Abstract
Objective: Frequent fast-food consumption is a well-known risk factor for obesity. This study sought to determine whether the availability of fast-food restaurants has an influence on body mass index (BMI).
METHODS: BMI and individual-level confounding variables were obtained from the 2007-08 Canadian Community Health Survey. Neighbourhood socio-demographic variables were acquired from the 2006 Canadian Census. The geographic locations of all restaurants in Canada were assembled from a validated business registry database. The density of fast-food, full-service and non-chain restaurants per 10,000 individuals was calculated for respondents’ forward sortation area. Multivariable regression analyses were conducted to analyze the association between restaurant density and BMI.
RESULTS: Fast-food, full-service and non-chain restaurant density variables were statistically significantly associated with BMI. Fast-food density had a positive association whereas full-service and non-chain restaurant density had a negative association with BMI (additional 10 fast-food restaurants per capita corresponded to a weight increase of 1 kilogram; p<0.001). These associations were primarily found in Canada’s major urban jurisdictions.
CONCLUSIONS: This research was the first to investigate the influence of fast-food and full-service restaurant density on BMI using individual-level data from a nationally representative Canadian survey. The finding of a positive association between fast-food restaurant density and BMI suggests that interventions aiming to restrict the availability of fast-food restaurants in local neighbourhoods may be a useful obesity prevention strategy.
Key Words: Obesity, fast foods, body mass index, environment and public health
Résumé
OBJECTIF: La consommation fréquente d’aliments de restauration rapide est un facteur de risque d’obésité bien connu. Nous avons cherché à déterminer si la présence de restaurants rapides a une influence sur l’indice de masse corporelle (IMC).
MÉTHODE: L’IMC et les variables de confusion individuelles ont été puisés dans l’Enquête sur la santé dans les collectivités canadiennes de 2007-2008. Les variables sociodémographiques par quartier ont été obtenues dans le Recensement du Canada de 2006. Nous avons déterminé l’emplacement géographique de tous les restaurants au Canada à partir d’un registre des entreprises validé. Nous avons calculé la densité pout 10 000 habitants des restaurants rapides, plein service et n’appartenant pas à une chaîne, selon la région de tri d’acheminement des répondants. Nous avons effectué des analyses de régression multivariées pour étudier l’association entre la densité des restaurants et l’IMC.
RÉSULTATS: Les variables de densité des restaurants rapides, plein service et n’appartenant pas à une chaîne présentaient une corrélation significative avec l’IMC. Pour la densité des restaurants rapides, cette association était positive, tandis que pour les restaurants plein service et n’appartenant pas à une chaîne, la densité était négativement associée à l’IMC (chaque tranche supplémentaire de 10 restaurants rapides par habitant correspondait à une hausse pondérale d’1 kilogramme; p<0,001). Ces associations étaient principalement observées dans les grands centres urbains du Canada.
CONCLUSIONS: Notre étude est la première à analyser l’influence de la densité des restaurants rapides et plein service sur l’IMC à l’aide de données individuelles provenant d’une enquête nationale représentative menée au Canada. La découverte d’une association positive entre la densité des restaurants rapides et l’IMC donne à penser que les interventions visant à limiter la présence des restaurants rapides à l’échelle des quartiers pourraient être des stratégies utiles pour prévenir l’obésité.
Mots Clés: obésité, aliments de restauration rapide, indice de masse corporelle, environnement et santé publique
Footnotes
Acknowledgements: This paper uses confidential microdata files from Statistics Canada’s Canadian Community Health Survey, 2007-08, and from the restaurant database from info Canada. All data analyses were conducted at the University of Western Ontario Research Data Centre. Funding for this research by the Canadian Institutes of Health Research operating grant (reference number: MOP-97763) is gratefully acknowledged. This is a substantially revised version of Simon Hollands’ thesis chapter submitted to the University of Western Ontario. The views expressed, however, are those of the authors and do not necessarily reflect the views of any affiliated organization.
Conflict of Interest: None to declare.
References
- 1.Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291(23):2847–50. doi: 10.1001/jama.291.23.2847. [DOI] [PubMed] [Google Scholar]
- 2.Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS. The built environment and obesity: A systematic review of the epidemiologic evidence. Health Place. 2010;16(2):175–90. doi: 10.1016/j.healthplace.2009.09.008. [DOI] [PubMed] [Google Scholar]
- 3.Prentice AM, Jebb SA. Fast foods, energy density and obesity: A possible mechanistic link. Obes Rev. 2003;4(4):187–94. doi: 10.1046/j.1467-789X.2003.00117.x. [DOI] [PubMed] [Google Scholar]
- 4.Pereira MA, Kartashov AI, Ebbeling CB, Van Horn L, Slattery ML, Jacobs DR, Jr, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005;365(9453):36–42. doi: 10.1016/S0140-6736(04)17663-0. [DOI] [PubMed] [Google Scholar]
- 5.Larsen K, Gilliland J. Mapping the evolution of ‘food deserts’ in a Canadian city: Supermarket accessibility in London, Ontario, 1961–2005. Int J Health Geogr. 2008;7:16. doi: 10.1186/1476-072X-7-16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Morland KB, Evenson KR. Obesity prevalence and the local food environment. Health Place. 2009;15(2):491–95. doi: 10.1016/j.healthplace.2008.09.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Mehta NK, Chang VW. Weight status and restaurant availability: A multilevel analysis. Am J Prev Med. 2008;34(2):127–33. doi: 10.1016/j.amepre.2007.09.031. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D. Obesity and the built environment: Does the density of neighborhood fast-food outlets matter? Am J Health Promot. 2009;23(3):203–9. doi: 10.4278/ajhp.071214133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Dunn R. Obesity and the availability of fast-food: An instrumental variables approach (March 31 2008). International Health Economics Association 6th World Congress, 2007: Explorations in Health Economics Working Paper. Available at: http://ssrn.com/abstract=989363.
- 10.Pearce J, Hiscock R, Blakely T, Witten K. A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents. Health Place. 2009;15(1):193–97. doi: 10.1016/j.healthplace.2008.04.003. [DOI] [PubMed] [Google Scholar]
- 11.Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, et al. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect. 2009;117(3):442–47. doi: 10.1289/ehp.11590. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Casey AA, Elliott M, Glanz K, Haire-Joshu D, Lovegreen SL, Saelens BE, et al. Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities. Prev Med. 2008;47(6):600–4. doi: 10.1016/j.ypmed.2008.10.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health. 2007;61(6):491–98. doi: 10.1136/jech.2006.051680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Simmons D, McKenzie A, Eaton S, Cox N, Khan MA, Shaw J, et al. Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia. Int J Obes (Lond) 2005;29(6):703–10. doi: 10.1038/sj.ijo.0802941. [DOI] [PubMed] [Google Scholar]
- 15.Hollands S, Campbell MK, Gilliland J, Sarma S. A spatial analysis of the association between restaurant density and body mass index in Canadian adults. Prev Med. 2013;57(4):258–64. doi: 10.1016/j.ypmed.2013.07.002. [DOI] [PubMed] [Google Scholar]
- 16.Cash S, Goddard E, Lacanilao R. Fat taxes and health outcomes: An investigation of economic factors influencing obesity in Canada. Edmonton, AB: Faculty of Agriculture & Forestry, and Home Economics, University of Alberta; 2007. [Google Scholar]
- 17.Spence JC, Cutumisu N, Edwards J, Evans J. Influence of neighbourhood design and access to facilities on overweight among preschool children. Int J Pediatr Obes. 2008;3(2):109–16. doi: 10.1080/17477160701875007. [DOI] [PubMed] [Google Scholar]
- 18.Gilliland JA, Rangel CY, Healy MA, Tucker P, Loebach JE, Hess PM, et al. Linking childhood obesity to the built environment: A multi-level analysis of home and school neighbourhood factors associated with body mass index. Can J Public Health. 2012;103(Suppl3):S15–21. doi: 10.1007/BF03403830. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Statistics Canada. Canadian Community Health Survey–Annual Component (CCHS) 2008. [Google Scholar]
- 20.Gorber CS, Shields M, Tremblay MS, McDowell I. The feasibility of establishing correction factors to adjust self-reported estimates of obesity. Health Rep. 2008;19(3):71–82. [PubMed] [Google Scholar]
- 21.Morland K, Wing S, Diez R A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23–29. doi: 10.1016/S0749-3797(01)00403-2. [DOI] [PubMed] [Google Scholar]
- 22.Statistics Canada. Census Dictionary. 2011. pp. 114–17. [Google Scholar]
- 23.Monday Report on Retailers. Directory of Restaurant and Fast Food Chains in Canada. Toronto, ON: Monday Report on Retailers; 2010. [Google Scholar]
- 24.Spence JC, Cutumisu N, Edwards J, Raine KD, Smoyer-Tomic K. Relation between local food environments and obesity among adults. BMC Public Health. 2009;9:192. doi: 10.1186/1471-2458-9-192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Chou SY, Grossman M, Saffer H. An economic analysis of adult obesity: Results from the Behavioral Risk Factor Surveillance System. J Health Econ. 2004;23(3):565–87. doi: 10.1016/j.jhealeco.2003.10.003. [DOI] [PubMed] [Google Scholar]
- 26.Stunkard AJ, Allison KC. Two forms of disordered eating in obesity: Binge eating and night eating. Int J Obes Relat Metab Disord. 2003;27(1):1–12. doi: 10.1038/sj.ijo.0802186. [DOI] [PubMed] [Google Scholar]
- 27.Stewart H, Blisard N, Jolliffe D. Econ Info Bull. 2006. Let’s eat out: Americans weigh taste nutrition and convenience; p. 16. [Google Scholar]
- 28.Eisenberg MJ, Atallah R, Grandi SM, Windle SB, Berry EM. Legislative approaches to tackling the obesity epidemic. CMAJ. 2011;183(13):1496–500. doi: 10.1503/cmaj.101522. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Mair JS, Pierce MW, Teret SP. The City Planner’s Guide to the Obesity Epidemic: Zoning and Fast Food. The Centers for Law and the Public’s Health: a Collaborative at Johns Hopkins and Georgetown Universities; 2005. [Google Scholar]
- 30.Alter DA, Eny K. The relationship between the supply of fast-food chains and cardiovascular outcomes. Can J Public Health. 2005;96(3):173–77. doi: 10.1007/BF03403684. [DOI] [PMC free article] [PubMed] [Google Scholar]