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Eating out instead of preparing food at home is making the global obesity epidemic worse, new research showed.

"One key finding that struck me is the high prevalence of food away from home (FAFH) consumption in some non-high-income countries (HIC), such as Benin and Togo in West Africa, and in small island developing states such as Vanuatu and Nauru," Mubarak Ayodeji Sulola, Heidelberg University, Germany, told Medscape Medical News.

"This finding challenges the narrative that FAFH is only a HIC phenomenon," said Sulola, who presented the findings in an abstract and poster at the 33rd European Congress on Obesity (ECO) 2026.

The literature on local food environments "suggests that FAFH may have fundamentally different meanings and dietary profiles across local context, he said. "In West Africa, this is potentially driven by a deeply ingrained cultural reliance on informal street food vendors, including both processed and traditional or unprocessed meals, whereas in Small Island Developing States, by a heavy dependence on imported processed foods."

Many Living With Overweight, Obesity

The researchers pooled cross-sectional individual-level datasets from 65 countries on 280,265 individuals who were at least 18 years old (51% women). Data spanned 2009 through 2021.They estimated the prevalence of respondents who self-reported at least one FAFH meal within a 7-day recall period at the global, country group, and county levels, and answered detailed questions about their consumption patterns. Answers were compared across sociodemographic factors such as income, sex, age, and level of education, as well as BMI across low-income (LIC), middle-income (MIC), and HIC countries. 

The analysis took into account population size and adjusted for country-specific characteristics such as local geography and cultural food norms. 

Overall, the researchers found a global FAFH consumption prevalence of 47.4%, but with a steep gradient, ranging from 30.1% in LICs to 83.4% in HICs. 

The average FAFH meal consumption in HICs (3.66) was more than three times higher than in LICs (1.05). 

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 United States, the 84% of adults who ate out at least once a week ate four meals away from home a week. Similarly, the 12% of adults in Timor-Leste who reported eating out at least once a week ate an average of three meals away from home per week.

Across all countries studied, FAFH consumption was consistently associated with being male, younger, unmarried, employed, and having a higher education across income groups. Also, a distinct wealth gradient was evident in non-HICs, where individuals in the highest wealth quintiles were more likely to be FAFH consumers. 

Notably, the researchers also found an association between eating out and living with overweight in LICs and with obesity in LICs, L-MICs, and HICs. 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. Similarly, in lower-middle-income countries, FAFH consumption frequency was 20% higher in those living with obesity.

The authors acknowledged 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. The analysis did not adjust for energy expenditure or physical activity level, which may be important confounders. 

Additionally, dietary data were self-reported and limited to meal counts rather than nutritional content and food sources, potentially underestimating true intake. Furthermore, the analysis was limited by a lack of comparable data across several parts of the world, including Western and Eastern Europe and Central America.

Nevertheless, they concluded, "FAFH consumption transitions from a marker of affluence in LICs to a ubiquitous behavioral norm in HICs. FAFH consumption remains a consistent driver of obesity across economic contexts, and public health interventions must address the out-of-home food sector as a critical leverage point for global obesity prevention, particularly as consumption rates continue to rise."

'All Hands on Deck'

"Given that existing research has shown that FAFH meals in many commercial food environments are energy-dense and high in sodium, sugar, and unhealthy fats, what people order matters just as much as how often they eat the FAFH meals," Sulola noted. "On the one hand, individuals need to be more vigilant about these issues and seek minimally processed, fresh options where possible. On the other hand, if local food environments are saturated with ultra-processed foods, making a healthy choice becomes incredibly difficult without broader policy changes."

"Ideally, we need all hands on deck, including national governments, public health bodies, and civil society, especially given historical examples of how food industry players have fallen short of self-regulation in pursuit of profit margins."

"For governments, the focal incentive is a matter of economic survival, considering that the skyrocketing healthcare costs associated with diet-related diseases like obesity and diabetes are unsustainable," Sulola said. "Once policymakers enforce mandatory standards, the food industry's incentive simply becomes compliance and maintaining market access."

Clinicians need to recognize that an individual's diet is also shaped by socioeconomic necessity, including the local food environment, he said. "Healthcare providers could help reduce the stigma and guilt often associated with obesity care by providing information on how to navigate specific local food options, rather than offering blanket advice that may not align with their environment."

No funding information was provided. Sulola declared no conflicts of interest. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.