Question

• In children and adolescents, how does fast food frequency affect weight gain and insulin resistance?

Clinical Bottom Lines

1. A strong positive association exists between frequency of visits to fast food restaurants and increases in body weight and insulin resistance, two major risk factors for type 2 diabetes.¹

Summary of Key Evidence

1. 3031 young (age 18-30 years in 1985-86) black and white adults were followed over 15 years.¹
2. Multiple linear regression models were used to investigate the association of fast food frequency at baseline and follow-up with 15 year changes in body weight and insulin resistance.
3. Fast food frequency was lowest for white women compared to other ethnic-sex groups.
4. After adjustment for lifestyle factors, baseline fast food frequency was directly associated with increases in bodyweight in both black (p=0.0050) and white people (p=0.0013).
5. Change in fast food frequency over 15 years was directly associated with increases in bodyweight in white people (p< 0.0001) with a weaker association in black people (p=0.1004).
6. Changes in fast food frequency over 15 years in both ethnic groups, was directly associated with increases in insulin resistance (p=0.0015 in black people, p=<0.0001 in white people).
7. By comparison with the average 15 year weight gain in participants with infrequent fast food use at baseline and at follow up, those with frequent fast food use at both baseline and follow up gained an extra 4.5 kg and had a two-fold increase in insulin resistance.

Additional Comments

• AAP recommendations for prevention of overweight and obesity:
  • Health supervision including identifying patients at risk, monitoring BMI yearly, encourage breastfeeding, healthy eating patterns, promoting physical activity, limiting television watching/video time to maximum of 2 hours per day.
  • Emphasis on advocacy in a local, state and national level.²
    

Citation

1. Pereira MA, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15 year prospective analysis. Lancet 2005;365:36-42.
2. American Academy of Pediatrics, Committee on Nutrition. Prevention of Pediatric Overweight and Obesity. Pediatrics 2003;112:424-30.

CAT Author: Lily Strong, MD

CAT Appraisers: Jonathan Fliegel, MD

Date appraised: April 27, 2005