Americans’ Perceptions about Fast Food fast food journal articles and How They Associate with Its Consumption and Obesity Risk Advances in Nutrition Oxford Academic
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Americans’ Perceptions about Fast Food fast food journal articles and How They Associate with Its Consumption and Obesity Risk Advances in Nutrition Oxford Academic
Powell LM , Han E , Chaloupka FJ . Economic contextual factors, food consumption, and obesity among U.S. adolescents . J Nutr 2010 ; 140 : 1175 – 80 . Interviews, questionnaires, and focus group discussions were used to assess perceptions of FF regarding beliefs, attitudes, and knowledge. A nationally representative survey reported that in 2003, 23% of Americans considered FF to be “good” , which did not change over 10 y. About two-thirds of Americans thought FF was “not good” in both 2003 and 2013, while the percentage who considered FF “not good at all” increased from 23% to 28% . One study directly measured adolescents’ beliefs about risks and benefits of eating FF in online panels using a 5-point Likert scale . The mean score of adolescents’ reported experience of positive health consequences after eating at FF restaurants every day was 2.8 and that for negative health consequences was 3.5 . Ploeg M , Mancino L , Tood JE , Clay DM , Scharadin B . Where do Americans usually shop for food and how do they travel to get there? Initial findings from the National Household Food Acquisition and Purchase Survey . USDA . 2015 March. . Available from: s.usda.gov/webdocs/publications/43953/eib138_erratasummary.pdf?v=42636 . People's perceptions of FF availability and food environments , knowledge of daily caloric requirements , and estimation of FF calories were estimated with a Likert scale or open-ended questions . Americans’ Perceptions about Fast Food fast food journal articles and How They Associate with Its Consumption and Obesity Risk Advances in Nutrition Oxford AcademicAmericans’ Perceptions about Fast Food fast food journal articles and How They Associate with Its Consumption and Obesity Risk Advances in Nutrition Oxford Academic Ayala GX , Mueller K , Lopez-Madurga E , Campbell NR , Elder JP . Restaurant and food shopping selections among Latino women in Southern California . J Am Diet Assoc 2005 ; 105 : 38 – 45 . A 2013 nationally representative phone survey of about 2000 American adults found that about 22% of Americans considered FF good, whereas 28% thought FF was “not good at all” . The others thought FF was “not too good”. Some of these perceptions had significant associations with the level of FFC. Those who perceived FF as convenient and beneficial to health, preferred the taste of FF compared with healthy foods, or had low self-efficacy for eating less fat were more likely to frequently eat FF than their counterparts. Americans who consumed less FF seemed more likely to view FF negatively. However, inconsistent findings were shown in the association between perceived FF health risks and FFC. Perceived FF availability in neighborhoods was not associated with FFC. Supplemental Tables 1 and 2 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at s/ . Future research is needed to confirm the association between perceived FF availability and FFC in the United States. Regulating accessibility of FF chains in the United States might not be as effective as raising FF price for obesity interventions , although the sustainable effects of health taxes on reducing consumption of targeted products and related harms are not known . Demonstrating quick and convenient preparation of nutritious alternatives to FF or providing restricted or guided choices in food outlets could be more promising interventions for the obesity epidemic in the United States as shown in intervention studies. Piron J , Smith LV , Simon P , Cummings PL , Kuo T . Knowledge, attitudes and potential response to menu labelling in an urban public health clinic population . Public Health Nutr 2010 ; 13 : 550 – 5 . Only 3 studies directly accessed Americans’ perceptions of FF. None of the studies examined the association between FF perceptions and the risk of obesity. ↑, higher; ↓, lower; −, no significant difference; FF, fast food; FFC, fast food consumption; GIS, Geographical Information System. DiNicolantonio JJ , Lucan SC , O'Keefe JH . The evidence for saturated fat and for sugar related to coronary heart disease . Prog Cardiovasc Dis 2016 ; 58 : 464 – 72 . Larson NI , Neumark-Sztainer DR , Story MT , Wall MM , Harnack LJ , Eisenberg ME . Fast food intake: longitudinal trends during the transition to young adulthood and correlates of intake . J Adolesc Health 2008 ; 43 : 79 – 86 . This study quality assessment tool was adopted from the NIH's quality assessment tool for observational cohort and cross-sectional studies . A study-specific global score, ranging from 0 to 7 , was calculated by summing up scores across all criteria. Our systematic review found that Americans do not have good knowledge of FF calories, or daily caloric requirements . However, two-thirds of Americans thought the food served at FF restaurants is not good for them, and even 73% of weekly FF consumers did so . Nonetheless, Americans continue to consume FF and think of FF as one of their casual dining options . FF images on television and frequent exposures to FF may induce people to perceive FF more positively by appealing to the perceptions of low cost, good taste, and convenience and desensitizing viewers to the possible health risks of FF. One study found that heavy television viewers perceived more positive health consequences but fewer health risks of eating in a FF restaurant every day than others . This study quality assessment tool was adopted from the NIH's quality assessment tool for observational cohort and cross-sectional studies . A study-specific global score, ranging from 0 to 7 , was calculated by summing up scores across all criteria. Boyland EJ , Kavanagh-Safran M , Halford JC . Exposure to ‘healthy’ fast food meal bundles in television advertisements promotes liking for fast food but not healthier choices in children . Br J Nutr 2015 ; 113 : 1012 – 18 . Sarmugam R , Worsley A . Dietary behaviours, impulsivity and food involvement: identification of three consumer segments . Nutrients 2015 ; 7 : 8036 – 57 . Wright A , Smith KE , Hellowell M . Policy lessons from health taxes: a systematic review of empirical studies . BMC Public Health 2017 ; 17 : 583 . Anderson B , Rafferty AP , Lyon-Callo S , Fussman C , Imes G . Fast-food consumption and obesity among Michigan adults . Prev Chronic Dis 2011 ; 8 : A71 . Flowchart of literature search and study selection procedure. FF, fast food; FFC, fast food consumption. Values are means ± SDs, unless otherwise indicated. #, frequency; FF, fast food; FFC, fast food consumption; IRR, incidence rate ratio; NR, not reported; OB, obese; OW, overweight; SSB, Sugar-Sweetened Beverages; SES, socioeconomic status. Zagorsky JL , Smith PK . The association between socioeconomic status and adult fast-food consumption in the U.S . Econ Hum Biol 2017 ; 27 : 12 – 25 . Flowchart of literature search and study selection procedure. FF, fast food; FFC, fast food consumption. Majority race/ethnic group were specified, otherwise multiple race/ethnic groups were involved in the study. An inverse socioeconomic gradient in FFC among adults and children has also been reported in the United States . Low-income and food-insecure people consume more FF owing in part to lack of access to healthy and affordable foods and perceived barriers of higher prices for healthy foods and lower prices for FF , which also contributes to sustaining FF as a major contributor to Americans’ diets. Additionally, a systematic review found that FF restaurants are more prevalent in low-income areas compared with middle- to higher-income areas and in areas with higher concentrations of ethnic minority groups compared with Caucasians . Disproportionately high access to FF in the United States is prevalent in predominantly black neighborhoods . Scholosser E . Fast food nation: the dark side of the all-American meal . New York, NY : Houghton Mifflin ; 2012 . James P , Arcaya MC , Parker DM , Tucker-Seeley RD , Subramanian SV . Do minority and poor neighborhoods have higher access to fast-food restaurants in the United States? Health Place 2014 ; 29 : 10 – 17 . Majority race/ethnic group were specified, otherwise multiple race/ethnic groups were involved in the study. Inclusion criteria were: 1) an original study , 2) conducted in the United States, 3) focused on FF, 4) that reported results on people's perceptions, attitudes, knowledge, or beliefs about FF or FFC, 5) included healthy people without disease, and 6) had a sample size ≥100. Among the 6 studies reporting participants’ weight status, 1 study had all obese participants , and in the majority of the studies at least two-thirds of participants were either overweight or obese . Three studies reported data from low-SES populations . A single study collected data from public health clinic clients . Lorts C , Ohri-Vachaspati P . Eating behaviors among low-income obese adults in the United States: does health care provider's advice carry any weight . Prev Med 2016 ; 87 : 89 – 94 . Consumption of fast food is common in the United States and many other industrialized countries, and it has been increasing steadily in some developing countries as well owing to factors such as its convenience, low cost, consistent taste, easy access through a variety of restaurant chains, and the FF industry's marketing effort . A 2013 survey showed that about half of Americans reported eating at FF restaurants at least weekly , and ∼80% of adults went to FF restaurants at least once per month . FF is one of the major components of Americans’ diet, as about 11% of their calories are derived from fast food consumption among adults . Liu JL , Han B , Cohen DA . Beyond neighborhood food environments: distance traveled to food establishments in 5 US cities, 2009–2011 . Prev Chronic Dis 2015 ; 12 : E126 . Khan T , Powell LM , Wada R . Fast food consumption and food prices: evidence from panel data on 5th and 8th grade children . J Obes 2012 ; 2012 : 857697 . Xue H , Wu Y , Wang X , Wang Y . Time trends in fast food consumption and its association with obesity among children in China . PLoS One 2016 ; 11 : e0151141 . This study aimed to systematically examine Americans’ perceptions of FF, defined as their beliefs, attitudes, and knowledge regarding FF, and to assess how FF perceptions are related to FFC and obesity risk. Thornton LE , Lamb KE , Ball K . Employment status, residential and workplace food environments: associations with women's eating behaviours . Health Place 2013 ; 24 : 80 – 9 . Demographics of study subjects were heterogeneous in the 13 studies. Two studies targeted children . The range of mean age in the 11 other studies was from 34.9 y to 57.6 y. Except for 1 study , the studies included both males and females. Five studies were race/ethnicity-based: 2 studies included mostly African-Americans and Latinos , 3 studies were specifically composed of African Americans , whites , or first-generation Mexican immigrant Latinos , whereas 8 studies had diverse race/ethnic groups . Russell CA , Buhrau D . The role of television viewing and direct experience in predicting adolescents’ beliefs about the health risks of fast-food consumption . Appetite 2015 ; 92 : 200 – 6 . No published studies examined the association between FF perception and obesity risk. Some reported on diverse associations between Americans’ perceptions of FF and FFC . Several salient points emerged regarding FF and obesity risk factors. First, an individual's positive attitudes about FF may associate with a high level of FFC. People had more frequent FF intake when they thought of FF as convenient , and preferred having a kid's menu and play area . Americans who consumed less FF seemed more likely to view FF negatively. Those who ate FF least often were about 2 times more likely to report FF as “not good at all” than those who ate FF at least weekly . In addition, girls who reported barriers in time and taste to healthy eating compared with FF had more frequent consumption of FF than others. Having low self-efficacy to avoid fat or the unhealthfulness of FF were also predictors of frequent FF restaurant use . Those who attempted weight loss ate less FF , which indicated weight concerns surrounding FFC. However, health care provider's advice to lose weight among obese subjects was not associated with lower FFC . In another study, neither ease of access nor fastness of FF had a significant association with FFC among Latina women . The association between Americans’ perceptions of FF and FFC 1 Schioth HB , Ferriday D , Davies SR , Benedict C , Elmstahl H , Brunstrom JM , Hogenkamp PS . Are you sure? Confidence about the satiating capacity of a food affects subsequent food intake . Nutrients 2015 ; 7 : 5088 – 97 . In addition, different levels of FFC across age, gender, and race/ethnicity may indicate demographic differences in FF perceptions. Most of the studies consistently found that the young , males , African Americans and Hispanics , the employed , the unmarried , obese or physically inactive people , or people who were not attempting to lose weight were more likely to have higher FFC than old, female, white, unemployed, married, non-obese, or physically active people or people who were attempting to lose weight. In contrast, 1 study found a higher likelihood of weekly FFC in white compared with African American, Hispanic, and other race/ethnic groups ; but no significant sex difference in FFC among African Americans . Beydoun MA , Powell LM , Chen X , Wang Y . Food prices are associated with dietary quality, fast food consumption, and body mass index among U.S. children and adolescents . J Nutr 2011 ; 141 : 304 – 11 . Although some FF industries have altered their menus to include healthier options , their aggressive FF marketing via television, mobile devices, and social media promotes liking of FF, but not specifically healthier FF choices . Research suggests that heavy television viewing might lead to less negative and more positive beliefs about FF's health consequences . Compared with adults, children are more susceptible to frequent FFC owing to peer influence and impulsive actions . Also, subgroups of American adults who have the highest percentage of total energy intake from FF include young adults , non-Hispanic blacks , and obese individuals . Young non-Hispanic blacks have the greatest intake from FF, contributing 21% of their total energy intake. A longitudinal study in the United States reported that instead of FF availability, FF price had a significant effect on adolescents’ BMI . Another study reported that a 10% higher FF outlet density in the neighborhood indicated by zip code was associated with a 0.3% higher frequency of children's weekly FFC; but a 10% higher FF price resulted in 5.3% lower FFC . Overweight/obese people can be more vulnerable to the FF availability in their neighborhood than others regarding their FFC . Only overweight/obese children had a sensitivity to FF availability influencing their FFC compared with non-overweight children . Obese people may purchase more calories when they go to FF restaurants than non-overweight individuals do . Lee-Kwan SH , Park S , Maynard LM , Blanck HM , McGuire LC , Collins JL . Parental characteristics and reasons associated with purchasing kids’ meals for their children . Am J Health Promot 2018 ; 32 : 264 – 70 . Previous studies have noted that the presence of FF in the neighborhood was not associated with individuals’ FFC , although higher BMI was found among subjects living with FF restaurants in the neighborhood . Yet, 1 study found that FF outlet density in low-income neighborhoods was positively associated with FFC . The negative perception of other food environments was also associated with greater FFC . We speculate that the conflicting research findings could be due to several reasons. First, methodological issues in Oexle and colleagues’ study , e.g., the conventional study design, examining a selective overweight/obese population, and not a using rigid boundary for FFC near the home, could have biased the findings. Second, individual perceptions and awareness of food environments are not fully captured by GIS-based data . Third, results may indicate that perceiving a short distance to FF availability in the neighborhood is not the major factor Americans use to decide their amount of FFC. Compared with others in developing countries who were exposed to FF later, Americans are less sensitive to nearby FF availability . Also Americans’ typical food shopping behaviors by car may lead them to feel no barriers to visiting relatively faraway FF restaurants. A study found that Americans travel an average of 2.6 miles from home to food establishments . Beydoun MA , Powell LM , Wang Y . The association of fast food, fruit and vegetable prices with dietary intakes among US adults: is there modification by family income? Soc Sci Med 2008 ; 66 : 2218 – 29 . Nevertheless, to our knowledge, our study is the first to systematically examine people's perception of FF and its association with FFC in the United States, and provides useful insight into obesity intervention strategies considering FF. To improve research into Americans’ FF perception and its impact on FFC, future studies should use longitudinal study designs with representative samples to examine the causal relationship between FF perceptions and FFC, and directly measure Americans’ perceptions regarding FF. For example, questions should assess whether Americans think FFC is good or bad for health and should be limited, or whether Americans think frequent FFC increases the risk of obesity and reducing FFC helps with weight loss. As shown here, perceptions may be more proximal drivers of FFC behavior than external factors, such as FF availability. For example, changing the perceived importance of calorie counts on menus for weight loss strategies may be needed to complement the environmental changes of posting the information. This would allow for the development of behavioral intervention strategies regarding food choice dictated by positive/negative perceptions, knowledge and attitude, and food environment/prices. Seven studies examined reasons or personal factors for purchasing FF with multiple-choice or open-ended questions, regarding negative compared with positive attitudes/beliefs toward FF and related health concerns, such as 1) preferred convenience , 2) affordability , 3) good taste , 4) more fun and socializing opportunities than other eating places , and, on the other hand, 5) perceptions of FF as unhealthful , etc. However, these studies were unable to fully document the diverse perspectives of Americans’ FF perceptions in the studies owing to the limitations of survey questionnaires. National Institutes of Health . Systematic evidence reviews & clinical practice guidelines . Quality assessment tool for observational cohort and cross-sectional studies. . Available from: s/in-develop/cardiovascular-risk-reduction/tools/cohort . Fleischhacker SE , Evenson KR , Rodriguez DA , Ammerman AS . A systematic review of fast food access studies . Obes Rev 2011 ; 12 : e460 – 71 . We extracted information including study setting, study design and objective, sample characteristics , fast food journal articles FF definition in the study, level of FFC, assessment and level of attitudes, knowledge, beliefs, and perceptions of FF and its associations with FFC and obesity, while following PRISMA guidelines, into a standardized data extraction form. Two co-authors carried out the literature search and data extraction. Wang Y , Wang L , Xue H , Qu W . A review of the growth of the fast food industry in China and its potential impact on obesity . Int J Environ Res Public Health 2016 ; 13 : 1112 . Number of fast food perception studies by research focus and study design. Research focus. Sampling pool. Age group of study subjects. Main characteristics of the 13 studies regarding Americans’ perceptions of fast food and FF consumption 1 Wang Y , Chen X . How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults? J Am Diet Assoc 2011 ; 111 : 1904 – 11 . The majority of the 13 studies investigated Americans’ psychosocial factors/personal preference in FF purchases or perceived food environments , such as FF availability in the neighborhood. The link between weight loss attempts and individuals’ health concerns about FF with FFC were addressed in 3 studies. Two studies examined the association of nutrition knowledge with FFC. No studies directly compared obesity risk by different FF perceptions . Hillier-Brown FC , Summerbell CD , Moore HJ , Routen A , Lake AA , Adams J , White M , Araujo-Soares V , Abraham C , Adamson AJ , et al.  The impact of interventions to promote healthier ready-to-eat meals sold by specific food outlets open to the general public: a systematic review . Obes Rev 2017 ; 18 : 227 – 46 . Ahmed HM . Obesity, fast food manufacture, and regulation: revisiting opportunities for reform . Food Drug Law J 2009 ; 64 : 565 – 75 . FF perceptions among obese individuals may be critical for diet behavior change and weight loss efforts. One study showed that obese adults attempting to lose weight consumed less FF than those not trying to lose weight after adjusting for health care provider's advice to lose weight. However, health care provider's advice to lose weight had insignificant differences on obese individuals’ weekly FFC after adjusting for the respondent's weight loss attempts . These findings indicate that FFC was perceived as bad for weight loss among obese adults. It may be that receiving health care providers’ advice to lose weight is not associated with a further reduction in FFC among those who are trying to lose weight, as they already consume energy-dense foods less often. On the other hand, health care providers may not educate patients well about FF as a typical example of energy-dense food, since those having a health care provider's advice but no weight loss attempts did not show a significant difference in FFC in that study. Overall, the link between FFC, FF establishments, and other food restaurants/market options being reported seems inconsistent. One study reported higher FFC among those with a negative perception of the food environment, such as poor produce availability , supermarket accessibility , and grocery quality around the neighborhood . However, another study found that neither personal perception of FF restaurants in neighborhoods nor the Geographic Information System -based presence of FF outlets within 1 mile of home was associated with a higher weekly FFC . Powell LM . Fast food costs and adolescent body mass index: evidence from panel data . J Health Econ 2009 ; 28 : 963 – 70 . Brown WV , Carson JA , Johnson RK , Kris-Etherton P . JCL roundtable: fast food and the American diet . J Clin Lipidol 2015 ; 9 : 3 – 10 . Center for Young Women's Health . Fast food facts . . Available from: shealth.org/2013/12/05/fast-food/ . Jeffery RW , Baxter J , McGuire M , Linde J . Are fast food restaurants an environmental risk factor for obesity? Int J Behav Nutr Phys Act 2006 ; 3 : 2 . Only 3 studies directly accessed Americans’ perceptions of FF. None of the studies examined the association between FF perceptions and the risk of obesity. ↑, higher; ↓, lower; −, no significant difference; FF, fast food; FFC, fast food consumption; GIS, Geographical Information System. Elbel B . Consumer estimation of recommended and actual calories at fast food restaurants . Obesity 2011 ; 19 : 1971 – 8 . Main characteristics of the 13 studies regarding Americans’ perceptions of fast food and FF consumption 1 Bryant R , Dundes L . Fast food perceptions: a pilot study of college students in Spain and the United States . Appetite 2008 ; 51 : 327 – 30 . Mager DR , Mazurak V , Rodriguez-Dimitrescu C , Vine D , Jetha M , Ball G , Yap J . A meal high in saturated fat evokes postprandial dyslipemia, hyperinsulinemia, and altered lipoprotein expression in obese children with and without nonalcoholic fatty liver disease . JPEN J Parenter Enteral Nutr 2013 ; 37 : 517 – 28 .
The association between Americans’ perceptions of FF and FFC 1 Reported associations between beliefs about health consequences of FF and FFC were inconsistent by gender. One study reported that FFC was higher in individuals reporting positive perceptions about FF's impact on health . However, FFC did not differ by perceived health risks of FF in 2 cross-sectional studies among adolescents and adults , whereas the risk of more frequent FFC lowered with the degree of concern about health among girls in a longitudinal study . Oexle N , Barnes TL , Blake CE , Bell BA , Liese AD . Neighborhood fast food availability and fast food consumption . Appetite 2015 ; 92 : 227 – 32 . We thank Linda Nguyen for her assistance in helping to conduct some related literature search. All authors have read and approved the final manuscript. Our systemic review found that only a relatively small number of studies have examined Americans’ perceptions of FF, and only 1 was a longitudinal study. Some of them assessed how Americans’ perceptions about FF might associate with FFC, but none examined whether or not Americans’ perceptions of FF affect obesity risk. Americans had both positive and negative beliefs and attitudes about FF. However, thus far, only 1 study has reported such specific results; and it was based on a phone survey. Future studies are needed in this field. In conclusion, only a small number of studies have examined Americans’ perceptions of FF and their associations with FFC. None have examined how they might link to obesity risk. Americans have both negative and positive perceptions of FF, and are likely to purchase more FF as they valued the convenience and taste of FF, and preferred kid's menus and play areas in FF restaurants over other eating places. Those who consumed less FF seemed more likely to view FF negatively. Further studies with longitudinal study designs and standardized direct measures of FF perceptions are needed. We modified the NIH quality assessment tool for observational cohort and cross-sectional studies to assess the quality of each included study by 7 criteria according to the study characteristics. For each criterion, a score of 1 was assigned if “yes” was the response, whereas “0” was assigned otherwise . A study-specific global score, ranging from 0 to 7 , was calculated by summing scores across all criteria. This quality assessment helped to describe the strength of the scientific evidence, but was not used to determine the inclusion of studies . Boyland EJ , Nolan S , Kelly B , Tudur-Smith C , Jones A , Halford JC , Robinson E . Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults . Am J Clin Nutr 2016 ; 103 : 519 – 33 . Jungwon Min, Lisa Jahns, Hong Xue, Jayanthi Kandiah, Youfa Wang, Americans’ Perceptions about Fast Food and How They Associate with Its Consumption and Obesity Risk, Advances in Nutrition , Volume 9, Issue 5, September 2018, Pages 590–601, s/nmy032 Furthermore, perceived health benefits of FF were associated with higher FFC, although perceived health risks of FF did not result in a significant difference in FFC in 2 studies . One study concluded that educating the public about the health risks of FF may not bring either people's attention to or desired changes in dietary behavior . Not just the convenience, entertainment, and socializing opportunities of FF , but also Americans’ low self-efficacy to eat less fat and avoid the unhealthfulness of FF may influence FFC. However, African Americans and Latina women did not take into account low price , easy access, and fastness of FF when choosing a FF restaurant; instead the taste and familiarity of FF guided their choices. Fryer CD , Ervin RB . Caloric intake from fast food among adults: United States, 2007–2010 . NCHS Data Brief 2013 : 1 – 8 . Lucan SC , Mitra N . Perceptions of the food environment are associated with fast-food consumption: findings from multi-level models . Int J Public Health 2012 ; 57 : 599 – 608 . Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide FF is often made with ingredients such as high-fat meat, refined grains, and added sugar and fats and is high in sodium, saturated fat, and cholesterol, which are harmful to health . FF often contributes to higher energy intake compared with traditional food items . Multiple studies have found that frequent FFC is associated with elevated BMI and cholesterol, and increased risk for obesity, hypertension, and diabetes . As obesity is becoming a global public health crisis and has resulted in high health and economic costs , researchers have recommended avoiding frequent FFC . Number of fast food perception studies by research focus and study design. Research focus. Sampling pool. Age group of study subjects. Barnes TL , Freedman DA , Bell BA , Colabianchi N , Liese AD . Geographic measures of retail food outlets and perceived availability of healthy foods in neighbourhoods . Public Health Nutr 2016 ; 19 : 1368 – 74 . Supported in part by research grants from the US NIH , the Eunice Kennedy Shriver National Institute of Child Health & Human Development , the USDA Agricultural Research Service , and the National Aeronautics and Space Administration Mission X program. The content of the paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Our reviewed research findings have several limitations. The quality of the studies reviewed was relatively low, e.g., predominately based on convenience sampling, local, cross-sectional, and race/ethnicity-based study designs, which may bias the results due to under/overrepresentation of certain groups. Also, the definition of FF used varied across the studies, and some of the studies did not directly measure FF perceptions. Cross-sectional data cannot assess causal relationships. None of the studies examined the association between FF perception and obesity risk. Xue H , Cheng X , Zhang Q , Wang H , Zhang B , Qu W , Wang Y . Temporal growth and spatial distribution of the fast food industry and its relationship with economic development in China—2005–2012 . Prev Med 2017 ; 102 : 79 – 85 . Values are means ± SDs, unless otherwise indicated. #, frequency; FF, fast food; FFC, fast food consumption; IRR, incidence rate ratio; NR, not reported; OB, obese; OW, overweight; SSB, Sugar-Sweetened Beverages; SES, socioeconomic status. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Beydoun MA , Wang Y . How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults? Eur J Clin Nutr 2008 ; 62 : 303 – 13 . Braithwaite I , Stewart AW , Hancox RJ , Beasley R , Murphy R , Mitchell EA , the ISAAC Phase Three Study Group . Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study . BMJ Open 2014 ; 4 : e005813 . Richardson AS , Boone-Heinonen J , Popkin BM , Gordon-Larsen P . Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum . BMJ Open 2012 ; 2 : e000698 . Nutrition knowledge could influence Americans’ FF perceptions and consumption. About four-fifths of FF restaurant users have an incorrect estimation of daily caloric requirements . On the other hand, the mandatory menu labeling in FF restaurants in New York City increased the correct estimation for FF calories among consumers in a low-income neighborhood by 60%, although the correct rate was still low . The majority of individuals thought FF calorie labeling was important , and that FF calorie information should be posted on the menu next to the food items . Hardcastle SJ , Thogersen-Ntoumani C , Chatzisarantis NL . Food choice and nutrition: a social psychological perspective . Nutrients 2015 ; 7 : 8712 – 15 . We searched PubMed and Google terms and conducted title and abstract searches: fast food, intake, consumption, knowledge, attitude, belief, perception, obesity, overweight, weight, BMI, the United States, and America. We also consulted several experts in the field. The search yielded 169 titles. We reviewed the titles and abstracts to exclude duplicates and publications not related to the topic, which resulted in 69 publications. We then reviewed the full papers. Thirteen publications met our inclusion criteria, with 3 of them brought to our attention by experts we consulted . Dugan A . Fast food still major part of US diet . Gallup news . August 6, 2013 . Available from: s.gallup.com/poll/163868/fast-food-major-part-diet.aspx . Prentice AM , Jebb SA . Fast foods, energy density and obesity: a possible mechanistic link . Obes Rev 2003 ; 4 : 187 – 94 . Wang Y , Beydoun MA , Liang L , Caballero B , Kumanyika SK . Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic . Obesity 2008 ; 16 : 2323 – 30 . Mistry SK , Puthussery S . Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence . Public Health 2015 ; 129 : 200 – 9 . FF refers to foods that are mass-produced and can be served quickly. They often provide lower nutritional value and higher sugar, fat, or sodium content compared with other dishes. In these studies, the most common definition of FF was foods derived from FF restaurants such as McDonald's, Pizza Hut, Burger King, Kentucky Fried Chicken, Taco Bell, Wendy's, and other similar establishments , unlike Piron and colleagues who focused solely on McDonald's . The consumption of FF was measured through various FFQs or 5-point Likert scales. Studies reported FFC with a frequency of 1 wk, 1 mo, 3 mo, or 1 y. Percentages or mean number of FF meals per week were reported . Satia JA , Galanko JA , Siega-Riz AM . Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina . Public Health Nutr 2004 ; 7 : 1089 – 96 . Author disclosures: JM, LJ, HX, JK, and YW, no conflicts of interest. One study was a cohort study ; all others were cross-sectional studies. One study was a cohort study ; all others were cross-sectional studies. Some research suggests that individuals’ beliefs, attitudes, and knowledge, such as perceived barriers, self-confidence, or risks/benefits in dietary behaviors, statistically predict eating behavior ; those having strong confidence in diet control are less likely to consume high-calorie diets . Impulsive individuals prefer convenience meals more than health-conscious individuals , whereas those who pay more attention to food labels are more likely to consume a healthy diet. Yet, no study has systemically examined how Americans think about FFC, and whether they want to limit or continue their FFC, as reducing FFC has been recommended for preventing obesity. Differences in nutrition- and health-related attitudes, beliefs, and knowledge, including making informed food choices and awareness of nutrition-related health risks , could be implicated in high FFC in the United States. We aimed to systematically examine Americans’ perceptions of fast food and how these perceptions might affect fast food consumption and obesity risk. We searched PubMed and Google for studies published in English until February 17, 2017 that reported on Americans’ perceptions regarding FF as well as those on their associations with FFC and obesity risk. Thirteen articles met inclusion criteria. Limited research has been conducted on these topics, and most studies were based on convenience samples. A 2013 nationally representative phone survey of about 2000 subjects showed that one-fifth of Americans thought FF was good for health, whereas two-thirds considered FF not good. Even over two-thirds of weekly FF consumers thought FF not good. Americans seem to have limited knowledge of calories in FF. Negative and positive FF perceptions were associated with FFC. Those who consumed less FF seemed more likely to view FF negatively. When Americans valued the convenience and taste of FF and preferred FF restaurants with kid's menus and play areas, they were likely to purchase more FF. Available research indicates neither perceived availability of FF nor Geographical Information System -based FF presence in the neighborhood has significant associations with weekly FFC. No studies examined potential links between FF perceptions and obesity risk. Americans’ perceptions of FF and how they might associate with FFC and obesity risk are understudied. Considerable variation was observed in Americans’ perceptions and FFC. This PDF is available to Subscribers Only Dave JM , An LC , Jeffery RW , Ahluwalia JS . Relationship of attitudes toward fast food and frequency of fast-food intake in adults . is debating good for you