Fast Food, Health Impacts, and Policy Responses in China and India

Background: In China and India, the fast-food industry has rapidly expanded in the past three decades, alongside rising rates of overweight, obesity, and diet-related non-communicable diseases (NCDs). Both governments have implemented policy responses addressing fast-food-related health risks. Objectives: (1) Synthesize research on fast food's health impacts in China and India to assess the existing evidence base and compare reported health outcomes. (2) Compare the structure, scope, and effectiveness of policy responses in the two countries. Methods: A narrative review of peer-reviewed studies since 2010 was conducted. Studies were selected based on relevance to fast-food-related health outcomes and policy responses in China and India. In total, 52 peer-reviewed studies were selected. Grey literature was also used to document recent policy developments. Results: Health outcomes: China's evidence base includes longitudinal and quasi-causal studies, whereas India relies largely on large population analyses and school-based studies. In China, studies link fast-food exposure to childhood and adult obesity, cardiometabolic risks, and acute health outcomes. In India, studies report similar associations, including hypertension and diabetes. Marginalized groups, including migrant workers and pregnant women, are particularly vulnerable, reinforcing health inequities. Policy effectiveness: National policies in both countries prioritize education over binding regulation. Their effectiveness against fast-food consumption and diet-related NCDs is largely limited and, especially in India, under-researched. Regulations on fast-food sales, advertising, and mandatory front-of-package nutrition labels are either absent or face significant implementation challenges. China's centralized framework, Healthy China 2030, contrasts with India's more fragmented approach, which features multiple frameworks and some regulatory measures beyond education. Binding subnational interventions, including zoning laws and health taxes, have demonstrated effectiveness in reducing fast-food consumption. Conclusions: Educational policies alone are insufficient to curb the growing health impacts of fast-food consumption. Stronger, enforceable national regulations are needed to reshape food environments and reduce the growing burden of fast-food-related NCDs.