Kansas State University

MANHATTAN — A new study finds that when it comes to making healthy food choices at restaurants, location plays as much of a role in calories as what you eat.

Katie Heinrich, a Kansas State University assistant professor of kinesiology, is part of a recently published study in the American Journal of Health Behavior that looks at how restaurants' marketing and location influence food choices. Rebecca Lee, currently at Arizona State University, led the study, titled "Obesogenic and Youth Oriented Restaurant Marketing in Public Housing Neighborhoods." It was conducted in Kansas and Missouri.

Among their findings, researchers observed that roughly 75 percent of entrées at restaurants near housing developments contained too many calories and fats and not enough whole grains, fruits and vegetables.

"There is the thought that people are unhealthy because they make poor choices, and that can certainly be true," Heinrich said. "But there is a huge influence from the environment that people are in that goes beyond individual responsibility. Here we saw that 75 percent of the time it's going to be very easy to pick an unhealthy entrée from a menu because those unhealthy entrées make up the majority of a menu."

The study used data collected from fast-food and table-service restaurants located in an 800-meter radius of 13 housing developments and four residential neighborhoods in the Kansas City, Kan., and Kansas City, Mo., metropolitan areas. The housing developments and residential neighborhoods shared a similar number of restaurants — although fast-food restaurants made up the majority of the two.

Heinrich helped develop and administer the Restaurant Assessment Tool, or RAT, to comprehensively evaluate the menus of restaurants in the sampled neighborhoods and collect marketing data.

Information about some neighborhood residents, such as their body mass index, level of physical activity and nutritional habits, was also collected and analyzed. Data also showed that a majority of residents in the housing developments were primarily African American and had lower income levels. Residents provided the data in a separate study about smoking habits in housing developments.

In addition to finding that restaurants in housing developments had fewer options for healthy entrées, researchers found:

• Fast-food restaurants used more "point-of-purchase" advertising — in-store advertising that presented options to supersize meal items, toys with purchase, mascots and other tactics aimed at younger consumers.

• Table-service restaurants had more entrées and more healthy entrées than fast-food restaurants.

"This is important because if you go to a restaurant that has a few healthy choices and a lot of unhealthy choices, the chance of picking an unhealthy entrée increases significantly," Heinrich said. "There has been a lot of research looking at the 'food desert' concept in which healthy foods are less available or accessible in lower-income neighborhoods. In this study we found that both neighborhoods had equal access to foods, but that the quality of those available to public housing was much lower."

Heinrich said the reason for this large difference is that fast food restaurants outnumber table service restaurants in housing development neighborhoods. This imbalance can influence residents with financial constraints to spend their limited funds on unhealthy foods.

"I think that there is a delicate balance between trying to make healthy food choices and having your environment facilitate healthy choices," Heinrich said. "But if we don't set up environments where the majority of choices can potentially be healthy, it becomes much more likely that people are going to make unhealthy choices."

The American Heart Association's Heartland Affiliate funded the project.