The Role of Dietary Habits in the Association Between Fast-Food Advertising and Childhood Obesity Among Urban School-Aged Children in Rawalpindi and Islamabad

Abstract

Rapid urbanization and increased media access have contributed to shifting dietary patterns among children in Pakistan. Childhood obesity is a growing public health concern in Pakistan, with fast-food advertising influencing children’s dietary behaviors. This study examined whether dietary habits mediate the relationship between exposure to fast-food advertising and childhood obesity among urban school-aged children in Rawalpindi and Islamabad. A cross-sectional analytical study was conducted with 246 parents of children aged 5–12 years using a structured questionnaire. Data were analyzed in SPSS using descriptive statistics, chi-square tests, and the PROCESS Macro (Model 4) for mediation. The chisquare test showed no significant association between advertising exposure and childhood obesity (χ²(3) = 0.122, p = 0.989). Mediation analysis indicated that advertising exposure significantly influenced unhealthy dietary habits (Path a: b = 1.3167, SE = 0.2340, p < 0.001), while dietary habits were not significantly associated with obesity (Path b: b = 0.0248, SE = 0.0771, p = 0.748). The direct effect of advertising on obesity was nonsignificant (c′ = –0.0510, p = 0.864), and the indirect effect (a×b = 0.0326, 95% CI: –0.1883 to 0.2598) was also nonsignificant. These findings suggest that advertising shapes eating behaviors but does not directly contribute to obesity outcomes, highlighting the need for parental guidance and stricter regulation of food marketing.