1. Introduction Incidence of obesity has been on the rise over the past decade. 15% of youth in the U.S. and one-third of adults are obese (CBS News). This trend has lead to an increase in health concerns not only for adults, but for children alike. This health disparity is a complex, multi-causational issue, but one of the most important factors may be that of unhealthy environments surrounding Americans today. The explosion of fast food restaurants and convenience foods that are inexpensive and are filled with preservatives may be a culprit for this epidemic (See Figure 1). According to Time Magazine: Healthland, there is now a 5:1 ratio of fast-food restaurants to supermarkets in the U.S. Also according to NationMaster, there are now 12,804 McDonald’s restaurants in the United States, more than any other country in the world. For these reasons, obesity rates in the United States are directly linked to an increase in fast-food availability and consumption Materials and methods Studies were found relating to obesity and its link to fast- food through the database PubMed on May 21, 2012. Using the key words, ‘fast-food,’ ‘restaurants,’ and ‘obesity’ the search was narrowed down. Seven studies were chosen to conduct a systematic review of finding scientific evidence related to the topic. The studies evaluated were published between the years 2003 and 2012. Studies containing cross- sectional and quasi-experimental design relating to multiple facets of the United States population were considered in this systematic review. Acknowledgments We would like to thank Dr. Peter Sternberg for a great May term in Epidemiology and to PubMed for helping us conduct our research. Results Seven studies and four websites were analyzed to determine our results as follows: Bauer, et al (2012) “Parental Employment and Work-Family Stress” aimed to find the association between parental employment status with the aspects of family food environment and how that influences eating habits. The study used a cross sectional design to distribute 4,777 surveys to parents and guardians in the metropolitan areas of the Midwestern United States. The results of the study were: Jobs with higher stress developed poor breakfast habits It was determined that the family food environment has one of the largest influences on a child’s eating habits and prevention of weight gain. Beaulieu, D. and Godin, G. (2012) “Staying in School for Lunch Instead of Eating in Fast-Food Restaurants” aimed to use intervention strategies in order to encourage high school students to eat lunch at school instead of at fast-food restaurants. The quasi-experimental design consisted of pre and post-test. Results of the study were: Prevention strategies were successful in increasing self- efficacy of students Students were able to realize the heath risks involved with eating at fast-food restaurants Bowman, S. A. and Vinyard, B. T. (2003) ”Fast-Food Consumption of U.S. Adults” aimed to compare the diet quality of adults that ate fast-food with those who prepared food at home in order to determine whether eating out increases overweight status. A cross-sectional survey was given to 9,872 individuals over the age of 20, resulting in: Statistically significant p-values of < 0.0001 Confidence level of 95% Fast-food was associated with eathing meals high in density and can lead to weight gain Conclusions Based on the findings from the seven studies and relating websites, increased access to fast-food is a major underlying cause of the obesity epidemic. The negative effects of fast food affect anyone regardless of their age, race, gender, or socioeconomic status. These studies have proven that preventing overconsumption of fast-food is one of the best ways to combat the obesity epidemic in the United States. Kasi Johnson and Blair Rummel Department of Health, Exercise and Rehabilitative Sciences, Winona State University, Winona, Minnesota 55987 Literature Cited Bauer, K& Et. Al. (2012). Elsevier: Social Science & Medicine. Parental Employment and Work-Family Stress: Association with Family Food Environments. Retrieved from http://ac.els-cdn.com/S0277953612002936/1-s2.0-S0277953612002936- main.pdf?_tid=a9d4ac08f5bb0233015acfc5e9c328d4&acdnat=1337644040_811444fd51 306900eebd1fe684dd7391 Beaulieu, D & Godin Gaston. (2012). Public Health Nutrition. Staying in School for Lunch Instead of Eating in Fast-Food Restaurants. Retrieved from http://journals.cambridge.org/download.php?file=%2FPHN%2FS1368980012000821a.p df&code=057e4abe046e3eb779829c68c457666d Bowman, S. A. & Vinyard, B. T. (September 2003) Fast Food Consumtion of U.S. Adults: Impact on Energy and Nutrient Intakes and Overweight Status. Jounal of the American College of Nutrition, volume 23, number 2. Retrieved from http://www.jacn.org/content/23/2/163.full Carpenter, C. & Davis, B. (March 2009) Proximity of Fast-Food Restaurants to Schools and Adolescent Obesity. American Journal of Public Health, volume 99, number 3. Retrieved from http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2008.137638 CBS News: HealthWatch. (2009). Fast-Food Linked to Child Obesity. Retrieved from http://www.cbsnews.com/2100-204_162-591325.html http://www.cbsnews.com/2100-204_162-591325.html Fraser, Lorna K., Et. Al. (16 April 2012). Fast Food and Obesity: A spatial Analysis in a Large Unites Kingdome Population of Children Aged 13-15. American Journal of Preventive Medicine, volume 42, issue 5, pages e77-e85. Retrieved from http://www.sciencedirect.com/science/article/pii/S0749379712001298 http://www.sciencedirect.com/science/article/pii/S0749379712001298 Hicken, Melanie. (2012). This Interactive Map Shows Exactly How Many Fast Food Restaurants There Are In Every State. Retrieved from http://articles.businessinsider.com/2012-01-28/strategy/30669674_1_fast-food-food- chains-food-restaurants http://articles.businessinsider.com/2012-01-28/strategy/30669674_1_fast-food-food- chains-food-restaurants Lee, H. (10 February 2012). The role of local food availability in explaining obesity risk among young school-aged children. Social Schience and Medicine, volume 74, issue 8, pages 1193-1203. Retrieved from http://www.sciencedirect.com.wsuproxy.mnpals.net/science/article/pii/S0277953612000 810 Li, F & Et. Al. (2009). National Institutes of Health. Obesity and the build environment: Does the density of neighborhood fast-food outlets Matter? Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730045/pdf/nihms138445.pdf Nationmaster.com (2012). McDonald’s Restaurants (most recent) by Country. Retrieved from http://www.nationmaster.com/graph/foo_mcd_res-food-mcdonalds-restaurants Time, Heathland. (2011). Numbers 5 to 1. Retrieved from (http://healthland.time.com/2011/08/12/the-ratio-of-fast-food-restaurants-to-grocery- stores-in-america-is-51/http://healthland.time.com/2011/08/12/the-ratio-of-fast-food-restaurants-to-grocery- stores-in-america-is-51/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730045/pdf/nihms138445.pdf. Figure 2. “PubMed comprises more than 21 million citations for biomedical literature from MEDLINE, life science journals and online books. ” For further information See the PubMed database or contact KAJohnson09@winona.edu or BRummel08@winona.edu KAJohnson09@winona.edu Carpenter, C. and Davis, B. (2009) “Proximity of Fast-Food Restaurant to Schools” aimed to examine the relationship between fast food restaurants near schools and obesity among middle and high school students. This cross sectional analysis used the 2002-2005 California Healthy Kids Survey to conclude: Living in a poor quality food environment has negative effects on adolescents’ eating patterns and being overweight Limiting the closeness of fast-food restaurants could help reduce obesity Fraser, L. K. (2012) “Fast-Food and Obesity” aimed to assess a possible relationship between eating fast-food and obesity. It also looked at access to fast-food and people’s consumption. This cohort study followed 14,610 children from birth to age 13, when they acquired data. The results of the study are as follows: Students need increasing nutrition education to help them make better food choices Lee, H. (2012) ”The Role of Local Food Proximity In Explaining Obesity” aimed to determine if proximity of poor food choices had a negative impact on a child’s BMI over the course of five years from kindergarten to fifth grade. This longitudinal cohort study used 11,400 students across the United States to determine their results. She found: This study claims that fast-food outlet exposure has no impact on a child’s weight gain and neither does a child’s socioeconomic status or ethnicity Many biases were not discussed in the findings, possibly skewing the results Li, F. et al. (2009) “Does Density of Neighborhood Fast-Food Outlets Matter” aimed to compare the variations in obesity among adults who live in neighborhoods of fast food outlets. This cross-sectional, multi- leveled survey randomly selected 1,221 residents whose average age was 50-75 from 120 neighborhoods from the U.S. Census. Results found were: Fast-food outlets in neighborhoods were associated with unhealthy lifestyles and increased risk of obesity Increased fast-food access causes obesity epidemic Figure 1. This map developed by the Business Insider War Room shows amount of fast food restaurants per capita in the U.S. ranging from most restaurants per 1,000 residents in dark red, to fewest restaurants in light pink Table 2. This table shows the numbers of girls and boys at ages 13 and 15 who consumed fast food and were obese. Table 1. Shows caloric and nurtrient intake for U.S. adults over the age of 20 who consumed fast food.