The Impact of Fast-Food Density on Obesity during the COVID-19 Lockdown in the UK: A Multi-Timepoint Study on British Cohort Data

ABSTRACT

Poor food environments are considered to trigger obesity and related health complications by restricting the local food options to predominantly low quality, energy-dense foods. This study investigated the impact of the food environment on obesity with a focus on any changes that might have occurred around the COVID lockdown period in the UK when majority of the population relied on food delivery and the local food environments. The proportion of fast-food retailers in the area and the Retail Food Environment Index (RFEI) were calculated for participants of the 1970 British Cohort Study (BCS70) at three timepoints pre-COVID (2016), the first UK nation-wide lockdown (April–May 2020) and post lockdown (September–October 2020). The association of the food environment and the odds of obesity was estimated through multivariable logistic regression, with adjustments being made for selected socioeconomic variables. A model using the fast-food proportion as the sole predictor estimated that higher fast-food proportion increased the odds of obesity by 2.41 in 2016, 2.89 during the lockdown and 1.34 post lockdown, compared with 1.87, 2.23, and 0.73, respectively, for the same three periods with adjustments being made for select socioeconomic variables. On the other hand, RFEI increased the odds of obesity only slightly at 1.01, 1.02 and 1.03, respectively, with the model with adjustments yielding respective similar values. The fast-food proportion model indicates that proximity to a poor food environment is linked to obesity, especially during the COVID lockdown period, but the impact of a poor-food environment is limited if the RFEI is used as its indicator. The findings will add much needed insights on the UK data and will inform public health planning and policy.