Associations between Fast-Food Restaurants Surrounding Kindergartens and Childhood Obesity: Evidence from China

The prevalence of obesity among preschool children has risen dramatically due to the influx of Western fast food in China. In this study, we aimed to provide clear evidence on the associations between fast-food restaurants and childhood obesity. We collected and combined three unique cross-sectional datasets: physical fitness data, geographic information, and the financial data of each kindergarten. The two-stage least squares were used for empirical analyses. The final data including 75,730 children were from 785 kindergartens in 82 cities and 23 provinces in China in 2018. The mean age of participants was 4.94 ± 0.87; 34,249 (45.2%) females and 41,481 (54.8%) males. The number of fast-food restaurants within 1, 2, and 3 km radii had a significant and positive correlation with obesity, and this correlation decreased as the radius increased. Furthermore, the distance to the nearest fast-food restaurant had a significant and negative correlation with obesity. Western fast-food restaurants contributed more to obesity than the broader definition of fast-food restaurants. There was marked heterogeneity between urban and rural areas. Our findings documented that fast-food restaurants had a significant and positive association with childhood obesity, thus the restriction of fast-food restaurants surrounding kindergartens might be considered