Background

Expansion in the number of restaurants, food deliveries, and takeaways has been proposed as one of the main driving factors for the increased levels of overweight and obesity in the UK. If this is true, one would anticipate that higher densities of food outlets around people’s residences would lead to higher obesity occurrence. Aim: To evaluate how the complex food environment is associated with body mass index (BMI) among middle-aged adults in the UK. This study investigated the exposure to different types of food outlets at the level of a population using postcode districts (PDs) as the sampling unit.

Methods

BMIs per Postcode District (PD) were obtained from UK Biobank. The number of fast food restaurants (FFR), full-service restaurants (FSR), delivery shops, takeaways, pubs and cafes were also obtained. Socioeconomic factors were collected (2011 Census).

Results

Densities of delivery, takeaways, fish&chip shops and FSRs per capita were not related to obesity (P=0.05, P=0.16, P=0.14, P=0.29, respectively). Surprisingly, FFRs, pubs and cafes were all inversely associated with obesity (FFRs= -β= -0.10; 95% CI: -0.19, -0.00; t= -2.14;P<0.03) (pubs-β= -0.32; 95% CI: -0.41, -0.23;t= -6.81; P<0.0001) (cafes-β= -0.41; 95% CI: -0.52, -0.31; t= -7.82; P<0.0001) respectively, suggesting that BMI decreased with greater density. However, in the multiple linear regression, fish&chip shops showed a weak association with the adjusted BMI. Nevertheless, obesity was not related to the density of the overall total food outlets (R²= 0.10, P=0.33).

Conclusions

This study contrasts other investigations in the UK that noted the association of obesity is linked to the high number of restaurants. Other factors have a more important role in the development of obesity. Further research is needed to see to what extent visiting these food outlets regularly may contribute to obesity and total energy intake.