Residential instability and obesity over time: the role of the social and built environment

Associations of Neighborhood Food Retail Environments with Weight Status in a Regional Pediatric Health System

Background: There have been mixed findings on the relationships between childhood obesity and macroscale retail food environments. The current study investigates associations of the neighborhood retail food environment with changes in children's weight status over 6 years in the Kansas City Metropolitan area. Methods: Anthropometrics and home addresses were collected during routine well-child visits in a large pediatric hospital (n = 4493; >75% were Black or Latinx children). Children had measures collected during two time periods ([Time 1] 2012-2014, [Time 2] 2017-2019). Establishment-level food environment data were used to determine the number of four types of food outlets within a 0.5-mile buffer from the children's residence: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Children who moved residences between periods were "movers" (n = 1052). Associations of baseline and changes in food environment status with Time 2 weight status were assessed using mixed-effects models. Results: Movers who experienced no change in the number of convenience stores or small grocery stores within a 0.5-mile of their home had increased likelihoods of having overweight/obesity and less favorable BMIz changes, compared with movers who experienced a decrease in convenience stores/small grocery stores within a 0.5-mile distance. No associations were observed among nonmovers. Conclusion: Findings suggest that moving to an area with fewer unhealthy retail food outlets (e.g., convenience stores) is associated with a lower risk of obesity in children. Future research is needed to determine whether larger-scale changes to the retail food environment within a neighborhood can support children's healthy weight.

Change in neighborhood socioeconomic status and childhood weight status and body composition from birth to adolescence

BACKGROUND

We aim to assess the associations between the change in neighborhood socioeconomic score (SES) between birth and 6 years and childhood weight status and body composition from 6 to 13 years.

METHODS

Data for 3909 children from the Generation R Study, a prospective population-based cohort in the Netherlands were analyzed. The change in neighborhood SES between birth and 6 years was defined as static-high, static-middle, static-low, upward, and downward mobility. Child body mass index (BMI), overweight and obesity (OWOB), fat mass index (FMI) and lean mass index (LMI) were measured at age 6, 10, and 13 years. The associations were explored using generalized estimating equations. The effect modification by child sex was examined.

RESULTS

In total, 19.5% and 18.1% of children were allocated to the upward mobility and downward mobility neighborhood SES group. The associations between the change in neighborhood SES and child weight status and body composition were moderated by child sex (p < 0.05). Compared to girls in the static-high group, girls in the static-low group had relatively higher BMI-SDS (β, 95% confidence interval (CI): 0.24, 0.09-0.40) and higher risk of OWOB (RR, 95% CI: 1.98, 1.35-2.91), together with higher FMI-SDS (β, 95% CI: 0.27, 0.14-0.41) and LMI-SDS (β, 95% CI: 0.18, 0.03-0.33). The associations in boys were not significant.

CONCLUSIONS

An increased BMI and fat mass, and higher risk of OWOB from 6 to 13 years were evident in girls living in a low-SES neighborhood or moving downward from a high- to a low-SES neighborhood. Support for children and families from low-SES neighborhoods is warranted.

The Urban Environment and Cardiometabolic Health

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Neighborhood Availability and Use of Food, Physical Activity, and Social Services Facilities in Relation to Overweight and Obesity in Children and Adolescents

OBJECTIVE

To evaluate the association of a combined measure of availability and use of facilities from the food environment and overweight (including obesity) among schoolchildren, while taking into account the physical activity and social-assistance environments.

METHODS

Cross-sectional study with a probabilistic sample of schoolchildren aged 7 to 14 years living in a southern Brazilian city (n = 2026). Multilevel analyses were performed with overweight as outcome and the food environment as main exposure. Models were adjusted for the physical activity and social-assistance environments, as well as individual and other residential neighborhood characteristics.

RESULTS

Greater availability of restaurants around the home was associated with higher odds of overweight (odds ratio [OR] = 1.40; 95% CI = 1.06-1.85). Stronger associations were found for schoolchildren reporting to use restaurants (OR = 1.48; 95% CI = 1.15-1.90). This association remained significant after adjusting for the presence of other food retailers. Schoolchildren who had social-assistance facilities around their homes, but reported not to use them, showed consistently higher odds of being overweight (OR = 1.34; 95% CI = 1.01-1.78) as compared to schoolchildren who had these facilities near home and used them. The physical activity environment was not associated with the outcome.

CONCLUSIONS

Availability and use of the food and social-assistance environments were significantly associated with overweight (including obesity) among the schoolchildren. Future research should consider the use of environmental facilities in combination to their geographical availability. Our results highlight the need for policies that limit the access to obesogenic food outlets by children and adolescents.

The built and social neighborhood environment and child obesity: A systematic review of longitudinal studies

The built and social neighborhood environment where a child lives has been increasingly studied as an exposure that may affect child weight long term. We conducted a systematic review of primary research articles published in 2011 through 2019 that reported results from longitudinal analyses of associations between neighborhood environment characteristics and child obesity or weight. Neighborhood environment measures included proximity to food stores, parks, and recreational facilities, walkability, crime, perceived safety, and social cohesion. Information on study population, exposure and outcome measures, and main results were extracted from 39 studies and results were presented for full cohorts and stratified by sex. Most studies were prospective cohorts (90%) with a median follow-up time of six years. Studies analyzing changes in the neighborhood versus changes in weight were less common than approaches analyzing baseline measures of the neighborhood environment in relation to obesity incidence or weight trajectories. Associations varied by sex, race/ethnicity, and age group. Within the food environment domain, the strongest evidence of adverse impact was for fast food restaurants but the effect was only apparent among girls. Results suggested green space, parks, and recreational facilities may have a beneficial effect on weight. Increased crime and low perceived safety may be risk factors for increased weight although not all studies were consistent. Standardization of measures across studies, investigation of multiple social and physical environment measures simultaneously, effect modification by demographic characteristics, and change in the environment vs change in weight analyses are needed to strengthen conclusions.

Longitudinal associations of neighborhood environment features with pediatric body mass index

INTRODUCTION

It has been posited that policies to promote child health and prevent obesity should target neighborhood environments but evidence on the impact of neighborhoods on child weight is conflicting and longitudinal studies (which have benefits for causal inference) are scarce.

METHODS

We used electronic health records (2007-2016) from an urban, pediatric integrated delivery system and linked children (N = 51,873, ages 6-19 years, 77% African American) to neighborhood-level data to investigate how changes in neighborhood environments relate to changes in body mass index (BMI). Measures of neighborhood environment were resources for healthy foods and physical activity ('resources'), greenness, violent crime rate, perceived safety and social cohesion. Fixed effects models estimated associations between changes in neighborhood environment exposures and changes in BMI z-score and whether effects differed by sex, baseline age, neighborhood socioeconomic status and population density.

RESULTS

Approximately 22% of the cohort was obese (BMI z-score ≥ 95th percentile). In adjusted models, increases in neighborhood greenness and perceived safety were associated with decreases in BMI z-score (mean change in BMI z-score for 1-SD increase for both: -0.012; 95% CI= (-0.018, -0.007)). Increases in neighborhood safety had a stronger effect in children ages 6-10 years than in older children. Increases in social cohesion were associated with increases in BMI z-score (mean change: 0.005 95% CI = (0.003, 0.008)) especially in boys. Increases in food and physical activity resources were not associated with changes in BMI.

CONCLUSIONS

This study suggests that increasing neighborhood greenness and safety are potential approaches to reduce children's BMI.

Changes in the Recreational Built Environment and Youth Body Mass Index

OBJECTIVE

Many cities have implemented programs to improve the recreational built environment. We evaluated whether neighborhood recreational built environmental changes are associated with change in body mass index (BMI).

METHODS

We performed a longitudinal assessment of association between the recreational built environment and BMI percent of 95th percentile (BMIp95). Patient data from 2012 to 2017 were collected from electronic medical records including height, weight, sex, race/ethnicity, insurance type, and address. BMIp95 was calculated. Environmental data including sidewalks, trails, Healthy Mile Trails, and parks were collected. Patients' neighborhood environments were characterized using proximity of features from home address. Multilevel linear regressions with multiple encounters per patient estimated effects of recreational features on BMIp95 and stratified models estimated effect differences.

RESULTS

Of 8282 total patients, 27.7% were non-Hispanic White, half were insured by Medicaid, and 29.5% changed residence. Median BMIp95 was 86.3%. A decrease in BMIp95 was associated with park proximity in the full cohort (-2.85; 95% CI [confidence interval]: -5.47, -0.24; P = .032), children with obesity at baseline (-6.50; 95% CI: -12.36, -0.64; P = .030) and privately insured children (-4.77; 95% CI: -9.14, -0.40; P = .032). Healthy Mile Trails were associated with an increase in BMIp95 among children without obesity (1.00; 95% CI 0.11, 1.89; P = .027) and children living in higher income areas (6.43; 95% CI: 0.23, 12.64; P = .042).

CONCLUSIONS

Differences in effect indicate that built environment changes may improve or exacerbate disparities. Improving obesity disparities may require addressing family-level barriers to the use of recreational features in addition to proximity.

Association between food, physical activity, and social assistance environments and the body mass index of schoolchildren from different socioeconomic strata

The aim of this article was to evaluate associations between body mass index (BMI) and use of and distance from subjects homes of elements of the food and physical activity environments and use of social assistance environment, in schoolchildren from 7 to 14 years living in Florianópolis (South Brazil), stratified by monthly family income. A cross-sectional study was conducted with a probabilistic sample of 2152 schoolchildren. Univariate and multivariate linear regression analyses were conducted to test for associations between BMI and the use of and distance from supermarkets, bakeries and farmers' markets; use of and distance from parks/playgrounds and football pitches; and use of health centers, Reference Centers for Social Assistance, instructional facilities, residents associations, religious groups and a Brazilian program for cash transfer. Overweight and obesity rates were 21.5 and 12.7%, respectively. Among schoolchildren from low-income families, living more than 11 min' walk from parks/playgrounds was associated with higher BMI (β = 0.53; 95% CI = 0.33-0.73). In the high-income strata, a longer distance from home to football pitches was associated with lower BMI (β = -0.49; 95% CI = -0.69; -0.29). Neither food nor social assistance environments were associated with BMI of schoolchildren, even when analyzed by income strata.

Residential mobility in early childhood and obesity at kindergarten age among children from the United States

BACKGROUND

Children who frequently move have poorer behavioural, emotional, and overall health. For similar reasons, the experience of changing home may contextualize children's risk for obesity. Few studies have assessed the relationship between residential mobility and obesity; even fewer explore this relationship with assessment of obesity before school age.

METHODS

We analysed data from the Early Childhood Longitudinal Study-Birth Cohort. Obesity at kindergarten age was determined from measured height and weight. Early childhood residential mobility was categorized as not moving or having moved once, twice, or three or more times. Analyses are weighted to be representative of children from the United States and variance estimates account for the complex survey design.

RESULTS

The prevalence of obesity at kindergarten age was 17.5%, and most children (71%) moved in early childhood. Compared with children who did not move, the adjusted odd ratios for obesity at kindergarten age were 0.72 (95% CI, 0.57-0.92), 0.70 (95% CI, 0.55-0.89), and 0.64 (95% CI, 0.50-0.84) for children who experienced 1, 2, or 3+ moves.

CONCLUSIONS

Our study suggests that obesity and mobility in early life are associated, but not in the way we might expect. Residential mobility may fit into a broader picture of instability and, on its own, may not elevate a child's risk for obesity.

Neighborhood Social Environment and Cardiovascular Disease Risk

Purpose of review

Limited physical activity (PA) and obesity are two primary risk factors for cardiovascular disease (CVD). Within a socio-ecological framework, neighborhood social environment may play a key role in influencing PA and obesity. However, the mechanisms underlying this relationship remain ambiguous. Our goals in this review are: (1) to summarize findings from the recent studies on neighborhood social environment in relation to PA and obesity as CVD risk factors, and (2) to briefly describe several innovative approaches to assessing neighborhood social environment.

Recent findings

Almost all recent studies assessed neighborhood social environment around residential areas. There were consistent associations between neighborhood social environment and PA and obesity, with some exceptions (indicating null associations or paradoxical associations). However, a focus on residential social environment may limit results because these studies did not account for any exposures occurring away from individuals' homes. Additionally, the majority of studies utilized a cross-sectional design, which limits our ability to make inferences regarding the causality of the association between social environment and PA or obesity as CV risk factors.

Summary

The majority of the studies on neighborhood social environment characterized factors around residential areas and assessed participant activity via self-reported surveys. Future research should leverage tools to account for the spatial mismatch between environmental exposures and outcomes by using global positioning systems, ecological momentary assessments, virtual neighborhood audits, and simulation modeling. These approaches can overcome major limitations by tracking individuals' daily activity and real-time perceptions of neighborhood social environments linked to CVD events.

Context Matters: Adolescent Neighborhood and School Influences on Young Adult Body Mass Index

PURPOSE

Both schools and neighborhoods play important roles in determining adolescent weight status, but little is known about their relative importance, particularly in predicting long-term weight outcomes. We assessed the impacts of both school and neighborhood socioeconomic composition, social connectedness, and built environment during adolescence on weight status in young adulthood.

METHODS

The study sample consisted of 14,625 respondents from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Data were analyzed using cross-classified multilevel modeling to examine the joint effect of adolescents' school and neighborhood predictors on body mass index (BMI) 13 years later.

RESULTS

Living in a neighborhood with lower average parent education during adolescence, and attending a school with lower average parent education, were each associated with higher BMI in young adulthood. Living in a neighborhood with more physical activity resources predicted lower young adult BMI, independent of adolescent weight, parent obesity status, and demographic characteristics. School physical activity resources and perceptions of social connectedness (in the school or neighborhood) were not significantly associated with young adult BMI.

CONCLUSIONS

These findings highlight the importance of school and neighborhood socioeconomic composition during adolescence on young adult weight status. Results also suggest that improving neighborhood infrastructure may promote healthy weight.

Body mass index and association with use of and distance from places for physical activity and active leisure among schoolchildren in Brazil. Cross-sectional study

BACKGROUND

We evaluated associations between use of public places for physical activity and active leisure (PAAL) and their distances from subjects' homes and indicators of overweight and obesity, among schoolchildren from different socioeconomic levels, in the city of Florianópolis, Brazil.

DESIGN AND SETTING

Cross-sectional study conducted on a sample of 2,152 schoolchildren aged 7 to 14 years, enrolled at 30 public and private schools.

METHODS

The exposure variables were the use of public places for PAAL in the neighborhood and their distance from schoolchildren's homes. The outcomes were body mass index (BMI) and waist circumference (WC). Univariate and multivariate linear regression analyses were conducted according to income strata.

RESULTS

Among the schoolchildren from low-income families, living closer to parks/playgrounds was associated with lower BMI (β = -2.15; 95% confidence interval, CI = -2.53; -1.77) and lower WC (β = -0.11 95% CI = -0.17; -0.05), while living at these distances from football pitches was associated with higher BMI (β = 1.73; 95% CI = 0.31; 3.15) and larger WC measurements (β = 0.03; 95% CI = 0.005; 0.14). Among the schoolchildren in low-income groups, living at an intermediate distance from beaches was associated with lower BMI (β = -1.10; 95% CI = -1.61; -0.59).

CONCLUSION

Living closer to parks/playgrounds was associated with lower BMI and WC among schoolchildren from low-income families. Living closer to football pitches was associated with higher BMI and WC among these schoolchildren. Living at intermediate distances from beaches was associated with lower BMI among these schoolchildren.

A Spatial Analysis of Body Mass Index and Neighborhood Factors in Community-Dwelling Older Men and Women

The spatial distribution of obesity among the older population can yield insights into the influence of contextual factors associated with this public health problem. We tested the relationship between neighborhood-level characteristics and body mass index (BMI) using global and local spatial statistics of geographic clustering, using data derived from a random-digit-dial sample of 5,319 community-dwelling adults aged 50 to 74 residing in 1,313 census tracts in New Jersey. Geographically weighted regression modeled associations between BMI clusters and neighborhood characteristics, including metrics of structure, safety, demographics, and amenities. Across the sample panel, average BMI was 28.62 kg/m(2) for women and 28.25 kg/m(2) for men. There was significant spatial clustering of obesity by census tract, varying by gender across the state. Neighborhood characteristics were more strongly related to BMI for women than men. This research illuminates the role of neighborhood contextual factors and will assist community planners, officials, and public health practitioners as they address the rise in obesity.