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Reconsidering the relationship between fast-food outlets, area-level deprivation, diet quality and body mass index: an exploratory structural equation modelling approach
  1. Matthew Hobbs1,2,
  2. Mark Green3,
  3. Kath Roberts4,
  4. Claire Griffiths2,
  5. Jim McKenna2
  1. 1GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
  2. 2Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  3. 3Geography and Planning, University of Liverpool, Liverpool, UK
  4. 4Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Matthew Hobbs, GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch 8041, New Zealand; matt.hobbs{at}


Background Internationally, the prevalence of adults with obesity is a major public health concern. Few studies investigate the explanatory pathways between fast-food outlets and body mass index (BMI). We use structural equation modelling to explore an alternative hypothesis to existing research using area-level deprivation as the predictor of BMI and fast-food outlets and diet quality as mediators.

Methods Adults (n=7544) from wave II of the Yorkshire Health Study provided self-reported diet, height and weight (used to calculate BMI). Diet quality was based on sugary drinks, wholemeal (wholegrain) bread and portions of fruit and vegetables. Fast-food outlets were mapped using the Ordnance Survey Points of Interest within 2 km radial buffers around home postcode which were summed to indicate availability. Age (years), gender (female/male) and long-standing health conditions (yes/no) were included as covariates.

Results There was little evidence linking fast-food outlets to diet or BMI. An independent association between fast-food outlet availability and BMI operated counterintuitively and was small in effect. There was also little evidence of mediation between fast-food outlet availability and BMI. However, there was more evidence that area-level deprivation was associated with increased BMI, both as an independent effect and through poorer diet quality.

Conclusion This exploratory study offers a first step for considering complexity and pathways linking fast-food outlets, area-level deprivation, diet quality and BMI. Research should respond to and build on the hypothesised pathways and our simple framework presented within our study.

  • obesity
  • health inequalities
  • preventive medicine
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  • Contributors All authors contributed significantly to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional review boards of Carnegie Faculty, Leeds Beckett University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.

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