Fast-food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta-analysis

Obes Rev. 2021 Feb;22 Suppl 1(Suppl 1):e12944. doi: 10.1111/obr.12944. Epub 2019 Sep 10.


Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.

Keywords: dietary behaviour; fast food; food environment; obesity.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Fast Foods
  • Humans
  • Overweight
  • Pediatric Obesity* / epidemiology
  • Pediatric Obesity* / etiology
  • Restaurants*