Fast-food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta-analysis.


Jia P(1)(2), Luo M(2)(3)(4), Li Y(5), Zheng JS(6), Xiao Q(2)(7)(8), Luo J(2)(5).
Author information:
(1)Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, the Netherlands.
(2)International Institute of Spatial Lifecourse Epidemiology
(ISLE), the Netherlands.
(3)Department of Reproductive Immunology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
(4)Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
(5)Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China.
(6)School of Life Sciences, Westlake University, Hangzhou, China.
(7)Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA.
(8)Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA.


Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.