Associations of built environment and proximity of food outlets with weight status: Analysis from 14 cities in 10 countries (original) (raw)
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Neighbourhood typologies and associations with body mass index and obesity: A cross-sectional study
Preventive Medicine, 2018
Little research has investigated associations between the combined food and physical activity (PA) environment, BMI (body-mass-index) and obesity. Cross-sectional data (n=22,889, age 18-86 years) from the Yorkshire Health Study were used [2010-2013]. BMI was calculated using self-reported height and weight; obesity=BMI≥30. Neighbourhood was defined as a 2km radial buffer; food outlets and PA facilities were sourced from Ordnance Survey Points of Interest (PoI) and categorised into 'fast-food', 'large supermarkets', 'convenience and other food retail outlets' and 'physical activity facilities'. Parks were sourced from Open Street Map. Availability was defined by quartiles of exposure and latent class analysis (LCA) was conducted on these five environmental variables. Linear and logistic regression were then conducted for BMI and obesity respectively for different neighbourhood types. Models adjusted for age, gender, ethnicity, area-level deprivation, and rural/urban classification. A five-class solution demonstrated best fit and was interpretable. Neighbourhood typologies were defined as; low availability, moderate availability, moderate PA, limited food, saturated and moderate PA, ample food. Compared to low availability, one typology demonstrated lower BMI (saturated, b=-0.50, [95% CI=-0.76,-0.23]), while three showed higher BMI (moderate availability, b= 0.49 [0.27,0.72]; moderate PA, limited food, b=0.30 [0.01,0.59]; moderate PA, ample food, b=0.32 [0.08,0.57]). Compared to the low availability, saturated neighbourhoods showed lower odds of obesity (OR=0.86 [0.75,0.99]) while moderate availability showed greater odds of obesity (OR=1.18 [1.05,1.32]). This study supports population-level approaches to tackling obesity however neighbourhoods contained features that were healthpromoting and-constraining. Embracing environmental complexity will be an important next step for researchers and policymakers in providing healthy places.
Journal of Epidemiology & Community Health, 2007
To determine whether socioeconomic and food-related physical characteristics of the neighbourhood are associated with body mass index (BMI; kg/m 2) independently of individual-level sociodemographic and behavioural characteristics. Design and methods: Observational study using (1) individual-level data previously gathered in five crosssectional surveys conducted by the Stanford Heart Disease Prevention Program between 1979 and 1990 and (2) neighbourhood-level data from (a) the census to describe socioeconomic characteristics and (b) data obtained from government and commercial sources to describe exposure to different types of retail food stores as measured by store proximity, and count of stores per square mile. Data were analysed using multilevel modelling procedures. The setting was 82 neighbourhoods in agricultural regions of California. Participants: 7595 adults, aged 25-74 years. Results: After adjusting for age, gender, ethnicity, individual-level socioeconomic status, smoking, physical activity and nutrition knowledge, it was found that (1) adults who lived in low socioeconomic neighbourhoods had a higher mean BMI than adults who lived in high socioeconomic neighbourhoods; (2) higher neighbourhood density of small grocery stores was associated with higher BMI among women; and (3) closer proximity to chain supermarkets was associated with higher BMI among women. Conclusion: Living in low socioeconomic neighbourhoods, and in environments where healthy food is not readily available, is found to be associated with increased obesity risk. Unlike other studies which examined populations in other parts of the US, a positive association between living close to supermarkets and reduced obesity risk was not found in this study. A better understanding of the mechanisms by which neighbourhood physical characteristics influence obesity risk is needed.
Neighborhood Food Environment and Walkability Predict Obesity in New York City
Environmental Health Perspectives, 2008
Background: Differences in the neighborhood food environment may contribute to disparities in obesity. oBjectives: The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability. Methods: This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject's home address. results: Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km 2 , respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27-1.32] in the fifth quintile (10.98 stores/km 2 ) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78-0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73-0.96) and for land-use mix was 0.91 (95% CI, 0.86-0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity. conclusions: Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity. key words: neighborhood studies, obesity, retail food environment, walkability. Environ Health Perspect 117:442-447 (2009). doi:10.1289/ehp.11590 available via http://dx.doi.org/ [Online 2 October 2008]
BMC Public Health
Background Evidence on the association between the presence of fast-food outlets and Body Mass Index (BMI) is inconsistent. Furthermore, mechanisms underlying the fast-food outlet presence-BMI association are understudied. We investigated the association between the number of fast-food outlets being present and objectively measured BMI. Moreover, we investigated to what extent this association was moderated by neighbourhood socio-economic status (NSES) and healthy food outlets. Additionally, we investigated mediation by frequency of fast-food consumption and amount of fat intake. Methods In this cross-sectional study, we used baseline data of adults in Lifelines (N = 149,617). Geo-coded residential addresses were linked to fast-food and healthy food outlet locations. We computed the number of fast-food and healthy food outlets within 1 kilometre (km) of participants’ residential addresses (each categorised into null, one, or at least two). Participants underwent objective BMI measur...
From neighborhood design and food options to residents’ weight status
Appetite, 2011
This study examined associations of accessibility, availability, price, and quality of food choices and neighborhood urban design with weight status and utilitarian walking. To account for self-selection bias, data on adult residents of a middle-to-high-income neighborhood were used. Participants kept a 2-day activity/travel diary and self-reported socio-demographics, height, and weight. Geographic Information Systems data were used to objectively quantify walking-related aspects of urban design, and number of and distance to food outlets within respondents' 1 km residential buffers. Food outlets were audited for availability, price, and quality of healthful food choices. Number of convenience stores and in-store healthful food choices were positively related to walking for errands which, in turn, was predictive of lower risk of being overweight/obese. Negative associations with overweight/obesity unexplained by walking were found for number of grocery stores and healthful food choices in sit-down restaurants. Aspects of urban form and food environment were associated with walking for eating purposes which, however, was not predictive of overweight/obesity. Access to diverse destinations, food outlets and healthful food choices may promote pedestrian activity and contribute to better weight regulation. Accessibility and availability of healthful food choices may lower the risk of overweight/obesity by providing opportunities for healthier dietary patterns. ß
Perspectives in public health, 2016
Inconsistencies in methodologies continue to inhibit understanding of the impact of the environment on body mass index (BMI). To estimate the effect of these differences, we assessed the impact of using different definitions of neighbourhood and data sets on associations between food outlet availability within the environment and BMI. Previous research has not extended this to show any differences in the strength of associations between food outlet availability and BMI across both different definitions of neighbourhood and data sets. Descriptive statistics showed differences in the number of food outlets, particularly other food retail outlets between different data sets and definitions of neighbourhood. Despite these differences, our key finding was that across both different definitions of neighbourhood and data sets, there was very little difference in size of associations between food outlets and BMI. Researchers should consider and transparently report the impact of methodologi...
Obesity and Urban Environments
International Journal of Environmental Research and Public Health, 2019
Obesity is a major public health issue, affecting both developed and developing societies. Obesity increases the risk for heart disease, stroke, some cancers, and type II diabetes. While individual behaviours are important risk factors, impacts on obesity and overweight of the urban physical and social environment have figured large in the recent epidemiological literature, though evidence is incomplete and from a limited range of countries. Prominent among identified environmental influences are urban layout and sprawl, healthy food access, exercise access, and the neighbourhood social environment. This paper reviews the literature and highlights the special issue contributions within that literature.
Neighborhood Food Environments and Body Mass Index
Amer J Prev Med, 2009
Background-Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior. Purpose-This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents. Methods-Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelfspace to all unobserved stores in the area. Results-After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI.
Relation between local food environments and obesity among adults
BMC Public Health, 2009
Background: Outside of the United States, evidence for associations between exposure to fastfood establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around people's homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and people's homes.