Abstract
BackgroundThere has been considerable interest in the role of access to unhealthy food options as a determinant of weight status. There is conflict across the literature as to the existence of such an association, partly due to the dominance of cross-sectional study designs and inconsistent definitions of the food environment. The aim of our study is to use longitudinal data to examine if features of the food environment are associated to measures of adolescent weight status.MethodsData were collected from secondary schools in Leeds (UK) and included measurements at school years 7 (ages 11/12), 9 (13/14), and 11 (15/16). Outcome variables, for weight status, were standardised body mass index and standardised waist circumference. Explanatory variables included the number of fast food outlets, supermarkets and ‘other retail outlets’ located within a 1 km radius of an individual’s home or school, and estimated travel route between these locations (with a 500 m buffer). Multi-level models were fit to analyse the association (adjusted for confounders) between the explanatory and outcome variables. We also examined changes in our outcome variables between each time period.ResultsWe found few associations between the food environment and measures of adolescent weight status. Where significant associations were detected, they mainly demonstrated a positive association between the number of amenities and weight status (although effect sizes were small). Examining changes in weight status between time periods produced mainly non-significant or inconsistent associations.ConclusionsOur study found little consistent evidence of an association between features of the food environment and adolescent weight status. It suggests that policy efforts focusing on the food environment may have a limited effect at tackling the high prevalence of obesity if not supported by additional strategies.
Highlights
There has been considerable interest in the role of access to unhealthy food options as a determinant of weight status
There were diverging patterns in standardised Body mass Index (BMI) and waist circumference (WC), with mean BMI SDS declining throughout adolescence and were standardised (WC SDS) increasing
When considered alongside an additional 10 outlets, the effect size is clinically significant. Such a finding would be appropriate for the number of fast food outlets along the travel route since the interquartile range (IQR) was 7–23
Summary
There has been considerable interest in the role of access to unhealthy food options as a determinant of weight status. The aim of our study is to use longitudinal data to examine if features of the food environment are associated to measures of adolescent weight status. Childhood obesity is a complex issue with multifactorial drivers including: psychological, activity and exercise levels, dietary, physiological, societal and environmental influences [11]. Identifying characteristics of this complex web that are modifiable is key for designing. Some policy makers have begun to react to this theory by restricting the location of new fast food outlets believing it will limit accessibility to unhealthy foods [13,14,15,16]. Policies should consider all food outlets (e.g. convenience stores), as well as national/global food systems that may promote unhealthy food options, to be truly effective
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