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Poor neighbourhoods have more takeaway outlets. /

Local takeaways create a double burden for obesity

People in the UK are spending more than ever on takeaway food and there’s good reason to believe that this is contributing to the nation’s obesity problem. Two-thirds of UK adults are either overweight or obese.

But the amount of excess weight the nation is carrying isn’t equal. On average, people in socially disadvantaged groups – those less educated or on lower incomes – are more likely to be overweight. This can be explained by the fact that the socially disadvantaged tend to have less time for cooking, less knowledge about healthy eating and less money for healthy food. Levels of takeaway food consumption are also greater in disadvantaged groups.

Disadvantage can also be environmental. We know that disadvantaged neighbourhoods tend to have greater numbers of takeaway outlets. Although all UK neighbourhoods have become less healthy in the last two decades, disadvantaged neighbourhoods have become unhealthier fastest. It would seem to make sense then that unequal neighbourhoods could be contributing to unequal waistlines.

“But I never use my local takeaway”

This, of course, assumes that neighbourhood food access influences what people eat and how much they weigh. A growing body of evidence suggests that it does. In an analysis, using data on nearly 6,000 people from the Fenland Study in Cambridgeshire, we showed that the greatest neighbourhood exposure to takeaway food was linked to consuming the equivalent of an additional serving of French fries per week and nearly doubling one’s odds of obesity.

We might like to believe that we make entirely free choices about what, when and where to eat. And we often hear from people that they never use their local takeaway outlets. But given that we need to buy our food from somewhere, we’re all influenced to some degree by what’s on offer within our environment. For people living or working in areas full of takeaways but short on healthier options, unhealthy choices are likely to be the easiest or only option. Among our Cambridgeshire adults, as many as 47 takeaway outlets were present within just a mile of one person’s home. And growth in the takeaway sector over two decades outpaced that of supermarkets, convenience stores and restaurants, so our environment has become more imbalanced towards greater availability of takeaway food.

Understanding levels of influence

Our new study explores the interplay between social disadvantage and access to neighbourhood takeaway outlets. We used low educational attainment as a marker of social disadvantage – so it’s also an indication of lacking the social, economic, behavioural and psychological resources that might leave people more vulnerable to their environment. For example, less well off consumers are particularly price sensitive, and may be disproportionately affected by the lure of takeaways serving large portions at low prices.

Cheap, calorific and ubiquitous.

This picture of the effects of a disadvantageous unhealthy neighbourhood being compounded by social disadvantage came through clearly in our analysis. People with the greatest exposure to takeaway outlets consumed a third more unhealthy takeaway food per day if they were the least educated than if they were highest educated. These differences would add up over a year to an additional consumption of over 4kg of unhealthy food. By comparison, people with least exposure to takeaway outlets consumed only a fifth more takeaway food if they were least educated.

In the paper, we also compared the odds of being obese for those facing this double burden of individual and neighbourhood disadvantage. We found that those least educated and most exposed to takeaways were three times more likely to be obese than the most educated and least exposed.

So while neighbourhood takeaway food access is important in shaping everyone’s diet and weight, the effects seem to be greater for those with less education. This means that where takeaways are most abundant, inequalities in diet and obesity are likely to be amplified.

What’s the takeaway message?

The good news is that this situation can be addressed. Fixing the food environment alone isn’t going to cure the obesity crisis, but healthier food choices can be better supported by modifying and shaping the geography of food access across our neighbourhoods.

Our results suggest that if we reduce takeaway access in particular, this will not only benefit all social groups, but will also minimise differences in consumption between social groups. Changing neighbourhoods may seem like a radical step, and there may be challenges, but such efforts are currently underway and are endorsed by NICE, Public Health England, the Greater London Authority and the Academy of Medical Royal Colleges.

Traditional individually-focused efforts, such as improving nutrition knowledge and cooking skills, may also be important but their success will be limited if we continue to live in neighbourhoods that make unhealthy choices the easy and cheap option. The effects of takeaway food outlet access on diet and weight and the implications of this access for social inequalities are now being realised by researchers and public health bodies and constitute a potentially important point of intervention for improving the health of all of us.

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