Background Obesity is influenced by a complex, multifaceted system of determinants, including the food environment. Governments need evidence to act on improving the food environment. The aim of this study was to review the evidence from spatial environmental analyses and to conduct the first series of meta-analyses to assess the impact of the retail food environment on obesity. Methods We performed a systematic review and random-effects meta-analyses, focusing on geographical–statistical methods to assess the associations between food outlet availability and obesity. We searched OvidSP-Medline, Scielo, Scopus and Google Scholar databases up to January 2022. The search terms included spatial analysis, obesity and the retail food environment. Effect sizes were pooled by random-effects meta-analyses separately according to food outlet type and geographical and statistical measures. Findings Of the 4118 retrieved papers, we included 103 studies. Density (n=52, 50%) and linear and logistic regressions (n=68, 66%) were the main measures used to assess the association of the food environment with obesity. Multilevel or autocorrelation analyses were used in 35 (34%) studies. Fast-food outlet proximity was positively and significantly associated with obesity (OR: 1.15, 95% CI: 1.02 to 1.30, p=0.02). Fresh fruit and vegetable outlet density and supermarket proximity were inversely associated with obesity (OR: 0.93, 95% CI: 0.90 to 0.96, p<0.001; OR: 0.90, 95% CI: 0.82 to 0.98, p=0.02). No significant associations were found for restaurants, convenience stores or any of the body mass index measures. Conclusions Food outlets which sell mostly unhealthy and ultra-processed foods were associated with higher levels of obesity, while fruit and vegetable availability and supermarket accessibility, which enable healthier food access, were related to lower levels of obesity. The regulation of food outlets through zoning laws may not be enough to tackle the burden of obesity. Regulations that focus on increasing the availability of healthy food within stores and ensure overall healthy food environments require further attention. PROSPERO registration number CRD42018111652. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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食物环境与肥胖：系统评价和荟萃分析


背景 肥胖受到复杂、多方面的决定因素系统的影响，包括食物环境。政府需要证据来采取行动改善食品环境。本研究的目的是回顾空间环境分析的证据，并进行第一系列荟萃分析，以评估零售食品环境对肥胖的影响。方法我们进行了系统评价和随机效应荟萃分析，重点关注地理统计方法来评估食品供应与肥胖之间的关联。我们检索了截至 2022 年 1 月的 OvidSP-Medline、Scielo、Scopus 和 Google Scholar 数据库。搜索术语包括空间分析、肥胖和零售食品环境。根据食品店类型以及地理和统计措施，分别通过随机效应荟萃分析汇总效应大小。结果 在 4118 篇检索到的论文中，我们纳入了 103 项研究。密度（n=52, 50%）以及线性和逻辑回归（n=68, 66%）是用于评估食物环境与肥胖之间关系的主要指标。 35 项研究 (34%) 使用了多水平或自相关分析。靠近快餐店与肥胖呈显着正相关（OR：1.15，95% CI：1.02 至 1.30，p=0.02）。新鲜水果和蔬菜的出口密度和超市邻近度与肥胖呈负相关（OR：0.93，95％CI：0.90至0.96，p<0.001；OR：0.90，95％CI：0.82至0.98，p=0.02）。没有发现餐馆、便利店或任何体重指数测量之间存在显着关联。 结论 销售大部分不健康食品和超加工食品的食品店与较高的肥胖率相关，而水果和蔬菜的供应以及超市的可及性（使人们能够获得更健康的食品）与较低的肥胖率相关。通过分区法对食品店进行监管可能不足以解决肥胖的负担。需要进一步关注注重增加商店内健康食品供应并确保整体健康食品环境的法规。 PROSPERO 注册号 CRD42018111652。与研究相关的所有数据都包含在文章中或作为补充信息上传。