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To examine the relationship between local food environments and obesity and assess the quality of studies reviewed.

Systematic keyword searches identified studies from US and Canada that assessed the relationship of obesity to local food environments. We applied a quality metric based on design, exposure and outcome measurement, and analysis.

We identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross‐sectional. Associations between food outlet availability and obesity were predominantly null. Among non‐null associations, we saw a trend toward inverse associations between supermarket availability and obesity (22 negative, 4 positive, 67 null) and direct associations between fast food and obesity (29 positive, 6 negative, 71 null) in adults. We saw direct associations between fast food availability and obesity in lower income …