Associations between neighbourhood takeaway food outlet exposure, takeaway food consumption and body weight Thomas Burgoine IPH Away Day 25 th April 2014, University Arms Hotel

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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 21 st century, 2008 Centre for Diet and Activity Research

Takeaways, Increased policy recognition “ though a clear relationship between fast food restaurants and obesity rates is less [well] demonstrated ”

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 outcome Centre 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 Weight (measured BMI) food consumption) Diet (takeaway Centre for Diet and Activity Research

Study design Centre for Diet and Activity Research 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 Centre for Diet and Activity Research

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/m 2 ) 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/m 2 (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 Centre for Diet and Activity Research Takeaway food access BMI and takeaway food consumption Socio-economic status (education)

Hypothetical models Source: adapted from Ford & Dzewaltowski (2008) Nutrition Reviews 66(4) Unhealthy food exposure Low SES High SES Low SES High SES Unhealthy food consumption …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. Centre for Diet and Activity Research

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. Centre for Diet and Activity Research