A Review of the Growth of the Fast Food Industry in China and Its Potential Impact on Obesity

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childhood obesity 31517 child-directed FF television advertising [[47]]. The microsimulation determined that the ban would reduce childhood obesity by almost 1% [[47]]. While this is the lowest percentage found, they discovered that it would have the
obesity 930 wdqu@fudan.edu.cnPublication date (epub): 11/2016Publication date (ppub): 11/2016AbstractThe fast-food (FF) industry and obesity rates have rapidly increased in China. This study examined the FF industry growth in China, key factors
obesity 1123 China, key factors contributing to the growth, and the association between FF consumption (FFC) and obesity . We collected related data from multiple sources and conducted analysis including linear regression
obesity 1649 assurance of food safety, new brands and foods have stimulated demand for FF. Studies have linked FFC with obesity risk, including a few reporting a positive association between FFC and obesity in China. Rapid expansion
obesity 1728 have linked FFC with obesity risk, including a few reporting a positive association between FFC and obesity in China. Rapid expansion of Western-style FF restaurants has also stimulated local FF industry growth.
obesity 2389 to a westernized diet is a result of multiple factors, which may contribute to observed increases in obesity and chronic diseases. Over the past two decades, the fast-food (FF) industry and obesity rates have
obesity 2478 increases in obesity and chronic diseases. Over the past two decades, the fast-food (FF) industry and obesity rates have increased rapidly in China [[1],[2]]. Nationwide over one-third of Chinese adults are overweight
obesity 4604 restaurants toward FF establishments. Studies have been performed for the association between FFC and obesity . The majority were conducted in Western countries and have demonstrated a positive association [[9],[10],[11],[12],[13],[14]].
obesity 5016 many public health consequences, while some have already become alarming as indicated by increasing obesity . FFC may also increase the risk of other chronic diseases such as cardiovascular diseases and diabetes
obesity 5520 and sodium, and prefers deep frying to boiling [[26]].Given China′s large population and the rising obesity prevalence, it is crucial to examine the impact of the FF industry expansion on weight outcomes. However,
obesity 5892 restaurants in China, the factors contributing to the FF industry growth, and the association between FFC and obesity in China. Although they are different, FF access serves as a proxy for FF intake.2. Literature SearchTo
obesity 6629 and reports met our inclusion criteria and were included.To examine the association between FFC and obesity in China, we searched for studies based on the guidelines of the Preferred Reporting Items for Systematic
obesity 6946 databases with the following terms: “China”, “fast food, or fast food consumption”, “overweight, obesity , or Body Mass Index (BMI)”. Study inclusion criteria were: (1) publication in English; (2) date of
obesity 7271 adolescents, or adults; and (5) studies needed to report the association between FFC (or FF access) and obesity (or BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR)). We also manually searched the reference
obesity 7671 reference, region and year of data collection, sample size, sex and age, study design, outcomes (like obesity or/and overweight), and main results (e.g., measures on the association). Among the 39 identified titles,
obesity 16982 years, more Chinese have become aware of some undesirable respects of FF such as that FFC may increase obesity risk. This may reduce demand for FF.2.4.2. Key Supply DriversReforms in China′s Agricultural and Trade
obesity 21445 local people enjoy spicy food.2.5. Increase of Obesity Prevalence in ChinaOver the past two decades, obesity has been increasing rapidly in China. National data show that the prevalence of overweight and obesity
obesity 21548 obesity has been increasing rapidly in China. National data show that the prevalence of overweight and obesity among adults increased from 20% in 1992 to 30% in 2002 and 42% in 2012 based on the Chinese BMI standard
obesity 21877 Obesity or Related OutcomesSome studies have examined the association between FFC or access to FF and obesity (or obesity-related measures like BMI, WHtR, WHpR) in China. Seven were based on regional data and nine
obesity 21889 Related OutcomesSome studies have examined the association between FFC or access to FF and obesity (or obesity -related measures like BMI, WHtR, WHpR) in China. Seven were based on regional data and nine were cross-sectional
obesity 22144 longitudinal studies (see Table 2). Overall, the studies indicate a positive association between FFC and obesity . Our previous study of over 24,000 children aged 2–18 in Beijing found that children consuming western
obesity 22568 breakfast outside the home (often likely consuming local FF) was positively associated with overweight and obesity (OR = 1.7, 95% CI = 1.1–2.3) [[15]]. Among Hong Kong Chinese adults, eating out at least twice a week
obesity 23367 studies in China using national and longitudinal data are warranted to examine the influence of FFC on obesity risk.Food products served in FF restaurants in China, especially Western style ones, usually have high
obesity 23813 DiscussionChina′s FF industry is large and is expanding rapidly, which parallels the rapid increase in obesity , urbanization and economic development. Over two million FF facilities operated throughout China in
obesity 24986 adolescents, and being boys are more likely to consume FF.Studies examining the association between FFC and obesity are predominately conducted in Western countries and many have reported a positive association between
obesity 25138 countries and many have reported a positive association between the number of FF restaurants and FFC and obesity [[9],[10],[11],[12],[13],[14]]. A systemic review based on 16 studies conducted in Western countries
obesity 25313 studies conducted in Western countries examined the association between FFC and risks of weight gain and obesity , and revealed mixed results [[11]]: six of the seven prospective cohort studies and four of the six
obesity 26138 high-income countries [[12]]. This study suggests market deregulation policies may contribute to the obesity epidemic by facilitating the spread of FFC. Another U.K. study reported a positive association between
obesity 26257 facilitating the spread of FFC. Another U.K. study reported a positive association between FFC and obesity (OR = 1.23, 95% CI = 1.02–1.49) among 4837 children aged 13–15 [[10]]. Obesity prevalence increased
obesity 26753 showing the fast expansions of FF industry and increased FFC likely have contributed to the increase of obesity in China. Overall, increasing studies in Western countries and China have reported a positive association
obesity 26883 increasing studies in Western countries and China have reported a positive association between FFC and obesity [[7],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24]].However, longitudinal
obesity 27180 lacking in the literature. We noted that some studies in China have examined the influence of FFC on obesity . Most of them reported a positive association, but are predominately cross-sectional studies based on
obesity 28253 may result in weight gain due to overeating or reduced physical activity, which are associated with obesity , including eating occasions away from home, large portion sizes, high consumption of beverages high
obesity 31527 FF television advertising [[47]]. The microsimulation determined that the ban would reduce childhood obesity by almost 1% [[47]]. While this is the lowest percentage found, they discovered that it would have the
obesity 32679 SES neighborhoods. Enacting similar policies and laws in China could contribute to reducing FFC and obesity .More public health perspectives in terms of the prevention of non-communicable chronic diseases should
obesity 34800 become a public health concerns considering the negative health consequences of FFC, including related obesity risks. Future research needs to examine the impact of the FF industry growth and of people’s FFC on
obesity 35548 industry revenue growth in China between 2015–2030.Figure 2Increase of prevalence (%) of overweight and obesity in China among adults and children from 2002 to 2012. Based on national representative data and Chinese
obesity 35739 representative data and Chinese BMI cut points, e.g., for adults, 24 < BMI < 28 for overweight, and BMI>28 for obesity ; for children, age-sex-specific BMI cut points were used.ijerph-13-01112-t001_Table 1Table 1Key statistics
obesity 37518 study characteristics and findings regarding the association between fast food consumption (FFC) and obesity in China.ReferencesRegion; Year of Data CollectionSample Size, Sex, and AgeStudy DesignOutcome (Prevalence)Main
obesity 39276 (sex specific sample size was not provided); 13 years or olderCross-sectional studyBMI, overweight, obesity Proximity to FF was positively associated with higher BMI. Adolescents who lived in the more developed
obesity 39598 collected in 2006.9788 adults (4659 men, and 5129 women); 18 years or olderCross-sectional studyOverweight/ obesity The relationship between FFC and overweight/obesity was irrelevant for Chinese segments that did not
obesity 39649 18 years or olderCross-sectional studyOverweight/obesityThe relationship between FFC and overweight/ obesity was irrelevant for Chinese segments that did not have access to FF. Factors that were most associated
obesity 40082 school children and adolescents (1559 boys and 1581 girls); 7–18 yearsCross-sectional studyOverweight/ obesity Having lunch in FF restaurant (versus home) was positively associated with overweight (OR = 2.03, 95%
obesity 40419 2011–2002.2283 school children (1189 boys and 1094 girls); 6–13 yearsCross-sectional studyGeneral obesity (based on BMI) and abdominal obesity (based on waist circumference)A high FF stores density was associated
obesity 40456 boys and 1094 girls); 6–13 yearsCross-sectional studyGeneral obesity (based on BMI) and abdominal obesity (based on waist circumference)A high FF stores density was associated with higher BMI and abdominal
obesity 40564 (based on waist circumference)A high FF stores density was associated with higher BMI and abdominal obesity in boys, but not in girls.[[17]]The Child and Adolescent Metabolic Syndromes Study (BCAMS), Beijing,
obesity 40800 in 2004.21,198 children (10,602 boys and 10,596 girls); 2–18 yearsCross-sectional studyOverweight/ obesity Children with western FFC ≥ 3 times per week were 1.50 times (95% CI = 1.12–2.02) as likely to be
obesity 41106 collected in 2004.1792 adolescents (899 boys and 893 girls); 11–17 yearsCross-sectional studyOverweight/ obesity Having breakfast outside the home (often likely consuming FF) was associated with overweight and obesity
obesity 41210 studyOverweight/obesityHaving breakfast outside the home (often likely consuming FF) was associated with overweight and obesity among females only (OR = 1.7, 95% CI = 1.1–2.3).[[23]]Xi’an, China; data were collected in 2004.1792
obesity 41410 in 2004.1792 adolescents (899 boys and 893 girls); 11–17 yearsCross-sectional studyOverweight and obesity The odds of overweight and obesity was 1.8 times (95% CI = 1.1–2.9) greater if the parents decided
obesity 41444 and 893 girls); 11–17 yearsCross-sectional studyOverweight and obesityThe odds of overweight and obesity was 1.8 times (95% CI = 1.1–2.9) greater if the parents decided to have Western FF than if the children
obesity 41770 girls); 7–12 yearsCross-sectional studyObesityIncreased consumption of fried foods was associated with obesity .[[16]]The “Better Health for Better Hong Kong” (BHBHK) Campaign, Hong Kong, China; data were collected
obesity 42104 out at least twice a week as compared to less than 2 times a week was associated increased odds of obesity (OR = 1.25, 95% CI = 1.06–1.49)

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