New research to be presented at this year's European Congress on Obesity (ECO 2026, Istanbul, Turkey, 12-15 May) suggests that no matter where people live, eating out instead of preparing meals at home is linked to weight gain and obesity.
Using nationally representative surveys in 65 countries [1], the study led by researchers from Göttingen University and Heidelberg University in Germany, underscores the need to look to the out-of-home food sector for reasons for, and solutions to, the obesity epidemic.
"Our findings suggest that eating away from home is consistently associated with obesity in low- and lower-middle-income countries, likely due to the ongoing nutrition transition in these countries, characterised by increasing accessibility of large portions of energy-dense foods in different food establishments," explained author Mubarak Sulola from Heidelberg University in Germany. "While eating out appears to be a marker of affluence in low-income countries, it has become the norm in high-income countries."
Consuming food and drinks prepared away from home (FAFH) by commercial establishments such as fast-food outlets is a key driver of the global obesity pandemic. Food prepared outside the home tends to be more processed and higher in salt, sugar, and unhealthy fats, and is associated with higher energy intake and higher body mass index (BMI).
However, most evidence to date is based on data from high-income countries (HICs), leaving a gap in knowledge for people in low- and middle-income countries (LMICs), where populations are more likely to experience coexisting forms of malnutrition, including micronutrient deficiencies and overweight or obesity.
To find out more, researchers analysed pooled individual-level data from nationally representative health surveys involving 280,265 adults (aged 18 or older, 51% female) in 65 countries conducted between 2009 and 2021 [2].
The survey participants had answered detailed questions about food consumption patterns, including recalling how many meals (breakfast, lunch, and dinner) they had eaten, which were prepared away from home in an average week. The answers were compared across sociodemographic factors such as income, sex, age, and level of education, as well as body-mass index (BMI) across low-, middle-, and high-income countries. The analysis took into account population size and adjusted for country-specific characteristics such as local geography and unique cultural food norms, to ensure that populations were accurately compared.
Almost half of adults worldwide eat out at least once a week
The analysis estimates that globally 47% of respondents consumed a FAFH meal at least once a week. However, the prevalence of FAFH varies widely across the globe, with 26% of adults reporting that they ate out at least once a week in the South East Asia region compared to 81% of respondents in the Americas (see figure 1 in full abstract). In central Europe, 36% of adults reported eating out at least once a week.
Overall, the average number of meals consumed out of home in HICs was over three times higher than in LICs (3.66 meals vs 1.06 meals).
However, among respondents who reported eating out at least once a week, the average number of meals away from home was similar (4.39 meals in HICs vs 3.51 meals in LICs). For example, in the USA, the 84% of adults reported eating out at least once a week, and on average they ate four meals away from home a week, compared to just 12% of adults in Timor Leste who reported eating out at least once a week, who on average had three meals away from home per week.
Across all countries studied, eating food away from home was driven by sex (males tended to eat out more frequently compared with women), by age (younger people being more likely to eat out), marital status (unmarried people tended to eat out more), employment status (workers being more likely to eat out), and by education (the most educated tending to eat out more frequently).
FAFH consumption frequency 39% higher in adults living with obesity
Importantly, the researchers also found a robust association between eating out and obesity. For example, respondents in LICs living with obesity had 39% higher rates of FAFH consumption than those with a normal body weight, while those living with overweight had 28% higher levels of FAFH consumption. Similarly, in lower-middle-income countries FAFH consumption frequency was 20% higher in those living with obesity.
Additionally, in LMICs, a distinct wealth gradient was evident, with adults in the highest income quintile more likely to eat out.
"In today's food environment, it's a challenge for people not to overeat and to choose foods that are nutritious and healthy," said senior author Professor Sebastain Vollmer from Göttingen University in Germany. "As the trend to eat out continues to rise around the world, public health interventions must target the out-of-home food sector as a critical leverage point for global obesity prevention."The authors acknowledge several limitations to the study, including its cross-sectional design, which cannot establish causal relationships, and the fact that some surveys were conducted as early as 2009. Additionally, the analysis did not adjust for energy expenditure or physical activity level, which may be important confounders. They also note that the analysis was limited by a lack of comparable data across several parts of the world, including Western and Eastern Europe and Central America. Additionally, dietary data were self-reported and limited to meal counts rather than nutritional content and food sources, potentially underestimating true intake.
