Does proximity to fast food cause childhood obesity? Evidence from public housing

2020

Obesity

Study Importance What is already known? ► Many factors (biology, built environment, social environment) influence food intake. ► The food environment may play a role in shaping childhood obesity in the United States. What does this study add? ► This study examines the relationship between the food environment and childhood obesity by using a large data set with detailed address information that more fully considers neighborhood selection and confounding. How might these results change the direction of research? ► Data such as these may inform the development of future health policy. Objective: This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes. Methods: A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects. Results: Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types. Conclusions: Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.

We investigate the health consequences of changes in the supply of fast food using the exact geographical location of fast food restaurants. Specifically, we ask how the supply of fast food affects the obesity rates of 3 million school children and the weight gain of over 3 million pregnant women. We find that among 9th grade children, a fast food restaurant within a tenth of a mile of a school is associated with at least a 5.2 percent increase in obesity rates. There is no discernable effect at .25 miles and at .5 miles. Among pregnant women, models with mother fixed effects indicate that a fast food restaurant within a half mile of her residence results in a 1.6 percent increase in the probability of gaining over 20 kilos, with a larger effect at .1 miles. The effect is significantly larger for African-American and less educated women. For both school children and mothers, the presence of non-fast food restaurants is uncorrelated with weight outcomes. Moreover, proximity to future fast food restaurants is uncorrelated with current obesity and weight gain, conditional on current proximity to fast food. The implied effects of fast-food on caloric intake are at least one order of magnitude larger for students than for mothers, consistent with smaller travel cost for adults.

Economics & Human Biology, 2014

We analyze, using an instrumental variable approach, the effect of the number of fast-food restaurants on school level obesity rates in Arkansas. Using distance to the nearest major highway as an instrument, our results suggest that exposure to fast-food restaurants can impact weight outcomes. Specifically, we find that the number of fast-food restaurants within a mile from the school can significantly affect school level obesity rates.

Academic Pediatrics, 2009

Objective.-Prior studies have shown an association between fast-food restaurants and adolescent body size. Less is known about the influence of neighborhood food stores on a child's body size. We hypothesized that in the inner-city, minority community of East Harlem, New York, the presence of convenience stores and fast-food restaurants near a child's home is associated with increased risk for childhood obesity as measured by body mass index (BMI).

American Economic Journal: Economic Policy, 2010

We investigate the health consequences of changes in the supply of fast food using the exact geographical location of fast food restaurants. Specifically, we ask how the supply of fast food affects the obesity rates of 3 million school children and the weight gain of over 3 million pregnant women. We find that among 9th grade children, a fast food restaurant within a tenth of a mile of a school is associated with at least a 5.2 percent increase in obesity rates. There is no discernable effect at .25 miles and at .5 miles. Among pregnant women, models with mother fixed effects indicate that a fast food restaurant within a half mile of her residence results in a 1.6 percent increase in the probability of gaining over 20 kilos, with a larger effect at .1 miles. The effect is significantly larger for African-American and less educated women. For both school children and mothers, the presence of non-fast food restaurants is uncorrelated with weight outcomes. Moreover, proximity to future fast food restaurants is uncorrelated with current obesity and weight gain, conditional on current proximity to fast food. The implied effects of fast-food on caloric intake are at least one order of magnitude larger for students than for mothers, consistent with smaller travel cost for adults.

American Journal of Public Health, 2009

Housing Policy Debate

While advocates argue that gentrification changes the neighborhood food environment critical to children's diet and health, we have little evidence documenting such changes or the consequences for their health outcomes. Using rich longitudinal, individual-level data on nearly 115,000 New York City children, including egocentric measures of their food environment and BMI, we examine the link between neighborhood demographic change ("gentrification"), children's access to restaurants and supermarkets, and their weight outcomes. We find that children in rapidly gentrifying neighborhoods see increased access to fast food and wait-service restaurants and reduced access to corner stores and supermarkets compared to those in non-gentrifying areas. Boys and girls have higher BMI following gentrification, but only boys are more likely to be obese or overweight. We find public housing moderates the relationship between gentrification and weight, as children living in public housing are less likely to be obese or overweight.

BMC Public Health, 2011

Background: Recent studies suggest that neighborhood fast food restaurant availability is related to greater obesity, yet few studies have investigated whether neighborhood fast food restaurant availability promotes fast food consumption. Our aim was to estimate the effect of neighborhood fast food availability on frequency of fast food consumption in a national sample of young adults, a population at high risk for obesity. Methods: We used national data from U.S. young adults enrolled in wave III (2001-02; ages 18-28) of the National Longitudinal Study of Adolescent Health (n = 13,150). Urbanicity-stratified multivariate negative binomial regression models were used to examine cross-sectional associations between neighborhood fast food availability and individual-level self-reported fast food consumption frequency, controlling for individual and neighborhood characteristics. Results: In adjusted analysis, fast food availability was not associated with weekly frequency of fast food consumption in non-urban or low-or high-density urban areas. Conclusions: Policies aiming to reduce neighborhood availability as a means to reduce fast food consumption among young adults may be unsuccessful. Consideration of fast food outlets near school or workplace locations, factors specific to more or less urban settings, and the role of individual lifestyle attitudes and preferences are needed in future research.

Journal of Business Research, 2014

In this research, the authors examine the effects on preschool-aged childhood obesity rates associated with the direct and moderating influence of fast food restaurant density levels, consumer poverty, and urbanization. Results show that higher levels of fast food restaurant saturation are associated with increased levels of childhood obesity in both urban and poor areas, with the largest negative effect of fast food availability on obesity occurring in more economically disadvantaged, urban areas. Findings highlight why the societal impacts of targeting vulnerable populations through corporate location selection strategies should be fully considered in social marketing initiatives, especially given that unhealthy products with long term health risks are increasingly accessible.