Type 2 Diabetes Increases in Areas With More Fast-Food Restaurants, Study Says

Food environments impact diabetes risk

Miodrag Ignjatovic/Getty Images

Key Takeaways

  • People who live in neighborhoods with many fast-food restaurants but few supermarkets are at greater risk of developing nutrition-related chronic diseases.
  • A new study looked at how food environments may impact the risk of developing type 2 diabetes.
  • Results showed that people in areas with more fast-food restaurants and fewer grocery stores have a higher risk of developing type 2 diabetes.

Past studies have shown that neighborhoods, where physical activity and healthy foods are readily available, are associated with reduced risk of type 2 diabetes. In a new study published in JAMA Network Open, researchers wanted to explore how the number of fast-food restaurants and supermarkets in a neighborhood may affect the risk of developing type 2 diabetes.

"We found that the availability of fast-food restaurants was associated with a higher risk of diabetes in all kinds of communities, including urban, suburban, or rural," says Rania Kanchi, a data analyst at New York University's Langone Medical Center, Department of Public Health, and one of the researchers on this study. "Supermarkets were associated with a lower risk of diabetes in suburban and rural communities."

Rania Kanchi

We found that the availability of of fast-food restaurants was associated with a higher risk of diabetes in all kinds of communities, including urban, suburban, or rural.

— Rania Kanchi

About the Study

The longitudinal cohort study included more than 4 million US veterans without type 2 diabetes, with a median age of approximately 59 years. Researchers compared the number of fast-food restaurants and supermarkets relative to other food outlets to get measures that they called "neighborhood food environments." Then they looked at the incidence of type 2 diabetes in different neighborhoods over time.

They found that neighborhoods with more fast-food restaurants were positively associated with a modestly increased risk of type 2 diabetes in all communities, whether urban or rural. And suburban and rural areas with more supermarkets saw a lower incidence of type 2 diabetes.

Lisa Andrews, MEd, RD, LD

When individuals lack easy access to nutritious, affordable food, they often must rely on fast-food restaurants or convenience stores to eat.

— Lisa Andrews, MEd, RD, LD

"The availability of food stores and restaurants in the neighborhood could potentially affect the kind of food people choose to eat, and thus could impact their risk of disease," explains Kanchi. 

Lisa Andrews, MEd, RD, LD, owner of Sound Bites Nutrition says she is not surprised by the results of this study. Neighborhoods with few supermarkets but many fast-food restaurants may negatively impact human health. These scenarios may lead to an intake of less nutritious, processed food while limiting access to and consumption of fruits and vegetables, whole grains, lean protein sources, and low-fat dairy products, she says.

"When individuals lack easy access to nutritious, affordable food, they often must rely on fast-food restaurants or convenience stores to eat," Andrews says. "The regular consumption of high-calorie, processed foods may lead to obesity or metabolic syndrome, which raise the risk for type 2 diabetes and other chronic illnesses."

Why Food Deserts Increase Diabetes Risk

Areas where there are few supermarkets but many fast-food restaurants are referred to as food deserts or food apartheid. Some people who live in these areas are low-income and may not have access to transportation to get to a supermarket.

"Food deserts usually occur in low-income communities in both big cities and rural towns scattered across the U.S.," says Cheryl Mussatto MS, RD, LD, a clinical dietitian at Cotton O'Neil Endocrinology Clinic in Topeka, Kansas, and blogger at

Mussatto explains that when there is only one grocery store in town, it limits the variety of food availability. Meanwhile, local restaurants are almost always fast-food chains serving typical American fare of large-portion sizes of foods high in fats, sugar, and sodium. 

"What ends up happening in food deserts is the residents usually buy the cheapest and most readily available foods—fatty, fried take-out, high-sodium prepared meals, candy, and soda," says Mussatto. "This way of eating sets up an unhealthy pattern of gaining excess weight putting people at a greater risk of serious chronic diseases such as type 2 diabetes."

Mussatto explains that in these situations, people who can least afford to get sick are also the most likely to suffer from chronic illness. ​

How to Improve Access to Nutritious Food

Improving access to nutritious meals in food deserts should be a national priority, and policy changes may be required to help dictate the number of fast-food restaurants and supermarkets in neighborhoods across America.

In the current study, the researchers conclude that tailored interventions are needed to target the availability of supermarkets. Meanwhile, restrictions on fast-food restaurants may help in all types of communities. Making small changes in different neighborhoods could have an impact on decreasing the risk of type 2 diabetes. 

"Increasing affordable healthy food options in supermarkets or improving transportation in suburban and rural communities could improve access to healthy food," says Kanchi. "Also, making healthier meal options more available in fast-food restaurants and policies like healthy beverage default laws could affect the choices people make when they eat out."

Innovative Ideas For Nutritious Food

Many people are working on solutions for areas experiencing food apartheid. Mussatto points to grassroots initiatives such as community gardens, food co-ops, and farmers' markets that are popping up in food deserts to increase access to nutritious food.

Andrews says she has seen an increase in Freedges, which are public refrigerators available for people to give, take and share perishable food. She has also seen communities set up mobile markets, where trucks visit food desert neighborhoods and sell fruit, vegetables, and other grocery items, often offering customers the option to pay with SNAP benefits.

"Some convenience stores have started stocking fresh fruit, low-fat yogurt, sandwiches,
and salads, but they are often priced higher than what would be found in a traditional
grocery store," says Andrews.

What This Means For You

Food choices make a difference in your risk of developing chronic nutrition-related diseases. If you live in an area with few supermarkets but many fast-food restaurants, look for options for access to nutritious foods. For instance, check if any mobile grocery trucks are available in your neighborhood or whether you may be able to join a community garden or food co-op through a local public health unit. You also can talk to a healthcare provider or registered dietitian for ideas on how to make nutritious choices in your situation.

3 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bilal U, Auchincloss AH, Diez-Roux AV. Neighborhood environments and diabetes risk and control. Curr Diab Rep. 2018;18(9):62. doi:10.1007/s11892-018-1032-2

  2. Kanchi R, Lopez P, Rummo PE, et al. Longitudinal analysis of neighborhood food environment and diabetes risk in the veterans administration diabetes risk cohort. JAMA Netw Open. 2021;4(10):e2130789. doi:10.1001/jamanetworkopen.2021.30789

  3. USDA Economic Research Service. Food Access Research Atlas.

By Cara Rosenbloom, RD
 Cara Rosenbloom RD is a dietitian, journalist, book author, and the founder of Words to Eat By, a nutrition communications company in Toronto, ON.