The role of fast-food restaurants in Body Mass Index (BMI)

Approximately 50 percent of Dutch adults is overweight. If health policies are not improved, this percentage is expected to rise even more in the future. Overweight is defined as having a Body Mass Index (BMI; one’s weight divided by square height in kilogram/metre²) of 25,0 or higher. Individuals with overweight are at increased risk of getting various chronic diseases, such as cardiovascular diseases. Recently, the role of our living environment – and particularly the presence of fast-food restaurants – in overweight has been increasingly highlighted. After all, fast-food restaurants are easily accessible and quickly serve predominantly unhealthy meals. Furthermore, the number of fast-food restaurants in the Netherlands has increased substantially in the last couple of years.

This study investigated whether adult Lifelines participants (147,027) who had more fast-food restaurants within the vicinity of their homes also had a higher BMI. Furthermore, we investigated whether the impact of fast-food restaurants differs between urban and rural areas. We established a linkage between residential addresses of Lifelines participants to LISA data (www.lisa.nl), a register containing locations of fast-food restaurants in the Netherlands. Based on this linkage, we could identify the presence of fast-food restaurants in the living environment (= the number of fast-food restaurants within 500 metres and 1 kilometre and the distance to the nearest fast-food restaurant from the residential address of participants). The linkage was performed without the identification of individual participants.

We found that Lifelines participants with multiple fast-food restaurants within 1 kilometre around the residential address had a higher BMI than participants with no fast-food restaurants within 1 kilometre around the residential address. Moreover, Lifelines participants who lived within 250 metres from the nearest fast-food restaurant had a higher BMI than Lifelines participants living more than 1 kilometre from the nearest fast-food restaurant. In rural areas, participants with one fast-food outlet within 500 metres had a higher BMI than participants with no fast-food outlets within 500 metres. This pattern was not seen in urban areas. We hope that policy-makers can use these results to create healthier living environments. Future studies could investigate the role of fast-food restaurants in changes in BMI over time.