Neighborhood socioeconomic differences in BMI: The role of fast-food outlets and physical activity facilities

Effect of fast-food environments on children's eating behaviour: A random effect within between analysis within the Generation R Study

BACKGROUND

Focussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast-food environment and satiety responsiveness, enjoyment of food and food responsiveness.

METHODS

We used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4-10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual-level exposure to fast-food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent-reported Child Feeding Questionnaire (CFQ).

RESULTS

We did not find evidence of between-associations of fast-food exposure and eating behaviour subscales. Considering within-associations, an increase in absolute fast-food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00-0.03]). No moderation by parental restriction was found.

CONCLUSIONS

In environments with ubiquitous fast-food outlets, an increased exposure to fast-food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast-food exposure contributes to overweight.

Are area-level socioeconomic inequalities in obesity moderated by neighbourhood greenery?

BACKGROUND

Reducing socioeconomic inequalities in obesity is a public health priority. Limited research exists on the role of neighbourhood environmental attributes in mitigating these inequalities. However, it has been shown that neighbourhoods with more greenery tend to have lower levels of socioeconomic inequalities in non-obesity health outcomes. We examined whether neighbourhood greenery moderates the association of area-level socioeconomic status (SES) with waist circumference.

METHODS

Data from 3,261 middle-aged and older adults who participated in a national cohort study conducted in Australia (2011-12) were used. The outcome was objectively measured waist circumference. For area-level SES, a composite index of disadvantage based on census data was used. We used two measures of neighbourhood greenery: mean greenness and geographic size of greenspace. They were assessed using the Normalized Difference Vegetation Index (NDVI) within 0.5, 1, and 2 km radius buffers around participants' homes. The mean NDVI value within each buffer area was used for the former, and the geographic size of the area with NDVI ≥ 0.6 (dense greenery) was used for the latter.

RESULTS

There was a significant negative association between area-level SES and waist circumference: one standard deviation higher score in the area-level SES indicator (less disadvantage) was associated with 1.76 cm (95% CI: -2.68, -0.83) lower waist circumference. Analyses stratified by greenery levels found similar significant associations in the areas with low and high levels of greenery but not in the areas with medium levels of greenery for both greenery measures within 1 km and 2 km buffers.

CONCLUSIONS

Consistent with previous studies, our study found that participants living in disadvantaged suburbs were likely to have a larger waist circumference than those living in advantaged suburbs. However, we also found that such socioeconomic inequalities in obesity were mitigated in the areas with medium levels of greenery for this sample of Australian adults. Our findings suggest that there may be an optimum level of greenery where inequalities in obesity are alleviated. Further research is needed to understand the mechanisms underlying these findings.

Obesity and COVID-19 Pandemics: Epidemiology, Mechanisms, and Management

Obesity is a principle causative factor of various metabolic dysfunctions, chronic inflammation, and multi-organ impairment. The global epidemic of obesity has constituted the greatest threat to global health. Emerging evidence has associated obesity with an increased risk of severe infection and poor outcomes from coronavirus disease 2019 (COVID-19). During current COVID-19 pandemic, the interaction between COVID-19 and obesity has exaggerated the disease burden of obesity more than ever before. Thus, there is an urgent need for consideration of universal measures to reduce the risk of complications and severe illness from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in obesity population. In this review, we first summarized the clinical evidence on the effect of obesity on susceptibility, severity, and prognosis of COVID-19. Then we discussed and the underlying mechanisms, including respiratory pathophysiology of obesity, dysregulated inflammation, upregulated angiotensin-converting enzyme 2 (ACE2) expression, hyperglycemia, and adipokines. Finally, we proposed recommendations on how to reduce the spread and pandemic of SARS-CoV-2 infection by prevention and treatment of obesity.

Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes

Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity.