast-food environment has the potential to lead to increased levels of obesity by providing opportunities for residents to consume energy-dense products. This longitudinal study aimed to examine whether change in body mass index (BMI) differed dependent on major chain fast-food outlet availability among women residing in disadvantaged neighbourhoods.

SETTING

Eighty disadvantaged neighbourhoods in Victoria, Australia.

PARTICIPANTS

Sample of 882 women aged 18-46 years at baseline (wave I: 2007/2008) who remained at the same residential location at all three waves (wave II: 2010/2011; wave III: 2012/2013) of the Resilience for Eating and Activity Despite Inequality study.

PRIMARY OUTCOME

BMI based on self-reported height and weight at each wave.

RESULTS

There was no evidence of an interaction between time and the number of major chain fast-food outlets within 2 (p=0.88), 3 (p=0.66) or 5 km (p=0.24) in the multilevel models of BMI. Furthermore, there was no evidence of an interaction between time and change in availability at any distance and BMI.

CONCLUSIONS

Change in BMI was not found to differ by residential major chain fast-food outlet availability among Victorian women residing in disadvantaged neighbourhoods. It may be that exposure to fast-food outlets around other locations regularly visited influence change in BMI. Future research needs to consider what environments are the key sources for accessing and consuming fast food and how these relate to BMI and obesity risk.

Temporal growth and spatial distribution of the fast food industry and its relationship with economic development in China - 2005-2012

The fast food (FF) industry has expanded rapidly in China during the past two decades, in parallel with an increase in the prevalence of obesity. Using government-reported longitudinal data from 21 provinces and cities in China, this study examined the growth over time and the spatial distribution patterns of the FF industry as well as the key social economic factors involved. We visualized the temporal and geographic distributions of FF industry development and conducted cross-sectional and longitudinal spatial analysis to assess associations between macroeconomic conditions, population dynamics, and the growth and distributional changes of the industry. It grew faster in the southeast coastal (more economically developed) areas since 2005 than in other regions. The industry was: 1) highly correlated with Gross Domestic Product; 2) highly correlated with per capita disposable income for urban residents; 3) moderately correlated with urban population; and 4) not correlated with an increase of population size. The mean center of the FF industry shifted westward as the mean center of the GDP moved in the same direction, while the mean center of the population shifted eastward. The results suggest that the rapid FF industry expansion in China was closely associated with economic growth and that improving the food environment should be a major component in local economic development planning.

Association between Childhood Obesity and Neighbourhood Accessibility to Fast-Food Outlets: A Nationwide 6-Year Follow-Up Study of 944,487 Children

OBJECTIVES

The aim of this 6-year follow-up study was to examine whether neighbourhood accessibility to fast-food outlets was associated with diagnosed childhood obesity, after adjustment for neighbourhood- and individual-level socio-demographic factors.

METHODS

This 6-year follow-up study comprised 484,677 boys and 459,810 girls aged 0-14 years in Sweden. The follow-up period ran from January 1, 2005, until hospitalisation/out-patient treatment for obesity, death, emigration or the end of the study period on December 31, 2010. Multilevel logistic regression models (individual-level factors at the first level and neighbourhood-level factors at the second level) were used to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

RESULTS

We identified 6,968 obesity cases (3,878 boys and 3,090 girls) during the follow-up period. Higher odds of childhood obesity for those living in neighbourhoods with accessibility to fast-food outlets was observed (OR = 1.14, 95% CI = 1.07-1.22) that remained significant after adjustments (OR = 1.06, 95% CI = 1.00-1.13).

CONCLUSIONS

This prospective nationwide study showed that the neighbourhood accessibility to fast-food outlets was independently associated with increased odds of diagnosed childhood obesity. This finding implicates that residential environments should be considered when developing health promotion programmes.

Secular trends in the prevalence of childhood overweight and obesity across Australian states: A meta-analysis

OBJECTIVE

To describe secular trends in the prevalence of overweight and obesity in Australian children in each state and territory.

DESIGN

Systematic search and numerical meta-analysis.

METHODS

A systematic search was conducted to identify all sources that objectively measured the height and weight of Australian children (aged 2-18 years) and had a sample size of at least 300. Raw and summary data were requested from authors and divided into age×sex×state×yearly slices to derive estimates of the prevalence of overweight and obesity. Following a double arcsine transformation to facilitate meta-analysis, all estimates were standardised for age, stratified by sex and analysed using sample-weighted non-linear regressions.

RESULTS

The systematic search identified 73 eligible sources (47 raw and 26 summary datasets), with 72.8% of data sourced from Victoria and South Australia. Prevalence trends varied from state to state, with three states or territories showing a marked plateau, two showing a decline in the more recent years and three showing continued linear increases. Tasmania and Northern Territory generally had the highest prevalence (30.2% and 24.3% overweight and obesity respectively), and the Australian Capital Territory had the lowest (12.4% overweight and obesity).

CONCLUSIONS

Prevalence, as well as prevalence trends, varied amongst Australian states and territories. At a national level, the prevalence trend has nearly plateaued for the past 15 years. However, upward prevalence trends appear to be persisting in Western Australia, South Australia and Tasmania. Findings highlight the need for ongoing efforts to address the issue of childhood obesity.

Evaluation of a 'healthiness' rating system for food outlet types in Australian residential communities

AIM

To obtain expert consensus to develop and evaluate a rating system on the relative healthiness of Australian suburbs' food outlet types.

METHODS

Twenty-four food outlet types and 10 local suburbs were identified from previous mapping studies and based on a scan of suburbs across one large Australian geographical region. Initial food outlet 'scores' for relative healthiness were proposed based on available literature, classified into five categories, from 'most' to 'least' healthy. In round 1 of a modified Delphi survey, participants, Australian public health and nutrition experts, were given each outlet type's definition and the proposed scores and invited to modify the scores based on their perceived 'healthiness'. In round 2, participants were able to revise or adjust their scores.

RESULTS

Median scores for food outlet types from both rounds highly correlated with the originally proposed scores (two-tailed Pearson's correlation coefficient 0.97 and 0.96, respectively, P = 0.01), and scores from round 1 highly correlated with those from round 2 (Pearson's coefficient 0.998, P = 0.01). Round 2 scores were used to calculate suburbs' overall food environment score, healthiness score, unhealthiness score and a ratio of unhealthiness to healthiness scores. There was strong positive correlation between suburbs' ratio of unhealthiness to healthiness scores and a previously recognised scoring ratio, Retail Food Environment Index (Spearman's rho 0.847, P < 0.01).

CONCLUSIONS

The study generated experts' consensus about relative healthiness of food outlet types found in Australian neighbourhoods. Proposed scores can be used to assess and compare healthiness of community food environments and to explore their associations with area characteristics, population's diet and health outcomes.

Food Environments and Obesity: Household Diet Expenditure Versus Food Deserts

OBJECTIVES

To examine the associations between obesity and multiple aspects of the food environments, at home and in the neighborhood.

METHODS

Our study included 38,650 individuals nested in 18,381 households located in 2104 US counties. Our novel home food environment measure, USDAScore, evaluated the adherence of a household's monthly expenditure shares of 24 aggregated food categories to the recommended values based on US Department of Agriculture food plans. The US Census Bureau's County Business Patterns (2008), the detailed food purchase information in the IRi Consumer Panel scanner data (2008-2012), and its associated MedProfiler data set (2012) constituted the main sources for neighborhood-, household-, and individual-level data, respectively.

RESULTS

After we controlled for a number of confounders at the individual, household, and neighborhood levels, USDAScore was negatively linked with obesity status, and a census tract-level indicator of food desert status was positively associated with obesity status.

CONCLUSIONS

Neighborhood food environment factors, such as food desert status, were associated with obesity status even after we controlled for home food environment factors.

Absolute and relative densities of fast-food versus other restaurants in relation to weight status: Does restaurant mix matter?

BACKGROUND

Given the continuing epidemic of obesity, policymakers are increasingly looking for levers within the local retail food environment as a means of promoting healthy weights.

PURPOSE

To examine the independent and joint associations of absolute and relative densities of restaurants near home with weight status in a large, urban, population-based sample of adults.

METHODS

We studied 10,199 adults living in one of four cities in southern Ontario, Canada, who participated in the Canadian Community Health Survey (cycles 2005, 2007/08, 2009/10). Multivariate models assessed the association of weight status (obesity and body mass index) with absolute densities (numbers) of fast-food, full-service and other restaurants, and the relative density (proportion) of fast-food restaurants (FFR) relative to all restaurants within ~10-minute walk of residential areas.

RESULTS

Higher numbers of restaurants of any type were inversely related to excess weight, even in models adjusting for a range of individual covariates and area deprivation. However, these associations were no longer significant after accounting for higher walkability of areas with high volumes of restaurants. In contrast, there was a direct relationship between the proportion of FFR relative to all restaurants and excess weight, particularly in areas with high volumes of FFR (e.g., odds ratio for obesity=2.55 in areas with 5+ FFR, 95% confidence interval: 1.55-4.17, across the interquartile range).

CONCLUSIONS

Policies aiming to promote healthy weights that target the volume of certain retail food outlets in residential settings may be more effective if they also consider the relative share of outlets serving more and less healthful foods.

Health Implications of Adults' Eating at and Living near Fast Food or Quick Service Restaurants

Background:

This paper examined whether the reported health impacts of frequent eating at a fast food or quick service restaurant on health were related to having such a restaurant near home.

Methods:

Logistic regressions estimated associations between frequent fast food or quick service restaurant use and health status, being overweight or obese, having a cardiovascular disease or diabetes, as binary health outcomes. In all, 2001 participants in the 2008–2009 Seattle Obesity Study survey were included in the analyses.

Results:

Results showed eating ⩾2 times a week at a fast food or quick service restaurant was associated with perceived poor health status, overweight and obese. However, living close to such restaurants was not related to negative health outcomes.

Conclusions:

Frequent eating at a fast food or quick service restaurant was associated with perceived poor health status and higher body mass index, but living close to such facilities was not.

Associations between BMI and home, school and route environmental exposures estimated using GPS and GIS: do we see evidence of selective daily mobility bias in children?

Background

This study examined whether objective measures of food, physical activity and built environment exposures, in home and non-home settings, contribute to children’s body weight. Further, comparing GPS and GIS measures of environmental exposures along routes to and from school, we tested for evidence of selective daily mobility bias when using GPS data.

Methods

This study is a cross-sectional analysis, using objective assessments of body weight in relation to multiple environmental exposures. Data presented are from a sample of 94 school-aged children, aged 5–11 years. Children’s heights and weights were measured by trained researchers, and used to calculate BMI z-scores. Participants wore a GPS device for one full week. Environmental exposures were estimated within home and school neighbourhoods, and along GIS (modelled) and GPS (actual) routes from home to school. We directly compared associations between BMI and GIS-modelled versus GPS-derived environmental exposures. The study was conducted in Mebane and Mount Airy, North Carolina, USA, in 2011.

Results

In adjusted regression models, greater school walkability was associated with significantly lower mean BMI. Greater home walkability was associated with increased BMI, as was greater school access to green space. Adjusted associations between BMI and route exposure characteristics were null. The use of GPS-actual route exposures did not appear to confound associations between environmental exposures and BMI in this sample.

Conclusions

This study found few associations between environmental exposures in home, school and commuting domains and body weight in children. However, walkability of the school neighbourhood may be important. Of the other significant associations observed, some were in unexpected directions. Importantly, we found no evidence of selective daily mobility bias in this sample, although our study design is in need of replication in a free-living adult sample.

Electronic supplementary material

The online version of this article (doi:10.1186/1476-072X-14-8) contains supplementary material, which is available to authorized users.

A cross sectional study investigating the association between exposure to food outlets and childhood obesity in Leeds, UK

BACKGROUND

Current UK policy in relation to the influence of the 'food environment' on childhood obesity appears to be driven largely on assumptions or speculations because empirical evidence is lacking and findings from studies are inconsistent. The aim of this study was to investigate the number of food outlets and the proximity of food outlets in the same sample of children, without solely focusing on fast food.

METHODS

Cross sectional study over 3 years (n = 13,291 data aggregated). Body mass index (BMI) was calculated for each participant, overweight and obesity were defined as having a BMI >85(th) (sBMI 1.04) and 95(th) (sBMI 1.64) percentiles respectively (UK90 growth charts). Home and school neighbourhoods were defined as circular buffers with a 2 km Euclidean radius, centred on these locations. Commuting routes were calculated using the shortest straight line distance, with a 2 km buffer to capture varying routes. Data on food outlet locations was sourced from Leeds City Council covering the study area and mapped against postcode. Food outlets were categorised into three groups, supermarkets, takeaway and retail. Proximity to the nearest food outlet in the home and school environmental domain was also investigated. Age, gender, ethnicity and deprivation (IDACI) were included as covariates in all models.

RESULTS

There is no evidence of an association between the number of food outlets and childhood obesity in any of these environments; Home Q4 vs. Q1 OR = 1.11 (95% CI = 0.95-1.30); School Q4 vs. Q1 OR = 1.00 (95% CI 0.87 - 1.16); commute Q4 vs. Q1 OR = 0.1.00 (95% CI 0.83 - 1.20). Similarly there is no evidence of an association between the proximity to the nearest food outlet and childhood obesity in the home (OR = 0.77 [95% CI = 0.61 - 0.98]) or the school (OR = 1.01 [95% CI 0.84 - 1.23]) environment.

CONCLUSIONS

This study provides little support for the notion that exposure to food outlets in the home, school and commuting neighbourhoods increase the risk of obesity in children. It seems that the evidence is not well placed to support Governmental interventions/recommendations currently being proposed and that policy makers should approach policies designed to limit food outlets with caution.

Food Away from Home and Childhood Obesity

Childhood obesity is associated with a number of serious health risks that can persist into adulthood. While trends in food away from home and fast-food consumption have paralleled trends in childhood obesity, it is important to identify whether this is a causal relationship. This paper reviews recent literature in this area to summarize if there is a consensus in research findings. We group the literature into two areas - consumption of and access to food away from home (FAFH). While no consensus findings have been reached in either area, the evidence of an association between FAFH consumption and childhood obesity has gained strength. Further, there is evidence that FAFH meals add calories to children's diets. The literature on the role of FAFH access and childhood obesity has continued producing mixed results.

Food access and children's BMI in Toronto, Ontario: assessing how the food environment relates to overweight and obesity

OBJECTIVES

The objective was to examine how access to fast food restaurants, less healthy/healthier food outlets and supermarkets relate to measured levels of overweight and obesity among grade 5 and 6 students.

METHODS

Measured height and weight data were obtained to measure BMI. The location and type of food outlet were derived from Toronto Public Health. The density of fast food, less healthy/healthy food outlets and supermarkets within a 1-km walk of the child's home was calculated along with the distance to the closest. Logistic regression models examined the relationship between food access and overweight/obesity.

RESULTS

Lower income residents were more likely to be overweight or obese, as were boys. Living in an area with a higher density of healthy food outlets and in close proximity to a supermarket decreased the odds of being overweight or obese.

CONCLUSIONS

Addressing several limitations in the literature, the findings confirm an association between the food retail environment and body weight. Density of healthy food outlets and distance to the nearest supermarket are important factors to be considered in addressing the childhood obesity pandemic.

The relative contribution of layers of the Social Ecological Model to childhood obesity

OBJECTIVE

The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children's weight status.

DESIGN

Cross-sectional survey of randomly selected households with children living in low-income diverse communities.

SETTING

A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child's residence to food and physical activity outlets.

SUBJECTS

Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights.

RESULTS

Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children's weight status.

CONCLUSIONS

The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

Is neighbourhood obesogenicity associated with body mass index in women? Application of an obesogenicity index in socioeconomically disadvantaged neighbourhoods

An aggregate index is potentially useful to represent neighbourhood obesogenicity. We created a conceptually-based obesogenicity index and examined its association with body mass index (BMI) among 3786 women (age 18-45y) in socio-economically disadvantaged neighbourhoods in Victoria, Australia. The index included 3 items from each of 3 domains: food resources (supermarkets, green grocers, fast food restaurants), recreational activity resources (gyms, pools, park space), and walkability (4+ leg intersections, neighbourhood walking environment, neighbourhood safety), with a possible range from 0 to 18 reflecting 0-2 for each of the 9 items. Using generalised estimating equations, neighbourhood obesogenicity was not associated with BMI in the overall sample. However, stratified analyses revealed generally positive associations with BMI in urban areas and inverse associations in rural areas (interaction p=0.02). These analyses are a first step towards combining neighbourhood characteristics into an aggregate obesogenicity index that is transparent enough to be adopted elsewhere and to allow examination of the relevance of its specific components in different settings.

The proportion of excessive fast-food consumption attributable to the neighbourhood food environment among youth living within 1 km of their school

The study objective was to estimate the proportion of excessive fast-food consumption by youth that is attributable to living and attending school in a neighbourhood with a moderate or high density of fast-food restaurants. This was a cross-sectional study of 6099 Canadian youths (aged 11-15 years) from 255 school neighbourhoods. All participants lived within 1 km of their school. The density of chain fast-food restaurants within a 1-km circular buffer surrounding each school was determined using geographic information systems. Excessive fast-food consumption (≥2 times per week) was assessed by questionnaire. Multilevel logistic regression analysis was used to examine associations. The population attributable risk estimates of excessive fast-food consumption due to neighbourhood exposure to fast-food restaurants were determined based on the prevalence of exposure and the results from the logistic regression. Eight percent of participants were excessive fast-food consumers. After adjusting for sociodemographic factors (i.e., gender, race, and socioeconomic status), it was found that youths from neighbourhoods with a moderate (odds ratio (OR), 1.68; 95% confidence interval (CI), 1.11-2.54) or high (OR 1.70; 95% CI 1.12-2.56) density of chain fast-food restaurants were more likely to be excessive fast-food consumers than were youths from neighbourhoods with no chain fast-food restaurants. Approximately 31% of excessive consumption was attributable to living in neighbourhoods with a moderate or high density of fast-food restaurants. Thus, the fast-food retail environment within which youth live and go to school is an important contributor to their eating behaviours.

Associations between childhood obesity and the availability of food outlets in the local environment: a retrospective cross-sectional study

PURPOSE

Examine whether individual-level childhood obesity is related to residential availability of fast food and healthy food outlets.

DESIGN

Retrospective cross-sectional study.

SETTING

Perth, Western Australia.

SUBJECTS

A total of 1850 children aged 5 to 15 years in 2005-2010 who participated in the Western Australian Health and Wellbeing Surveillance System survey.

MEASURES

Geographical Information Systems were used to calculate a range of measures of fast food and healthy food outlet access and availability. For example, distance to nearest and access and density measures within 800 m and 3 km of each child's residence were all tested.

ANALYSIS

Multivariate logistic regression analysis, controlling for individual-level sociodemographic factors and lifestyle behaviors.

RESULTS

An increasing number of healthy food outlets within 800 m of a child's home was associated with a significantly reduced risk of being overweight/obese in all models tested. After controlling for age, physical activity, time spent sedentary, weekly takeaway consumption, area disadvantage, and count of fast food outlets, each additional healthy food outlet within 800 m was associated with a 20% decrease in the likelihood of a child being overweight or obese (odds ratio: .800, 95% confidence intervals: .686-.933).

CONCLUSION

The local food environment around children's homes has an independent effect on child weight status. These findings highlight the importance of the built environment as a potential contributor towards child health, which should be considered when developing community health promotion programs.

More neighborhood retail associated with lower obesity among New York City public high school students

Policies target fast food outlets to curb adolescent obesity. We argue that researchers should examine the entire retail ecology of neighborhoods, not just fast food outlets. We examine the association between the neighborhood retail environment and obesity using Fitnessgram data collected from 94,348 New York City public high school students. In generalized hierarchical linear models, the number of fast food restaurants predicted lower odds of obesity for adolescents (OR:0.972 per establishment; CI:0.957-0.988). In a "placebo test" we found that banks--a measure of neighborhood retail ecology--also predicted lower obesity (OR:0.979 per bank; CI:0.962-0.994). Retail disinvestment might be associated with greater obesity; accordingly, public health research should study the influence of general retail disinvestment not just food-specific investment.

Clustering of unhealthy food around German schools and its influence on dietary behavior in school children: a pilot study

BACKGROUND

The availability of fast foods, sweets, and other snacks in the living environment of children is assumed to contribute to an obesogenic environment. In particular, it is hypothesized that food retailers are spatially clustered around schools and that a higher availability of unhealthy foods leads to its higher consumption in children. Studies that support these relationships have primarily been conducted in the U.S. or Australia, but rarely in European communities. We used data of FFQ and 24-HDR of the IDEFICS study, as well as geographical data from one German study region to investigate (1) the clustering of food outlets around schools and (2) the influence of junk food availability on the food intake in school children.

METHODS

We geocoded food outlets offering junk food (e.g. supermarkets, kiosks, and fast food restaurants). Spatial cluster analysis of food retailers around child-serving institutions was conducted using an inhomogeneous K-function to calculate global 95% confidence envelopes. Furthermore, a food retail index was implemented considering the kernel density of junk food supplies per service area, adjusted for residential density. We linked the food retail index to FFQ and 24-HDR data of 384 6- to 9-year-old school children in the study region and investigated the impact of the index on food intake, using multilevel regression models adjusted for sex, age, BMI, parent's education and income, as well as adjusting for over- and underreporting of food intake.

RESULTS

Comparing the 95% confidence envelopes to the observed K-function, we showed that food stores and fast food restaurants do not significantly cluster around schools. Apart from this result, the food retail index showed no effect on BMI (β=0.01,p=0.11) or food intake variables assessed by FFQ and 24-HDR.

CONCLUSION

In the built environment of the German study region, clustering of food retailers does not depend on the location of schools. Additionally, the results suggest that the consumption of junk food in young children is not influenced by spatial availability of unhealthy food. However, investigations should be replicated in other European communities to increase environmental variability.

The number and type of food retailers surrounding schools and their association with lunchtime eating behaviours in students

Background

The primary study objective was to examine whether the presence of food retailers surrounding schools was associated with students’ lunchtime eating behaviours. The secondary objective was to determine whether measures of the food retail environment around schools captured using road network or circular buffers were more strongly related to eating behaviours while at school.

Methods

Grade 9 and 10 students (N=6,971) who participated in the 2009/10 Canadian Health Behaviour in School Aged Children Survey were included in this study. The outcome was determined by students’ self-reports of where they typically ate their lunch during school days. Circular and road network-based buffers were created for a 1 km distance surrounding 158 schools participating in the HBSC. The addresses of fast food restaurants, convenience stores and coffee/donut shops were mapped within the buffers. Multilevel logistic regression was used to determine whether there was a relationship between the presence of food retailers near schools and students regularly eating their lunch at a fast food restaurant, snack-bar or café. The Akaike Information Criteria (AIC) value, a measure of goodness-of-fit, was used to determine the optimal buffer type.

Results

For the 1 km circular buffers, students with 1–2 (OR= 1.10, 95% CI: 0.57-2.11), 3–4 (OR=1.45, 95% CI: 0.75-2.82) and ≥5 nearby food retailers (OR=2.94, 95% CI: 1.71-5.09) were more likely to eat lunch at a food retailer compared to students with no nearby food retailers. The relationships were slightly stronger when assessed via 1 km road network buffers, with a greater likelihood of eating at a food retailer for 1–2 (OR=1.20, 95% CI:0.74-1.95), 3–4 (OR=3.19, 95% CI: 1.66-6.13) and ≥5 nearby food retailers (OR=3.54, 95% CI: 2.08-6.02). Road network buffers appeared to provide a better measure of the food retail environment, as indicated by a lower AIC value (3332 vs. 3346).

Conclusions

There was a strong relationship between the presence of food retailers near schools and students’ lunchtime eating behaviours. Results from the goodness of fit analysis suggests that road network buffers provide a more optimal measure of school neighbourhood food environments relative to circular buffers.

Do adolescents who live or go to school near fast-food restaurants eat more frequently from fast-food restaurants?

This population-based study examined whether residential or school neighborhood access to fast food restaurants is related to adolescents' eating frequency of fast food. A classroom-based survey of racially/ethnically diverse adolescents (n=2724) in 20 secondary schools in Minneapolis/St. Paul, Minnesota was used to assess eating frequency at five types of fast food restaurants. Black, Hispanic, and Native American adolescents lived near more fast food restaurants than white and Asian adolescents and also ate at fast food restaurants more often. After controlling for individual-level socio-demographics, adolescent males living near high numbers fast food restaurants ate more frequently from these venues compared to their peers.

Identification of the appropriate boundary size to use when measuring the food retail environment surrounding schools

This study included 6,971 students in grades 9 and 10 (ages 13 to 16 years) from 158 schools who participated in the 2009/2010 Health Behaviour in School-aged Children Study. Students provided information on where they typically ate lunch. The number of food retailers was obtained for six road network buffer sizes (500, 750, 1,000, 1,500, 2,000, and 5,000 meters) surrounding schools. Associations between the presence of food retailers near schools and students' lunchtime eating behaviours were examined using multilevel logistic regression. Comparisons of model fit statistics indicated that the 1,000 m buffer provided the best fit. At this distance, students with ≥3 food retailers near their schools had a 3.42 times greater relative odds (95% CI: 2.12-5.52) of eating their lunchtime meal at a food retailer compared to students with no nearby food retailers. Students who had ≥2 food retailers within 750 m of their schools had a 2.74 times greater relative odds (95% CI: 1.75-4.29), while those who had ≥1 food retailer within 500 m of their schools had 2.27 times greater relative odds of eating at food retailer (95% CI: 1.46-3.52) compared to those with no nearby food retailers. For distances greater than 1,000 m, no consistent relationships were found.

Patterns of obesogenic neighborhood features and adolescent weight: a comparison of statistical approaches

BACKGROUND

Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk, and findings have been inconsistent.

PURPOSE

Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches.

METHODS

Anthropometric measures were taken on 2682 adolescents (53% female, mean age=14.5 years) from 20 Minneapolis/St. Paul MN schools in 2009-2010. Neighborhood environmental variables were measured using GIS data and by survey. Gender-stratified regressions related to BMI z-scores and obesity to (1) separate neighborhood variables; (2) composites formed using factor analysis; and (3) clusters identified using spatial latent class analysis in 2012.

RESULTS

Regressions on separate neighborhood variables found a low percentage of parks/recreation, and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low SES, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops.

CONCLUSIONS

The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.

The influence of local food environments on adolescents' food purchasing behaviors

This study examined the relationship between the neighborhood food environment and the food purchasing behaviors among adolescents. Grade 7 and 8 students (n = 810) at 21 elementary schools in London, Ontario, Canada completed a questionnaire assessing their food purchasing behaviors. Parents of participants also completed a brief questionnaire providing residential address and demographic information. A Geographic Information System (GIS) was used to assess students' home and school neighborhood food environment and land use characteristics. Logistic regression analysis was conducted to assess the influence of the home neighborhood food environment on students' food purchasing behaviors, while two-level Hierarchical Non-Linear Regression Models were used to examine the effects of school neighborhood food environment factors on students' food purchasing behaviors. The study showed that approximately 65% of participants reported self-purchasing foods from fast-food outlets or convenience stores. Close proximity (i.e., less than 1 km) to the nearest fast-food outlet or convenience store in the home neighborhood increased the likelihood of food purchasing from these food establishments at least once per week by adolescents (p < 0.05). High fast-food outlet density in both home and school neighborhoods was associated with increased fast-food purchasing by adolescents (i.e., at least once per week; p < 0.05). In conclusion, macro-level regulations and policies are required to amend the health-detracting neighborhood food environment surrounding children and youth's home and school.

Associations of fast food restaurant availability with dietary intake and weight among African Americans in the Jackson Heart Study, 2000-2004

OBJECTIVES

We examined the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the southeastern United States.

METHODS

We investigated cross-sectional associations of FFR availability with dietary intake and body mass index (BMI) and waist circumference in 4740 African American Jackson Heart Study participants (55.2 ± 12.6 years, 63.3% women). We estimated FFR availability using circular buffers with differing radii centered at each participant's geocoded residential location.

RESULTS

We observed no consistent associations between FFR availability and BMI or waist circumference. Greater FFR availability was associated with higher energy intake among men and women younger than 55 years, even after adjustment for individual socioeconomic status. For each standard deviation increase in 5-mile FFR availability, the energy intake increased by 138 kilocalories (confidence interval [CI] = 70.53, 204.75) for men and 58 kilocalories (CI = 8.55, 105.97) for women. We observed similar associations for the 2-mile FFR availability, especially in men. FFR availability was also unexpectedly positively associated with total fiber intake.

CONCLUSIONS

FFR availability may contribute to greater energy intake in younger African Americans who are also more likely to consume fast food.

Body mass index and the built and social environments in children and adolescents using electronic health records

BACKGROUND

No prior studies in children have evaluated how age may modify relationships of the built and social environments with BMI, nor evaluated the range of scales and contexts over which places may influence health.

PURPOSE

To systematically evaluate associations of 33 environmental measures in three domains (land use, physical activity, and social environments) with BMI in children and adolescents in five geographies.

METHODS

A cross-sectional, multilevel analysis was completed in 2009-2010 of electronic health record data (2001-2008) from 47,769 children aged 5-18 years residing in a 31-county region of Pennsylvania. Associations of environmental measures with BMI were evaluated using 0.5-mile network buffers; census tracts; minor civil divisions (i.e., townships, boroughs, cities); a mixed definition of place (townships, boroughs, and census tracts in cities); and counties, overall and by age strata.

RESULTS

Among all children, lower levels of community socioeconomic deprivation and greater diversity of physical activity establishments were associated with lower BMI. Associations of environmental measures differed by age, depending on scale and context. For example, higher population density was associated with lower BMI in older children; this effect was strongest in the larger geographies. Similarly, a lower level of county sprawl was associated with lower BMI in older children.

CONCLUSIONS

Associations differed by age and definition of place, suggesting that the benefits of environmental intervention may not be uniform across the childhood age range. The study demonstrated the utility of using electronic patient information for large-scale, population-based epidemiologic research, a research area of growing interest and investment in the U.S.

Urban v. suburban perceptions of the neighbourhood food environment as correlates of adolescent food purchasing

OBJECTIVE

To assess the relationship between adolescent perception of time to walk to neighbourhood food retail outlets and purchasing of sugar-sweetened beverages (SSB), fast and convenience food items, and to test for differences by urban v. suburban environment.

DESIGN

Cross-sectional observational study.

SETTING

Twin Cities Metropolitan Area, Minnesota, USA.

SUBJECTS

Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure, and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted.

RESULTS

There were 634 adolescents, approximately half male, predominantly white, with a middle-class background. Greater perceived time to food outlets was associated with less frequent purchasing of SSB, convenience store foods and fast-food items. Multivariate models showed that a perceived shorter walking time (i.e. 1-5 v. 31+ min) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10 min walk (B = 0·05, P = 0·02).

CONCLUSIONS

A reduction in consumption of SSB and other energy-dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.

Neighborhood restaurant availability and frequency of eating out in relation to dietary intake in young Japanese women

Exposure to food service establishments is considered to encourage consumption and contribute to poorer diet quality, and hence adverse health profiles. However, empirical verification of these links remains rare, particularly in young adults and non-Western populations. The objective of this cross-sectional study was to test the hypothesis that neighborhood restaurant availability and frequency of eating out are associated with unfavorable patterns of dietary intake and thus possibly higher body mass index (BMI) and waist circumference in young Japanese women. The subjects were 989 female Japanese dietetic students 18 to 22 y of age. Dietary intake and frequency of eating out (i.e., consumption of commercially prepared meals) during the preceding month were assessed using a comprehensive, self-administered diet history questionnaire. Neighborhood restaurant availability was defined as the number of restaurants within a 0.5-mile (0.8-km) radius of residence (i.e., full-service restaurants, limited-service restaurants, and cafeterias). Increasing frequency of eating out was associated with higher intake of meat, confectionery and bread, and dietary fat, lower intake of fruit and vegetables, rice, and dietary fiber, and higher dietary energy density. However, neighborhood restaurant availability was not associated with either the frequency of eating out or any of the dietary variables examined. Further, frequency of eating out and neighborhood restaurant availability were not associated with BMI or waist circumference. In conclusion, although frequency of eating out was positively associated with unfavorable dietary intake patterns in a group of young Japanese women, neighborhood restaurant availability was not associated with frequency of eating out or dietary intake.

Home and neighbourhood correlates of BMI among children living in socioeconomically disadvantaged neighbourhoods

A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5-12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = - 0·04, 95 % CI - 0·06, - 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.

A systematic review of fast food access studies

The frequent consumption of energy-dense fast food is associated with increased body mass index. This systematic review aims to examine the methodology and current evidence on fast food access and its associations with outcomes. Six databases were searched using terms relating to fast food. Only peer-reviewed studies published in English during a 10-year period, with data collection and analysis regarding fast food access were included. Forty articles met the aforementioned criteria. Nearly half of the studies (n = 16) used their own set of features to define fast food. Studies predominantly examined the relationship between fast food access and socioeconomic factors (n = 21) and 76% indicated fast food restaurants were more prevalent in low-income areas compared with middle- to higher-income areas. Ten of 12 studies found fast food restaurants were more prevalent in areas with higher concentrations of ethnic minority groups in comparison with Caucasians. Six adult studies found higher body mass index was associated with living in areas with increased exposure to fast food; four studies, however, did not find associations. Further work is needed to understand if and how fast food access impacts dietary intake and health outcomes; and if fast food access has disparate socioeconomic, race/ethnicity and age associations.

Environmental correlates of adiposity in 9-10 year old children: considering home and school neighbourhoods and routes to school

The rapid speed of the recent rise in obesity rates suggest environmental causes. There is therefore a need to determine which components of the environment may be contributing to this increase. In this cross-sectional study, we examined the associations between adiposity and the characteristics of areas around homes, schools and routes to school among 1995 9-10 year old boys and girls in Norfolk, UK. The relationships between Fat Mass Index (FMI, calculated as fat mass (kg)/height (m)(2)) and objectively computed environmental indicators describing access to food outlets and physical activity facilities, the safety and connectivity of the road network, and the mix of land uses present were investigated. Multivariable hierarchical regression models were fitted with log-transformed FMI as the outcome, and stratification by gender and mode of travel to school. Among girls, better access to healthy food outlets (supermarkets and greengrocers) in the home environment was associated with lower FMI while better access to unhealthy outlets (takeaways and convenience stores) around homes and schools was associated with higher FMI. Also in girls, a higher proportion of accessible open land and a lower mix of land uses around the school were associated with higher FMI. Among boys the presence of major roads in the home neighbourhood was associated with higher FMI among non-active travellers, while major roads in the school neighbourhood were associated with lower FMI among active travellers. No significant associations were seen between FMI and any of the route characteristics. While the relative paucity of associations provides few indicators for the design of effective interventions, there was some evidence that environmental characteristics may be more important among active travellers than non-active travellers, and among girls than boys, suggesting that future interventions should be sensitive to such differences.

Local food outlets, weight status, and dietary intake: associations in children aged 9-10 years

BACKGROUND

The rising prevalence of childhood obesity is a key public health issue worldwide. Limited evidence suggests that there may be interactions between environmental factors at a neighborhood level and the development of obesity, with the availability and accessibility of food outlets being potentially important.

PURPOSE

To examine how the weight status and dietary intake of 1669 children aged 9-10 years was associated with neighborhood food outlets in a cross-sectional study.

METHODS

Availability of food outlets was computed from GIS data for each child's unique neighborhood. Outlets were grouped into BMI-healthy, BMI-unhealthy, or BMI-intermediate categories according to food type sold. Weight status measurements were objectively collected, and food intake was recorded using 4-day food diaries. Data were collected in 2007 and analyzed in 2009.

RESULTS

Availability of BMI-healthy outlets in neighborhoods was associated with lower body weight (1.3 kg, p=0.03); BMI (0.5 kg/m(2), p=0.02); BMI z-score (0.20, p=0.02); waist circumference (1.3 cm, p=0.02); and percentage body fat (1.1%, p=0.03) compared to no availability. In contrast, neighborhood availability of BMI-unhealthy outlets was inversely associated with body weight (1.3 kg, p=0.02); BMI (0.4 kg/m(2), p=0.05); BMI z-score (0.15, p=0.05); waist circumference (1.1 cm, p=0.04); and percentage body fat (1.0%, p=0.03). Unhealthy food intake (fizzy drinks 15.3%, p=0.04, and noncarbonated "fruit" drinks 11.8%, p=0.03) was also associated with availability of BMI-unhealthy food outlets.

CONCLUSIONS

Features of the built environment relating to food purchasing opportunities are correlated with weight status in children.

Associations between neighbourhood characteristics, body mass index and health-related behaviours of adolescents in the Kiel Obesity Prevention Study: a multilevel analysis

BACKGROUND/OBJECTIVES

To understand determinants of overweight, several studies addressed the association between neighbourhood characteristics and adult obesity. However, little is known about the association of such characteristics with adolescents' overweight. This study aims at the influence of neighbourhood characteristics on adolescent body mass index (BMI) and lifestyle and to what extent BMI and lifestyle variation between neighbourhoods can be explained by neighbourhood characteristics.

SUBJECTS/METHODS

We used cross-sectional data from the Kiel Obesity Prevention Study collected between 2004 and 2008 in 28 different residential districts of the city of Kiel (North Germany). Anthropometric data were available for 1675 boys and 1765 girls (n=3440) aged 13-15 years, and individual lifestyle factors and sociodemographic data were included in the analysis. At the macro level, six different neighbourhood characteristics were used: unemployment rate, population density, traffic density, prevalence of energy-dense food supply, number of sports fields and parks, and crime rate. To test our main hypothesis, linear and logistic multilevel regression analyses were performed to predict BMI and lifestyle factors in individuals nested in neighbourhoods.

RESULTS

Findings of multilevel analysis show little between-neighbourhood variations in BMI and health-related behaviours. In all, 2% of BMI variation, 4% of media time variation and 3% of variation in snacking behaviour could be attributed to differences in neighbourhoods.

CONCLUSIONS

Environmental factors are significantly associated with adolescent BMI and health-related behaviour; however, their total effect is small. Owing to these results, recommendations for structural policy measures as part of prevention of overweight in adolescents must be made cautiously.