Association Between Food Outlet Density and Overweight/Obesity Among Adults in Delhi, India Open Access

Patel, Opal (2016)

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Background/Objectives: The food environment has been implicated as an underlying contributor to the global obesity epidemic. However, few studies have evaluated the relationship between the food environment and overweight/obesity in low- and middle-income countries (LMICs). The aim of this study was to assess the association of food outlet density with overweight/obesity in Delhi, India.

Subjects/Methods: Data are from a cross-sectional, population-based study conducted in Delhi (2010-11). Participants were randomly sampled from 134 census enumeration blocks (CEBs) (n=5,364). GIS data were available for 131 CEBs (n=5,264). The number of food outlets (full service and fast food restaurants) within a 1-km buffer of CEBs was recorded by trained staff, and participants were assigned to tertiles of food outlet density based on their resident CEB. Height and weight were measured using standardized procedures and overweight/obesity was defined as a BMI ≥25 kg/m2.

Results: The most common food outlets were Indian savory restaurants (57%), Indian sweet shops (25%), and pizza shops (7.7%). Only 5.0% of outlets were Western franchises (e.g., KFC, McDonald's, and Subway). In unadjusted logistic regression models, participants in the highest versus lowest tertile of food outlet density were significantly more likely to be overweight/obese: OR (95% CI), 1.44 (1.24, 1.67). After adjustment for age, household income, and education, the effect was attenuated: 1.08 (0.92, 1.26). Results were consistent with further adjustment for tobacco and alcohol use, moderate physical activity, and owning a bicycle, motorized bike, or car.

Conclusions: Most food outlets were Indian, suggesting that the nutrition transition in this megacity may be better characterized by increases in unhealthy Indian food rather than Western food. Increased food outlet density in the residence area of adults in Delhi, India, is positively associated with overweight/obesity. This association was largely explained by socioeconomic status. Further research is needed that explores these associations in other LMICs.

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