INSIGHTS ALONG THE PATH TO SUSTAINABILITY| November 30, 2005

The Built Environment and Food Choice: Understanding Adolescent Overweight in the CLUE II Cohort

MIA A. PAPAS, MS, Doctoral Candidate, Department of Epidemiology, JHSPH (Presenter)
KATHY J. HELZLSOUER, MD, MHS, Professor, Department of Epidemiology, JHSPH

SUMMARY

Introduction 

Obesity is an important public health problem with serious long-term consequences.  The intake of energy dense foods, such as those consumed at fast food restaurants, contributes to obesity.  Increased consumption of fast food has been one of the most dramatic changes in the American diet over the past decades.  Fast food is particularly popular among adolescents, with one-third of U.S. adolescents consuming fast food on any given day.  This study investigates the impact fast food use has on dietary quality and risk of chronic disease among adolescents.
  
Methods 

Study participants were 812 adolescents from the CLUE II prospective cohort established in Washington County, Maryland in 1989.  Based on responses to a food frequency questionnaire, adolescents were categorized as consuming fast food less than once per week, one to two times per week, or greater than two times per week.  The association between fast food, dietary quality and risk of overweight, high cholesterol, and high blood pressure was investigated.  The tracking of fast food use from adolescence into adulthood and the longitudinal association between fast food use and health status was explored.

Results 

The majority of adolescents (75%) ate at fast food restaurants at least once per week.  Increased frequency of fast food restaurant use was associated with greater energy intakes and increased consumption of fried foods, sweets and snacks, and non-diet soda, and fewer vegetables, protein, fiber, and calcium (p < 0.05).  High intakes of meats, fried foods, dietary fat, saturated fat, and fast food increased the risk of having at least one chronic disease risk factor.  High intakes of cereals, fruits, and carbohydrates were protective against having at least one chronic disease risk factor.  In adulthood, over half the participants (60%) continued to eat at fast food restaurants at least once per week.  Eating out tracked from adolescence into adulthood.

Conclusions 

Regular fast food consumption was strongly associated with poor dietary habits and risk of early markers of chronic disease among adolescents.  Fast food restaurant use tracked from adolescence into adulthood, indicating the early establishment of life-long eating habits.
 
Implications for Sustainability
 
Achieving a livable future is accomplished through equitable and sustainable use of resources, improving health for everyone and leaving a world fit for future generations.  The current “obesogenic” environment in the United States promotes the over-consumption of energy and discourages physical activity, threatening our ability to achieve a livable future.  Focusing on the context within which dietary choices are made will be fundamental for halting the obesity epidemic.  Future research within this cohort will focus on the access and availability of fast food restaurants near residences and schools.  Understanding the relative contribution that the local food environment makes in influencing dietary consumption patterns and obesity can lead to successful community-based prevention efforts.

PRESENTER BIOGAPHY

Mia Papas is a doctoral candidate in the Epidemiology Department and a research associate in the Department of Pediatrics at the University of Maryland, Baltimore.  Her research interests include cancer prevention, obesity, nutrition, and child development.  Her work has included investigations of growth rates and obesity among children who experienced early growth deficiency, dietary quality of inner-city adolescent mothers, and the role of fiber in colorectal cancer carcinogenesis.  Additionally, Mia has taught courses in statistical and epidemiologic methods to students at the University of Massachusetts, professionals at the New England Epidemiology Institute, and fellows in the Johns Hopkins-Fogarty African Bioethics Training Program.  Mia received a Bachelor of Science degree in Mathematics from Fairfield University in Fairfield, CT and a Master of Science degree in Epidemiology from the University of Massachusetts in Amherst, MA.