Limiting fast-food outlets can reduce childhood overweight and obesity

Restricting new fast-food sellers in areas where there are already a large number could reduce obesity and overweight in children.

Study: Planning policies to restrict fast food and inequalities in child weight in England: a quasi-experimental analysis. Image Credit: Paulo PFZ STUDIO/Shutterstock.com

In a recent study published in obesity, researchers investigated whether a policy in England that banned new fast-food outlets effectively reduced obesity and overweight in children.

Their findings indicated that restricting new fast-food sellers in areas where there are already a large number could reduce obesity and overweight in children.

Background

The United Kingdom has among the highest rates of childhood obesity in Europe, with obesity among ten and 11-year-olds increasing from slightly under 32% in 2006-07 to nearly 41% in 2020-21. The pandemic is thought to have been one of the drivers for this change.

Childhood obesity is associated with several short-term and long-term effects. In the short term, it reduces life quality and is linked to depression, anxiety, stigma, bullying, and self-esteem issues.

In the long term, childhood obesity can continue into adulthood and increase the risk of mental disorders, diabetes, and cardiovascular diseases. The cost of obesity-related conditions for the National Health Service was estimated to be £6.1 million in 2015, and this is expected to rise to £9.7 billion by 2050.

Complex factors influence obesity, but environmental factors, especially outside the home, play a major role. Fast food intake and the density of fast-food outlets have been linked to higher energy consumption and obesity, particularly in low-income areas.

The density of fast-food outlets in England has increased from 142 per 100,000 residents in 2019 to 170 in 2021. The impacts are unequally felt, as deprived areas contain five times more outlets than wealthier areas.

In recent years, half of local governments have introduced planning guidelines that target limits on new outlets and promote healthier food environments. Gateshead, among the most deprived areas, implemented stricter planning policies to reduce childhood obesity.

A complete ban on new fast-food outlets since 2015 aimed to lower obesity in 10 and 11-year-olds from 23% to less than 10% by 2025. Studies show a reduction in fast-food outlets in Gateshead compared to areas without similar policies.

About the Study

In this study, researchers investigated whether reducing fast-food outlets leads to changes in childhood obesity and reduces health inequalities, exploring the impact of the policy within five years and whether it is more effective in deprived areas with high fast-food outlet density.

They gathered data on children’s weight and food outlets from national monitoring programs, also including population size and area-level deprivation indices, with higher scores indicating more deprivation.

The outcome variable was the prevalence of obesity and overweight in 10 and 11-year-old children, while outlet density was calculated as the number of outlets for every 100,000 residents in each area.

For the analysis, researchers considered areas in Gateshead to be the treatment group and matched them to areas from nearby regions that did not implement similar restrictions.

They then used statistical models to analyze the impact of restricting fast-food outlets, controlling for deprivation scores.

Findings

Areas in Gateshead had a consistently higher prevalence of obesity and overweight among children aged 10 and 11 compared to the control areas. Gateshead also had a higher density of fast-food outlets compared to control areas throughout the years.

The prevalence decreased from 38% in 2011 to 35.5% in 2015 but rose again to 37.7% by 2020. Over time, the difference in prevalence between Gateshead and the control areas narrowed.

The impact of planning guidance on reducing obesity and overweight prevalence was not statistically significant overall, but area-level deprivation scores did show a strong effect.

Notably, the planning policy had a significant reduction in obesity and overweight prevalence in the second and third-most deprived areas. This effect remained for the second most deprived area after sensitivity analysis.

Conclusions

The study provides evidence of the effectiveness of local planning policy in reducing obesity and overweight in children aged 10 and 11 within four years of implementation. There was a 10% reduction in fast-food outlet density in Gateshead within four years of the policy. 

Decreases in prevalence were observed in the second most deprived areas, which also had the highest concentration of fast-food outlets before the policy.

Researchers found no effects at the population level and noted that the effect could take longer than four years to be measurable.

These findings have policy implications, indicating that planning policies could help reduce inequalities in childhood obesity and overweight, relying on a structural approach to improve health outcomes rather than relying on changes in individual behavior.

However, the growing presence of online food delivery needs further research to understand its impact on access to unhealthy food and whether current policies need updates to address the changing food environment.