1 University of Illinois, Chicago, Chicago, United States of America; 2 Instituto de Nutrição, Universidade do Estado do Rio de Janeiro,Rio de Janeiro, Brazil; 3 Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Sao Paulo, Brazil
Background/objective: In Brazil, half of the adult population is overweight. Little evidence is available for Latin American contexts on whether exposure to fast food (FF) restaurants affects diet or obesity. The aim of the study is to examine the associations between the availability and distance to FF restaurants and FF visits, food consumption, and overweight rates in Brazil. Methods: Cross-sectional study conducted in 2011 recruited 1842 adults in Sao Paulo, Brazil. Dependent variables were overweight rates (body mass index – BMI ≥ 25.0 kg/m2), frequent fast food visits, and sugarsweetened beverage (SSB) and fruit and vegetable (FV) consumption. Poisson generalized estimating equations with robust variance were used to model the associations of distance to the nearest FF and FF density (including national and international chains and locally owned stores) and outcome variables. Models were adjusted for individual-level characteristics (age, gender, education, income) and median neighborhood income. Results: Half of the participants were overweight. We found a positive trend in the association of FF density and visits. Eating at FF was 1.5 times more likely to happen among participants who lived in neighborhoods with higher FF density. FV consumption was lower among those living closer to FF. SSB consumption was higher among participants living in higher FF density areas. Overweight prevalence was 17% higher in the 4th quartile of FF density, when compared with the 1st quartile of FF density after adjustment of individual- and neighborhood-level covariates. Associations between FF density and overweight prevalence only remained for men in sex-stratified models. Conclusions: Living near fast food restaurants was associated with FV and SSB consumption, fast food visits, and overweight rates in Sao Paulo. Understanding the effects of the FF presence in Brazil can contribute to a broader understanding of increasing rates of obesity in the country and to more effective local policy-making.