Worldwide relation between the number of McDonalds restaurants

Letter to the Editor
doi: 10.1111/joim.12126
Worldwide relation between the number of McDonald’s
restaurants and the prevalence of obesity
Dear Sir,
Obesity is a worldwide health problem. Fast food is
widely considered to be responsible for obesity.
McDonald’s is a symbol of such fast food [1].
However, the global relation between fast food
availability and obesity is unclear [2]. The aim of
this study was to determine whether there is a
correlation between the number of McDonald’s
restaurants and the prevalence of obesity worldwide.
In total, 44 countries were included in the present
study. This group comprised the 20 most populated countries of the world, the five most populated countries of each continent and a few other
countries that were included in a recent nutritional study [3]. The number of McDonald’s restaurants per million inhabitants was calculated
for each of these countries (www.mcdonalds.com).
Countries were classified according to quartiles of
the number of Mac Donald’s restaurants per
million inhabitants. The proportion of overweight
persons according to each of these quartiles was
calculated using World Health Organization data
[4]. The correlation between the proportion of
overweight individuals and the number of McDonald’s restaurants per million inhabitants was
investigated.
The study population was approximately 5500
million, corresponding to 75% of the world population. A total of 31 045 McDonald’s restaurants
were located in these countries corresponding to
approximately 95% of the total number of McDonald’s restaurants in the world. There were between
0 and 45 (in the USA) McDonald’s restaurants per
million inhabitants. We found that there was a very
strong correlation between the number of McDonald’s restaurants and the proportion of overweight
individuals in the 44 countries (R2 = 0.95) (Fig. 1),
although we did not establish a causal relationship.
Indeed, worldwide Mac Donald’s restaurants
implantation probably follows a trend in alimentation behaviour changes. It is an accompaniment
of such changes. Consequently, the potential
impact of decreasing the number or even a total
Prevalence of overweight persons per quartile of number of
Mc Donald® restaurants per million inhabitants in 44 countries
0.3
y = 0.067x – 0.02
R² = 0.948
0.25
0.2
0.15
0.1
0.05
0
Q1
Q2
Q3
Q4
Fig. 1 Proportion of overweight individuals according to
quartiles of the number of McDonald’s restaurants per
million inhabitants in 44 countries.
lack of Mc Donald’s restaurants removal remains
unknown. Furthermore, this highly solid robust
relationship indicates that the number of Mc
Donald’s restaurants implantation is a strong
local indicator of obesity risk. Following this indicator could help to evaluate the onset obesity in a
given population.
Finally, other countries and other fast food restaurants, in addition to McDonald’s, should have been
included in the present study; however, it is highly
unlikely that this would have changed the overall
findings. Indeed, including 75% of the world population and 95% of McDonald’s restaurants was
likely to produce reliable results.
Conflict of interest statement
No conflict of interest was declared.
Authors’ contributions
FL designed the study and analysed the data, SM
collected the data, AA wrote the first draft of the
manuscript and KT and FA were responsible for
overseeing the study. All authors have seen and
approved the final version of the manuscript.
ª 2013 The Association for the Publication of the Journal of Internal Medicine
1
A. Alh
eriti
ere et al.
A. Alheritiere; S. Montois; M. Galinski; K. Tazarourte & F. Lapostolle
From the SAMU 93, Unit
e Recherche-EnseignementQualit
e, Universit
e Paris 13, Sorbonne Paris Cit
e, Bobigny,
France
References
1 McDonald D. Challenging Ronald: McDonald versus McDonald’s. J Paediatr Child Health 2012; 48: 103–5.
2 Shier V, An R, Sturm R. Is there a robust relationship between
neighbourhood food environment and childhood obesity in the
USA? Public Health 2012; 126: 723–30.
2
ª 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Letter to the Editor
3 Messerli FH. Chocolate consumption, cognitive function, and
Nobel laureates. N Engl J Med 2012; 367: 1562–4.
4 World Health Organization (WHO). World health statistics
2012 (www.who.int).
Correspondence: Fr
ed
eric Lapostolle MD, PhD, SAMU 93 – UF
Recherche-Enseignement-Qualit
e, Universit
e Paris 13, Sorbonne
Paris Cit
e, EA 3509, H^
opital Avicenne, 125, rue de Stalingrad,
93009 Bobigny, France.
(fax: + 33-1-48-96-44-93; e-mail: [email protected].
fr).