By now, it should be clear that eating at ready-to-eat food outlets isn’t the healthiest thing to do. But as a new study points out, even just living around them can make a difference.

A game of odds

Nutrition is a lot about statistics. Not all fast food is necessarily unhealthy; just most of it. A single unhealthy meal won’t make much of a difference, but many of them will. Apparently, just being exposed to many unhealthy food options is enough to make a significant difference in many people’s health.

Researchers led by Lu Qi from Tulane University in New Orleans analyzed data from the UK Biobank. This is a large-scale biomedical database and research resource containing genetic, lifestyle, and health information from half a million UK participants. They measured participants’ exposure to three categories of venues: pubs or bars, restaurants or cafeterias and fast-food restaurants.

Exposure was determined by proximity (living within 1-kilometer/0.62 miles, or a within a 15-minute walk) and density (the number of ready-to-eat food outlets within the predefined 1-kilometer/0.62 miles).

The team found that people living in the highest density of ready-to-eat food outlets had an overall 16% greater risk of heart failure compared to those with no such venues near their homes. Furthermore, heart failure risk was higher among participants without a college degree and in areas without physical activity facilities (such as gyms or swimming pools). The difference between the three types of venues was relatively small.

“Most previous research on the relation between nutrition and human health has been focused on food quality, while neglecting the impact of food environment,” Qi said. “Our study highlights the importance of accounting for food environment in nutrition research.”

The researcher also told ZME Science that socioeconomic factors may impact the eating behaviors such as deciding whether to eat outside or at home.

How we can get people to eat better

The researchers did not analyze the type of food offered by the outlets. Some outlets offered healthier types of food, others did not. But again, it’s a game of odds — eat out enough and you’re bound to have unhealthy nutrition.

Within the 1-kilometer range of where all participants lived, there were an average of 3.57 ready-to-eat outlets. That’s basically 3-4 food places right where you live. The average street distance to pubs and bars was just 700 meters (0.44 miles). People are exposed to a large density of ready-to-eat environments, and this appears to cause long-term problems.

Qi suggests that a main focus should be replacing outlets that generally provide unhealthy foods with those that provide healthy foods such as Mediterranean foods.

Ultimately, encouraging people who live close to bars and restaurants to eat healthier involves a multifaceted approach, blending education, environment modification, and policy interventions. Municipalities need to work with local outlets to incentivize them to offer healthier foods. Another approach is to create community groups that encourage eating healthy. Things like community health challenges could help to build support networks around making healthier choices.

However, these measures are bound to be challenging.

A 2023 Association Presidential Advisory reviewed the landscape for food and noted a systemic lack of focus on improving food environments and the food system. We focus a lot on our health, but given how much food influences our health, we give it surprisingly little attention. Taxes and financial incentives are rarely focused on encouraging the purchase of healthy foods, even when it comes to children.

Broader studies are needed

It’s still early days for understanding how our local environment affects how we eat. Even this study is skewed as the participants were older and whiter than the general population.

In an accompanying editorial, Elissa Driggin M.D. and Ersilia M. DeFilippis, M.D., both of Columbia University Medical Center in New York, emphasize the importance of such studies, especially when it comes to racially and ethnically diverse populations.

“Given the clear association between Black race and high incidence of heart failure as compared to White patients, as well as associations with worse heart failure outcomes, attention to food environment in this high-risk population is of the utmost importance,” they wrote.

“It has already been demonstrated that compared to predominantly White neighborhoods, there are significantly fewer supermarkets in predominantly Black neighborhoods, which are likely to be inversely associated with ready-to-eat food environments.” Around 94% of participants in the study were of White European ancestry.

The bottom line is that eating healthy is still difficult for a lot of people, especially those from impoverished backgrounds. Living close to pubs and fast-food places just makes it all the more difficult.

“Consuming a healthy diet is too hard for too many people,” said Eduardo Sanchez, M.D., M.P.H., FAHA, the Association’s chief medical officer for prevention. “Structural racism and factors that contribute to poverty mean that historically excluded people suffer the consequences of poor-quality diets at disproportionate levels. For over a century, we’ve saved and improved lives at the American Heart Association and will continue to focus on initiatives like this in our next 100 years by ensuring everyone, everywhere enjoys their healthiest lives.”