Letter to the Editor

doi: 10.1111/joim.12126

Worldwide relation between the number of McDonalds restaurants and the prevalence of obesity
Dear Sir,
Obesity is a worldwide health problem. Fast food is widely considered to be responsible for obesity. McDonalds 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 McDonalds 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 ve most populated countries of each continent and a few other countries that were included in a recent nutritional study [3]. The number of McDonalds restaurants per million inhabitants was calculated for each of these countries (www.mcdonalds.com). Countries were classied according to quartiles of the number of Mac Donalds 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 McDonalds 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 McDonalds restaurants were located in these countries corresponding to approximately 95% of the total number of McDonalds restaurants in the world. There were between 0 and 45 (in the USA) McDonalds restaurants per million inhabitants. We found that there was a very strong correlation between the number of McDonalds 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 Donalds 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

0.3 0.25 0.2 0.15 0.1 0.05 0 y = 0.067x 0.02 R = 0.948

Prevalence of overweight persons per quartile of number of Mc Donald restaurants per million inhabitants in 44 countries

Q1

Q2

Q3

Q4

Fig. 1 Proportion of overweight individuals according to quartiles of the number of McDonalds restaurants per million inhabitants in 44 countries.

lack of Mc Donalds restaurants removal remains unknown. Furthermore, this highly solid robust relationship indicates that the number of Mc Donalds 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 McDonalds, should have been included in the present study; however, it is highly unlikely that this would have changed the overall ndings. Indeed, including 75% of the world population and 95% of McDonalds restaurants was likely to produce reliable results. Conict of interest statement No conict of interest was declared. Authors contributions FL designed the study and analysed the data, SM collected the data, AA wrote the rst draft of the manuscript and KT and FA were responsible for overseeing the study. All authors have seen and approved the nal version of the manuscript.

2013 The Association for the Publication of the Journal of Internal Medicine

A. Alh eriti ere et al.

Letter to the Editor

 Recherche-EnseignementFrom the SAMU 93, Unite  , Universite  Paris 13, Sorbonne Paris Cite  , Bobigny, Qualite France

A. Alh eriti ere; S. Montois; M. Galinski; K. Tazarourte & F. Lapostolle

3 Messerli FH. Chocolate consumption, cognitive function, and Nobel laureates. N Engl J Med 2012; 367: 15624. 4 World Health Organization (WHO). World health statistics 2012 (www.who.int).  de ric Lapostolle MD, PhD, SAMU 93 UF Correspondence: Fre , Universite  Paris 13, Sorbonne Recherche-Enseignement-Qualite , EA 3509, Ho ^pital Avicenne, 125, rue de Stalingrad, Paris Cite 93009 Bobigny, France. (fax: + 33-1-48-96-44-93; e-mail: frederic.lapostolle@avc.aphp. fr).

References
1 McDonald D. Challenging Ronald: McDonald versus McDonalds. J Paediatr Child Health 2012; 48: 1035. 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: 72330.

2013 The Association for the Publication of the Journal of Internal Medicine Journal of Internal Medicine