Implications of fast food restaurant concentration for preschool-aged childhood obesity

Abstract

In this research, the authors examine the effects on preschool-aged childhood obesity rates associated with the direct and moderating influence of fast food restaurant density levels, consumer poverty, and urbanization. Results show that higher levels of fast food restaurant saturation are associated with increased levels of childhood obesity in both urban and poor areas, with the largest negative effect of fast food availability on obesity occurring in more economically disadvantaged, urban areas. Findings highlight why the societal impacts of targeting vulnerable populations through corporate location selection strategies should be fully considered in social marketing initiatives, especially given that unhealthy products with long term health risks are increasingly accessible.

Introduction

The increasing tendency to eat food prepared outside the home, especially fast food, has been one of the most significant changes in food consumption over the past 50 years (Binkley, 2006). Food purchases outside the home now account for nearly 50% of Americans' total yearly food expenditures (Economic Research Service/United States Department of Agriculture (ERS/USDA), 2009, National Restaurant Association (NRA), 2012). In addition, almost one out of every three children eats fast food on a daily basis, a rate that has increased more than fivefold since 1970 (Bowman, Gortmaker, Ebbeling, Pereira, & Ludwig, 2004). Considering the fact that childhood obesity has more than tripled over the past generation, a better understanding of the potential effects of these long-term trends on children's health and welfare is needed (Centers for Disease Control and Prevention [CDC], 2012). Children now develop adult disorders, such as hypertension and type 2 diabetes, rarely observed in prior generations (Goran, Ball, & Cruz, 2003). Further, obese children and teens face a high likelihood of becoming obese adults (CDC, 2012). The childhood obesity epidemic has both immediate and long-term detrimental effects on the health and well-being of millions of Americans (Elbel et al., 2011, Grier et al., 2007).

The prevalence of both childhood and adult obesity rapidly increased over the same time period that the number of fast food restaurants more than doubled (e.g., Nielsen, Siega-Riz, & Popkin, 2002). Very young children living in lower income, urban communities where access to healthy food options may be more limited (CDC, 2012) are especially at risk. Today, 14% of lower-income, preschool-aged children are obese, and one-third are considered either overweight or obese (CDC, 2012). Consequently, many in the marketing and consumer health communities are concerned about the relationship between fast food consumption and childhood obesity. Prior research has examined the impact of fast food bundling (Sharpe & Staelin, 2010), pricing (Khan, Powell, & Wada, 2012), and advertising (Hudson, Hudson, & Peloza, 2008) on children's health and welfare. However, the implications associated with restaurant location decisions, a subtler component of the strategic marketing process, have largely been ignored. While prior literature suggests that greater fast food consumption is indeed related to greater weight gain and obesity (Niemeier et al., 2006, Pereira et al., 2005), studies examining the specific relationship between fast food availability and obesity show mixed results. Further, information regarding how a high concentration of fast food outlets may negatively affect young children's health is extremely limited (Fleischhacker, Evenson, Rodriguez, & Ammerman, 2011).

As questions regarding the social impact of fast food marketing tactics continue to mount (Center for Science in the Public Interest, 2008, Food Research and Action Center, 2012), research is needed to provide greater insight into the relationship between fast food accessibility and the development of early childhood obesity. More specifically, a better understanding of how environmental factors may influence childhood obesity is necessary to develop more effective interventions to reduce the problem (Salois, 2012, Sturm and Cohen, 2009). Preschool aged children, whose obesity rates across the U.S. range from 10 to 15% or higher (CDC, 2012), represent a particularly vulnerable consumer group and serve as the focus of the present study (Centers for Disease Control and Prevention, 2012, Center for Science in the Public Interest, 2008). Thus, the current research considers fast food accessibility as an element of the built environment and examines how two specific environmental factors, poverty and urbanization levels, may moderate the relationship between fast food accessibility and preschool childhood obesity rates. Based on the findings, several public policy and social marketing initiatives are proposed that may help communities better address the problem of early childhood obesity.