Built environment and change in body mass index in older women

Association of the built environment and neighborhood resources with obesity-related health behaviors in older veterans with hypertension

OBJECTIVE

To evaluate the association of the built environment and neighborhood resources with exercise, diet, and body mass index (BMI).

METHOD

Person-level data were collected from 533 veterans with uncontrolled hypertension. Neighborhood measures were: (a) census-tract level walkability; and (b) healthy food proximity (HFP). Robust or logistic regression (adjusting for age, race, education, comorbidity, and clustered by provider) was used to evaluate associations between neighborhood and exercise duration (hours/week), exercise adherence (% adherent), saturated fat index (0-10), Healthy Eating Index (HEI; 0-100), HEI adherence (≥ 74 score), stage of change (SOC) for exercise and diet (% in action/maintenance), BMI (kg/m²), and obesity (BMI ≥ 30 kg/m²).

RESULTS

The adjusted difference in HEI score (standard error [SE]) between the highest and lowest walkability tertiles was 3.67 (1.35), p = .006; the corresponding comparison for the saturated fat index was 1.03 (.50), p = .041 and BMI was -1.12 (.45), p = .013. The adjusted odds ratio (OR; 95% confidence intervals [CI]) between the highest and lowest walkability tertiles for HEI adherence was 2.16 [1.22, 3.82], p = .009 and for action/maintenance for exercise SOC was 1.78 [1.15, 2.76], p = .011. The adjusted difference (SE) between the highest and lowest HFP tertiles for exercise duration was .65 (.31), p = .03. The adjusted OR [95% CI] between the highest and lowest HFP tertiles for exercise adherence was 1.74 [1.08, 2.79], p = .023 and for action/maintenance for exercise SOC was 1.75 [1.10, 2.79], p = .034.

CONCLUSIONS

Geographical location is associated with exercise and diet. Environment-tailored health recommendations could promote healthier lifestyles and decrease obesity-related cardiovascular disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A comprehensive bibliometrics of 'walkability' research landscape: visualization of the scientific progress and future prospects

This study quantitatively investigated the scientific progress of walkability research landscape and its future prospects using bibliometric indicators to highlight the research hotspots. The results accentuated multifaceted nature of walkability research landscape with a strong association towards public health disciplines. Keyword co-occurrence analysis emphasized that majority of the walkability studies centred on the interactions between walking and other three main factors such as built environment attributes, transportation and obesity. Based on the identified research hotspots, a brief state-of-the-art review of walkability studies was presented. Future prospects based on the unexplored research gaps within the hotspots were also discussed. High correlation (r = 0.99, p < 0.05) between annual publications and citation counts demonstrated the significance of walkability studies to the contemporary scientific community. Being one of the comprehensive studies to evaluate the historic trajectory of walkability research landscape, the findings were expected to accelerate a comprehensive understanding of the walkability research domain that will assist future research direction.

Neighborhood Walkability and BMI Change: A National Study of Veterans in Large Urban Areas

OBJECTIVE

Improving neighborhood walkability has been proposed as a policy intervention to reduce obesity. The objective of this study was to evaluate longitudinal relationships between neighborhood walkability and body weight among adults living in large urban areas.

METHODS

In this retrospective longitudinal study of United States military veterans using Department of Veterans Affairs health care, Veterans Affairs clinical and administrative data (2007-2014) were linked to environmental measures constructed from public (2006-2014) and proprietary (2008-2014) sources, and linear regression models with person fixed effects were used to estimate associations between walkability and BMI among 758,434 men and 70,319 women aged 20 to 80 years in 2009 to 2014.

RESULTS

Neighborhood walkability was associated with small reductions in BMI. Effects were most pronounced among men aged 30 to 49 and 50 to 64. For women, differences were largest in the two youngest age groups, 20 to 29 and 30 to 49, though only estimates for all women combined were statistically significant. For women aged 30 to 49, effect sizes grew when the sample was limited to those who remained in the same neighborhood during the entire follow-up period.

CONCLUSIONS

Investments in the built environment to improve walkability may be a useful strategy for weight control in some segments of the adult population.

Adiposity and changes in movement-related behaviors in older adult women in the context of the built environment: a protocol for a prospective cohort study

Background

In older adults, sedentary behaviors increase while physical activity decreases over time following the compositional nature of 24-h behaviors. These changes in movement-related behaviors (MRBs) might be associated with unhealthy weight gain and several health comorbidities. However, information is lacking on how obesity influences longitudinal changes in the composition of MRBs in older adults. Furthermore, the moderating effect of the built environment on prospective associations between obesity and MRBs in older adults is not fully understood. Therefore, using an integrated time-use approach, this study aims to identify prospective associations between obesity and MRBs together with an assessment of the moderating effect of the built environment in elderly women.

Methods

The study was designed as a prospective 7-year follow-up study. It is based on two previous cross-sectional studies that enable the use of participant data (women aged 60+ years, n = 409) as a baseline dataset in the current study. All methods designed for 7-year follow-up are based on previous studies. The data collection comprises device-based measurement of MRBs (ActiGraph GT1M accelerometer), objective assessment of body adiposity (multi-frequency bioelectrical impedance analysis), subjective assessment of the built environment (NEWS-A questionnaire), and other possible confounding factors. Time spent in sedentary behavior, light physical activity, and moderate-to-vigorous physical activity will be used as three components in a composition reflecting individual MRBs. In linear multiple compositional regression analysis assessing the prospective association between obesity and MRBs, the 7-year follow-up composition of the three mentioned components represents the dependent variable. The 7-year changes in the percentage of body fat (body adiposity), baseline composition of MRBs, and parameters of the built environment represent regressors.

Discussion

This study will use an integrated time-use approach to explore causality from obesity to device-measured behaviors in older women. The design and respective analysis consider the compositional nature of MRBs data and the potential moderating effects of various factors. A comprehensive assessment of causality may help to develop multilevel interventional models that enhance physical activity in older adults.

The Role of Built Environment on Health of Older Adults in Korea: Obesity and Gender Differences

This study examines the effect of the built environment on obesity in older adults, taking into consideration gender difference. In this regard, we ask two questions: (1) How does the built environment affect obesity in older adults? (2) Is there a gender difference in the effect of the built environment? To examine the research questions, this study uses the 2015 Korean National Health and Nutrition Survey and geographically weighted regression (GWR) analysis. The empirical analyses show that environmental factors have stronger effects on local obesity rates for older men than for older women, which indicates a gender difference in obesity. Based on these findings, we suggest that public health policies for obesity should consider the built environment as well as gender difference.

Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study

Background

Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan.

Methods

We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged).

Results

We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults.

Conclusion

Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults’ weight status.

Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

The joint effects of family risk of obesity and neighborhood environment on obesity among women

Obesity is a significant health problem in the United States that has encouraged a search for modifiable risk factors, such as walkable neighborhood designs. Prior research has shown linkages between a family history of obesity (i.e., due to either genetic or non-genetic factors) and an individual's risk of elevated body mass index (BMI). Yet, we know little about the possible interactions between neighborhood walkability and family susceptibility to unhealthy BMI in predicting individual BMI. This paper addresses this important research gap using a sample of 9918 women, derived from vital and administrative data in the Utah Population Database. We use a novel indicator of familial risk (a summary measure of siblings' BMI) and a neighborhood walkability score to capture familial susceptibility and environmental exposures, respectively. The analysis focuses on distinct risk combinations of familial susceptibility and neighborhood walkability. Compared with the "best" combination of lean family BMI history and more walkable neighborhoods, women in all of the other three family weight history/neighborhood categories show greater risks of obesity. Our results also indicate that the neighborhood environment has a strong association with individual obesity among women with higher family risk of obesity but that the association between neighborhood environment and individual obesity is even stronger for women with a lower family risk of obesity.

Geographic variation in the relationship between body mass index and the built environment

Studies examining associations between weight status and neighborhood built environment (BE) have shown inconsistent results and have generally focused on urban settings. However, many Americans do not live in metropolitan areas and BE impacts may be different outside of metropolitan areas. We sought to examine whether the relationship between body mass index (BMI) and neighborhood BE exists and varies by geographic region across small towns in the United States. We conducted telephone surveys with 2156 adults and geographic information systems data in nine towns located within three geographic regions (Northeast, Texas, Washington) in 2011 and 2012. Multiple regression models examined the relationship between individual BMI and BE measures. Most physical activity variables were significantly associated with lower BMI in all geographic regions. We saw variation across geographic region in the relationship between characteristics of the BE variables and BMI. Some perceived and objectively-measured characteristics of the BE were significantly associated with adult BMI, but significant relationships varied by geographic region. For example, in the Northeast, perceived attractiveness of the neighborhood as a reason for why they chose to live there was associated with lower BMI; in Texas, the perceived presence of a fast food restaurant was negatively associated with BMI; in Washington, perceived presence of trees along the streets was associated with lower BMI. Our findings suggest that regional variation plays a role in the relationship between adult BMI and BE characteristics in small towns. Regardless of geographic location, interventions should encourage utilitarian walking and other forms of physical activity.

Neighborhood Walkability and Adiposity in the Women's Health Initiative Cohort

INTRODUCTION

Neighborhood environments may play a role in the rising prevalence of obesity among older adults. However, research on built environmental correlates of obesity in this age group is limited. The current study aimed to explore associations of Walk Score, a validated measure of neighborhood walkability, with BMI and waist circumference in a large, diverse sample of older women.

METHODS

This study linked cross-sectional data on 6,526 older postmenopausal women from the Women's Health Initiative Long Life Study (2012-2013) to Walk Scores for each participant's address (collected in 2012). Linear and logistic regression models were used to estimate associations of BMI and waist circumference with continuous and categorical Walk Score measures. Secondary analyses examined whether these relationships could be explained by walking expenditure or total physical activity. All analyses were conducted in 2015.

RESULTS

Higher Walk Score was not associated with BMI or overall obesity after adjustment for sociodemographic, medical, and lifestyle factors. However, participants in highly walkable areas had significantly lower odds of abdominal obesity (waist circumference >88 cm) as compared with those in less walkable locations. Observed associations between walkability and adiposity were partly explained by walking expenditure.

CONCLUSIONS

Findings suggest that neighborhood walkability is linked to abdominal adiposity, as measured by waist circumference, among older women and provide support for future longitudinal research on associations between Walk Score and adiposity in this population.

Path Analysis of Campus Walkability/Bikeability and College Students' Physical Activity Attitudes, Behaviors, and Body Mass Index

PURPOSE

The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students' body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators.

DESIGN

Cross-sectional.

SETTING

Thirteen university campuses.

PARTICIPANTS

A total of 1384 student participants.

MEASURES

Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA.

ANALYSIS

Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation.

RESULTS

The overall model fit was good with χ² of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = -.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = -.057).

CONCLUSIONS

The ease of walking and biking on a campus was related to college students' walking behavior and their BMI. Students' PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Research on neighborhood effects on health in the United States: A systematic review of study characteristics

Neighborhood effects on health research has grown over the past 20 years. While the substantive findings of this literature have been published in systematic reviews, meta-analyses, and commentaries, operational details of the research have been understudied. We identified 7140 multi-level neighborhoods and health papers published on US populations between 1995 and 2014, and present data on the study characteristics of the 256 papers that met our inclusion criteria. Our results reveal rapid growth in neighborhoods and health research in the mid-2000s, illustrate the dominance of observational cross-sectional study designs, and show a heavy reliance on single-level, census-based neighborhood definitions. Socioeconomic indicators were the most commonly analyzed neighborhood variables and body mass was the most commonly studied health outcome. Well-known challenges associated with neighborhood effects research were infrequently acknowledged. We discuss how these results move the agenda forward for neighborhoods and health research.

Obtaining Longitudinal Built Environment Data Retrospectively across 25 years in Four US Cities

BACKGROUND

Neighborhood transportation infrastructure and public recreational facilities are theorized to improve the activity, weight, and cardiometabolic profiles of individuals living in close proximity to these resources. However, owing to data limitations, there has not been adequate study of the influence of timing and placement of new infrastructure on health over time.

METHODS

This protocol details methods of the four cities study to perform retrospective field audits in order to capitalize on existing longitudinal health data from the coronary artery risk development in young adults (CARDIA) study. We developed and verified measures of recreation facilities (trails, parks) and transportation infrastructure (bus, light rail, bicycle parking, bicycle paths) in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA (USA). We identify introductions, renovations, and closures between 1985 and 2010 to develop measures of facility and infrastructure change. Ultimately, these data were linked to CARDIA sites' respondents' geographic locations over the 25-year study period to examine associations with health behaviors and outcomes.

RESULTS

Data available for retrospective audits was inconsistent by city, primarily due to record-keeping differences. We found large increases in bicycle infrastructure, with the exception of Birmingham, AL, USA. Excluding the addition of a new rail line in Minneapolis, MN, USA, few changes occurred in bus service, rail, and parks.

CONCLUSION

Our method represents innovation toward the collection of retrospective neighborhood data for use in longitudinal analyses. The data produced give insight into the way neighborhood infrastructure has changed over time and the potential relationship between these changes and health behaviors.

Spatial clustering of physical activity and obesity in relation to built environment factors among older women in three U.S. states

BACKGROUND

Identifying spatial clusters of chronic diseases has been conducted over the past several decades. More recently these approaches have been applied to physical activity and obesity. However, few studies have investigated built environment characteristics in relation to these spatial clusters. This study's aims were to detect spatial clusters of physical activity and obesity, examine whether the geographic distribution of covariates affects clusters, and compare built environment characteristics inside and outside clusters.

METHODS

In 2004, Nurses' Health Study participants from California, Massachusetts, and Pennsylvania completed survey items on physical activity (N = 22,599) and weight-status (N = 19,448). The spatial scan statistic was utilized to detect spatial clustering of higher and lower likelihood of obesity and meeting physical activity recommendations via walking. Clustering analyses and tests that adjusted for socio-demographic and health-related variables were conducted. Neighborhood built environment characteristics for participants inside and outside spatial clusters were compared.

RESULTS

Seven clusters of physical activity were identified in California and Massachusetts. Two clusters of obesity were identified in Pennsylvania. Overall, adjusting for socio-demographic and health-related covariates had little effect on the size or location of clusters in the three states with a few exceptions. For instance, adjusting for husband's education fully accounted for physical activity clusters in California. In California and Massachusetts, population density, intersection density, and diversity and density of facilities in two higher physical activity clusters were significantly greater than in neighborhoods outside of clusters. In contrast, in two other higher physical activity clusters in California and Massachusetts, population density, diversity of facilities, and density of facilities were significantly lower than in areas outside of clusters. In Pennsylvania, population density, intersection density, diversity of facilities, and certain types of facility density inside obesity clusters were significantly lower compared to areas outside the clusters.

CONCLUSIONS

Spatial clustering techniques can identify high and low risk areas for physical activity and obesity. Although covariates significantly differed inside and outside the clusters, patterns of differences were mostly inconsistent. The findings from these spatial analyses could eventually facilitate the design and implementation of more resource-efficient, geographically targeted interventions for both physical activity and obesity.

Built environment change and change in BMI and waist circumference: Multi-ethnic Study of Atherosclerosis

OBJECTIVE

To examine longitudinal associations of the neighborhood built environment with objectively measured body mass index (BMI) and waist circumference (WC) in a geographically and racial/ethnically diverse group of adults.

METHODS

This study used data from 5,506 adult participants in the Multi-Ethnic Study of Atherosclerosis, aged 45-84 years in 2000 (baseline). BMI and WC were assessed at baseline and four follow-up visits (median follow-up 9.1 years). Time-varying built environment measures (population density, land-use, destinations, bus access, and street characteristics) were created using Geographic Information Systems. Principal components analysis was used to derive composite scores for three built environment factors. Fixed-effects models, tightly controlling for all time-invariant characteristics, estimated associations between change in the built environment, and change in BMI and WC.

RESULTS

Increases in the intensity of development (higher density of walking destinations and population density, and lower percent residential) were associated with less pronounced increases or decreases over time in BMI and WC. Changes in connected retail centers (higher percent retail, higher street connectivity) and public transportation (distance to bus) were not associated with changes in BMI or WC.

CONCLUSIONS

Longitudinal changes in the built environment, particularly increased density, are associated with decreases in BMI and WC.

Is neighbourhood obesogenicity associated with body mass index in women? Application of an obesogenicity index in socioeconomically disadvantaged neighbourhoods

An aggregate index is potentially useful to represent neighbourhood obesogenicity. We created a conceptually-based obesogenicity index and examined its association with body mass index (BMI) among 3786 women (age 18-45y) in socio-economically disadvantaged neighbourhoods in Victoria, Australia. The index included 3 items from each of 3 domains: food resources (supermarkets, green grocers, fast food restaurants), recreational activity resources (gyms, pools, park space), and walkability (4+ leg intersections, neighbourhood walking environment, neighbourhood safety), with a possible range from 0 to 18 reflecting 0-2 for each of the 9 items. Using generalised estimating equations, neighbourhood obesogenicity was not associated with BMI in the overall sample. However, stratified analyses revealed generally positive associations with BMI in urban areas and inverse associations in rural areas (interaction p=0.02). These analyses are a first step towards combining neighbourhood characteristics into an aggregate obesogenicity index that is transparent enough to be adopted elsewhere and to allow examination of the relevance of its specific components in different settings.

Food environment, walkability, and public open spaces are associated with incident development of cardio-metabolic risk factors in a biomedical cohort

We investigated whether residential environment characteristics related to food (unhealthful/healthful food sources ratio), walkability and public open spaces (POS; number, median size, greenness and type) were associated with incidence of four cardio-metabolic risk factors (pre-diabetes/diabetes, hypertension, dyslipidaemia, abdominal obesity) in a biomedical cohort (n=3205). Results revealed that the risk of developing pre-diabetes/diabetes was lower for participants in areas with larger POS and greater walkability. Incident abdominal obesity was positively associated with the unhealthful food environment index. No associations were found with hypertension or dyslipidaemia. Results provide new evidence for specific, prospective associations between the built environment and cardio-metabolic risk factors.

Activity-Friendly Built Environment Attributes and Adult Adiposity

Physically-active and sedentary behaviors are determinants of adult weight gain and are associated with built-environment attributes. We reviewed recent evidence on built-environment attributes with adult adiposity. Of 41 relevant papers identified, 34 reported cross-sectional, six recorded prospective findings, and one included both cross-sectional and prospective designs. In 15 cross-sectional examinations of composite built environment indices (walkability; composite other), seven identified significant positive relationships in the expected direction; of 42 instances examining particular walkability elements (density, connectivity, land use mix), 13 were positive. Of 44 instances examining proximity of utilitarian and recreational destinations, there were 13 positive associations; and, of 41 instances examining pedestrian-environment attributes, 12 were positive. In the seven prospective studies, 20 sets of relationships were identified - nine were significant and in the expected direction. Evidence on built environment/adiposity relationships remains modest and could be strengthened through improvements in measurement methods and with further evidence from prospective studies.

Does change in the neighborhood environment prevent obesity in older women?

Neighborhood environment is consistently associated with obesity; changes to modifiable aspects of the neighborhood environment may curb the growth of obesity in the US and other developed nations. However, currently the majority of studies are cross-sectional and thus not appropriate for evaluating causality. The goal of this study was to evaluate the effect of a neighborhood-changing intervention on changes in obesity among older women. Over the past 30 years the Portland, Oregon metropolitan region has made significant investments in plans, regulatory structures, and public facilities to reduce sprawl and increase compact growth centers, transit-oriented development approaches, and green space. We used geocoded residential addresses to link data on land-use mix, public transit access, street connectivity, and access to green space from four time points between 1986 and 2004, with longitudinal data on body mass index (BMI) from a cohort of 2003 community-dwelling women aged 66 years and older. Height and weight were measured at clinic visits. Women self-reported demographics, health habits, and chronic conditions, and self-rated their health. Neighborhood socioeconomic status was assessed from census data. Neighborhood walkability and access to green space improved over the 18-year study period. On average there was a non-significant mean weight loss in the cohort between baseline (mean age 72.6 years) and the study's end (mean age 85.0 years). We observed no association between neighborhood built environment or change in built environment and BMI. Greater neighborhood socioeconomic status at baseline was independently associated with a healthier BMI at baseline, and protected against an age-related decline in BMI over time. BMI decreases with age reflect increased frailty, especially among older adults with complex morbidities. Future research should consider the influence of the neighborhood environment on additional relevant health outcomes and should include measures of the social environment in conjunction with built environment measures.