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Association Between the Fast-Food Environment and Obesity in Canada: a Cross-Sectional Analysis

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Association Between the Fast-Food Environment and Obesity in Canada: a Cross-Sectional Analysis Western University Scholarship@Western Electronic Thesis and Dissertation Repository 5-22-2012 12:00 AM Association between the Fast-Food Environment and Obesity in Canada: A Cross-sectional Analysis Simon Hollands The University of Western Ontario Supervisor Dr. Sisira Sarma The University of Western Ontario Graduate Program in Epidemiology and Biostatistics A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Simon Hollands 2012 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Epidemiology Commons Recommended Citation Hollands, Simon, "Association between the Fast-Food Environment and Obesity in Canada: A Cross- sectional Analysis" (2012). Electronic Thesis and Dissertation Repository. 546. https://ir.lib.uwo.ca/etd/546 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. The Association between the Fast-Food Environment and Obesity in Canada: A Cross-sectional Analysis (Spine title: Fast-food and Obesity in Canada) (Monograph) by Simon Hollands Graduate Program in Epidemiology and Biostatistics A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Simon Hollands 2012 THE UNIVERSITY OF WESTERN ONTARIO School of Graduate and Postdoctoral Studies CERTIFICATE OF EXAMINATION Supervisor Examiners ______________________________ ______________________________ Dr. Sisira Sarma Dr. Isaac Luginaah Supervisory Committee ______________________________ Dr. John Koval ______________________________ Dr. Jason Gilliland ______________________________ Dr. William Avison ______________________________ Dr. Karen Campbell The thesis by Simon Hollands entitled: The Association between the Fast-Food Environment and Obesity in Canada: A Cross-sectional Analysis is accepted in partial fulfillment of the requirements for the degree of Master of Science ______________________ _______________________________ Date Chair of the Thesis Examination Board ii Abstract Frequent fast-food consumption is associated with weight gain therefore it is hypothesized that relative availability of fast-food is a risk factor for obesity. This thesis examined the association between the neighbourhood-level density of fast-food outlets and adult body mass index (BMI) in Canada. Population-based data on BMI and socio- economic variables from the 2008 Canadian Community Health Survey [CCHS] and selected neighbourhood-level socio-economic data from 2006 Canadian Census were merged with a commercial database containing geographic locations of all restaurants in Canada. The association between BMI and fast-food density (per 10,000 people in CCHS respondent’s FSA) was analyzed using ordinary least squares regression. Spatial clustering of BMI was also investigated and spatial-regression analysis was conducted. FSA-level fast-food density is significantly associated with BMI in Canadian adults, predominantly in females and non-rural area. This population-based analysis established that availability of fast-food restaurants is an important risk factor for obesity in Canada. iii Keywords Obesity, Body Mass Index, Built Environment, Fast-food Restaurant, Food Service Environment, Convenience iv Acknowledgements First and foremost I would like to thank my family. I would not be here without the loving support of my parents throughout my entire journey. Additionally, to my older brother who introduced me to epidemiology and provided invaluable support from the beginning. I would like to acknowledge Dr. Sarma for his guidance and commitment in helping me develop as a researcher, this thesis would not have been possible without him. As well as my committee members Dr Campbell and Dr Gilliland who gave valuable insight and support all the way through. Also, I want to thank Brad Corbett for his facilitation and cooperation while working in the RDC as well as the examiners, Dr Luginaah, Dr Koval, and Dr Avison who all gave valuable feedback and recommendations for which I would like to acknowledge. I would also like to recognize the financial support from the Canadian Institute for Health Research as well as the Western Graduate Research Scholarship. Finally I would like to thank my classmates, the PhD students, and Dr Hajizadeh, who all helped me at one point or another but most importantly, for their friendship and camaraderie which made the last two years some of the best years of my life. v Contents CERTIFICATE OF EXAMINATION ______________________________________ ii Abstract _______________________________________________________________ iii Keywords _____________________________________________________________ iv Index of Tables _________________________________________________________ ix Index of Figures _________________________________________________________x List of Abbreviations _____________________________________________________ xi Chapter 1 Introduction ________________________________________________ 1 1.1 Built Environment and Obesity _________________________________________ 3 1.2 Food Environment and Obesity _________________________________________ 4 1.3 Spatial Clustering of Obesity ___________________________________________ 6 1.4 Objectives ___________________________________________________________ 8 Chapter 2 Literature Review ____________________________________________ 9 2.1 Review of the Built Environment and Obesity _____________________________ 9 2.1.1 Literature Search ___________________________________________________________ 10 2.1.2 Sample Population __________________________________________________________ 11 2.1.3 Outcome Measures __________________________________________________________ 12 2.1.4 Exposure Measures _________________________________________________________ 12 2.1.4.1 Urban Sprawl __________________________________________________________ 13 2.1.4.2 Neighbourhood Walkability and Physical Activity ____________________________ 13 2.1.4.3 Land Use Mix _________________________________________________________ 14 2.1.4.4 Food Environment ______________________________________________________ 14 2.1.5 Discussion ________________________________________________________________ 15 2.2 Review of Availability of Fast-food and Obesity ___________________________ 18 2.2.1 Study Characteristics ________________________________________________________ 18 2.2.2 Study Results ______________________________________________________________ 24 vi 2.2.2.1 Exposure Measures _____________________________________________________ 24 2.2.2.1.1 Fast-food Index _____________________________________________________ 24 2.2.2.1.2 Fast-food Count _____________________________________________________ 25 2.2.2.1.3 Fast-food Availability ________________________________________________ 25 2.2.2.1.4 Fast-food Proximity __________________________________________________ 27 2.2.2.1.5 Fast-food Density ____________________________________________________ 27 2.2.3 Discussion ________________________________________________________________ 28 2.2.3.1 Cross Sectional Design __________________________________________________ 28 2.2.3.2 Longitudinal Design ____________________________________________________ 29 2.2.3.3 Ecological Design ______________________________________________________ 29 2.3 Spatial Clustering of Obesity __________________________________________ 31 2.3.1 Spatial Clustering of Obesity in Canada _________________________________________ 31 2.3.2 Spatial Clustering in the USA _________________________________________________ 32 2.4 Conclusion _________________________________________________________ 33 Chapter 3 Methods __________________________________________________ 34 3.1 Theoretical and Empirical Motivation ___________________________________ 34 3.1.1 Consumption of Fast-food and Obesity __________________________________________ 34 3.1.2 Individual-level Food Choice Model ____________________________________________ 37 3.1.2.1 Taste_________________________________________________________________ 39 3.1.2.2 Health _______________________________________________________________ 40 3.1.2.3 Cost (Monetary) _______________________________________________________ 40 3.1.3 Convenience _______________________________________________________________ 41 3.2 Data Sources ________________________________________________________ 46 3.2.1 Individual-level Data (2007-08 CCHS) __________________________________________ 46 3.2.2 Neighbourhood-level Data (2006 Canadian Census) _______________________________ 47 3.2.3 Restaurant Data ____________________________________________________________ 48 3.3 Variables ___________________________________________________________ 50 3.3.1 Outcome Variable __________________________________________________________ 50 3.3.2 Primary Exposure Measures __________________________________________________ 50 3.3.3 Secondary Exposure Measures ________________________________________________ 51 3.3.4 Confounders _______________________________________________________________ 52 vii 3.3.5 Sub Group Analysis _________________________________________________________ 66 3.4 Spatial Distribution of BMI ___________________________________________ 67 3.4.1 Spatial Clustering of BMI ____________________________________________________
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