Social inequalities in the use of online food delivery services and associations with weight status: cross-sectional analysis of survey and consumer data

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Abstract

ABSTRACT

Background

Little is known about who uses online food delivery services and how use of these services is associated with social inequalities in food purchasing and diet-related health. This study explored associations between social position and use of online takeaway food and grocery delivery services, and its association with weight status.

Methods

Data were obtained from households in a consumer research panel living in London and the north of England (n=1521) in February 2019. Use of online grocery delivery services was determined via recorded purchases, and takeaway food delivery app use via survey responses. Social position was approximated through occupation-based social grade and household income. We used logistic regression to estimate the association between social position and use of online delivery services, and the relationship between online delivery service use and weight status.

Results

Overall, 13.2% of respondents used takeaway food delivery apps over a 7-day period and 15.6% of households used online grocery delivery services over a 4-week period. High-income households were more likely to use online grocery delivery services than low-income households (OR 2.01, 95% CI 1.22 to 3.34). In contrast, households with lower social grade were more likely to use takeaway food delivery apps compared with households in the highest grade (OR 2.31, 95% CI 1.38 to 3.87). While takeaway food delivery app use was positively associated with living with obesity (relative risk ratio 1.84, 95% CI 1.20 to 2.82), use of online grocery delivery services was not.

Discussion

Findings indicate that use of online food delivery services is patterned by markers of social position and weight status, which may lead to dietary inequalities. The potential impact of increased and differential usage of online delivery services on diet and dietary inequalities warrants further research.

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Most cited references 43

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Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Ashkan Afshin, Patrick John Sur, Kairsten A. Fay … (2019)

Summary Background Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity. Methods By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of disease-specific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome. Findings In 2017, 11 million (95% uncertainty interval [UI] 10–12) deaths and 255 million (234–274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs), low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs), and low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates. Interpretation This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually. Funding Bill & Melinda Gates Foundation.

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Obesity: preventing and managing the global epidemic. Report of a WHO consultation.

Society Obesity (2000)

Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.

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Eating out of home and its association with dietary intake: a systematic review of the evidence.

C Lachat, E Nago, R. Verstraeten … (2012)

During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer-reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross-sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Public Health

Journal ID (iso-abbrev): BMJ Public Health

Journal ID (hwp): bmjph

Journal ID (publisher-id): bmjph

Title: BMJ Public Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2753-4294

Publication date Collection: December 2024

Publication date (Electronic): 24 July 2024

Volume: 2

Issue: 2

Electronic Location Identifier: e000487

Affiliations

[1 ]departmentPopulation Health Innovation Lab , London School of Hygiene & Tropical Medicine , London, UK

[2 ]departmentMRC Epidemiology Unit , University of Cambridge , Cambridge, UK

[3 ]departmentDepartment of Psychology , University of Liverpool , Liverpool, UK

[4 ]departmentDepartment of Agri-Food Economics and Marketing , University of Reading , Reading, UK

[5 ]departmentPopulation Health Sciences, Bristol Medical School , University of Bristol , Bristol, UK

Author notes

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Additional supplemental material is published online only. To view, please visit the journal online ( https://doi.org/10.1136/bmjph-2023-000487).

None declared.

DrAlexandra IreneKalbus; alexandra.kalbus@ 123456lshtm.ac.uk

SC and AIK are joint first authors.

Author information

Alexandra Irene Kalbus http://orcid.org/0000-0002-7388-7074

Article

Publisher ID: bmjph-2023-000487

DOI: 10.1136/bmjph-2023-000487

PMC ID: 11816591

PubMed ID: 40018610

SO-VID: 69eb7f52-ed72-4d3c-aebf-228644576feb

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 August 2023

Date accepted : 16 May 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100022244, National Institute for Health Research Applied Research Collaboration West;

Funded by: UK Medical Research Council;

Award ID: MR/P021999/1

Funded by: FundRef http://dx.doi.org/10.13039/501100012349, School for Public Health Research;

Award ID: PD-SPH-2015

Funded by: ESRC;

Funded by: MRC Epidemiology Unit, University of Cambridge;

Award ID: MC_UU_00006/7

Funded by: FundRef http://dx.doi.org/10.13039/501100023699, Health Data Research UK;

Funded by: National Institute for Health and Care Research Policy Research Programme;

Funded by: BBSRC;

Award ID: BB/V004832/1

Funded by: FundRef http://dx.doi.org/10.13039/501100001921, Public Health Research Programme;

Funded by: National Institute for Health and Care Research Public Health Policy Research Unit;

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Social inequalities in the use of online food delivery services and associations with weight status: cross-sectional analysis of survey and consumer data

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Abstract

ABSTRACT

Background

Methods

Results

Discussion

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Karger: Nutrition and Dietetics

Most cited references 43

Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Obesity: preventing and managing the global epidemic. Report of a WHO consultation.

Eating out of home and its association with dietary intake: a systematic review of the evidence.

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