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Epidemiology and Population Health

Fast food outlets, physical activity facilities, and obesity among adults: a nationwide longitudinal study from Sweden

Abstract

Background

While neighborhood deprivation is a well-known predictor of obesity, the mechanisms behind this association are unclear and these are important to clarify before designing interventions focusing on modifiable neighborhood environmental factors in order to reduce obesity risk.

Objectives

This study examined the longitudinal association between availability of fast-food outlets and physical activity facilities and the risk of obesity among adults.

Methods

This study used multiple national register data from Sweden. During the 11-year follow-up period between 2005 and 2015, data from 1,167,449 men and 542,606 women, aged 20–55 years, were accessible for inclusion in this analysis. Incidence of obesity was identified based on a diagnosis of obesity during the follow-up period derived from clinical register data. Neighborhood availability of fast-food outlets and physical activity facilities were assessed in 2005 and Cox regression was used in the statistical analysis. Individual socio-demographic factors and neighborhood deprivation were used as covariates.

Results

There were no meaningful associations between neighborhood fast-food outlets or physical activity facilities and obesity in men or women. Neighborhood deprivation was, however, consistently and strongly associated with incidence of obesity in both men and women.

Conclusions

Availability of fast-food outlets and lack of physical activity facilities appear unlikely to cause obesity in Swedish adults. Other potentially modifiable environmental factors within specific social and cultural settings that may influence obesity risk should be examined in future studies.

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References

  1. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–14.

    PubMed  Google Scholar 

  2. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011;377:557–67.

    PubMed  PubMed Central  Google Scholar 

  3. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.

    CAS  PubMed  Google Scholar 

  4. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    PubMed  PubMed Central  Google Scholar 

  5. Garrow JS. Energy balance and obesity in man. 2nd ed. New York; Amsterdam: Elsevier/North-Holland Biomedical Press; 1978. p. 243. completely rev, sole distributors for the U.S.A. and Canada Elsevier North-Holland.

  6. Stunkard AJ, Foch TT, Hrubec Z. A twin study of human obesity. JAMA. 1986;256:51–4.

    CAS  PubMed  Google Scholar 

  7. Stunkard AJ, Sørensen TI, Hanis C, Teasdale TW, Chakraborty R, Schull WJ, et al. An adoption study of human obesity. N Engl J Med. 1986;314:193–8.

    CAS  PubMed  Google Scholar 

  8. Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull. 1989;105:260–75.

    CAS  PubMed  Google Scholar 

  9. Ball K, Crawford D. Socioeconomic status and weight change in adults: a review. Soc Sci Med. 2005;60:1987–2010.

    PubMed  Google Scholar 

  10. McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29:29–48.

    PubMed  Google Scholar 

  11. Garner DM, Wooley SC. Confronting the failure of behavioral and dietary treatments for obesity. Clin Psychol Rev. 1991;11:729–80.

    Google Scholar 

  12. Gill TP. Key issues in the prevention of obesity. Br Med Bull. 1997;53:359–88.

    CAS  PubMed  Google Scholar 

  13. Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. BMJ. 1997;315:477–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55:111–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15:351–77.

    CAS  PubMed  Google Scholar 

  16. Stafford M, Cummins S, Ellaway A, Sacker A, Wiggins RD, Macintyre S. Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Soc Sci Med. 2007;65:1882–97.

    PubMed  Google Scholar 

  17. Mason KE, Pearce N, Cummins S. Associations between fast food and physical activity environments and adiposity in mid-life: cross-sectional, observational evidence from UK Biobank. Lancet Public Health. 2018;3:e24–33.

    PubMed  Google Scholar 

  18. Mackenbach JD, Rutter H, Compernolle S, Glonti K, Oppert J-M, Charreire H, et al. Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project. BMC Public Health. 2014;14:223.

    Google Scholar 

  19. Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC. The built environment and obesity. Epidemiol Rev. 2007;29:129–43.

    PubMed  Google Scholar 

  20. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

    PubMed  PubMed Central  Google Scholar 

  21. Gortmaker SL, Swinburn B, Levy D, Carter R, Mabry PL, Finegood D, et al. Changing the future of obesity: science, policy and action. Lancet. 2011;378:838–47.

    PubMed  PubMed Central  Google Scholar 

  22. Sundquist K, Malmström M, Johansson S-E. Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol Community Health. 2004;58:71–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Sundquist K, Winkleby M, Ahlén H, Johansson S-E. Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden. Am J Epidemiol. 2004;159:655–62.

    PubMed  Google Scholar 

  24. Hamano T, Li X, Sundquist J, Sundquist K. Association between childhood obesity and neighbourhood accessibility to fast-food outlets: a nationwide 6-year follow-up study of 944,487 children. OFA. 2017;10:559–68.

    Google Scholar 

  25. Kawakami N, Li X, Sundquist K. Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2 165 000 people. J Epidemiol Community Health. 2011;65:866–72.

    PubMed  Google Scholar 

  26. Winkleby M, Sundquist K, Cubbin C. Inequities in CHD Incidence and case fatality by neighborhood deprivation. Am J Prev Med. 2007;32:97–106.

    PubMed  PubMed Central  Google Scholar 

  27. Gilthorpe MS. The importance of normalisation in the construction of deprivation indices. J Epidemiol Community Health. 1995;49(Suppl 2):S45–50.

    PubMed  PubMed Central  Google Scholar 

  28. Kawakami N, Winkleby M, Skog L, Szulkin R, Sundquist K. Differences in neighborhood accessibility to health-related resources: a nationwide comparison between deprived and affluent neighborhoods in Sweden. Health Place. 2011;17:132–9.

    PubMed  Google Scholar 

  29. Larson NI, Story MT, Nelson MC. Neighborhood environments. Am J Prev Med. 2009;36:74–81.e10.

    PubMed  Google Scholar 

  30. Cummins S, Macintyre S. “Food deserts”—evidence and assumption in health policy making. BMJ. 2002;325:436–8.

    PubMed  PubMed Central  Google Scholar 

  31. Ghosh-Dastidar B, Cohen D, Hunter G, Zenk SN, Huang C, Beckman R, et al. Distance to store, food prices, and obesity in urban food deserts. Am J Prev Med. 2014;47:587–95.

    PubMed  PubMed Central  Google Scholar 

  32. Suarez JJ, Isakova T, Anderson CAM, Boulware LE, Wolf M, Scialla JJ. Food access, chronic kidney disease, and hypertension in the U.S. Am J Prev Med. 2015;49:912–20.

    PubMed  PubMed Central  Google Scholar 

  33. Clary CM, Ramos Y, Shareck M, Kestens Y. Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study. Prev Med. 2015;71:83–7.

    PubMed  Google Scholar 

  34. Mason KE, Bentley RJ, Kavanagh AM. Fruit and vegetable purchasing and the relative density of healthy and unhealthy food stores: evidence from an Australian multilevel study. J Epidemiol Community Health. 2013;67:231–6.

    PubMed  Google Scholar 

  35. Drewnowski A, Darmon N. The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr. 2005;82:265S–73S.

    CAS  PubMed  Google Scholar 

  36. Franck C, Grandi SM, Eisenberg MJ. Taxing junk food to counter obesity. Am J Public Health. 2013;103:1949–53.

    PubMed  PubMed Central  Google Scholar 

  37. Powell LM, Chaloupka FJ. Food prices and obesity: evidence and policy implications for taxes and subsidies. Milbank Q. 2009;87:229–57.

    PubMed  PubMed Central  Google Scholar 

  38. Pearce J, Hiscock R, Blakely T, Witten K. A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents. Health Place. 2009;15:193–7.

    PubMed  Google Scholar 

  39. Ellaway A, Lamb KE, Ferguson NS, Ogilvie D. Associations between access to recreational physical activity facilities and body mass index in Scottish adults. BMC Public Health. 2016;16:756.

    PubMed  PubMed Central  Google Scholar 

  40. Sundquist K, Eriksson U, Kawakami N, Skog L, Ohlsson H, Arvidsson D. Neighborhood walkability, physical activity, and walking behavior: The Swedish Neighborhood and Physical Activity (SNAP) study. Soc Sci Med. 2011;72:1266–73.

    PubMed  Google Scholar 

  41. Pearce J, Witten K, Hiscock R, Blakely T. Are socially disadvantaged neighbourhoods deprived of health-related community resources? Int J Epidemiol. 2007;36:348–55.

    PubMed  Google Scholar 

  42. Macintyre S, Macdonald L, Ellaway A. Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland. Soc Sci Med 2008;67:900–14.

    PubMed  PubMed Central  Google Scholar 

  43. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370–9.

    CAS  PubMed  Google Scholar 

  44. Pettersson J, Johansson K, Rössner S, Neovius M. Prevalence of obesity and abdominal obesity in Swedish primary care and occupational health clinics. Obes Facts. 2008;1:251–7.

    PubMed  PubMed Central  Google Scholar 

  45. Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008;32:992–1000.

    CAS  Google Scholar 

  46. Lissner L, Johansson S-E, Qvist J, Rössner S, Wolk A. Social mapping of the obesity epidemic in Sweden. Int J Obes. 2000;24:801–5.

    CAS  Google Scholar 

  47. Sundquist K, Qvist J, Johansson S-E, Sundquist J. Increasing trends of obesity in Sweden between 1996/97 and 2000/01. Int J Obes. 2004;28:254–61.

    CAS  Google Scholar 

  48. Neovius M, Janson A, Rössner S. Prevalence of obesity in Sweden. Obes Rev Off J Int Assoc Study Obes. 2006;7:1–3.

    CAS  Google Scholar 

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Acknowledgements

This Research was supported by the Swedish Heart-Lung Foundation, the Swedish Research Council, and ALF funding from Region Skåne to Kristina Sundquist.

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Authors

Contributions

KO drafted the manuscript. XL performed statistical analysis. KS provided funding. KS acquired the data. KO, XL, TA, TH, PWF, TN, and KS conceived and designed the research. KO, XL, TA. TH, PWF, TN, and KS made critical revision of the manuscript for key intellectual content.

Corresponding author

Correspondence to Kenta Okuyama.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Ethics Committee at Lund University, Sweden.

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Okuyama, K., Li, X., Abe, T. et al. Fast food outlets, physical activity facilities, and obesity among adults: a nationwide longitudinal study from Sweden. Int J Obes 44, 1703–1711 (2020). https://doi.org/10.1038/s41366-020-0588-5

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