Neighbourhood out-of-home food environment, menu healthiness, and their associations with meal purchasing and diet quality: a multiverse analysis.

backgroundGovernments worldwide have implemented various interventions to improve the healthiness of food offered by out-of-home outlets. However, there is limited evidence on whether healthier menus would influence individual dietary behaviours and quality. In this cross-sectional study, we investigated associations between different measures of the neighbourhood out-of-home food environment, incorporating menu healthiness, and out-of-home meal purchasing and diet quality.

methodsWe used a sample of 3,481 adults in Great Britain (GB) with valid home postcodes from the 2021 International Food Policy Study. We linked this sample to a national database of food outlet geographical locations to characterise individuals' exposure to the out-of-home food environment. The exposure metrics included menu healthiness scores, availability, proximity, and relative composition of out-of-home food outlets in various neighbourhood buffers around the home (i.e., 500 - 1600 m). Outcomes considered were out-of-home meal consumption and overall diet quality. Using multiverse analyses, where multiple reasonable analytical choices can be tested, we investigated the associations between different exposure measures and these outcomes.

resultsGB adults had access to an average of 97 (95% CI 91, 104) out-of-home food outlets within 1600 m of their homes. The number of both healthier and less healthy out-of-home food outlets was positively associated with the number of meals purchased out-of-home across all neighbourhood buffers, e.g., every 10 additional less healthy out-of-home food outlets within 500 m of the home corresponded to a 6% (95% CI = 2, 11) increase in the frequency of out-of-home meal purchases in the previous week. Proximity, relative composition, and menu healthiness of neighbourhood out-of-home outlets were not associated with out-of-home meal purchase frequency after adjusting for multiple comparisons. There were no consistent associations between out-of-home food environment exposures and diet quality.

conclusionThe only aspect of the neighbourhood out-of-home food environment associated with out-of-home meal purchase frequency was the number of out-of-home food outlets. Menu healthiness of out-of-home food outlets was not associated with how often people purchased out-of-home meals or overall diet quality. Interventions focusing on mitigating the proliferation of out-of-home food outlets may be more effective in changing individual dietary behaviour than those focusing on food served.