Fast Food Environment Research Articles

Effect of fast-food environments on children's eating behaviour: A random effect within between analysis within the Generation R Study.

Focussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast-food environment and satiety responsiveness, enjoyment of food and food responsiveness. We used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4-10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual-level exposure to fast-food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent-reported Child Feeding Questionnaire (CFQ). We did not find evidence of between-associations of fast-food exposure and eating behaviour subscales. Considering within-associations, an increase in absolute fast-food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00-0.03]). No moderation by parental restriction was found. In environments with ubiquitous fast-food outlets, an increased exposure to fast-food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast-food exposure contributes to overweight.

Can mindful eating buffer against the influence of neighbourhood fast food exposure on unhealthy food intake?

A food-abundant environment is associated with unhealthy food intake, but not everyone is affected to the same degree. Mindful eating, which is eating with attention and awareness, has been associated with less external eating and less food cravings, and could act as a protective factor against influences from the food environment. The current study aimed to investigate whether the association between exposure to fast-food around the home and unhealthy food intake was moderated by mindful eating. The study was conducted in 1086 Dutch adults of 55 years and older of the Longitudinal Aging Study Amsterdam study. The mindful eating domains (Mindful Eating Behavior Scale) were tested as moderating variables in the linear regression models with absolute and relative density of fast-food outlets in the neighbourhood (400, 800 and 1600m) as independent variables and unhealthy food intake (snacks (g/d)) and saturated fat as a percentage of total energy intake (en%)) as dependent variable. Bootstrapping with 5000 samples using the pick-a-point approach showed that after adjustments, only two out of 48 interactions terms were statistically significant: Eating with Awareness (EwA) and Eating without Distraction (EwD) moderated the positive association between the relative density of fast-food outlets and saturated fat (en%) respectively in a buffer of 800m (interaction EwA: B=-0.84, 95% CI [-1.46; -0.22]) and in a buffer of 1600m (interaction EwD: B=-0.82, 95% CI [-1.61; -0.04]). The results of the current study indicate that mindful eating cannot buffer against the influence of the fast-food abundant environment on unhealthy food intake. Future research is needed to confirm these findings, for example in younger populations.

Fast-food environments and BMI changes in the Dutch adult general population: the Lifelines cohort.

This study investigated cross-sectional and longitudinal associations of fast-food outlet exposure with BMI and BMI change, as well as moderation by age and genetic predisposition. This study used Lifelines' baseline (n = 141,973) and 4-year follow-up (n = 103,050) data. Participant residential addresses were linked to a register with fast-food outlet locations (Nationwide Information System of Workplaces [Dutch: Landelijk Informatiesysteem van Arbeidsplaatsen,LISA]) using geocoding, and the number of fast-food outlets within 1 km was computed. BMI was measured objectively. A weighted BMI genetic risk score was computed, representing overall genetic predisposition toward elevated BMI, based on 941 single-nucleotide polymorphisms genome-wide significantly associated with BMI for a subsample with genetic data (BMI: n = 44,996; BMI change: n = 36,684). Multivariable multilevel linear regression analyses and exposure-moderator interactions were tested. Participants with ≥1 fast-food outlet within 1 km had a higher BMI (B [95% CI]: 0.17 [0.09 to 0.25]), and those with ≥2 fast-food outlets within 1 km increased more in BMI (B [95% CI]: 0.06 [0.02 to 0.09]) than participants with no fast-food outlets within 1 km. Effect sizes on baseline BMI were largest among young adults (age 18-29 years; B [95% CI]: 0.35 [0.10 to 0.59]) and especially young adults with a medium (B [95% CI]: 0.57 [-0.02 to 1.16]) or high genetic risk score (B [95% CI]: 0.46 [-0.24 to 1.16]). Fast-food outlet exposure was identified as a potentially important determinant of BMI and BMI change. Young adults, especially those with a medium or high genetic predisposition, had a higher BMI when exposed to fast-food outlets.

Neighborhood Fast-Food Environments and Hypertension in Canadian Adults

Hypertension is a leading cause of cardiovascular disease and premature death worldwide. Neighbourhoods characterized by a high proportion of fast-food outlets may also contribute to hypertension in residents; however, limited research has explored these associations. This cross-sectional study assessed associations between neighbourhood fast-food environments, measured hypertension, and self-reported hypertension. Data from 10,700 adults living in urban areas was obtained from six Canadian Health Measures Survey cycles (2007-2019). Each participant's blood pressure was measured at a mobile clinic six times. Measured hypertension was defined as having an average SBP of ≥140, a DBP ≥90 mm Hg or being on blood pressure-lowering medication. Participants were also asked if they had been diagnosed with high blood pressure or if they take blood pressure-lowering medication (i.e., self-reported hypertension). The proportion of fast-food outlets relative to the sum of fast-food outlets and full-service restaurants in each participant's neighbourhood was obtained from the Canadian Food Environment Dataset, and analyses were conducted in 2022. The mean proportion of fast-food outlets was 23.3% (standard deviation (SD): 26.8%). A one SD increase in the proportion of fast-food outlets was associated with higher odds of measured hypertension in the full sample (OR=1.17, 95% CI 1.05, 1.31) and in sex-specific models (women: OR=1.14, 95% CI 1.01, 1.29; men: OR=1.21, 95% CI 1.03, 1.43). Associations between the proportion of fast-food outlets and self-reported hypertension were inconclusive. Findings suggest that reducing the proportion of fast-food restaurants in neighbourhoods may be a factor that could help reduce hypertension rates.

Associations between neighbourhood fast-food environments and hypertension in Canadian adults.

ObjectivesHypertension is a leading cause of cardiovascular disease and premature death. Neighbourhoods characterized by a high proportion of fast-food outlets may contribute to hypertension in residents; however, limited research has explored these associations. The objectives of this study were to assess associations between neighbourhood fast-food environments, measured and self-reported hypertension.
 ApproachWe used data from 10,700 adults who participated in six cycles of the Canadian Health Measures Survey (CHMS). Measured hypertension was defined as having an average systolic blood pressure (BP) of ≥140, a diastolic BP ≥90 mm Hg or being on BP lowering medication. Participants were also asked if they had been diagnosed with high BP or if they take BP lowering medication (i.e., self-reported hypertension). We characterized the fast-food environment of each participant’s neighbourhood using the Canadian Food Environment Dataset (Can-FED). We considered the proportion of fast-food outlets relative to fast-food outlets and full-service restaurants as a continuous variable.
 ResultsThe mean proportion of fast-food outlets was 23.3% (SD 26.8%). A one standard deviation (SD) increase in the proportion to fast-food outlets was associated with higher odds of measured hypertension in the full sample (OR=1.17, 95% CI 1.05 to 1.31) and in sex-specific models (women: OR=1.14, 95% CI 1.01 to 1.29; and men: OR=1.21, 95% CI 1.03 to 1.43). A one standard deviation (SD) increase in the proportion to fast-food outlets was associated with higher odds of self-reported hypertension in the full sample (OR=1.13, 95% CI 1.02 to 1.24); however, associations were inconclusive in sex-specific models (women: OR=1.11, 95% CI 0.99 to 1.26; and men: OR=1.14, 95% CI 0.99 to 1.33).
 ConclusionBy linking neighbourhood food environment measures that were created from an administrative data source (the Statistics Canada Business Register) to individual-level data from the CHMS, we were able to demonstrate that reducing the proportion of fast-food outlets in neighbourhoods may reduce rates of hypertension and support individually targeted interventions.

The association between the obesogenic environment and 6-month and 24-month weight change in a rural weight loss intervention trial in the United States

The unique obesogenic environment may influence the ability to effectively maintain weight loss in rural areas. The aim of this study was to examine the contextual relationship of neighborhood disadvantage, distance to supermarkets and supercenters, and fast food, dollar store, and exercise facility environments on weight loss following a weight-loss intervention in the United States. This analysis (n = 1177) linked weight loss outcomes from a rural, primary care-based randomized controlled trial to contextual data collected from residential addresses. Outcomes include 6-month and 24-month percent weight loss. These outcomes were compared across contextual variables, including tract level disadvantage, food accessibility, and food/exercise availability. Covariates were included in ordinary least squares (OLS) multivariable regression models for 6-month and 24-month weight loss measures, across three weight loss interventions. Contextual variables were not significantly related to percent weight loss overall across treatment arms. Participants living in a 5-mile buffer to dollar stores experienced approximately a 2% (p < 0.05) lower weight loss, but only in the least effective counseling arm (individual clinic visits), while controlling for both individual and contextual factors. Our results suggest that specific contextual variables in rural populations may play an important role in moderating weight loss outcomes especially under the conditions of less effective interventions.

A College Fast-Food Environment and Student Food and Beverage Choices: Developing an Integrated Database to Examine Food and Beverage Purchasing Choices among College Students.

Universities typically offer residential students a variety of fast-food dining options as part of the student meal plan. When residential students make fast-food purchases on campus there is a digital record of the transaction which can be used to study food purchasing behavior. This study examines the association between student demographic, economic, and behavioral factors and the healthfulness of student fast-food purchases. The 3781 fast-food items sold at the University of North Carolina at Charlotte from fall 2016 to spring 2019 were given a Fast-Food Health Score. Each student participating in the university meal plan was given a Student Average Fast-Food Health Score; calculated by averaging the Fast-Food Health Scores associated with each food and beverage item the student purchased at a fast-food vendor, concession stand, or convenience store over a semester. This analysis included 14,367 students who generated 1,593,235 transactions valued at $10,757,110. Multivariate analyses were used to examine demographic, economic, and behavioral factors associated with Student Average Fast-Food Health Scores. Being of a low income, spending more money on fast-food items, and having a lower GPA were associated with lower Student Average Fast-Food Health Scores. Future research utilizing institutional food transaction data to study healthy food choices is warranted.

Associations between the fast-food environment and diabetes prevalence in the Netherlands: a cross-sectional study

Diabetes is a major health concern and is influenced by lifestyle, which can be affected by the neighbourhood environment. Specifically, a fast-food environment can influence eating behaviours and thus diabetes prevalence. Therefore, our aim was to assess the relationship between fast-food environment and diabetes prevalence for urban and rural environments in the Netherlands, using multiple indicators and buffer sizes. In this cross-sectional study, data on a nationwide sample of adults older than 19 years in the Netherlands were taken from the 2012 Dutch national health survey (from Public Health Monitor), in which participants were surveyed on topics related to health and lifestyle behaviour. Fast-food outlet exposures were determined within street-network buffers of 100 m, 400 m, 1000 m, and 1500 m around residential addresses. For each of these buffers, three indicators were calculated: presence (yes or no) of fast-food outlets, fast-food outlet density, and ratio. Logistic regression analyses were carried out to assess associations of these indicators with diabetes, adjusting for potential confounders and stratifying into urban and rural areas. 387 195 adults were surveyed, 284 793 of whom were included in the study. 22 951 (8%) reported having diabetes. Fast-food outlet exposures were positively associated with diabetes prevalence. We did not observe large differences between urban and rural areas. The effect estimates were small for all indicators. For example, in the 400 m buffer in the urban environment, the odds ratio (OR) for having diabetes among people with a fast-food outlet present compared with those without, was 1·006 (95% CI 1·003-1·009) using the presence indicator. The presence indicator showed higher effect estimates and the most consistent results across buffer sizes (ranging from OR 1·005 [95% CI 1·000-1·010] with the 1000 m buffer to 1·016 [1·005-1·028] with the 1500 m buffer in urban areas and from 1·002 [0·998-1·005] with the 1500 m buffer to 1·009 [1·006-1·018] with the 100 m buffer in rural areas) compared with the density and ratio indicators. The results confirm the evidence that the fast-food outlet environment is a diabetes risk factor. All data included were at the individual level and the variability was ensured by the spatial distribution and number of participants. In this study, we only accounted for residential exposure because we were unable to account for exposure outside the residential environment. The findings of this study encourage local governments to consider the potential adverse effects of fast-food exposures and aim at minimising unhealthy food access. Global Geo Health Data Centre, Utrecht University, Netherlands.

The association between fast-food outlet proximity and density and Body Mass Index: Findings from 147,027 Lifelines Cohort Study participants

Unhealthy food environments may contribute to an elevated Body Mass Index (BMI), which is a chronic disease risk factor. We examined the association between residential fast-food outlet exposure, in terms of proximity and density, and BMI in the Dutch adult general population. Additionally, we investigated to what extent this association was modified by urbanisation level. In this cross-sectional study, we linked residential addresses of baseline adult Lifelines Cohort participants (n = 147,027) to fast-food outlet locations using geo-coding. We computed residential fast-food outlet proximity, and density within 500 m, 1, 3, and 5 km. We used stratified (urban versus rural areas) multilevel linear regression models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, and address density. The mean BMI of participants was 26.1 (SD 4.3) kg/m2. Participants had a mean (SD) age of 44.9 (13.0), 57.3% was female, and 67.0% lived in a rural area. Having two or more (urban areas) or five or more (rural areas) fast-food outlets within 1 km was associated with a higher BMI (B = 0.32, 95% confidence interval (CI): 0.03, 0.62; B = 0.23, 95% CI: 0.10, 0.36, respectively). Participants in urban and rural areas with a fast-food outlet within <250 m had a higher BMI (B = 0.30, 95% CI: 0.03, 0.57; B = 0.20, 95% CI: 0.09, 0.31, respectively). In rural areas, participants also had a higher BMI when having at least one fast-food outlet within 500 m (B = 0.10, 95% CI: 0.02, 0.18). In conclusion, fast-food outlet exposure within 1 km from the residential address was associated with BMI in urban and rural areas. Also, fast-food outlet exposure within 500 m was associated with BMI in rural areas, but not in urban areas. In the future, natural experiments should investigate changes in the fast-food environment over time.

The Association between Fast Food Outlets and Overweight in Adolescents Is Confounded by Neighbourhood Deprivation: A Longitudinal Analysis of the Millennium Cohort Study.

The aim of our study is to utilise longitudinal data to explore if the association between the retail fast food environment and overweight in adolescents is confounded by neighbourhood deprivation. Data from the Millennium Cohort Study for England were obtained for waves 5 (ages 11/12; 2011/12; n = 13,469) and 6 (ages 14/15; 2014/15; n = 11,884). Our outcome variable was overweight/obesity defined using age and sex-specific International Obesity Task Force cut points. Individuals were linked, based on their residential location, to data on the density of fast food outlets and neighbourhood deprivation. Structural Equation Models were used to model associations and test for observed confounding. A small positive association was initially detected between fast food outlets and overweight (e.g., at age 11/12, Odds Ratio (OR) = 1.0006, 95% Confidence Intervals (CI) = 1.0002–1.0009). Following adjusting for the confounding role of neighbourhood deprivation, this association was non-significant. Individuals who resided in the most deprived neighbourhoods had higher odds of overweight than individuals in the least deprived neighbourhoods (e.g., at age 11/12 OR = 1.95, 95% CIs = 1.64–2.32). Neighbourhood deprivation was also positively associated to the density of fast food outlets (at age 11/12 Incidence Rate Ratio = 3.03, 95% CIs = 2.80–3.28).

Interactions among Reward Sensitivity and Fast-Food Access on Healthy Eating Index Scores in Adolescents: A Cross-Sectional Study.

Food cues in the environment may contribute to obesity as the consumption of unhealthy foods may reinforce reward pathways in the brain. To understand how person-level differences in reward sensitivity may be associated with diet quality, this study aimed to examine the moderating role of the availability of fast food in the environment on the relationship between reward sensitivity and diet quality in adolescents. Participants (n = 152; 55% female; Mage: 12.5 ± 0.93 y) completed the drive and reward subscales of the Behavioral Inhibition System (BIS)/Behavioral Activation System (BAS) Scale to assess reward sensitivity and completed two 24 h dietary recalls from which Healthy Eating Index (HEI) scores (total score and subscales of adequacy and moderation) were calculated. Fast-food environment (FFE) was operationalized as the total number of fast-food outlets within 1 km around participants’ home address. Linear regressions were used to examine the main effects and interactions between reward sensitivity and FFE in relation to HEI score. Interactions were found between FFE and BAS drive (p = 0.02) and BAS reward (p < 0.01) on HEI adequacy. There were no interaction effects on HEI moderation or HEI total scores. For individuals who had lower access exposure to fast-food outlets (−1 SD), there was a stronger positive association between higher BAS drive (t = 2.85, p = 0.01, 95% CI (0.35, 1.94)) and HEI adequacy scores and between higher BAS reward (t = 3.27, p > 0.01, 95% CI (0.72, 2.93)) and HEI adequacy scores. By examining reward sensitivity to potential food cues in residential neighborhood food environments, it is possible to understand which adolescents are more sensitive to environmental food cues and implement interventions to buffer these influences.

Food Experiences and Dietary Patterns of International Students at a Canadian University.

Purpose: Postsecondary students who move to a new country to continue their education experience a drastic shift in food landscape, often resulting in unhealthy dietary adaptations.Methods: This mixed-method study explored the eating experiences and dietary patterns of 30 international students attending a Canadian university. Data were collected through focus groups that were analyzed thematically and dietary records analyzed for compliance with Canada's Food Guide for Healthy Living (2007).Results: Results showed that many participants want to maintain home country food traditions, yet their new independent living status and novel food environments led to changes in dietary habits. Limited food skills, busy schedules, reduced access to familiar foods, and fast-food environments contributed to unhealthy eating patterns. These perceptions were reflected in the high consumption of "other", less nutritious foods and low servings of fruits and vegetables, milk products and alternatives, and grain products.Conclusions: These findings show that international university students face dual challenges of transitioning into independent living without sufficient food skills and family supports, and exposure to unfamiliar and unhealthy food environments. Resources need to be developed for newly enrolled international students that emphasize food awareness, food skills, and healthy eating habits.

Genetic risk of obesity as a modifier of associations between neighbourhood environment and body mass index: an observational study of 335 046 UK Biobank participants

BackgroundThere is growing recognition that recent global increases in obesity are the product of a complex interplay between genetic and environmental factors. However, in gene-environment studies of obesity, ‘environment’ usually...

Taste and Health Information on Fast Food Menus to Encourage Young Adults to Choose Healthy Food Products: An Experimental Study.

Currently, a great number of people have an unhealthy dietary intake, leading to chronic diseases. Despite the high prevalence of obesity and people being overweight, only a few strategies to promote healthier food products have been proven effective. Therefore, the objective of this study was to test the effect of the presence of health information and its integration into a fast food menu context on young adults’ healthy food choices. An experimental between-subjects design consisting of three conditions—subtle, explicit, and no health information—was conducted among 142 participants aged 18 to 24 (Mage: 21.49, SD = 1.77). The results showed that when health information about healthy products was provided, the level of integration of the information into the menu context had an effect. More specifically, participants exposed to explicit health information about healthy products provided on the fast food menu were more likely to choose a healthy food product compared to participants exposed to subtle integrated health information. No interaction effect for moderating factors was found. In line with the healthy food promotion model, the findings suggest that the provision of explicit health information on healthy products stimulates healthy food choices in a fast food environment.

COVID-19: impact on the urban food retail system and dietary inequalities in the UK

ABSTRACT COVID-19 has focused minds on the resilience of the urban food retail system in supplying adequate food to the whole population. In this commentary, we discuss the impacts on diet of four plausible changes to food retailing in the UK: relocalisation of the food retail system, accelerated uptake of digital grocery, restructuring of fast-food environment and impacts on food banking and emergency food aid. We finish by outlining the challenge for research, policy and planning.

Association between time-weighted activity space-based exposures to fast food outlets and fast food consumption among young adults in urban Canada

BackgroundDespite increased attention on retail food environments and fast food consumption, results from previous studies have been inconsistent. Variation in measurement of exposure to retail food environments and the context of the built environment are possible reasons for inconsistencies. The purpose of the current study is to examine the association between exposure to fast food environment and fast food consumption among young adults, and to explore possible associations between built environment and fast food consumption.MethodsWe employed an observational, cross-sectional study design. Cross-sectional surveys were conducted in 2016 and 2017. In a sample of 591 young adults aged 16–30 years in five Canadian cities, we constructed and computed individual-level time-weighted number and ratio of fast food outlets in activity spaces derived from GPS trajectory data. Negative binomial regression models estimated the associations between exposure measures and frequency of fast food consumption (number of times consuming fast food meals in a seven-day period), controlling for built environment characterization and individual-level characteristics.ResultsSignificant positive associations were found between time-weighted number of fast food outlets and count of fast food meals consumed per week in models using a radius of 500 m (IRR = 1.078, 95% CI: 0.999, 1.163), 1 km (IRR = 1.135, 95% CI: 1.024, 1.259), or 1.5 km (IRR = 1.138, 95% CI: 1.004, 1.289) around GPS tracks, when generating activity spaces. However, time-weighted ratio of fast food outlets was only significantly associated with count of fast food meals consumed when a radius of 500 m is used (IRR = 1.478, 95% CI: 1.032, 2.123). The time-weighted Active Living Environment Index with Transit measure was significantly negatively related to count of fast food meals consumed across all models.ConclusionsOur study demonstrated associations of time-weighted activity space-based exposure to fast food outlets and fast food consumption frequency in a sample of young adults in urban Canada, and provides evidence of the association between context of built environment and fast food consumption, furthering discussion on the utility of individual-level, activity space-based data and methods in food environment research. These results imply that both food retail composition and activity spaces in urban areas are important factors to consider when studying diets.

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

BackgroundThe association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption.MethodsA correlational study was conducted in which a nationwide sample of 1038 respondents living across The Netherlands completed a survey. Respondents reported their fast food consumption (amount/week) as well as perceived descriptive and injunctive norms regarding fast food consumption in their neighbourhood. Fast food outlet exposure was measured by the average count of fast food outlets within a 400 m walking distance buffer around the zip-codes of the respondents, using a retail outlet database. Regression models were used to assess associations between residential fast food outlet exposure, fast food consumption, and social norm perceptions, and a bootstrapping procedure was used to test the indirect -mediation- effect. Separate analyses were performed for descriptive norms and injunctive norms.ResultsThere was no overall or direct association between residential fast food outlet exposure and residents’ fast food consumption. However, fast food outlet exposure was positively associated with neighbourhood social norms (descriptive and injunctive) regarding fast food consumption, which in turn were positively associated with the odds of consuming fast food. Moreover, results of the bootstrapped analysis provided evidence of indirect effects of fast food outlet exposure on fast food consumption, via descriptive norms and injunctive norms.ConclusionsIn neighbourhoods with more fast food outlets, residents were more likely to perceive fast food consumption in the neighbourhood as more common and appropriate. In turn, stronger neighbourhood social norms were associated with higher fast food consumption. Acknowledging the correlational design, this study is the first that implies that neighbourhood social norms may be a mediating pathway in the relation between the residential fast food environment and fast food consumption. Future research may examine the role of neighbourhood social norms in other contexts and explore how the changing food environment may shift our consumption norms.

Socioeconomic position and the impact of increasing availability of lower energy meals vs. menu energy labelling on food choice: two randomized controlled trials in a virtual fast-food restaurant

BackgroundFood consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice.MethodsAcross two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives.ResultsThe analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (− 71 kcal, p < 0.001, partial η2 = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (− 18 kcal, p = 0.116, partial η2 = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered.ConclusionsIn a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP.Trial registrationStudy protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).

Association between fast-food outlet exposure and Body Mass Index in 124,286 Lifelines participants

Abstract Background Elevated Body Mass Index (BMI) is a key risk factor for numerous non-communicable diseases, such as cardiovascular diseases, cancer, diabetes type II and dementia. Previous studies showed associations between fast-food outlet exposure and BMI, but contained methodological shortcomings. Particularly within the Netherlands, evidence is scarce. We aimed to examine the association between fast-food outlet exposure and BMI among the Dutch adult general population, and whether this association was mediated by daily caloric intake. Methods Cross-sectionally linking baseline adult data (N = 124,286) from the Lifelines cohort to fast-food outlet location (LISA: employer register) data, we regressed fast-food outlet density (within distances of 500 metre(m), and 1, 3, and 5 kilometre (km)) and fast-food outlet proximity around participants’ residential address on BMI. We used multilevel regression and multilevel mediation models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation and neighbourhood address density. We stratified analyses for urban and rural areas, as these involve different living environments and study populations. Results More than half (56%) of participants was overweight (BMI ≥ 25.0). The average BMI in urban and rural areas was 25.9 (SD 4.4) and 26.3 (SD 4.3), respectively. In rural areas, having at least three fast-food outlets within 500 m was associated with higher BMI (B = 0.17, 95% confidence interval (CI): 0.06, 0.28). In urban areas, having at least five fast-food outlets within 1 km was associated with higher BMI (B = 0.42, 95% CI: 0.20, 0.63). Having the nearest fast-food outlet within 100m was associated with higher BMI (B = 0.43, 95% CI: 0.19, 0.67). The associations were partly explained by daily caloric intake. Conclusions Fast-food outlet exposure may be an important environmental determinant of BMI. Policy-makers should consider intervening upon the fast-food environment. Key messages Fast-food outlets within 500 metres in rural areas and 1 kilometre in urban areas may play a fundamental role in the rise of BMI. Targeting fast-food outlets may be key to reduce BMI on a population level.

Description and Evaluation of Changes to the Rural Nutrition Environment After Implementation of Community-led Policy, System, and Environment Change Strategies (P04-163-19)

ObjectivesTo assess the nutrition environment in three rural Louisiana parishes (counties) with high rates of poverty (range 25%-41.7%), obesity (>40%), and chronic diseases and to better understand the local nutrition environment in rural, low-income, food insecure areas and to evaluate policy, systems, and environmental (PSE) change strategies aimed at improving the rural food environment. MethodsHealthy Access, Behaviors, Communities was a community-participatory, multi-level approach to obesity prevention in Louisiana. This evaluation used a descriptive, mixed methods design that focused on 1st and 3rd year project data. Nutrition environments were assessed using the reduced Nutrition Environment Measurement Survey (NEMS) for food stores and restaurants. Pre and post NEMS scores were compared to determine if PSE interventions were effective in improving the nutrition environment. ResultsOverall, 48 food stores and 39 restaurants were assessed at baseline, while 45 food stores and 36 restaurants were assessed at follow-up. Different numbers between baseline and follow-up assessments are due to store closures/openings. Except for the grocery store and fast food environments in Madison parish, the food environments were poor across the targeted parishes, with NEMS scores indicating a lack of healthy grocery items (stores) or a lack of healthy menu options (restaurants). With few exceptions, average NEMS scores generally increased slightly over the assessments, which is a positive trend; however, these positive changes did not result in the food retail environment moving from unhealthy to healthy. Five stores were targeted by the coalition to implement PSE changes. Of the partner stores, the average number of healthy foods available increased in all categories, except skim or low-fat milk, from baseline to post-intervention. ConclusionsFindings from baseline indicate that the nutrition environment in these poor, rural parishes can present challenges to individuals attempting to meet preventative health recommendations. PSE interventions can improve the nutrition environment in these locations. Funding SourcesCenters for Disease Control High Obesity 1416 Cooperative agreement.