Associations between neighbourhood takeaway food outlet exposure, takeaway food consumption and body weight

Thomas BurgoineIPH Away Day25th April 2014, University Arms Hotel

• The Centre for Diet and Activity Research (CEDAR) is focussed on:

• studying the determinants of dietary and PA behaviours

• developing and evaluating public health interventions

• helping shape public health practice and policy.

• The Centre is one of five Centres of Excellence in Public health Research funded through the UKCRC.

• Find out more: http://www.cedar.iph.cam.ac.uk/

About CEDAR

Introduction

• UK obesity levels have reached ‘epidemic’ proportions

• 29% increase in expenditure on foods consumed out of the home in the last 10 years

• Meals consumed outside of the home are less healthy: more energy dense, more saturated fat, more salt; bigger portions

• Takeaway consumption associated with weight gain over time

• Neighbourhood access to takeaway food outlets may play an important role in determining diet and health

Sources: Food – an analysis of the issues, 2008 Food matters – towards a strategy for the 21st century, 2008

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Takeaways, Increased policy recognition

Food Environment effect on

diet/weight

Morland and Evenson 2009

Mehta and Chang 2008

Chou et al 2004

Maddock et al 2004

Boone-Heinonen et al 2011

Davis and Carpenter 2009

Currie et al 2009

Powell et al 2007

Bodor et al 2007

Moore et al 2008

Zenk et al 2005

Laraia et al 2004

Wrigley et al 2003

Rose and Richards 2004

No or unexpected food environment

effect on diet/weight

Simmons et al 2005

Spence et al 2009

Jeffery et al 2006

Mobley et al 2006

Rundle et al 2009

Sturm and Datar 2005

Crawford et al 2008

Burdette and Whitaker 2004

Boone-Heinonen et al 2011

Morland et al 2002

Edmonds et al 2001

Cummins et al 2005

Burgoine et al 2009

Burgoine et al 2011

BMI outcome

Diet outcomeCentre for Diet and Activity Research

Evidence?

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Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: population based, cross sectional study

Institute of Public Health

Burgoine, T., Forouhi, N.G., Griffin, S.J., Wareham, N. and Monsivais, P. (2014) BMJ 348 (7950)

The Fenland Study sample

5442 adults

Aged 29-62

Weight (measured BMI)

food consumption)Diet (takeaway

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Study design

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WORK HOME

JOURNEY

Participants exposed to:

• 32 takeaway outlets on average

• up to as many as 165 outlets

• majority of outlets at work.

Takeaway Exposure - Consumption

** p<0.001; * p<0.05. a Q1, least exposed – Q4, most exposed. β co-efficients represent change in takeaway type food consumption (g) per quartile of takeaway food outlet exposure. All models control for age, sex, education (individual-level socio-economic status), daily

energy intake (kcal), car ownership and supermarket availability. Commuting and combined models also adjust for journey length. Error bars represent 95% confidence intervals.

3.0g

5.7g

(least exposed) (most exposed)

40g/week

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Takeaway Exposure – Body Mass Index

** p<0.001; * p<0.05. a Q1, least exposed – Q4, most exposed. β co-efficients represent estimated BMI (kg/m2) per quartile of takeaway food outlet exposure. All models control for age, sex, education (individual-level socio-economic status), smoking status, car ownership

and supermarket availability. Commuting and combined models also adjust for journey length. Error bars represent 95% confidence intervals.

1.21kg/m2

(least exposed) (most exposed)

Conclusions

• Neighbourhood takeaway food environments matter.

• Limiting the number of takeaway food outlet encountered on a daily basis may be one way of positively influencing diets and body weight

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Takeaway food

access

BMI and takeawayfood consumption

Socio-economic status (education)

Hypothetical models

Source: adapted from Ford & Dzewaltowski (2008) Nutrition Reviews 66(4)

Unhealthy food exposure Unhealthy food exposure

Low SES

High SES

Low SES

High SES

Unh

ealt

hy f

ood

cons

umpt

ion

Unh

ealt

hy f

ood

cons

umpt

ion

…with evidence of an interaction?

“Deprivation amplification”

Exposure by Education - Consumption

Means, 95% CIs adjusted for age, sex, household income, energy intake, car access, weighted journey distance, supermarket availability.

Adapted from Burgoine et al In Preparation

Exposure by Education – Body Mass Index

Means, 95% CIs adjusted for age, sex, smoking status, household income, car access, weighted journey distance, physical activity energy expenditure, supermarket availability.

Adapted from Burgoine et al In Preparation

Conclusions

• Less educated individuals, living in ‘unhealthy’ neighbourhoods, face a particular challenge (deprivation amplification)

• Neighbourhood takeaway food environments matter, across all education groups.

• Results indicate that the association between takeaway exposure and takeaway consumption varies according to level of education

• Environmental interventions may to some extent reduce socio-economic patterning of diet.

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ACKNOWLEDGEMENTS

Thank you to Pablo Monsivais, Nita Forouhi, Simon Griffin, Nick Wareham, Soren Brage.

This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC 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.

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