Obesity and the Built Environment: Does the Density of Neighborhood Fast-Food Outlets Matter?

Abstract

Purpose To examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast-food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics. Design Cross-sectional and multilevel design. Setting Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon. Subjects A total of 1,221 residents (mean age=65 years old) recruited randomly from 120 neighborhoods (48% response rate). Measures A Geographic Information System-based measure of fast-food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass index (BMI), frequency of visits to local fast-food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity. Analyses Multilevel logistic regression analyses. Results Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI≥30) for neighborhoods with a high-density of fast-food restaurants in comparison to those with a low density: odds ratios [OR] for obesity, 95% confidence interval [CI] were: 1.878 (CI=1.006-3.496) for weekly visits to local fast-food restaurants; 1.792 (CI=1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI=1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI=1.705-38.086) for non-Hispanic black residents. Conclusion Increased density of neighborhood fast-food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.

Small-area variations in overweight and obesity in an urban area of Nigeria: The role of fast food outlets

“…It is consistent with findings of the neighbourhood-based studies of obesity in Portland, Oregon, United States of America (Li et al, 2008(Li et al, , 2009a(Li et al, , 2009b. Common to these Portland studies is the emphasis on the strong association between fast food outlet distribution and BMI.…”

Area-level deprivation and adiposity in children: is the relationship linear?

“…It is reasonable therefore, to assume that the mechanisms linking obesity and area level deprivation reflect the underlying effects of deprivation on dietary habits and physical activity status. Evidence suggests that the deprivation of an area is associated with characteristics of the food (43)(44)(45)(46)(47) and physical activity environment (43,45,(48)(49)(50), with more deprived areas thought to be more obesogenic (51). Of further interest is that fact that the relationship between obesity and SES is stronger, and in many cases only shown to be statistically significant in girls.…”

Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children

“…This finding highlights the potential importance of the presence of commercial establishments that offer a variety of healthy food options within the neighbourhood. Other work indicates the presence of supermarkets in a neighbourhood is associated with reduced odds for obesity among residents (67) and a high density of fastfood restaurants or convenience stores is associated with greater likelihood of being obese (47,68) . Therefore, the neighbourhood food environment may be an important determinant of sweetened beverage consumption among pre-school children.…”