Weight Status and Restaurant Availability

A Multilevel Analysis
  • Neil K. Mehta
    Address correspondence and reprint requests to: Neil K. Mehta, MSc, Population Studies Center, 239 McNeil Building, University of Pennsylvania, 3718 Locust Walk, Philadelphia PA 19104.
    Graduate Group in Demography, University of Pennsylvania, Philadelphia, Pennsylvania

    Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Virginia W. Chang
    Graduate Group in Demography, University of Pennsylvania, Philadelphia, Pennsylvania

    Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania

    Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania

    Philadelphia Veterans Affairs Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

    Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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      Empiric studies find that contextual factors affect individual weight status over and above individual socioeconomic characteristics. Given increasing levels of obesity, researchers are examining how the food environment contributes to unhealthy weight status. An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants.


      This study analyzed the relationship between the restaurant environment and weight status across counties in the United States. Individual data from the 2002–2006 Behavioral Risk Factor Surveillance System (N=714,054) were linked with restaurant data from the 2002 U.S. Economic Census. Fast-food and full-service restaurant density, along with restaurant mix (the ratio of fast-food to full-service restaurants), were assessed.


      Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status (BMI and the risk of being obese). In contrast, a higher density of full-service restaurants was associated with lower weight status.


      Area-level restaurant mix emerged as an important correlate of weight status, with components of the restaurant environment exhibiting differential associations. Hence, it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes. Areas with a high density of full-service restaurants were indicative of a more healthful eating environment, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. Future prospective studies are required to delineate causal pathways.
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        • Cummins S.
        • Macintyre S.
        Food environments and obesity: neighbourhood or nation?.
        Int J Epidemiol. 2006; 35: 100-104
        • Egger G.
        • Swinburn B.
        An “ecological” approach to the obesity pandemic.
        BMJ. 1997; 315: 477-480
        • French S.A.
        • Story M.
        • Jeffery R.W.
        Environmental influences on eating and physical activity.
        Annu Rev Public Health. 2001; 22: 309-335
        • Hill J.O.
        • Wyatt H.R.
        • Reed G.W.
        • Peters J.C.
        Obesity and the environment: where do we go from here?.
        Science. 2003; 299: 853-855
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • et al.
        Prevalence of overweight and obesity in the United States, 1999–2004.
        JAMA. 2006; 295: 1549-1555
        • Chou S.Y.
        • Grossman M.
        • Saffer H.
        An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System.
        J Health Econ. 2004; 23: 565-587
        • Lopez R.
        Urban sprawl and risk for being overweight or obese.
        Am J Public Health. 2004; 94: 1574-1579
        • Poortinga W.
        Perceptions of the environment, physical activity, and obesity.
        Soc Sci Med. 2006; 63: 2835-2846
        • Chang V.W.
        • Christakis N.A.
        Income inequality and weight status in US metropolitan areas.
        Soc Sci Med. 2005; 61: 83-96
        • Chang V.W.
        Racial residential segregation and weight status among US adults.
        Soc Sci Med. 2006; 63: 1289-1303
        • Cohen D.A.
        • Finch B.K.
        • Bower A.
        • et al.
        Collective efficacy and obesity: the potential influence of social factors on health.
        Soc Sci Med. 2006; 62: 769-778
        • Binkley J.K.
        • Eales J.
        • Jekanowski M.
        The relation between dietary change and rising U.S. obesity.
        Int J Obes. 2000; 24: 1032
        • Kant A.K.
        • Graubard B.I.
        Eating out in America, 1987–2000: trends and nutritional correlates.
        Prev Med. 2004; 38: 243-249
        • Pereira M.A.
        • Kartashov A.I.
        • Ebbeling C.B.
        • et al.
        Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis.
        Lancet. 2005; 365: 36-42
        • Lin B.H.
        • Frazão E.
        • Guthrie J.
        Away-from-home food increasingly important to quality of American diet.
        Agricultural Information Bulletin. 1999; 749 (Available online at:
        • Bowman S.A.
        • Vinyard B.T.
        Fast food consumption of U.S. adults: impact on energy and nutrient intakes and overweight status.
        J Am Coll Nutr. 2004; 23: 163-168
      1. United States Department of Health and Human Services (USDHHS). Statement by Julie L. Gerberding on the Centers for Disease Control and Prevention’s Role in promoting healthy lifestyles before the Senate Committee on Appropriations, Subcommittee on Labor, HHS, Education and Related Agencies. Available online at:

        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • et al.
        Prevalence and trends in obesity among U.S. adults, 1999–2000.
        JAMA. 2002; 288: 1723-1727
      2. United States Department of Agriculture (USDA), Economic Research Service. Food Consumer Price Index, Prices and Expenditures: Food Expenditure Tables (Tables 7 and 17). Available online at:

        • Boardman J.D.
        • Saint Onge J.M.
        • Rogers R.G.
        • et al.
        Race differentials in obesity: the impact of place.
        J Health Soc Behav. 2005; 46: 229-243
        • Ford E.S.
        • Mokdad A.H.
        • Giles W.H.
        • et al.
        Geographic variation in the prevalence of obesity, diabetes, and obesity-related behaviors.
        Obes Res. 2005; 13: 118-122
        • Robert S.A.
        • Reither E.N.
        A multilevel analysis of race, community disadvantage, and body mass index among adults in the U.S..
        Soc Sci Med. 2004; 59: 2421-2434
        • Maddock J.
        The relationship between obesity and the prevalence of fast food restaurants: state-level analysis.
        Am J Health Promot. 2004; 19: 137-143
        • Burdette H.L.
        • Whitaker R.C.
        Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children.
        Prev Med. 2004; 38: 57-63
        • Jeffery R.W.
        • Baxter J.
        • McGuire M.
        • et al.
        Are fast food restaurants an environmental risk factor for obesity?.
        Int J Behav Nutr Phys Act. 2006; 3: 2
        • Simmons D.
        • McKenzie A.
        • Eaton S.
        • et al.
        Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia.
        Int J Obes. 2005; 29: 703-710
        • Morland K.
        • Wing S.
        • Diez Roux A.
        • et al.
        Neighborhood characteristics associated with the location of food stores and food service places.
        Am J Prev Med. 2002; 22: 23-29
        • Reidpath D.D.
        • Burns C.
        • Garrard J.
        • et al.
        An ecological study of the relationship between social and environmental determinants of obesity.
        Health Place. 2002; 8: 141-145
        • Cummins S.C.
        • McKay L.
        • MacIntyre S.
        McDonald’s restaurants and neighborhood deprivation in Scotland and England.
        Am J Prev Med. 2005; 29: 308-310
        • Sturm R.
        • Datar A.
        Body mass index in elementary school children, metropolitan area food prices and food outlet density.
        Public Health. 2005; 119: 1059-1068
        • Robert S.A.
        Socioeconomic position and health: The independent contribution of community socioeconomic context.
        Annu Rev Sociol. 1999; 25: 489
        • Stewart H.
        • Blisard N.
        • Dean J.
        Let’s eat out: Americans weigh taste, convenience, and nutrition.
        Economic Information Bulletin. 2006; 19 (Available online at:
        • Duncan C.
        • Jones K.
        • Moon G.
        Context, composition and heterogeneity: using multilevel models in health research.
        Soc Sci Med. 1998; 46: 97-117
        • French S.A.
        • Harnack L.
        • Jeffery R.W.
        Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic correlates.
        Int J Obes Relat Metab Disord. 2000; 24: 1353-1359
        • Zenk S.N.
        • Schulz A.J.
        • Israel B.A.
        • et al.
        Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit.
        Am J Public Health. 2005; 95: 660-667
        • Baker E.A.
        • Kelly C.
        • Barnidge E.
        • et al.
        The Garden of Eden: acknowledging the impact of race and class in efforts to decrease obesity rates.
        Am J Public Health. 2006; 96: 1170-1174
        • Sloane D.C.
        • Diamant A.L.
        • Lewis L.B.
        • et al.
        Improving the nutritional resource environment for healthy living through community-based participatory research.
        J Gen Intern Med. 2003; 18: 568-575
        • Chung C.
        • Myers S.L.
        Do the poor pay more for food?.
        J Consum Aff. 1999; 33: 276
        • Ezzati M.
        • Martin H.
        • Skjold S.
        • et al.
        Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys.
        J R Soc Med. 2006; 99: 250-257
        • Yun S.
        • Zhu B.P.
        • Black W.
        • et al.
        A comparison of national estimates of obesity prevalence from the behavioral risk factor surveillance system and the National Health and Nutrition Examination Survey.
        Int J Obes. 2006; 30: 164-170
        • Weaver T.W.
        • Kushi L.H.
        • McGovern P.G.
        • et al.
        Validation study of self-reported measures of fat distribution.
        Int J Obes Relat Metab Disord. 1996; 20: 644-650
        • Jeffery R.W.
        Bias in reported body weight as a function of education, occupation, health and weight concern.
        Addict Behav. 1996; 21: 217-222
        • Stewart A.L.
        The reliability and validity of self-reported weight and height.
        J Chronic Dis. 1982; 35: 295-309