Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: population based, cross sectional studyBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1464 (Published 13 March 2014) Cite this as: BMJ 2014;348:g1464
- Thomas Burgoine, research associate1,
- Nita G Forouhi, group leader1,
- Simon J Griffin, professor of general practice12,
- Nicholas J Wareham, director1,
- Pablo Monsivais, senior university lecturer12
- 1UKCRC Centre for Diet and Activity Research, Medical Research Council (MRC) Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- 2Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
- Correspondence to: T Burgoine
- Accepted 31 January 2014
Objectives To examine the association between environmental exposure to takeaway food outlets, takeaway food consumption, and body weight, while accounting for home, work place, and commuting route environments.
Design Population based, cross sectional study, using data on individual participants’ diet and weight, and objective metrics of food environment exposure.
Participants Working adults participating in the Fenland Study, Cambridgeshire, UK (n=5442, aged 29-62 years), who provided home and work addresses and commuting preferences. Takeaway food outlet exposure was derived using data from local authorities for individual environmental domains (at home, at work, and along commuting routes (the shortest route between home and work)), and for exposure in all three domains combined. Exposure was divided into quarters (Q); Q1 being the least exposed and Q4 being the most exposed.
Main outcome measures Self reported consumption of takeaway type food (g/day; pizza, burgers, fried foods, and chips) using food frequency questionnaires, measured body mass index, and cut-offs for body mass index as defined by the World Health Organization.
Results In multiple linear regression models, exposure to takeaway food outlets was positively associated with consumption of takeaway food. Among domains at home, at work, and along commuting routes, associations were strongest in work environments (Q4 v Q1; β coefficient=5.3 g/day, 95% confidence interval 1.6 to 8.7; P<0.05), with evidence of a dose-response effect. Associations between exposure in all three domains combined and consumption were greater in magnitude across quarters of exposure (Q4 v Q1; 5.7 g/day, 2.6 to 8.8; P<0.001), with evidence of a dose-response effect. Combined exposure was especially strongly associated with increased body mass index (Q4 v Q1; body mass index 1.21, 0.68 to 1.74; P<0.001) and odds of obesity (Q4 v Q1; odds ratio 1.80, 1.28 to 2.53; P<0.05). There was no evidence of effect modification by sex.
Conclusions Exposure to takeaway food outlets in home, work, and commuting environments combined was associated with marginally higher consumption of takeaway food, greater body mass index, and greater odds of obesity. Government strategies to promote healthier diets through planning restrictions for takeaway food could be most effective if focused around the workplace.
We thank local councils for kindly supplying data to enable this work; all the volunteers who participated in the Fenland Study, as well as Fenland Study Coordination, Field Epidemiology, and data cleaning teams; and Søren Brage for his expertise on adjustment for physical activity energy expenditure.
Contributors: The study analysis was devised by TB and PM. TB was responsible for data collection from local councils, and led on data analysis, in consultation with PM, NGF, SJG, and NJW. TB and PM drafted the manuscript together. All authors read and approved the final manuscript. TB is the guarantor.
Funding: This work was undertaken by the Centre for Diet and Activity Research, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Core MRC Epidemiology Unit support through programmes MC_UU_12015/1 and MC_UU_12015/5 is acknowledged. All authors remain independent from funders.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Centre for Diet and Activity Research, a UK Clinical Research Collaboration Public Health Research Centre of Excellence, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Fenland study volunteers gave written informed consent and the study was approved by the local research ethics committee for Cambridge. All other data analysed were in the public domain.
Data sharing: No additional data available.
Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/.