Are restaurants responsible for the obesity epidemic?

It has become almost the conventional wisdom that the obesity epidemic is at least partially attributable to people eating out. I for one really try and avoid eating out because I always feel like I end up eating junk food. But does this really matter? Do people actually eat more overall when they eat out more?

Economists Michael Anderson and David A. Matsa from UC Berkeley and Northwestern University respectively say no. In a working paper published last year, they argue that when people eat out they eat less at home -- resulting in only a tiny net gain in caloric intake.

To analyze the effects of restaurant access on obesity, the authors look at data from the Interstate Highway system. There are a lot of "highway towns" in America -- towns that grew up around a major highway and usually have large numbers of restaurants. The authors compared people living in these highway towns to their more rural neighbors who were located away from town. Though they found that their sample set contained two groups of people with substantially different access to restaurants, the obesity rates in the two samples were identical. Here is the key charts (Figures 1 and 2 from the paper):


Figure 1 shows the distributions of distances to the nearest restaurant for people living near or far away from the highway. You can see that people far away from the highway are not as close to a restaurant as those near a highway. (Presumably this has to do largely with the ability to get on the highway if you are not in a highway town and go to one.) Figure 2 shows the distribution of body mass indexes (a measure of obesity) for these groups. Note how the distributions are essentially identical.

(As an aside, I thought of one confound for this data, and I can't figure out whether they controlled for it. Maybe someone can read the paper more thoroughly and explain it to me. The confound is income. Maybe people who live closer to the highway have higher income. Given that people with low income have higher rates of obesity, the income effect may be masking the restaurant access effect.)

How can we explain this failure to see a difference in obesity with increased restaurant access? The authors then examine food intake data collected by the U.S. Department of Agriculture. The food intake data come from the Continuing Survey of Food Intake by Individuals, conducted from 1994 to 1996.

The authors wanted to establish how food intake in restaurants relates to food intake at home. They found that people substitute calories consumed at restaurants for calories consumed at home. This makes sense. If you go out to a restaurant, you aren't going to be hungry to eat at home:

If calories consumed throughout the day are substitutes, then our theoretical model suggests that people will compensate for larger portions at restaurants by consuming less throughout the rest of the day. Consistent with this prediction, the coefficient in the daily-level fixed effects regression is substantially less than the corresponding estimate at the meal-level. In fact, eating out increases daily intake by only 24 calories -- compared to an average caloric intake of 1,944 calories per day. This effect is statistically insignificant and represents a decline of almost 90 percent from the corresponding meal-level estimate. The result suggests that, although individuals tend to eat more at restaurants, they compensate to a substantial degree by eating less throughout the rest of the day. Meal-level estimates therefore overestimate the net effect of restaurants on total caloric intake.(Emphasis mine.)

How do we resolve this finding with the observation that restaurant food consumption correlates with obesity? The authors note that individuals who often eat at restaurants consume more both at home and at restaurants.

The between-individual coefficient is significantly larger than the fixed effects coefficient (235 versus 24), implying that individuals who frequent restaurants also eat more at home. This difference suggests that selection may explain why a number of observational studies have found a link between caloric intake and food away from home. Of course, even with individual fixed effects, the decision to eat at a restaurant is not exogenous. Given the size of restaurant portions, we suspect that consumers tend to eat at restaurants on days when they are hungrier. The 24 calorie per meal estimate therefore represents an upper bound and suggests that restaurant meals do not have a substantive causal effect on total caloric intake. (Emphasis mine.)

These findings if true have a great deal to say about obesity abatement policy. If it is indeed true that people will substitute calories consumed in restaurants for those at home and vice versa then sin taxes such as a restaurants tax will have little effect at reducing obesity rates. The whole issue has to do with the elasticity of demand for restaurant food. If demand for restaurant food then increases in prices will reduce quantity consumed but people will just get their food elsewhere -- likely in the same quantity.

The authors illustrate this problem with the calculation of the likely effects of a 50% restaurant tax. They point out to important effects. First, the tax will only moderately decrease the rates of obesity. Second, the cost of imposing such a tax, in terms of deadweight loss (the reduction in economic activity coming from the tax raising prices) and the loss of government revenue, would be significantly higher than the cost of paying for health care at the higher rates of obesity.

Next we compute a conservative estimate of the potential benefits of the restaurant tax to compare to the deadweight loss. The results from our natural experiment (presented in Section 5) suggest that taxing restaurant consumption would provide minimal benefit to public health. The point estimates, reported in Table 6, are close to zero and precisely estimated. To be conservative, assume that the effect of restaurant prices on body mass is one standard error greater than our point estimate (this corresponds to approximately the 85th percentile). In that scenario, a 50 percent tax would reduce the prevalence of overweight individuals by 1.3 percentage points -- compared to the 66 percent of Americans who were overweight in 2004. Using results from Finkelstein et al. (2003), a 1.3 percentage point decrease in the prevalence of overweight individuals reduces covered medical expenditures by $2.3 billion (reported in the second-to-last column of Table 8). The last column of Table 8 combines this estimate of the benefits with estimates of the deadweight loss from the previous paragraph to compute the ratio of the welfare costs to the potential benefits associated with a 50 percent restaurant tax. In all cases, the costs dominate the benefits, and the cost-benefit ratio ranges from 5.3-to-1 to 14.4-to-1.

While the deadweight loss associated with a tax policy is substantial, the deadweight loss associated with a zoning policy against restaurants, such has those proposed in New York City and Los Angeles, is likely even greater. With a tax policy, the government recaptures all of the out-of-pocket price increase from consumers. But with zoning regulations, only part of the effective price increase is recaptured by nearby firms while the rest is dissipated in increased time and fuel expenditures by consumers who travel further to access their nearest restaurant and wait in longer lines when they arrive.

I think the authors make a good point in emphasizing that regulators responsible for obesity abatement policy often have difficulty getting the public to comply with how their regulations are intended to work. Ban this food, and people will eat some other (and probably just as bad food). Limit access, and people will drive farther. Tax restaurants, and people will eat junk food at home. This is tough stuff.

I am not posting this to suggest that the government can have no effect on obesity through public health policy, but I do think that a bit of reticence and humility will be required in projecting the positive consequences of such policies.

The authors state their conclusions here:

At this point, many policymakers and public health advocates have shifted to designing policies intended to reduce the impact of restaurants on obesity, even while they acknowledge that convincing evidence of such a link has proven elusive. For example, the FDA recently organized a forum in which participants focused on proposing implementable solutions to the challenge of obesity in the context of away-from-home foods, even while the organizers cautioned that "there does not exist a conclusive body of evidence establishing a causal link between the availability or consumption of away-from-home foods and obesity" (Keystone 2006).

Our findings indicate that the causal link between the availability of restaurant foods and obesity is minimal at best. Manipulating the distance to the nearest restaurant using Interstate Highway proximity as an instrument demonstrates that restaurants have no significant effect on BMI or overweight status. These results are precisely estimated and robust to different specifications and samples. Translating the distance measure into an economic cost, point estimates imply that a 50 percent reduction in restaurant prices would have no positive effect on the prevalence of overweight individuals. Even the extreme tail of a 95 percent confidence interval implies that this policy would not reduce the overweight prevalence by more than 4.6 percentage points (while 66 percent of Americans were overweight in 2004). Similar conclusions hold when using BMI or an obese indicator as the outcome of interest.


These results, combined with work in the context of traffic safety (Peltzman 1975) and tobacco (Adda and Cornaglia 2006), suggest that regulating specific inputs into the health and safety production functions can be ineffective when optimizing consumers can compensate along other margins. Although restaurants conveniently deliver calories at a low marginal cost, they are only one source among many. The same principle may apply to other targeted obesity interventions as well. For example, two recent large-scale, multi-state randomized trials of school-based programs that improved the nutritional content of cafeteria meals found no effect on student weight (Nader et al. 1999; Caballero et al. 2003). One principal investigator notes, in retrospect, that the intervention could not control what the children ate outside of school (Kolata 2006). Future research and policy proposals may find greater success if it is designed to account for the optimizing behavior of the targeted subjects.(Emphasis mine.)

Hat-tip: and Marginal Revolution

More like this

Earlier this month, the DC City Council passed the Healthy Schools Act, which will raise nutritional standards for school meals, increase the amount of physical and health education students receive, create school gardens, and do all kinds of other commendable things. The difficult part is that it'…
Castro's Cuba has seen a precipitous drop in obesity rates and in the deaths associated with cardiovascular risk: Cuba's economic crisis of 1989-2000 resulted in reduced energy intake, increased physical activity, and sustained population-wide weight loss. The authors evaluated the possible…
Five million dollars. That’s how much the fast food industry spends every day to peddle largely unhealthy foods to children. And because studies have found that exposure to food marketing does indeed make kids want to eat more, advertising is often tapped as an obvious way to address child obesity…
There is an interesting discussion going on at the Becker-Posner blog about obesity abatement. Richard Posner talks about the NY ordinance requiring that calorie counts of food be prominently labeled fast food restaurants: The significance of the New York City ordinance lies in its requiring that…

this is plausible. the caloric intake of the average american isn't THAT high...if we were farmers or something. it's the activity level. in any case, i think you should link to a term like deadweight loss when mentioning it...the wiki chart is very illuminating.

Done. For those who don't understand deadweight loss, you really should read the link.

This is a little surprise to me. I eat less at home because I am in control of the quantities. I find that restaurant portions are much larger than I would like, but childhood conditioning (in my case, the children in Bangladesh coupled with food rationing following WWII) makes it difficult for me to leave any food on my plate.

By Gray Gaffer (not verified) on 03 Jun 2008 #permalink

Ok, so I am biased the moment you said a pair of economists studied this problem. I don't trust economists when it comes to nutrition.

If I understand you correctly the researchers are saying that proximity to highways correlates to how often you eat out. Has this actually been shown? This has to be a false assumption.

1,944 Calories/day is on the low side of calorific intake. Also the food intake data was from 1994-1996; portion sizes in restaurants have grown since then and so might not be so accurate.

I always get a big enough portion to take home enough for another meal. "Clean plate club" or not, I can't finish it. Clearly, lots of people can.

Reading this article I kept thinking that surely no sensible person could think that eating at restaurants was making people fat when Fast Food is so obviously a more serious culprit. I am assuming that I have run into some linguistic issue and that "Restaurants" here refers to Fast Food outlets as well as, er, what I would call Restaurants where they have cloth serviettes and proper crockery and cutlery and frown at you when you don't order wine?
Otherwise I'm really confused.

"...the observation that restaurant food consumption correlates with obesity"

What observation? You said at the top of the post that it was conventional wisdom, which is true, it's one of the many many stereotypes about fat people. I don't know of any actual observations (studies) that correlate restaurant food consumption with obesity.

Considering that JUST one breakfast sandwich can equal the total recommended daily caloric intake and JUST one specialty burger can equal THREE X RDCI, toss in the fries & milkshakes, add decreased activity levels & you'll end up with one FAT MF! (No matter where you live)

By Healthy Living (not verified) on 05 Jun 2008 #permalink

@ephant - I had the same problem. I assume is the same usage as in "McDonalds Family Restaurant", something I've never heard anyone use in real life unless they worked for McDonalds or were being sarcastic.