The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?
Open accessAbstract
Background Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear.Objective Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake.Design This cross-sectional analysis studied 4466 US children aged 2-18 y from NHANES 2007-2010. Cluster analysis identified 2 dietary patterns for the non-fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes.Results Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (β: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption.Conclusions Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses.
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A recent analysis of NHANES 2007-2010 showed that half of US children, ages 2-18 years, consumed fast-food and 10.5% were high consumers, with more than 30% of their daily calories coming from fast-food restaurants.
“A recent analysis of NHANES 2007–2010 showed that half of US children, ages 2–18 years, consumed fast-food and 10.5 % were high consumers, with more than 30 % of their daily calories coming from fast-food restaurants [5].”
From Comparison of the nutrient content of children’s menu items at US restaurant chains, 2010–2014 (2015) · cites this paper as [5]
The overall proportion of highly processed food in diets has grown.
“and the overall proportion of highly processed food in diets has grown (50,51).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [51]
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Self-citationCarlos, J., Ng, S. W., Bonilla, R., Tovar, J., & Popkin, B. M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0189026 · Cited by 46 · see citing works
Self-citationDiet Quality and Eating Practices among Hispanic/Latino Men and Women: NHANES 2011–2016
Overcash, F. M., & Reicks, M. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18031302 · Cited by 44 · see citing works
“Intake of meals prepared outside the home and convenience foods or ‘ready-meals’ is prevalent among Hispanic/Latino adults and has been associated with poorer diet quality and health outcomes [36,37].”
BackgroundStern, D., Poti, J. M., Ng, S. W., Robinson, W. R., Gordon‐Larsen, P., & Popkin, B. M. (2016) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.121806 · Cited by 44 · see citing works
“Iterations that produced the largest R(2) values indicated the best fit for the data and maximized the interclusterto-intracluster variability ratio (32, 33).”
BackgroundSelf-citationRacial and Ethnic Disparities in Dietary Intake among California Children
Guerrero, A. D., & Chung, P. J. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2015.08.019 · Cited by 42 · see citing works
Selected nutritional habits of teenagers associated with overweight and obesity
Zalewska, M., & Maciorkowska, E. (2017) · PeerJ · doi:10.7717/peerj.3681 · Cited by 42 · see citing works
Emond, J. A., Longacre, M. R., Drake, K. M., Titus, L. J., Hendricks, K. M., MacKenzie, T. A., Harris, J. L., Carroll, J. E., Cleveland, L. P., Gaynor, K., et al. (2019) · Appetite · doi:10.1016/j.appet.2019.05.012 · Cited by 41 · see citing works
Lim, S. K., Lim, H., & Després, J. (2020) · Obesity · doi:10.1002/oby.22935 · Cited by 39 · see citing works
“The increased consumption of fast food has been shown to be associated with increase in energy density (5), excessive portion sizes, high glycemic load (6), and low intakes of vegetables, fruits, and milk (7).”
BackgroundBlack, J., & Billette, J. (2015) · Canadian Journal of Public Health · doi:10.17269/cjph.106.4658 · Cited by 38 · see citing works
Ultra-processed food targets bone quality via endochondral ossification
Zaretsky, J., Griess-Fishheimer, S., Carmi, A., Shmul, T. T., Ofer, L., Sinai, T., Penn, S., Shahar, R., & Ornan, E. M. (2021) · Bone Research · doi:10.1038/s41413-020-00127-9 · Cited by 36 · see citing works
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Bleiweiss-Sande, R., Sacheck, J. M., Chui, K. K. H., Goldberg, J. P., Bailey, C. P., & Evans, E. W. (2020) · Appetite · doi:10.1016/j.appet.2020.104696 · Cited by 33 · see citing works
Diet-Related Behaviors and Diet Quality among School-Aged Adolescents Living in Greece
Benetou, V., Kanellopoulou, A., Kanavou, E., Fotiou, A., Stavrou, M., Richardson, C., Orfanos, P., & Kokkevi, A. (2020) · Nutrients · doi:10.3390/nu12123804 · Cited by 32 · see citing works
Man, C. S., Lim, K. H., Ying, C. Y., Kee, C. C., Kuay, L. K., Huey, T. C., Baharudin, A., & Aziz, N. S. A. (2021) · Journal of Health Population and Nutrition · doi:10.1186/s41043-021-00254-x · Cited by 32 · see citing works
“For example, products such as sugary beverages and chips from retail food stores contain similar levels of fat and sugar as in fast food [29].”
BackgroundResultTambalis, K. D., Panagiotakos, D. B., Psarra, G., & Sidossis, L. S. (2018) · Public Health Nutrition · doi:10.1017/s1368980018002707 · Cited by 32 · see citing works
“speculated that among US schoolchildren fast-food consumers had higher intakes of sugar-sweetened beverages and fried potatoes and lower intakes of vegetables, fruits and low-fat mixed dishes than non-consumers((7)).”
BackgroundResultInfluentialFood Away from Home and Childhood Obesity
Mancino, L., Todd, J. E., Guthrie, J., & Lin, B. (2014) · Current Obesity Reports · doi:10.1007/s13679-014-0121-z · Cited by 34 · see citing works
Health and Economic Impacts of Overweight/Obesity
Schneider, P., Popkin, B. M., Shekar, M., Eberwein, J. D., Block, C. F., & Okamura, K. S. (2020) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-1491-4_ch3 · Cited by 31 · see citing works
Self-citationNg, S. W., Poti, J. M., & Popkin, B. M. (2016) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.127944 · Cited by 30 · see citing works
“However, other studies have described racial/ethnic or income disparities in consumption of food away from home (FAFH)(3) (4, 5).”
BackgroundSelf-citationA research agenda to guide progress on childhood obesity prevention in Latin America
Kline, L., Jones‐Smith, J. C., Miranda, J. J., Pratt, M., Reis, R. S., Rivera, J. Á., Sallis, J. F., & Popkin, B. M. (2017) · Obesity Reviews · doi:10.1111/obr.12572 · Cited by 46 · see citing works
Self-citationKalka, E., Pastuszak, A., & Buśko, K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0220514 · Cited by 29 · see citing works
Measuring the nutrition transition and its dynamics
Popkin, B. M. (2020) · Public Health Nutrition · doi:10.1017/s136898002000470x · Cited by 28 · see citing works
Self-citationPerceptions of Processed Foods Among Low-Income and Immigrant Parents
Bleiweiss-Sande, R., Goldberg, J. P., Evans, E. W., Chui, K. K. H., & Sacheck, J. M. (2019) · Health Education & Behavior · doi:10.1177/1090198119885419 · Cited by 27 · see citing works
The Obesity Crisis as Market Failure: An Analysis of Systemic Causes and Corrective Mechanisms
Karnani, A., McFerran, B., & Mukhopadhyay, A. (2016) · Journal of the Association for Consumer Research · doi:10.1086/686244 · Cited by 27 · see citing works
“As food habits are significantly shaped during childhood by one’s family (Poti et al. 2014), it is highly likely that food consumption patterns and habits formed in childhood persist to some degree as children become adults (Gibson et al. 2012).”
BackgroundAssociation of serum vitamin D concentrations with dietary patterns in children and adolescents
Ganji, V., Martineau, B., & FLEIT, W. E. V. (2018) · Nutrition Journal · doi:10.1186/s12937-018-0365-7 · Cited by 27 · see citing works
“Studies relating vitamin D intake with the vitamin D status have shown conflicting results [13, 15, 27].”
Association of feeding behavior with jaw bone metabolism and tongue pressure
Fujita, Y., & Maki, K. (2018) · Japanese Dental Science Review · doi:10.1016/j.jdsr.2018.05.001 · Cited by 26 · see citing works
Büyüktuncer, Z., Akyol, A., Ayaz, A., Nergiz‐Unal, R., Canyolu, B. A., Coşgun, E., Özdemir, P., Pekcan, A. G., & Besler, H. T. (2019) · Journal of Health Population and Nutrition · doi:10.1186/s41043-019-0202-4 · Cited by 26 · see citing works
Fast food intake and excess weight gain over a 1‐year period among preschool‐age children
Emond, J. A., Longacre, M. R., Titus, L. J., Hendricks, K. M., Drake, K. M., Carroll, J. E., Cleveland, L. P., & Dalton, M. A. (2020) · Pediatric Obesity · doi:10.1111/ijpo.12602 · Cited by 27 · see citing works
Chi, D. L., Dinh, M. A., da Fonseca, M. A., Scott, J. M., & Carle, A. C. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2015.02.011 · Cited by 26 · see citing works
“However, recent work has questioned this approach based on the influence the remainder of the child’s diet can have on health outcomes.(43) Similarly, in regard to oral health, any potential adverse effects associated with fast foods are likely to be modified by factors such as exposure to topical fluorides and access…”
BackgroundComparison of the nutrient content of children’s menu items at US restaurant chains, 2010–2014
Deierlein, A. L., Peat, K., & Claudio, L. (2015) · Nutrition Journal · doi:10.1186/s12937-015-0066-4 · Cited by 25 · see citing works
“5 % were high consumers, with more than 30 % of their daily calories coming from fast-food restaurants [5].”
BackgroundHidaka, B. H., Thodosoff, J. M., Kerling, E. H., Hull, H. R., Colombo, J. A., & Carlson, S. E. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqx007 · Cited by 25 · see citing works
“When compared to reference data from the United Kingdom in 1985, children from all 3 studies, representing the United States, the United Kingdom, and Germany, have a mean body fat percent close to the 98th percentile of the historical group (20).”
BackgroundInfluentialKant, A. K., & Graubard, B. I. (2018) · PLoS ONE · doi:10.1371/journal.pone.0191584 · Cited by 25 · see citing works
Perez, P. A., & DiPatrizio, N. V. (2018) · PLoS ONE · doi:10.1371/journal.pone.0205021 · Cited by 25 · see citing works
“DIO is associated with a host of metabolic abnormalities that include type-2 diabetes [5, 6].”
BackgroundKostecka, M. (2014) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.306.5792 · Cited by 24 · see citing works
The Fast-Casual Conundrum: Fast-Casual Restaurant Entrées Are Higher in Calories than Fast Food
Jake‐Schoffman, D. E., Davidson, C. R., Hales, S. B., Crimarco, A. E., Dahl, A. A., & Turner‐McGrievy, G. M. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.03.020 · Cited by 23 · see citing works
Taillie, L. S., Afeiche, M. C., Eldridge, A. L., & Popkin, B. M. (2016) · Public Health Nutrition · doi:10.1017/s1368980016002196 · Cited by 23 · see citing works
“It will also be important to consider selection issues associated with away-from-home eating, as previous work has found that children who eat more away-from-home foods also eat less healthy diets at home((36)).”
BackgroundSelf-citationSylvetsky, A. C., Visek, A. J., Turvey, C., Halberg, S. E., Weisenberg, J. R., Lora, K. R., & Sacheck, J. M. (2020) · Nutrients · doi:10.3390/nu12040885 · Cited by 23 · see citing works
“Higher SSB intake among adolescents who attend school near a fast-food outlet has been reported previously [31], and elevated CSSB consumption when eating out, particularly at fast-food venues, is well documented [32,33].”
BackgroundShinozaki, N., Murakami, K., Asakura, K., Masayasu, S., & Sasaki, S. (2020) · Nutrients · doi:10.3390/nu13010067 · Cited by 21 · see citing works
“the number of clusters [40], cubic clustering criterion [39,41], the sample size (cluster solutions were retained only if each cluster contained 5% of the total sample in each meal type) [42], and the interpretation of each cluster [41,43].”
BackgroundWolters, M., Joslowski, G., Plachta‐Danielzik, S., Standl, M., Müller, M. J., Ahrens, W., & Buyken, A. E. (2018) · Nutrients · doi:10.3390/nu10101442 · Cited by 20 · see citing works
“In addition, the preferred consumption of fast foods itself has repeatedly been related to an unfavorable body composition among children and adolescents [43–46] even though it is possible that associations with measures of obesity risk may partly reflect relations to the associated behaviors rather than the preferred…”
BackgroundEck, K., Delaney, C., Leary, M. P., Famodu, O. A., Olfert, M. D., Shelnutt, K. P., & Byrd‐Bredbenner, C. (2018) · Nutrients · doi:10.3390/nu10081040 · Cited by 19 · see citing works
“School-age children rely on their parents to make some of their food-related decisions, but kids also consume about a one-third of their meals away from home [12] with this proportion increasing into the teen years [26,27].”
BackgroundFujita, Y., Goto, S., Ichikawa, M., Hamaguchi, A., & Maki, K. (2016) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2016.08.036 · Cited by 18 · see citing works
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Patetta, M. A., Pedraza, L. S., & Popkin, B. M. (2019) · Nutrition Journal · doi:10.1186/s12937-019-0460-4 · Cited by 17 · see citing works
Self-citationKim, D.-Y., Ahn, A.-L., Lee, H., Choi, J., & Lim, H. (2019) · Nutrients · doi:10.3390/nu11112740 · Cited by 16 · see citing works
“preferences, and poor eating behaviors [16], including dietary patterns, rather than fast food consumption itself 31 [10,14].”
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“This impact encompasses several repercussions, including the potential for weight gain and obesity due to the habitual intake of calorie-dense yet nutrient-deficient junk food [28,29].”
BackgroundFood supply chains and child and adolescent diets: A review
Nordhagen, S. (2020) · Global Food Security · doi:10.1016/j.gfs.2020.100443 · Cited by 15 · see citing works
Güven, Y., & Öncü, E. (2022) · Nutrition Research · doi:10.1016/j.nutres.2022.03.004 · Cited by 13 · see citing works
Trends in Calories and Nutrients of Beverages in U.S. Chain Restaurants, 2012–2017
Frelier, J. M., Moran, A. J., Vercammen, K. A., Jarlenski, M., & Bleich, S. N. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2019.03.023 · Cited by 13 · see citing works
Pan, K. (2019) · PubMed · doi:10.17615/m0je-wb81 · Cited by 13 · see citing works
Differences in the sugar content of fast-food products across three countries
Lewis, N., Huang, Q., Merkel, P., Rhee, D. K., & Sylvetsky, A. C. (2020) · Public Health Nutrition · doi:10.1017/s136898002000110x · Cited by 12 · see citing works
Nudging low-medium income mothers towards healthy child options in an online restaurant scenario
Caso, G., & Vecchio, R. (2022) · Appetite · doi:10.1016/j.appet.2022.106360 · Cited by 11 · see citing works
Geographic Clustering of Fast-Food Restaurants Around Secondary Schools in Hong Kong
Cheung, J. T. H., Tang, K. C., & Koh, K. P. (2021) · Preventing Chronic Disease · doi:10.5888/pcd18.200601 · Cited by 11 · see citing works
“The World Health Organization warned that excessive consumption of a high-fat diet is associated with childhood obesity (7).”
Childhood Obesity: Epidemiology, Determinants, and Prevention
Mohamed, S. M. (2015) · Journal of Nutritional Disorders & Therapy · doi:10.4172/2161-0509.1000156 · Cited by 11 · see citing works
“Further, fast food consumption is also associated with higher intake of sugarsweetened beverages and French fries and lower intake of milk, fruit, and vegetables [22,23].”
BackgroundCarroll, J. E., Sturgeon, S. R., Bertone‐Johnson, E. R., VanKim, N. A., Longacre, M. R., Dalton, M. A., & Emond, J. A. (2024) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2023.12.008 · Cited by 10 · see citing works
Carroll, J. E., Price, G. D., Longacre, M. R., Hendricks, K. M., Langeloh, G., Beach, P., Dalton, M. A., & Emond, J. A. (2021) · Appetite · doi:10.1016/j.appet.2021.105465 · Cited by 10 · see citing works
Chemicals, cans and factories: how grade school children think about processed foods
Bleiweiss-Sande, R., Goldberg, J. P., Evans, E. W., Chui, K. K. H., Bailey, C. P., & Sacheck, J. M. (2020) · Public Health Nutrition · doi:10.1017/s1368980019003859 · Cited by 10 · see citing works
Does excessive fast-food consumption impair our health?
Popkin, B. M. (2022) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqac110 · Cited by 10 · see citing works
Self-citationAssociation between food intake patterns and serum vitamin D concentrations in US adults
Ganji, V., Shi, Z., Al-Abdi, T., Hejap, D. A., Attia, Y., Koukach, D., & Elkassas, H. (2022) · British Journal Of Nutrition · doi:10.1017/s0007114522001702 · Cited by 9 · see citing works
“For example, using the NHANES data, Poti et al. (42) derived Western and Prudent food patterns.”
Strategies elementary school children use to influence mothers' food purchasing decisions
Monalisa, N., Frongillo, E., Blake, C., Steck, S., & Dipietro, R. B. (2023) · Maternal and Child Nutrition · doi:10.1111/mcn.13539 · Cited by 6 · see citing works
Choi, Y., & Yoon, H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17062060 · Cited by 9 · see citing works
“Studies have revealed that manufactured food had poorer nutritional quality and more calories, which can result in increasing body mass and higher level of health problems [72].”
BackgroundOdo, F. A., & Ezeanyika, U. S. L. (2015) · Cited by 9 · see citing works
Lacko, A. M., Popkin, B. M., & Taillie, L. S. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.06.006 · Cited by 9 · see citing works
Self-citationYoon, S. R., Fogleman, S., Kim, H.-Y., Lee, K., & Kim, O. Y. (2020) · Clinical Nutrition Research · doi:10.7762/cnr.2020.9.2.107 · Cited by 9 · see citing works
“[39] demonstrated that FF consumers had unhealthier dietary patterns outside the FF restaurant based on the data from the NHANES 2007–2010.”
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Popkin, B. M. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.08.018 · Cited by 9 · see citing works
Self-citationPhysical Activity and Smartphone Use in University Students
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Development of a Menu Board Literacy and Self-efficacy Scale for Children
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In Defense of Food Curriculum: A Mixed Methods Outcome Evaluation in Afterschool
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Alimentação fora de casa e biomarcadores de doenças crônicas em adolescentes brasileiros
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Contributing Factors to Childhood Overweight and Obesity in Kuwait
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“is associated with a lower overall diet quality in American children aged 2–18 years old; children characterized as high consumers of fast food presented a higher intake of sugar-sweetened beverages and French fries, and a lower consumption of fruits and vegetables when compared with children characterized as low cons…”
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Childhood Obesity: Solutions to Address a Growing Health Concern
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“• Limit or discontinue high calorie, high fat, high sugar, and low fiber food, snacks and meals [24].”
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“2015;32(4):1582-1590 ISSN 0212-1611 • CODEN NUHOEQ S.”
Influential
- Authors
- Poti, J. M., Duffey, K. J., & Popkin, B. M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- 162-171
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC3862453
- OpenAlex
- W2131271354
- Cited by
- 175
- References
- 67
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 7 · 2022: 12 · 2021: 11 · 2020: 31 · 2019: 21 · 2018: 13 · 2017: 20 · 2016: 14 · 2015: 13 · 2014: 11 · 2012: 1
- FWCI
- 12.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2r24hd050924-06)
- National Heart, Lung, and Blood Institute (R01HL104580)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007686)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924, 5R24 HD050924)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- fast food consumption, childhood obesity, overweight, dietary habits, Western diet, prudent diet, dietary intake, children, NHANES
- MeSH terms
- Adolescent, Energy Intake, Child, Child, Preschool, Cross-Sectional Studies, Diet, Feeding Behavior, Humans, Nutrition Surveys, Obesity, Regression Analysis, Restaurants, Socioeconomic Factors, Nutrition Assessment, Body Mass Index, Prevalence, Multivariate Analysis, Cluster Analysis, Fast Foods
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