How does Urbanization Contribute to Western Fast Food Consumption and Childhood Obesity in China—The Mediating Role of Food Environment
Embargo until
2020-12-01
Date
2016-10-20
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Publisher
Johns Hopkins University
Abstract
Background: Childhood obesity prevalence in China has been rising rapidly over the past three decades, while China has been under a rapid economic transition including the urbanization process, accompanied by dramatic changes in the food environment including the widespread of Western fast food restaurants. This study aims to study the linkage between urbanization and its impact on the food environments and childhood obesity, with a particular interest in Western fast food consumption.
Methods: Longitudinal data collected during 2004- 2011 in the China Health and Nutrition Survey (CHNS) were used. CHNS is an open cohort study following households started in 1989 until recently. It covers a wide range of regions in terms of geographical locations, socio- economic status and dietary habits. This study focused on the sample of 1,878 children aged two to eighteen years, and conducted longitudinal data analyses and structural equation modeling to explore the impact of urbanization on food environments, on children’s Western fast food consumption and their weight status, as well as the role that the food environments played for the latter two.
Results: Urbanization was associated with all components of the food environment, including the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18~3.54), other indoor restaurants (OR=2.93, 95% CI: 2.28~3.76) , supermarkets (OR=2.43, 95% CI: 2.04~2.89) and open- air markets (OR=2.56, 95% CI: 1.77~3.70), food prices for apples (β=0.06, 95% CI: 0.04~0.08) and lean pork (β=0.02, 95% CI: 0.01~0.03), as well as the community norms for fast food consumption (RR=1.28, 95% CI: 1.22~1.33), fast food preferences (RR=1.09, 95% CI: 1.06~1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01~1.03). It was also associated with Western fast food consumption in the past three months among both boys (OR=1.98, 95% CI: 1.68~2.35) and girls (OR=1.88, 95% CI: 1.60~2.22), while the socio- cultural environment and food prices mediated such association. Urbanization was also found to be positively related to the odds of being overweight or obese among boys (OR=1.38, 95% CI: 1.13~1.67) but not girls, and the density of fast food outlets, food prices for apples or flour, and community norms for nutrition knowledge mediated such relationship.
Conclusions: Urbanization contributed to shifts in various types and dimensions of the food environments, and increased Western fast food consumption and obesity rates among children in China over the past decade. Chinese children tended to favor Western fast food, which might partially result in increased obesity rate. Public health professionals and policy makers need to pay attention to and address the side effects of urbanization and the spread of fast food restaurants to fight the growing childhood obesity epidemic.
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Keywords
children, obesity, urbanization, food environment, china