November 4

Obesity vs fast food availability


We’ve been told countless times that the availability of fast food is one of the drivers of obesity in the United States.
We all know the nutritional content of fast food is not what most of us would consider optimal. It’s loaded with carbohydrates and all kinds on nasty vegetable fats and trans fats. So it makes sense that more fast food restaurants in a given area would correlate with an increased incidence of obesity.
But, as I never tire of saying, correlation is not causation.
The charts below from the United States Department of Agriculture Economic Research Service would seem to show that rates of obesity in the United States are greater where there are fewer fast food outlets and less in the areas of greatest fast food concentration.
I wrote a post on observational studies a while back because I got tired of people asking me about studies that surface almost daily showing eating meat causes colon cancer or saturated fat causes heart disease. Virtually all of these studies are observational studies, and I wanted something I could refer to to show that these kinds of studies don’t demonstrate causation. They demonstrate only correlation. Which is good only for designing a real study to try to prove causation.
I got so wrapped up in focusing on the correlation-isn’t-causation theme that I forgot to mention something extremely important. Though correlation does not mean causation, the opposite, the lack of correlation probably does imply lack of causation.
Taking the above graphs at face value, you would have to say that fast food availability probably doesn’t cause obesity.
As anyone who reads this blog regularly should know, I am no proponent of fast food. I think the best thing people can do for their health is to spend more time in their own kitchens. Only then do they have full 100 percent control of what goes into the food they prepare.
As I wrote in a previous post, people who dine out at restaurants, even high-end restaurants, get a lot of bad fats they hadn’t bargained for. And since the number of people eating one of more meals out daily is at an all-time high, it’s no surprise that obesity is at an all-time high.
Adult obesity chart
Fast food restaurant availability chart

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  1. Even when you cook at home you are not completely sure of what is in your food – unless you eat all organic. When you eat non-organic corn there is a 90%+ chance that you are eating GMO (genetically modified) corn, since 90%+ of all corn grown in the US is tainted by Monsanto and other companies that want to hide the fact that the food is a GMO product.
    Many processed foods are labeled with ingredients that virtually no one knows what they are or if they are healthy. It would help if the FDA would look out for the welfare of the people of the US rather than the producers of food products that in my opinion,are probably making 40%+ of the US population fat or obese. Europe will not allow the sale of many of the food products that our own FDA allows. Europe has determined that they are not healthy. I believe that our FDA is not doing a good job protecting the citizens of the US.

    1. Correction: When I cook at home there is 0% chance that I am eating GMO corn (or any cereal grain for that matter), because I choose not to partake of a class of foods that contribute very little in the way of useful nutrients while containing toxins.
      Now, you could say the same about meat, eggs, and dairy, but I live in Norway where animal welfare is important enough that there are laws ensuring anomals a number of months grazing outside, as well as regulating the space each animal needs and the sort of feed they can get during winter. Eggs from free range chickens aren’t more expensive (why would they be?) and our dairy actually has an expiration date. 😛

  2. This “conversation” has so many facets – I don’t know where to begin. But I’ll just suggest a couple right off the top of my head that need to be mentioned. (And forget correlation vs. causation for now).
    1. Singling out just six fast food restaurants is such a small sample of food options, it’s ridiculous, and bordering on useless.
    2. Think about pizza parlors alone (both chain and the millions of independently owned places). The amount of carbs in that industry alone is staggering.
    3. The fact that a good majority of the nation even has a fast food restaurant “per thousand” population alone is enough to make you sick. And many if not most are in higher-density locations. Look at NYC, a fast food place each block. An elevator ride down to obesity.
    Dr. Eades – In my opinion – obesity cannot really be targeted at fast food places, but the entire “mentality” that exists in this particular time in history. Sandwiches, crunchy chips, bread and starch based entrees and sides – it’s what the “food world” has become.
    I’ve been LCHF for over 2 years – and it’s getting even harder to find a place that gives me even a smidge of a choice to eat sensibly.
    And what do you see when you go to the supermarket? Where families would go to buy their “healthy” home cooked food? Nothing but junk!
    How many items are even worth buying at a supermarket anymore? It’s a stretch to find heavy whipping cream nowadays too (soy milk, low fat, and everything else dominates the shelf space).
    In other words – while “Fast food” has been an enemy of varying titles over the years (high fat – then high carb – then high cholesterol – whatever), it’s only ONE part of the entire food industry that has gone ENTIRELY down the tubes.

    1. First, it’s not just six outlets that are represented. I grabbed the royalty-free graphic at the top of the post off of the web. It isn’t representative of all the fast food outlets in the chart. I assume the ones in the chart include many more than those six and do included pizza places.
      I agree that people do indeed purchase plenty of junk from the grocery store for home consumption. I didn’t say people could eat crappy on their own at home – I said that the best thing people could do for their health is to spend more time in their own kitchen making their own non-junk food.

    2. What I see in the local supermarket is truly astounding. Yesterday, I found a can of “low fat” coconut milk. Why would you ever use a low fat version of coconut milk? I thought the only reason for buying it was to obtain the benefit of coconut oil.
      50% of the time I can’t find a plain full fat yogurt in the dairy section. I have to ask the dairy guy to find one in the back for me. It is like I am buying porno in 1950 and it comes in a brown paper bag. That is how bad it has gotten.
      The dairy guy was in his 60’s and I asked him about this and he thought it was nuts too. His suggestion was to just eat “real food,” and he was not over weight in my opinion.

      1. It truly is astounding what can be found on the shelves of the local grocer. Even the shelves of the local natural foods grocer. Maybe even more astounding there.

    3. At most fast food restaurants you can pick and choose to your satisfaction. I have been on a LCHF diet since 2005. When I am eating out and in a hurry I eat a McDouble sans bun and ketchup. This meal will keep me sated until I can dine at a non fast-food restaurant or at home. I do not regard this practice as harmful and I do not think eating this food item would contribute to obesity.

      1. I agree. That’s what Tom Naughton did so successfully in the movie Fat Head.
        Fast food is an easy target for the anti-fat crowd because, for the most part, fast food contains a lot of fat. But it also contains a ton of carb, which I think is the real problem. If you look at Morgen Spurlock’s movie Supersize Me, you’ll see that most of what he actually overate was sugar while all the emphasis was on his fat consumption.
        Which is why I posted these charts side by side. To show that it isn’t all that easy to assess blame for the obesity epidemic.

  3. I guess, fast food should not be singled out. Whole pattern of eating is distorted. People eat all sort of sub-optional things at home which they bought from a store – boxed cereals, crackers, countless snacks. I observed many times that in almost all families with mom at home and several small children busy mom just give them cereal with milk in the morning, peanut butter sandwiches at lunch, they walk everywhere with a zip-lock full of golden fish crackers or Cheerios and drink juice from boxes or a baby-cup. Family eats normal food maximum once a day, when dad comes from his work, and on Friday often is a pizza night. I didn’t have several small children at the same time, I understand how their caregiver could be tired, and I don’t want to be harsh, it is just very understandable how people reach for an easiest solution when they can ease their life.
    Working moms or moms with several teenagers do not have more relaxed life, I just choose one of many examples.

  4. I agree that one needs to be savvy shopping at “supermarkets”. I bought a steak and noticed it had “ingredients” listed. Really? I am overjoyed to have found a rural butcher shop within driving distance with very reasonable prices (after looking for a long time).
    Home cookin’ is best and judicious shopping is important.
    Good to have you back with us again!

  5. Absolutely agree that the best thing we can do is eat at home. I’m a diabetic and have managed to get my A1c down from 13 to 4.9 and off all insulin just by following Dr. Bernstein’s “Diabetes Solution”. We rarely eat out because even salads and grilled meats are not ‘safe’. For example, you can eat shrimp scampi at Red Lobster for zero carbs, but get that same shrimp as a wood-fired skewer and I believe it’s something like 36 carbs…which means they’re putting something on it to help it look better (sugar?).

  6. Broadly speaking (the wide swath through the Deep South, the Ohio Valley, and Western reservation areas, the obesity map might show a correlation between poverty and obesity, at least in rural areas.

  7. Hmm. It looks to me like there’s a much better correlation with people who are underemployed and do too much sitting around relative to how much eating they do.

  8. Mike,
    Readers might check out my blog post at where I talk about observational studies. I need this shameless plug because you probably have more energy than I do so in the battle of “I never get tired of saying….” I could be in trouble. I never get tired of saying that that the correct statement is observational studies do not NECESSARILY imply causality. The problem is that often they do and confronted with the red meat will cause cancer study we can’t use an absolute. The association with red meat and cancer does not imply causality because they are BAD observational studies. Is it all a matter of opinion? To some extent it is in the statistics that you use are a kind of opinion. But my blog post lists Bradford Hill’s criteria for when an observational study implies causality. We need to avoid throwing out the baby (Hill’s demonstration that cigarette smoking really does cause lung cancer) with the bath water (the associations found by HSPH). In some sense, all science is observational. It just has to be good observation and Hill’s criteria are a good guide. Even thermodynamics, the most mathematical and seemingly impregnable branch of science rests on observation. As soon as somebody observes a perpetual motion system, it is all over. You agree, right?

    1. I do agree re the perpetual motion system.
      And I do agree with your statement that “observational studies do not NECESSARILY imply causality.”
      And I do agree with Bradford Hill’s criteria as to how an observational study can imply causality, as in with the data on smoking, which is extremely strong.
      But most observational studies published today are pieces of crap that don’t come anywhere near Hill’s criteria and don’t imply squat, yet the media picks them up and runs with them as if they do.
      Consequently, I look at observational studies the same way I look at offers of free money from Nigerian bankers. Maybe one offer in a zillion might be legitimate, but I’m going to ignore them all until I see substantial proof one is on the up and up.

  9. @ Will
    As Dr. Eades has just said: Correlation is not necessarily causation. I know that a lot of concern has been expressed about genetically modified foods, and non-organic foods in general, but here again, has there been any proof that non-organic really is harmful? Specifically, that these foods cause obesity? Organic foods might be better. Sometimes. But some of the pesticides, etc., allowed for organic foods are things I’d rather not eat, either. I love the little farmer’s market stand where I buy things in summer time. But I’ve noticed that, while the end-season red bell peppers used to be filled with webs and worms, the past few years, the peppers have been completely clean. I’m sure the farmers have chosen a strain of peppers that are resistant to those webs and worms. I’m happy for the no-worms peppers, whether or not they’re genetically modified.
    There are so many things beyond the black-and-white/ non-organic vs. organic discussion — things we might not even be aware of. I read a while back that a common drug used for diabetes is the same chemical as is used as a pesticide on crops. So how would we know whether obesity is caused by the non-organic foods sprayed with that pesticide, or the same chemical in the drugs someone is taking? Even organic things can be sprayed with commercial pesticides/fungicides while in a transit between farmer and grocery store. Because of the nation’s fat-phobia, organic pasture-raised pork might still be modified to be to be low-fat. Or, like some “pasture-raised” chicken I recently bought, have a strong metallic, fishy taste from who knows what other “organic” thing they fed them.
    The FDA no doubt has let us down at times. But my impression is that the “obesity epidemic” is not something unique to the US. Even if it were, there would be many other factors besides the non-organic foods that the FDA allows in the American diet.

    1. @ Marilyn
      I have to agree with you. There is no proof that GM foods are harmful and there is no proof that they are not harmful. I believe that we will understand the truth about genetically modified foods in 50 or 100 years or so. Eating natural foods has been proven safe long term. My personal health is somewhat set. I ate what was put in front of me when I was a kid. I didn’t question it, I ate it. It’s not that simple in todays world. We have choices. Many of these choices are made possible by FDA rules. Thankfully people like you, Dr. Eades and others on this list are doing the questioning today.
      I believe in my gut feelings, and my gut is telling me not to eat foods modified by mankind when the motives behind these modifications are profit. Even nature allows genetic modifications, but I think these modifications were and are based on survival, not financial gain. When genetically modified foods are not labeled as such, it is difficult to keep them out of a diet.
      I tend to believe the studies performed by health oriented organizations trump those done by groups funded by the companies that want to sell the GMO foods. Perhaps this is why dozens of countries worldwide ban genetically modified food, as well as many other processes used in the US to provide food.
      I agree with your comments about the FDA. They are certainly not perfect, but they are doing many things right. The FDA is part of our government and our government and politics in general are subject to financial pressures – both positive and negative.
      I’m thankful that my grandkids are eating natural foods as much as is possible. In todays world it is almost impossible to keep all of the unhealthy choices off of the dining table. Forcing labels to list “most” of the ingredients on food products was a huge step forward.
      Dr. Eades, thank you for this forum!!

  10. It IS fantastic to see a new post, especially since there’s still that wee little tempest in a teapot going on over at Amazon about Campbell’s China Study: it features three low-fat, high fiber, “let’s eat all the grains we can get our hands on”, “we really need to rid the planet of livestock for food since it’s the leading cause of global warming” — um — opinionated persons who are still (three and a half years later!!) staunchly arguing for a vegan diet and all are boring in the extreme. So it’s refreshing to come here and find some common sense and logical discussion. Phew.
    One bit of housekeeping; I’m guessing you meant “theme” in the following phrase (2nd para below charts); focusing on the correlation-isn’t-causation them
    Once again – so happy to see you posting more!

    1. Thanks for your comment. Don’t know if you saw it or not, but just in case you didn’t, here is my take on the China Study.
      And thanks for the heads up on the typo. I fixed it.
      I used to proof read my posts half a dozen times, then have MD proof them, then do it again myself. And typos still slipped through. Now I proof a time or two myself and use crowd sourcing for the rest of my proof reading. So, please, if you see an error, let me know.

  11. Proof reading anything you’ve written is nigh-impossible – and we’re all happy to help, I’m sure.
    I did read your China Study post – think it’s time to re-read it – and stop being drawn in by that on-going argument over there. No one’s about to convince the other side since at this point its down to hard-core dieters. But – funnily enough – even now TCC still comes along and puts his (very patronizing and frequently insulting) two cents’ worth in. (Really only worth about a ha’penny!)

  12. I believe you argument here has its own problem. Fast food outlets as measure of population density is quite misleading. If a town of 1000 has two outlets that is 2 per 1000. If a block in New York smaller than the town in city had 10000 people it would need 20 outlets to reach 2 per 1000, while 10 outlets on the block would service everyone better than the town. I live in subdivision with 7 fast food outlets for over 10000 people in small area, while 2 outlets in all northern Canada would be about equal while only permitting about 20% of the population to use the 2. In the map the highest density is where there are no people.
    Interstate interchanges tend to have lots of fast food frequently in low population areas where the nearest town does not support the outlets, the Interstate does. Super highway interchanges in cities do not have fast food, the neighbourhoods do.

    1. That’s why I say correlation does equal causation. There are too many variables to take into consideration. What I do know is that the big fast food chains don’t put restaurants in unless they’ve done their homework and are sure the demographics will support the restaurant. And they’re pretty good. When is the last time you saw a McDonald’s close down?

      1. My point is simply the charts do not disprove fast food is not a driver. I would guess that bigger soft drinks have a lot to do with obesity but as you say, it is not easy to prove.
        Canada is not as fat as the US and has pretty much the same fast food. I wonder why that would be.
        It is getting hard to find Kentucky Fried Chicken in Ottawa, they keep disappearing and not opening new ones. Arby’s has also come and gone.
        I liked the Australian show with you helped with very much.

  13. Looks like an inverse correlation if anything. Or maybe in CO we simply order Diet Coke.
    As to comments on GMOs, I’m genetically modified, so why would I balk at eating genetically-modified foods. It all depends on what the modifications are.

  14. I never noticed people in MacD are particularly fat. I suggested someplace an infomal experiment. See how many people in MacD ae overweight or fat. If you don’t normally go there, I recommend the specialite de la maison: the coffee is always hot.

    1. The coffee is always hot, and it’s always pretty good. But since Startbucks and other similar coffee places are now as ubiquitous as McDonald’s I haven’t darkened the door of one of the latter in years. I much prefer a hot, fresh Café Americano to anything Mickey Ds has to offer.

  15. Some fast food is actually pretty darn good food too … In ‘n Out burger being one! My whole family loved it, although they rarely like food not cooked at home. It was basically cooked well.
    As for correlation … is there actually a high correlation between a high-starch diet and obesity? Looking through the book “What I eat”, or studying what people eat all over the world, MOST people eat a high starch diet. In the US, most people at lots of starches when I was growing up. Not much obesity though. We didn’t exercise much either. Worldwide, in most developing countries, starch provides the most calories, but most people are thin. There is an odd exception for tribal people who eat mainly bananas … they are chubby.
    Worldwide, there IS a high correlation between “Western foods” and obesity. Those “Western foods” are the packaged ones for sale everywhere … cookies, bread, pop. They ARE high-carb foods, but not the high carb foods that were traditionally eaten. Maybe it’s that resistant starch again. Or the fructose content (which would account for the chubby banana eaters).
    I don’t know, but I do know that when I eat a traditional Asian diet, I lose weight. Even though it has a lot of rice and some beans. And generally a fair bit of beef and poultry and fish and eggs, plus loads of vegies.

    1. I grew-up in a society without a fast food, where most people cooked from a scratch because they didn’t have a choice, and a lot of starches was consumed. In a such society most people look thin especially the young ones, but there are plenty of deceases of modern civilization (high blood pressure, cancer, diabetes, Alzheimer, ischemia, caries, inflamed gums) in the population anyway, many middle-aged people develop a central-body spread, and most old folks are fat-skinny. For a person who lives in US , thinness became the ultimate mark of a healthiness, but it is not so. Eating self-cooked traditional meals is way better than eating the standard American diet, but relying heavily on starches is not benign.

  16. There are a few fast food places that do provide low carb options: For example the Chik-fil-aA grilled market salad has 13 grams of carbs and 4 grams of fiber. The Buttermilk ranch sauce adds ony one more carb. Although I don’t see it on their national menu, my local branch offers grilled nuggets that are not breaded for close to no carbs. They also offer lemonade with Splenda instead of sugar.The Low Carb Burger at Carl’s Junior a Southern California chain comes wrapped in lettuce and has 9 grams of carb (probably in the dressing) and 1 gram of fiber. This is a big burger with meat, cheese, onions and tomato. In n Out , another local California chain offeres a burger protein style– i. e. wrapped in a lttuce leaf instead of a bun for 11 grams of cab and 3 grams of fiber. The more people shop around and look low carb alternatives, the more they will be offered. Here in California we also have Panda Express00 chinese fast food, It offers you steamed vegetables as an alternative to rice . The rest depends on which entrees you choose, but low carb entrees are available. Making food fast, tasty low carb and cheap is not impossible. It’s just not going to happen unless it is also profitable.

  17. I’m beginning to think that unless I have a personal relationship with the producer of the food I am consuming, I am out of luck in controlling what goes into the dishes I prepare. Case in point: I’ve started making my own sausage from ground pork, because I can’t afford the sugar-free stuff in the grocery stores and I would have to order online to get the nitrate-free stuff. I’ve been doing this for quite a while. On a whim recently, I read the ingredients of Kroger’s packaged ground pork: MSG and other natural flavors. Ridiculous! And my brother-in-law, who was once a butcher, said even the grocery-store brand whole chickens I buy are injected with solution. I didn’t believe him until I read the label closely. All food is adulterated unless you pick it yourself, grow it yourself, raise it yourself, and/or butcher it yourself — unless you have personal knowledge of its origins. So it seems to me, it doesn’t matter whether you’re eating in a fast food restaurant or buying your goods from your local large-chain grocer: you’re going to ultimately be disappointed by it.

  18. Everytime I go in the US (I am Canadian), I make it a point to go the fast food joints. I loved the Arby’s smoked meat burger with curly fries I recently got in Atlanta. Everytime I come back, I’m leaner. Why? Because I don’t get as much free time doing nothing as when I am home and I eat less and walk a lot. We got a lot of fast food in Canada but nowhere near as many as in the states.
    I’m a big proponent of low carb but it’s not like a bit of bread is going to kill you. The problem is that fat people act fat: do nothing all day, eat out a lot, drink disgusting soda, etc. The fat definitely gets to the brain, and the brain gets to the fat.
    I toyed at one point with the idea of getting fat and then getting very lean while eating an exclusively fast food diet (while filming and logging the whole thing). Perhaps McD. would have sponsored me. I don’t have time for this, so I suggest a Dr. Eades should do it!

    1. Someone already has done it. Tom Naughton‘s documentary film Fat Head is about that very thing. Losing weight with fast food. It’s a great movie. Disclosure: I’m one of the interviewees and appear multiple times in the movie.

  19. Thank you for the friendly correlation-isn’t-causation reminder.
    I think another line to take with this fast food issues is a need to move away from villifying the industry. They do a ton of things wrong, but they do have the resources (and motivation to keep us as customers) to make a change in our food supply. Why else does Wal Mart carry organic products? Because they want those of us that read this blog to buy products from them. We need to be building bridges and speaking with our buying power.

  20. Hi guys, indeed I agree with the blog that what you trying to convey to the people. My suggestion is the fast food is always not good for health.

    1. It is not true, Paul. Very often it is possible to make a rather healthy choice in almost any fast-food place. My main two objections – the fat they use for the cooking is of a poor quality and meat is commercially raised. However, I can’t afford to eat a grass-fed meat all the time anyway, and I order mostly grilled burgers with vegetables or barbecued meat in a fast-food places. I really have no problem to find where to eat away from my home while following a LC diet. Very convenient.

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