The Centre for Diet and Activity Research (CEDAR) is focussed on:

1. Associations between neighbourhood takeaway food outlet exposure, takeaway food consumption and body weight Thomas Burgoine IPH Away Day 25th April 2014, University Arms Hotel

2. About CEDAR • The Centre for Diet and Activity Research (CEDAR) is focussed on: • studying the determinants of dietary and PA behaviours • developing and evaluating public health interventions • helping shape public health practice and policy. • The Centre is one of five Centres of Excellence in Public health Research funded through the UKCRC. • Find out more: http://www.cedar.iph.cam.ac.uk/

3. Introduction • UK obesity levels have reached ‘epidemic’ proportions • 29% increase in expenditure on foods consumed out of the home in the last 10 years • Meals consumed outside of the home are less healthy: more energy dense, more saturated fat, more salt; bigger portions • Takeaway consumption associated with weight gain over time • Neighbourhood access to takeaway food outlets may play an important role in determining diet and health Sources: Food – an analysis of the issues, 2008 Food matters – towards a strategy for the 21st century, 2008 Centre for Diet and Activity Research

4. Takeaways, Increased policy recognition “though a clear relationship between fast food restaurants and obesity rates is less [well] demonstrated”

5. Evidence? Food Environment effect on diet/weight No or unexpected food environment effect on diet/weight Morlandand Evenson 2009 Maddock et al 2004 Mobley et al 2006 Burdette and Whitaker 2004 Currie et al 2009 Chou et al 2004 Boone-Heinonenet al 2011 Jeffery et al 2006 Crawford et al 2008 Simmons et al 2005 Powell et al 2007 Davis and Carpenter 2009 Mehta and Chang 2008 Spence et al 2009 Sturm and Datar 2005 Rundle et al 2009 Edmonds et al 2001 Boone-Heinonenet al 2011 Bodoret al 2007 Morland et al 2002 Zenk et al 2005 Laraia et al 2004 Burgoine et al 2011 Cummins et al 2005 Burgoine et al 2009 Rose and Richards 2004 Wrigley et al 2003 Moore et al 2008 BMI outcome Diet outcome Centre for Diet and Activity Research

6. Centre for Diet and Activity Research

7. Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: population based, cross sectional study Burgoine, T., Forouhi, N.G., Griffin, S.J., Wareham, N. and Monsivais, P. (2014) BMJ 348 (7950) Institute of Public Health

9. The Fenland Study sample 5442adults Aged29-62 Weight (measured BMI) Diet (takeaway food consumption) Centre for Diet and Activity Research

10. Study design HOME WORK • Participants exposed to: • 32 takeaway outlets on average • up to as many as 165 outlets • majority of outlets at work. JOURNEY Centre for Diet and Activity Research

11. Takeaway Exposure - Consumption 5.7g 3.0g (least exposed) (most exposed) ** p<0.001; * p<0.05. a Q1, least exposed – Q4, most exposed. β co-efficients represent change in takeaway type food consumption (g) per quartile of takeaway food outlet exposure. All models control for age, sex, education (individual-level socio-economic status), daily energy intake (kcal), car ownership and supermarket availability. Commuting and combined models also adjust for journey length. Error bars represent 95% confidence intervals.

12. 40g/week Centre for Diet and Activity Research

13. Takeaway Exposure – Body Mass Index 1.21kg/m2 (least exposed) (most exposed) ** p<0.001; * p<0.05. a Q1, least exposed – Q4, most exposed. β co-efficients represent estimated BMI (kg/m2) per quartile of takeaway food outlet exposure. All models control for age, sex, education (individual-level socio-economic status), smoking status, car ownership and supermarket availability. Commuting and combined models also adjust for journey length. Error bars represent 95% confidence intervals.

14. Conclusions • Neighbourhood takeaway food environments matter. • Limiting the number of takeaway food outlet encountered on a daily basis may be one way of positively influencing diets and body weight Socio-economic status (education) Takeaway food access BMI and takeaway food consumption Centre for Diet and Activity Research

15. Hypothetical models “Deprivation amplification” …with evidence of an interaction? Low SES Low SES Unhealthy food consumption Unhealthy food consumption High SES High SES Unhealthy food exposure Unhealthy food exposure Source: adapted from Ford & Dzewaltowski (2008) Nutrition Reviews 66(4)

16. Exposure by Education - Consumption Means, 95% CIs adjusted for age, sex, household income, energy intake, car access, weighted journey distance, supermarket availability. Adapted from Burgoine et al In Preparation

17. Exposure by Education – Body Mass Index Means, 95% CIs adjusted for age, sex, smoking status, household income, car access, weighted journey distance, physical activity energy expenditure, supermarket availability. Adapted from Burgoine et al In Preparation

18. Conclusions • Less educated individuals, living in ‘unhealthy’ neighbourhoods, face a particular challenge (deprivation amplification) • Neighbourhood takeaway food environments matter, across all education groups. • Results indicate that the association between takeaway exposure and takeaway consumption varies according to level of education • Environmental interventions may to some extent reduce socio-economic patterning of diet. Centre for Diet and Activity Research

19. ACKNOWLEDGEMENTS Thank you to Pablo Monsivais, Nita Forouhi, Simon Griffin, Nick Wareham, Soren Brage. This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Centre for Diet and Activity Research