Associations of food outlet exposure near secondary schools with food outlet use and unhealthy food intake during school time in England

Background Amid rising childhood obesity, local governments in England are introducing planning policies to restrict opening of new takeaways near schools. Extending the focus beyond outlets targeted by these policies, we analyse relationships between different types of food outlets near schools, food purchases and the intake of foods high in fat, sugar or salt (HFSS) during school time by adolescents aged 17–18 years. Methods The Diet and Eating Behaviours across Early Adulthood Transitions (DEBEAT) study collected data from students in the final year of school (Year 13) between September 2023 and April 2024 in England, the United Kingdom. Diet data were collected using three online 24-hour dietary recalls, with school and personal data reported by questionnaire. Exposures were counts of seven food outlet types within 400-metre buffers around school boundaries. Multilevel logistic regression analysed associations between exposure to each type of food outlet and two binary outcomes: 1) purchase of food from a food outlet as opposed to food obtained from elsewhere (e.g., home and school), and 2) eating occasions which had >50% of energy intake from HFSS foods, as opposed to those of ≤50% energy intake from HFSS foods, during school hours. Analyses were adjusted for exposure to other food outlet types, school characteristics, individual sociodemographic and health-related covariates. Results Our analyses included 1,245 individuals who attended 222 schools and reported data across 3,074 eating occasions within school hours. Of these eating occasions, 20% included food purchased from a food outlet, and 55% contained >50% energy from HFSS foods. Of the 222 schools, two thirds had at least one takeaway in the surrounding area, 55% a supermarket, and 30% a chain fast-food outlet. Only exposure to supermarkets was associated with greater odds of purchasing food from a food outlet: OR 1.61 (95% CI: 1.07, 2.42) for exposure to 1–2 supermarkets, compared to no supermarkets. Weak evidence suggested that greater exposure to either chain fast-food outlets (OR 1.40, 95% CI 0.90, 2.18 for exposure to ≥3 fast-food outlets) or takeaways (OR 1.13, 95% CI 0.73, 1.76 for exposure to >5 takeaways) was associated with increased odds of HFSS food intake. Conclusions Greater supermarket exposure near schools was associated with a higher probability of food outlet use during school time, but not with a higher likelihood of a high-HFSS eating occasion. Takeaway-focused planning policies do not fully address the range of outlets used by older adolescents for school-time food purchasing, particularly supermarkets.