van Erpecum CPL, van Zon SKR, Bültmann U, et al. - In urban and rural areas, an association was found between fast-food outlet exposure within 1 km from the residential address and body mass index (BMI).

• Unhealthy food environments could contribute to an increased BMI.

• This cross-sectional study involved adult Lifelines Cohort participants (n = 147,027) to investigate the link between residential fast-food outlet exposure and BMI in the Dutch adult general population, as well as to know the extent to which this link is altered by urbanisation level.

• The mean BMI was 26.1 (SD 4.3) kg/m ² , and a higher BMI was evident in relation to having two or more (urban areas) or five or more (rural areas) fast-food outlets within 1 km.

• A higher BMI was recorded in participants in urban and rural areas with a fast-food outlet within <250 m.

• Fast-food outlet exposure within 500 m was found to be related to a higher BMI in rural areas.