PT - JOURNAL ARTICLE AU - Hobbs, Matthew AU - Green, Mark AU - Roberts, Kath AU - Griffiths, Claire AU - McKenna, Jim TI - Reconsidering the relationship between fast-food outlets, area-level deprivation, diet quality and body mass index: an exploratory structural equation modelling approach AID - 10.1136/jech-2018-211798 DP - 2019 Sep 01 TA - Journal of Epidemiology and Community Health PG - 861--866 VI - 73 IP - 9 4099 - http://jech.bmj.com/content/73/9/861.short 4100 - http://jech.bmj.com/content/73/9/861.full SO - J Epidemiol Community Health2019 Sep 01; 73 AB - 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.