Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Health Services, University of Washington School of Public Health, Seattle.
JAMA Netw Open. 2020 Oct 1;3(10):e2019519. doi: 10.1001/jamanetworkopen.2020.19519.
Restaurants spend billions of dollars on marketing. However, little is known about the association between restaurant marketing and obesity risk in adults.
To examine associations between changes in per capita county-level restaurant advertising spending over time and changes in objectively measured body mass index (BMI) for adult patients.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used regression models with county fixed effects to examine associations between changes in per capita county-level (370 counties across 44 states) restaurant advertising spending over time with changes in objectively measured body mass index (BMI) for US adult patients from 2013 to 2016. Different media types and restaurant types were analyzed together and separately. The cohort was derived from deidentified patient data obtained from athenahealth. The final analytic sample included 5 987 213 patients, and the analysis was conducted from March 2018 to November 2019.
Per capita county-level chain restaurant advertising spending.
Individual-level mean BMI during the quarter.
The included individuals were generally older (37.1% older than 60 years), female (56.8%), and commercially insured (53.5%). For the full population of 29 285 920 person-quarters, there was no association between changes in all restaurant advertising per capita (all media types, all restaurants) and changes in BMI. However, restaurant advertising spending was positively associated with weight gain for patients in low-income counties but not in high-income counties. A $1 increase in quarterly advertising per capita across all media and restaurant types was associated with a 0.053-unit increase in BMI (95% CI, 0.001-0.102) for patients in low-income counties, corresponding to a 0.12% decrease in BMI at the 10th percentile of changes in county advertising spending vs a 0.12% increase in BMI at the 90th percentile.
The results of this study suggest that restaurant advertising is associated with modest weight gain among adult patients in low-income counties. To date, there has been no public policy action or private sector action to limit adult exposure to unhealthy restaurant advertising. Efforts to decrease restaurant advertising in low-income communities should be intensified and rigorously evaluated to understand their potential for increasing health equity.
餐厅在营销上花费了数十亿美元。然而，人们对餐厅营销与成年人肥胖风险之间的关联知之甚少。
研究随时间变化的县级人均餐厅广告支出变化与成人患者身体质量指数（BMI）的变化之间的关系。
设计、地点和参与者：这项队列研究使用带有县固定效应的回归模型，分析随时间变化的县级（44 个州的 370 个县）人均餐厅广告支出变化与美国成年患者身体质量指数（BMI）的变化之间的关系。分析中同时考虑了不同的媒体类型和餐厅类型，也分别进行了分析。该队列来自 athenahealth 获得的匿名患者数据。最终分析样本包括 5987213 名患者，分析于 2018 年 3 月至 2019 年 11 月进行。
县级连锁餐厅广告支出的人均水平。
季度个体平均 BMI。
纳入的个体年龄较大（37.1%年龄超过 60 岁），女性（56.8%），商业保险（53.5%）。在 29285920 人的全部人群中，所有餐厅广告人均支出的变化与 BMI 的变化之间没有关联。然而，对于低收入县的患者，餐厅广告支出与体重增加呈正相关，而对于高收入县的患者则没有。在所有媒体和餐厅类型中，每季度广告人均支出增加 1 美元与 BMI 增加 0.053 个单位（95%CI，0.001-0.102）相关，对于广告支出变化处于县广告支出第 10 百分位的患者，BMI 相应下降 0.12%，而对于广告支出变化处于第 90 百分位的患者，BMI 增加 0.12%。
本研究结果表明，餐厅广告与低收入县成年患者的体重适度增加有关。到目前为止，尚无公共政策或私营部门采取行动限制成年人接触不健康的餐厅广告。应加强在低收入社区减少餐厅广告的力度，并对其潜在的增加健康公平的效果进行严格评估。
