Bad Band

Looking for “Culprits” in Fast and Take-Out Food

Two new studies in AJCN provide observations on the relationship between health outcomes and fast food, take-out, café, or home-cooked meals. These studies find an association of worse outcomes with fast food and take out. But the real question is, why? What are the causal relationships behind these observations? In an editorial, Barry Popkin suggests that the “culprits” must be either the fast food or the “type of person” who consumes it.

Nutrition research is rife with undertones of a dichotomy between bad food and bad people. Are there other ways of thinking about this subject?

Take-Out, Delivery, Café, and Home-Cooked Meals

The first of these two studies used data from the UK Biobank for 5,197 persons. The data included consumption of take-out, delivery, and home-cooked meals. In addition, it had data on meals eaten in a fast food and restaurant café.  Ahmad Albalawi, Catherine Hambly, and John Speakman analyzed the relationship of these different kinds of meals with BMI and body composition.

They found that individuals with low BMI and low body fat more often consumed home-cooked meals. But delivery and take-away meals were more frequent choices for persons with high BMI and body fat. Finally, they found that consumption of meals in a fast food or restaurant café did not have a consistent relationship with BMI and body composition.

Albalawi et al say clearly that these observations cannot support conclusions about causality or the direction of it.

Fast Food, Adipose Tissue, and Fatty Liver Disease

Andrew Odegaard and colleagues used data from the CARDIA study to evaluate the relationship between fast food consumption and abdominal fat tissue, as well as fatty liver disease. They had a robust sample of 3,156 young adults.

What they found was a clear association between eating more fast food and having more abdominal fat, more liver fat, and more fatty liver disease. Again, they could not offer conclusions about causality. Just an association.


Popkin looks at these studies and wants to know who the “culprits” are – fast food or the “type of person” who eats it. But we would like to suggest that a broader view might be helpful.

Social and economic factors play a complex role in what, when, where, and how we eat. These social mechanisms are powerful, but not studied in much detail, as Morten Larsen points out in a fascinating 2015 research report. Time and work stresses, for example, might play a role in the feasibility of the home-cooked meals that the current studies connect to good health outcomes. Is it the home-cooked meal that confers this benefit? Or is it the social context that makes a home-cooked meal even feasible? Or unfeasible?

Many other social determinants of health come into play. So really, is it wise to reduce these observations into a question of bad food or bad “types” of people?

Click here for the Albalawi study, here for the Odegaard study, and here for the Popkin editorial. For the Larsen report, click here.

Bad Band, painting by Paul Klee / WikiArt

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June 18, 2022