Associations between the built environment and obesity: an umbrella review

The association of obesogenic environments with weight status, blood pressure, and blood lipids: A cross-sectional pooled analysis across five cohorts

In this observational cross-sectional study, we investigated the relationship between combined obesogenic neighbourhood characteristics and various cardiovascular disease risk factors in adults, including BMI, systolic blood pressure, and blood lipids, as well as the prevalence of overweight/obesity, hypertension, and dyslipidaemia. We conducted a large-scale pooled analysis, comprising data from five Dutch cohort studies (n = 183,871). Neighbourhood obesogenicity was defined according to the Obesogenic Built-environmental CharacterisTics (OBCT) index. The index was calculated for 1000m circular buffers around participants' home addresses. For each cohort, the association between the OBCT index and prevalence of overweight/obesity, hypertension and dyslipidaemia was analysed using robust Poisson regression models. Associations with continuous measures of BMI, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were analysed using linear regression. All models were adjusted for age, sex, education level and area-level socio-economic status. Cohort-specific estimates were pooled using random-effects meta-analyses. The pooled results show that a 10 point higher OBCT index score was significantly associated with a 0.17 higher BMI (95%CI: 0.10 to 0.24), a 0.01 higher LDL-cholesterol (95% CI: 0.01 to 0.02), a 0.01 lower HDL cholesterol (95% CI: -0.02 to -0.01), and non-significantly associated with a 0.36 mmHg higher systolic blood pressure (95%CI: -0.14 to 0.65). A 10 point higher OBCT index score was also associated with a higher prevalence of overweight/obesity (PR = 1.03; 95% CI: 1.02 to 1.05), obesity (PR = 1.04; 95% CI: 1.01 to 1.08) and hypertension (PR = 1.02; 95% CI: 1.00 to 1.04), but not with dyslipidaemia. This large-scale pooled analysis of five Dutch cohort studies shows that higher neighbourhood obesogenicity, as measured by the OBCT index, was associated with higher BMI, higher prevalence of overweight/obesity, obesity, and hypertension. These findings highlight the importance of considering the obesogenic environment as a potential determinant of cardiovascular health.

Neighbourhood walkability and greenspace and their associations with health-related fitness in urban dwelling Canadian adults

OBJECTIVE

Muscular strength and body composition are important components of health-related fitness (HRF). Grip strength and body fat percent, in particular, are associated with chronic disease and affected by health behaviours. Evidence suggests relationships between the neighbourhood built environment (BE) and HRF exist, however, few studies have focused on grip strength and body fat percent. Therefore, our study aimed to estimate the sex-specific associations between the neighbourhood BE, grip strength, and body fat percent among urban-dwelling Canadian adults.

METHODS

We analyzed cross-sectional survey and HRF data collected in 2011-2015 from 4052 males and 7841 females (Alberta's Tomorrow Project, Canada). Grip strength and body fat percent were measured via handgrip dynamometry and bioelectrical impedance analysis, respectively. Walkability (Canadian Active Living Index) and greenness (Normalized Difference Vegetation Index) estimates were linked to participant data. Sex-stratified covariate-adjusted linear regression models estimated the associations between the BE and HRF variables.

RESULTS

Walkability was negatively associated with grip strength and body fat percent in males (β -0.21, 95%CI: -0.31 to -0.11 and β -0.08, 95%CI: -0.15 to -0.02, respectively) and females (β -0.06, 95%CI: -0.10 to -0.01 and β -0.08, 95%CI: -0.14 to -0.02, respectively). Greenness was positively associated with grip strength in males (β 6.99, 95%CI: 3.62 to 10.36) and females (β 2.72, 95%CI: 1.22 to 4.22) but not with body fat percent. Controlling for physical activity and sitting did not attenuate these associations.

CONCLUSION

Characteristics of the neighbourhood BE appear to be associated with muscular strength and body composition, independent of physical activity and sedentary behaviour.

Co-occurrence of obesogenic behaviors and their implications for mental health during the COVID-19 pandemic: a study with university students

BACKGROUND

The university years are a critical period for young adults, as they are more exposed to obesogenic behaviors and experience stressful situations that compromise their mental health. This study aims to estimate the prevalence of anxiety and depression symptoms and evaluate the association between the combined occurrence of obesogenic behaviors among university students.

METHODS

A cross-sectional study was conducted on students from a public university in Brazil during the COVID-19 pandemic. Data were collected from July to August 2020 using an online questionnaire. The outcome variables (anxiety and depression symptoms) were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). The co-occurrence of obesogenic behaviors was measured based on irregular consumption of fruits and vegetables, frequent consumption of ultra-processed foods, physical inactivity during leisure time, and sedentary behavior. A Venn diagram was used for the exploratory analysis. To verify the association between the outcome and explanatory variables, a directed acyclic graph model was constructed, and multivariate logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs).

RESULTS

A total of 1,353 students aged 18-24 years participated in this study. Symptoms of anxiety and depression were present in 46.1% and 54.6% of the participants, respectively. The most prevalent combination of obesogenic behaviors was frequent consumption of ultra-processed foods, physical inactivity during leisure time, and sedentary behavior (17.2%). The greater the number of simultaneous obesogenic behaviors, the higher the chance to present symptoms of anxiety [OR: 2.81 (95%CI: 1.77-4.46)] and depression [OR: 3.46 (95%CI: 2.20-5.43)].

CONCLUSION

These findings reinforce the need to take actions to promote mental health in the university environment in conjunction with programs to promote a healthy lifestyle and improve the physical and mental well-being of students.

Exposome-Wide Association Study of Body Mass Index Using a Novel Meta-Analytical Approach for Random Forest Models

BACKGROUND

Overweight and obesity impose a considerable individual and social burden, and the urban environments might encompass factors that contribute to obesity. Nevertheless, there is a scarcity of research that takes into account the simultaneous interaction of multiple environmental factors.

OBJECTIVES

Our objective was to perform an exposome-wide association study of body mass index (BMI) in a multicohort setting of 15 studies.

METHODS

Studies were affiliated with the Dutch Geoscience and Health Cohort Consortium (GECCO), had different population sizes (688-141,825), and covered the entire Netherlands. Ten studies contained general population samples, others focused on specific populations including people with diabetes or impaired hearing. BMI was calculated from self-reported or measured height and weight. Associations with 69 residential neighborhood environmental factors (air pollution, noise, temperature, neighborhood socioeconomic and demographic factors, food environment, drivability, and walkability) were explored. Random forest (RF) regression addressed potential nonlinear and nonadditive associations. In the absence of formal methods for multimodel inference for RF, a rank aggregation-based meta-analytic strategy was used to summarize the results across the studies.

RESULTS

Six exposures were associated with BMI: five indicating neighborhood economic or social environments (average home values, percentage of high-income residents, average income, livability score, share of single residents) and one indicating the physical activity environment (walkability in 5 -km buffer area). Living in high-income neighborhoods and neighborhoods with higher livability scores was associated with lower BMI. Nonlinear associations were observed with neighborhood home values in all studies. Lower neighborhood home values were associated with higher BMI scores but only for values up to € 300,000 . The directions of associations were less consistent for walkability and share of single residents.

DISCUSSION

Rank aggregation made it possible to flexibly combine the results from various studies, although between-study heterogeneity could not be estimated quantitatively based on RF models. Neighborhood social, economic, and physical environments had the strongest associations with BMI. https://doi.org/10.1289/EHP13393.

Association between Young People's Neighbourhoods' Characteristics and Health Risk Factors in Saudi Arabia

INTRODUCTION

A neighbourhood's environmental characteristics can positively or negatively influence health and well-being. To date, no studies have examined this concept in the context of Saudi Arabian youth. Therefore, this study aimed to evaluate the association between a neighbourhood's environmental characteristics and health risk factors among Saudi Arabian youth.

METHODS

A total of 335 secondary-school students (175 males, 160 females), aged 15-19 years old, participated. Body mass index (BMI) and waist circumference measurements were taken, and physical activity (steps) was measured via pedometer. The perceived neighbourhood environment was assessed using the International Physical Activity Questionnaire Environment Module (IPAQ-E).

RESULTS

Significant differences were found between the youths from urban, rural farm, and rural desert locations in terms of BMI, waist circumference, daily steps, accessibility, infrastructure, social environment, household vehicles, safety, and access to facilities (p < 0.001). Rural desert youths were less active, and males (26.43 + 8.13) and females (24.68 + 5.03) had higher BMIs compared to the youths from other areas. Chi-square analysis revealed a significant difference (χ21 = 12.664, p < 0.001) between the genders as to social-environment perceptions. Males perceived their neighbourhood as a social environment more than was reported by females (68.39% and 50.28%, respectively). Pearson's correlation revealed negative significant relationships between steps and both safety of neighbourhood (r = -0.235, p < 0.001) and crime rate (r = -0.281, p < 0.001).

DISCUSSION

Geographical location, cultural attitudes, lack of facilities, and accessibility impact youth physical-activity engagement and weight status; this includes environmental variables such as residential density, neighbourhood safety, household motor vehicles, and social environment.

CONCLUSIONS

This is the first study examining associations with neighbourhood environments in the youths of the Kingdom of Saudi Arabia. Significant associations and geographical differences were found. More research and policy interventions to address neighbourhoods' environmental characteristics and health risk factors relative to Saudi Arabian youth are warranted.

Neighborhood physical environments and change in cardiometabolic risk factors over 14 years in the study of Women's health across the nation

BACKGROUND

Neighborhood physical environments may influence cardiometabolic health, but prior studies have been inconsistent, and few included long follow-up periods.

METHODS

Changes in cardiometabolic risk factors were measured for up to 14 years in 2830 midlife women in the Study of Women's Health Across the Nation, a multi-ethnic/racial cohort of women from seven U.S. sites. Data on neighborhood food retail environments (modified Retail Food Environment Index) and walkability (National Walkability Index) were obtained for each woman's residence at each follow-up. Data on neighborhood access to green space, parks, and supermarkets were available for subsets (32-42%) of women. Models tested whether rates of change in cardiometabolic outcomes differed based on neighborhood characteristics, independent of sociodemographic and health-related covariates.

RESULTS

Living in more (vs. less) walkable neighborhoods was associated with favorable changes in blood pressure outcomes (SBP: -0.27 mmHg/year, p = 0.002; DBP: -0.22 mmHg/year, p < 0.0001; hypertension status: ratio of ORs = 0.79, p < 0.0001), and small declines in waist circumference (-0.09 cm/year, p = 0.03). Small-magnitude associations were also observed between low park access and greater increases in blood pressure outcomes (SBP: 0.37 mmHg/year, p = 0.003; DBP: 0.15 mmHg/year, p = 0.04; hypertension status: ratio of ORs = 1.16, p = .04), though associations involving DBP and hypertension were only present after adjustment for sociodemographic variables. Other associations were statistically unreliable or contrary to hypotheses.

CONCLUSION

Neighborhood walkability may have a meaningful influence on trajectories of blood pressure outcomes in women from midlife to early older adulthood, suggesting the need to better understand how individuals interact with their neighborhood environments in pursuit of cardiometabolic health.

Meta-analysis investigating the impact of the LEPR rs1137101 (A>G) polymorphism on obesity risk in Asian and Caucasian ethnicities

Obesity is a chronic condition which is identified by the buildup of excess body fat caused by a combination of various factors, including genetic predisposition and lifestyle choices. rs1137101 (A > G) polymorphism in the CHR1 domain of LEPR protein linked to different diseases including obesity. Nevertheless, the connection between this polymorphism and the likelihood of developing obesity has not been determined definitively. Therefore, a meta-analysis was conducted to assess the relationship between rs1137101 and the risk of obesity. The meta-analysis included all studies meeting pre-defined criteria, found through searching databases up until February 2023. A combined odds ratio with a 95% confidence interval was estimated as overall and in continent subgroups for homozygous, heterozygous, recessive, dominant and allelic models using the fixed or the random-effects model. The meta-analysis identified 39 eligible studies with cases and controls (6099 cases/6711 controls) in 38 articles under different ethnic backgrounds. The results indicated a significant relationship between rs1137101 and the likelihood of developing obesity in each of the genetic models [the homozygous model (GG vs. AA: 95% Confidence Interval = 1.12-1.73, Odds Ratio = 1.39, P value = 0.003); the heterozygous model (AG vs. AA: 95% Confidence Interval = 1.07-1.42, Odds Ratio = 1.23, P value = 0.005); the dominant model (AG/GG vs AA: 95% Confidence Interval = 1.10-1.49, Odds Ratio = 1.28, P value = 0.001); the recessive model (GG vs AA/AG: 95% Confidence Interval = 1.02-1.45, Odds Ratio = 1.21, P value = 0.03); and the allelic model (G vs A; 95% Confidence Interval = 1.07-1.33, Odds Ratio = 1.19, P value = 0.002)] tested. Additionally, with an FDR <0.05, all genotypic models demonstrated statistical significance. The association remained significant among subgroups of Asian and Caucasian populations, although analysis in some genetic models did not show a significant association. Begg's and Egger's tests did not show publication biases. In sensitivity analysis, one particular study was found to have an impact on the Recessive model's significance, but other models remained unaffected. The current meta-analysis found significant indications supporting the association between rs1137101 and obesity. To avail a deeper understanding of this association, future research should include large-scale studies conducted in diverse ethnic populations.

Effects of changes in residential fast-food outlet exposure on Body Mass Index change: longitudinal evidence from 92,211 Lifelines participants

BACKGROUND

Evidence on the association between fast-food outlet exposure and Body Mass Index (BMI) remains inconsistent and is primarily based on cross-sectional studies. We investigated the associations between changes in fast-food outlet exposure and BMI changes, and to what extent these associations are moderated by age and fast-food outlet exposure at baseline.

METHODS

We used 4-year longitudinal data of the Lifelines adult cohort (N = 92,211). Participant residential addresses at baseline and follow-up were linked to a register containing fast-food outlet locations using geocoding. Change in fast-food outlet exposure was defined as the number of fast-food outlets within 1 km of the residential address at follow-up minus the number of fast-food outlets within 1 km of the residential address at baseline. BMI was calculated based on objectively measured weight and height. Fixed effects analyses were performed adjusting for changes in covariates and potential confounders. Exposure-moderator interactions were tested and stratified analyses were performed if p < 0.10.

RESULTS

Participants who had an increase in the number of fast-food outlets within 1 km had a greater BMI increase (B(95% CI): 0.003 (0.001,0.006)). Decreases in fast-food outlet exposure were not associated with BMI change (B(95% CI): 0.001 (-0.001,0.004)). No clear moderation pattern by age or fast-food outlet exposure at baseline was found.

CONCLUSIONS

Increases in residential fast-food outlet exposure are associated with BMI gain, whereas decreases in fast-food outlet exposure are not associated with BMI loss. Effect sizes of increases in fast-food outlet exposure on BMI change were small at individual level. However, a longer follow-up period may have been needed to fully capture the impact of increases in fast-food outlet exposure on BMI change. Furthermore, these effect sizes could still be important at population level considering the rapid rise of fast-food outlets across society. Future studies should investigate the mechanisms and changes in consumer behaviours underlying associations between changes in fast-food outlet exposure and BMI change.

Walking to work: The role of walkability around the workplace in a Dutch adult commuting population

Current evidence on neighborhood walkability and active commuting focuses on residential rather than workplace environment. This cross-sectional study investigated whether higher workplace walkability (WW) was associated with commute walking, both independently and together with residential walkability, using data from 6769 respondents of the 2017 Dutch national travel survey. In a fully adjusted logistic regression model, 10% increase in WW was associated with 32% higher odds of commute walking (Odds ratio (OR): 1.31, 95% Confidence Interval (CI: 1.27-1.36). The estimates were stronger in rural dwellers than urban residents, (ORrural 1.49, 95%CI: 1.34-1.64 vs ORhighly.urban 1.19, 95%CI: 1.13-1.26). In participants with both high residential walkability and WW, we observed 215% higher odds (OR 3.15, 95% CI: 2.48-3.99) of commute walking compared to those with low walkability in both. Our study indicated the importance and complementary nature of walkable residence and workplace in contribution to physical activity of working individuals through active commuting.

Breaking prolonged sitting increases 24-h physical activity and self-perceived energy levels but does not acutely affect cognition in healthy adults

INTRODUCTION

It is unknown whether predetermined (un)interrupted sitting within a laboratory setting will induce compensatory changes in human behaviours (energy intake and physical activity) once people return to a free-living environment. The effects of breaking up prolonged sitting on cognition are also unclear.

METHODS

Twenty-four (male = 13) healthy participants [age 31 ± 8 y, BMI 22.7 ± 2.3 kg/m2 (mean ± SD)] completed 320 min mixed-feeding trials under prolonged sitting (SIT) or with 2 min walking at 6.4 km/h every 20 min (ACTIVE), in a randomised crossover design. Human behaviours were recorded post-trial under free-living conditions until midnight. Cognitive performance was evaluated before and immediately after SIT and ACTIVE trials. Self-perceived sensations (appetite, energy and mood) and finger prick blood glucose levels were collected at regular intervals throughout the trials.

RESULTS

There were no differences between trials in eating behaviour and spontaneous physical activity (both, p > 0.05) in free-living conditions, resulting in greater overall total step counts [11,680 (10740,12620) versus 6049 (4845,7253) steps] and physical activity energy expenditure (PAEE) over 24-h period in ACTIVE compared to SIT (all, p < 0.05). Greater self-perceived levels of energy and lower blood glucose iAUC were found in ACTIVE trial compared to SIT trial (both, p < 0.05). No differences were found in cognitive performance between trials (all, p > 0.05).

CONCLUSION

Breaking up sitting does not elicit subsequent behavioural compensation, resulting in greater 24-h step counts and PAEE in healthy adults. Breaking up sitting reduces postprandial glucose concentrations and elicits greater self-perceived energy levels, but these positive effects do not acutely translate into improved cognitive function.

Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association

The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.

Comparative analysis of temporal trends of obesity and physical inactivity in Brazil and the USA (2011-2021)

BACKGROUND

The prevalence of obesity is rising in all subregions of America, including Brazil. To understand the obesity problem in Brazil better, a possible approach could be to analyze its obesity trend by comparing it with the reality of a country that went previously through the epidemiological transition, such as the USA. In addition, the obesity trend must be analyzed in comparison with obesity risk factors trends, such as the physical inactivity (PI) trend. Our aim was comparatively to analyze the temporal trends of obesity between Brazil and the USA from the perspective of temporal trends of PI.

METHODS

We conducted a temporal trend study based on data from national cross-sectional surveys: the VIGITEL (Surveillance System for Factors of Health Risk and Protection for Chronic Diseases by Telephone Survey) for Brazil and the BRFSS (Behavioral Risk Factor Surveillance System) for the USA, comparing the annual prevalence of obesity and PI between 2011 and 2021. For the analysis of each temporal variation, linear regressions were performed with the Prais-Winsten test, and Pearson's correlation coefficient was conducted to correlate the trends of the same variables between countries and of different variables within each country.

RESULTS

Considering the total sample, Brazil [coefficient (95%CI) 0.6 (0.4;0.7), p = 0.000] and the USA [coefficient (95%CI) 0.5 (0.5;0.6), p = 0.000] showed increasing trends in obesity. The tendency of PI was of stabilization in the two countries [Brazil: coefficient (95%CI) -0.03 (-0.3;0.2), p = 0.767 and USA coefficient (95%CI) -0.03 (-0.2;0.1), p = 0.584]. In addition, there was a correlation between obesity trends between Brazil and the USA (r = 0.971; p = 0.000), but there was no correlation between PI trends between the two countries, nor with obesity and PI trends within each country.

CONCLUSIONS

In the last decade, there was a trend towards increasing obesity and stabilization in PI, both in Brazil and the USA. However, there was no association between temporal trends in obesity and physical inactivity in both countries. Our data reinforce a call to action to prevent and control obesity, going with and beyond PI reduction.

A systematic review on the relationship between the built environment and children's quality of life

BACKGROUND

Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design.

OBJECTIVE

We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL.

METHODS

Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception.

RESULTS

Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed.

CONCLUSIONS

Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research.

Impact of the Neighborhood Food Environment on Dietary Intake and Obesity: a Review of the Recent Literature

PURPOSE OF REVIEW

The built environment impacts obesogenic behaviors and in turn body weight outcomes. This review summarizes recent research demonstrating environmental impacts on dietary intake and obesity with a specific focus on the neighborhood food environment.

RECENT FINDINGS

In the previous five years, an abundance of reviews and research studies have been undertaken to elucidate how the neighborhood food environment impacts diet and obesity. This includes studies using primary data collection and secondary data analyses in various populations across the globe. Taken together, current research presents mixed evidence on the impact of the neighborhood food environment on both dietary intake and obesity. While there is some evidence that certain features of the neighborhood food environment influence health behaviors and outcomes in particular populations, it is imperative to acknowledge the complexity of how neighborhood features interact and constantly evolve when considering place-based influences on health behaviors and outcomes.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.

Association of perceived and objective neighborhood walkability with accelerometer-measured physical activity and sedentary time in the Maastricht Study

BACKGROUND

We investigated the association of neighborhood walkability with accelerometer-measured physical activity (PA) and sedentary behavior (SB) and examined whether objective and subjective measures of walkability resulted in similar findings.

METHODS

PA and SB from the first 7689 Maastricht Study participants ages 40-75 from 2010 to 2017 were measured using accelerometers for 7 days. Mean daily step count, light-intensity PA, moderate- to vigorous- intensity PA (MVPA), and SB were calculated. Objective walkability was measured by the 7-component Dutch Walkability Index within 500 m Euclidean buffers around residential addresses of participants. Subjective walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Linear regression models analyzed the associations of walkability with PA and SB, controlling for potential confounders.

RESULTS

Objective walkability was negatively associated with light intensity PA in the most walkable quartile (b = -14.58, 95% CI = -20.94, -8.23). Compared to participants living in the least walkable neighborhoods, those in the most walkable quartile had statistically significantly higher SB levels (b = 11.64, 95% CI = 4.95, 18.32). For subjective walkability, mean daily step count was significantly higher in the most walkable quartile (b = 509.60, 95% CI = 243.38, 775.81). Higher subjective walkability was positively associated with MVPA (b = 4.40, 95% CI = 2.56, 6.23).

CONCLUSION

Living in a neighborhood with higher objective walkability was associated with lower levels of PA and higher SB levels while higher subjective walkability was associated with higher levels of PA. These results show discordant findings and thus, the effect of walkability on participant PA and SB within our sample is to be determined.

Socioecologic Factors Associated With Obesity in Adolescents With Epilepsy in the United States

BACKGROUND

Obesity among youth with epilepsy has multifactorial etiology, yet socioecologic obesity risk factors (eg, neighborhood factors) have not been examined in this population. This study examined (1) the prevalence of obesity adjusting for relevant covariates and (2) socioecologic correlates of obesity in adolescents with epilepsy aged 10-17 years.

METHODS

This cross-sectional study used 2017-2018 National Survey of Children's Health data (total n = 27,094; epilepsy n = 184). Chi-square tests compared weighted prevalence of obesity with relevant covariates among all adolescents and adolescents with epilepsy. Weighted multiple logistic regression models were conducted to adjust for covariates.

RESULTS

The prevalence of obesity in adolescents with epilepsy was 27.8% (95% confidence interval [CI] 15.4%-40.3%) vs 15.1% (95% CI 14.1%-16.2%) for the non-epilepsy group. Adolescents with epilepsy also had higher odds of obesity after adjusting for age, gender, race/ethnicity, household income, physical activity, and medical home (odds ratio [OR] 2.1, 95% CI 1.2-3.8). Adjusting for sociodemographics, anxiety (OR 4.5, 95% CI 1.3-15.6), 2 or more adverse childhood experiences (OR 7.3, 95% CI 1.6-33.4), neighborhood detracting elements (eg, OR 5.2, 95% CI 1.5-18.5 for 1 detracting element), and forgone care (ie, unmet health care needs) (OR 22.4, 95% CI 3.8-132.8) were associated with obesity in adolescents with epilepsy. Adjusting for multiple comparisons, neighborhood detracting elements (P < .0001) and forgone care (P < .0007) remained significant.

CONCLUSION

Variables related to mental health, family functioning, built environment, and forgone care were associated with obesity in adolescents with epilepsy, but the association was not fully explained by these factors. Obesity interventions for this population should consider multiple levels of influence including the community and special health care needs of this population.

Neighborhood Social Environment and Body Mass Index: The Mediating Role of Mental Wellbeing

The association between neighborhood-built environment and body mass index (BMI) is well-characterized, whereas fewer studies have explored the mechanisms underlying the relationship between neighborhood social environment and obesogenic behaviors. Using data from a random sample of 16,820 residents ≥18 years from all 169 Connecticut towns and seven ZIP Codes in New York, this study examines the influence of neighborhood social environment on residents' mental wellbeing, physical activity, and BMI. Structural equation modeling was conducted to estimate direct and indirect effects of neighborhood social environment on BMI, using mental wellbeing and physical activity as intermediate variables. There were significant total [β(SE) = 0.741 (0.170), p < 0.0001], direct [β(SE) = 0.456 (0.1890), p = 0.016], and indirect [β(SE) = 0.285 (0.061), p < 0.0001] effects of neighborhood social environment on BMI. Low physical activity was a partial mediator of the effect of non-favorable neighborhood social environment on BMI [β(SE) = -0.071 (0.011), p < 0.0001]. The association between neighborhood social environment and BMI was also mediated by mental wellbeing [β(SE) = 0.214 (0.060), p < 0.0001], and by mental wellbeing through physical activity [β(SE) = 0.071 (0.011), p < 0.0001]. Study findings provide further support for building strong social environments to improve population health and suggest that strategies prioritizing mental wellbeing may benefit behavioral interventions aimed at reducing obesity risk and should be a focus of prevention efforts in and of itself.

Non-traditional data sources in obesity research: a systematic review of their use in the study of obesogenic environments

BACKGROUND

The complex nature of obesity increasingly requires a comprehensive approach that includes the role of environmental factors. For understanding contextual determinants, the resources provided by technological advances could become a key factor in obesogenic environment research. This study aims to identify different sources of non-traditional data and their applications, considering the domains of obesogenic environments: physical, sociocultural, political and economic.

METHODS

We conducted a systematic search in PubMed, Scopus and LILACS databases by two independent groups of reviewers, from September to December 2021. We included those studies oriented to adult obesity research using non-traditional data sources, published in the last 5 years in English, Spanish or Portuguese. The overall reporting followed the PRISMA guidelines.

RESULTS

The initial search yielded 1583 articles, 94 articles were kept for full-text screening, and 53 studies met the eligibility criteria and were included. We extracted information about countries of origin, study design, observation units, obesity-related outcomes, environment variables, and non-traditional data sources used. Our results revealed that most of the studies originated from high-income countries (86.54%) and used geospatial data within a GIS (76.67%), social networks (16.67%), and digital devices (11.66%) as data sources. Geospatial data were the most utilised data source and mainly contributed to the study of the physical domains of obesogenic environments, followed by social networks providing data to the analysis of the sociocultural domain. A gap in the literature exploring the political domain of environments was also evident.

CONCLUSION

The disparities between countries are noticeable. Geospatial and social network data sources contributed to studying the physical and sociocultural environments, which could be a valuable complement to those traditionally used in obesity research. We propose the use of information available on the Internet, addressed by artificial intelligence-based tools, to increase the knowledge on political and economic dimensions of the obesogenic environment.

The influence of neighborhood built environment on school-age children's outdoor leisure activities and obesity: a case study of Shanghai central city in China

Objective

The aim of this study was to examine the influencing pathways of the neighborhood built environment on children's outdoor leisure activities and obesity.

Methods

A total of 378 elementary school students from 10 schools in central Shanghai were selected by a convenient sampling method for questionnaire survey and accelerometer tracking.

Results

1) The neighborhood built environment could affect children's obesity not only through direct effect (β = 0.15, p < 0.05), but also through the mediating effect of outdoor leisure activities (β = 0.19, p < 0.05). 2) For boys, the neighborhood built environment could affect children's obesity not only through direct effect (β = 0.17, p < 0.05), but also through the mediating effect of outdoor leisure activities (β = 0.26, p < 0.05). For girls, the neighborhood built environment could affect children's obesity only through the mediating effect of outdoor leisure activities (β = 0.13, p < 0.05).

Conclusion

The neighborhood built environment and outdoor leisure activities are important influencing factors in children's obesity. The neighborhood built environment and outdoor leisure activities could have direct and indirect effects on children's obesity, while there are gender differences in the influencing pathways of the neighborhood built environment on children's obesity. This study suggests that improving the neighborhood built environment and promoting outdoor leisure activities in children have important value for influencing children's obesity.

Identifying risk factors affecting exercise behavior among overweight or obese individuals in China

Background

The disease burden caused by obesity has increased significantly in China. Less than 30% of those who are obese meet the weekly physical activity standards recommended by the WHO. Risk factors that influence exercise behavior in people with obesity remain unclear.

Methods

Based on the survey from the Chinese General Social Survey program (CGSS) in 2017, 3,331 subjects were identified and enrolled in the univariate and multiple probit regression models. We aimed to identify the association between SRH and the exercise behavior of obese people and further explore the influencing factors of active physical activity in this group of people.

Results

The proportion of active physical activity in obese people was 25%. Groups with better SRH, higher education and income were more likely to participate in sports. Obese people who lived in rural areas, were unmarried or divorced, or fell within the age range of 35-40 had a significantly lower percentage of engagement in active physical activity.

Conclusions

The proportion of people with obesity who meet the WHO recommendation for physical activity in China is not ideal. Health promotion programs for those who are obese need to be further strengthened and targeted, especially for rural areas, low-income families, and middle-aged obese people.

A spatial indicator of environmental and climatic vulnerability in Rome

BACKGROUND

Urban areas are disproportionately affected by multiple pressures from overbuilding, traffic, air pollution, and heat waves that often interact and are interconnected in producing health effects. A new synthetic tool to summarize environmental and climatic vulnerability has been introduced for the city of Rome, Italy, to provide the basis for environmental and health policies.

METHODS

From a literature overview and based on the availability of data, several macro-dimensions were identified on 1,461 grid cells with a width of 1 km² in Rome: land use, roads and traffic-related exposure, green space data, soil sealing, air pollution (PM_2.5, PM₁₀, NO₂, C₆H₆, SO₂), urban heat island intensity. The Geographically Weighted Principal Component Analysis (GWPCA) method was performed to produce a composite spatial indicator to describe and interpret each spatial feature by integrating all environmental dimensions. The method of natural breaks was used to define the risk classes. A bivariate map of environmental and social vulnerability was described.

RESULTS

The first three components explained most of the variation in the data structure with an average of 78.2% of the total percentage of variance (PTV) explained by the GWPCA, with air pollution and soil sealing contributing most in the first component; green space in the second component; road and traffic density and SO₂ in the third component. 56% of the population lives in areas with high or very high levels of environmental and climatic vulnerability, showing a periphery-centre trend, inverse to the deprivation index.

CONCLUSIONS

A new environmental and climatic vulnerability indicator for the city of Rome was able to identify the areas and population at risk in the city, and can be integrated with other vulnerability dimensions, such as social deprivation, providing the basis for risk stratification of the population and for the design of policies to address environmental, climatic and social injustice.

Social determinants of health, health disparities, and adiposity

Social determinants of health (SDoH), or the socioeconomic, environmental, and psychosocial conditions in which individuals spend their daily lives, substantially influence obesity as a cardiovascular disease (CVD) risk factor. The coronavirus disease 2019 (COVID-19) pandemic highlighted the converging epidemics of obesity, CVD, and social inequities globally. Obesity and CVD serve as independent risk factors for COVID-19 severity and lower-resourced populations most impacted by adverse SDoH have the highest COVID-19 mortality rates. Better understanding the interplay between social and biologic factors that contribute to obesity-related CVD disparities are important to equitably address obesity across populations. Despite efforts to investigate SDoH and their biologic effects as drivers of health disparities, the connections between SDoH and obesity remain incompletely understood. This review aims to highlight the relationships between socioeconomic, environmental, and psychosocial factors and obesity. We also present potential biologic factors that may play a role in the biology of adversity, or link SDoH to adiposity and poor adipo-cardiology outcomes. Finally, we provide evidence for multi-level obesity interventions targeting multiple aspects of SDoH. Throughout, we emphasize areas for future research to tailor health equity-promoting interventions across populations to reduce obesity and obesity-related CVD disparities.

Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica

BACKGROUND

Childhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.

METHODS

A Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.

RESULTS

Average years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.

CONCLUSIONS

Especially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.

The Fidget Factor and the obesity paradox. How small movements have big impact

The hypothesis is that the Fidget Factor is the innate neurological pulse that propels humans and other species to move to support their health. Fidgets, previously thought to be spontaneous, are neurologically regulated and highly ordered (non-random). Modern societies being chair-based overwhelm Fidget Factor pulses and consequently inflict chair-based living for transportation, labor, and leisure. Despite impulses firing through the nervous system, people sit because environmental design overwhelms the biology. Urbanization and chair-based societies were designed after the industrial revolution to promote productivity; however, the consequence has been opposite. Crushing the natural urge to move—the Fidget Factor—is a public health calamity. Excess sitting is associated with a myriad of detrimental health consequences and impairs productivity. Fidgeting may reduce all-cause mortality associated with excessive sitting. The Fidget Factor offers hope; data demonstrate that workplaces and schools can be designed to promote activity and free people's Fidget Factors. Evidence shows that people are happier, healthier, wealthier, and more successful if their Fidget Factors are freed.

Heterogeneity in place effects on health: The case of time preferences and adolescent obesity

We leverage a natural experiment in combination with data on adolescents' time preferences to assess whether there is heterogeneity in place effects on adolescent obesity. We exploit the plausibly exogenous assignment of military servicemembers, and consequently their children, to different installations to identify place effects. Adolescents' time preferences are measured by a validated survey scale. Using the obesity rate in the assigned installation county as a summary measure of its obesity-related environments, we show that exposure to counties with higher obesity rates increases the likelihood of obesity among less patient adolescents but not among their more patient counterparts.

Neighborhood Walkability and Cardiovascular Risk in the United States

Neighborhood walkability may be associated with increased physical activity and thus may confer protection against cardiovascular disease and associated risk factors. We sought to characterize the association between neighborhood-level cardiovascular diseases and risk factors with neighborhood walkability across US census tracts.We linked the Centers for Disease Control and Prevention (CDC) PLACES dataset which provided census-tract level prevalence of coronary artery disease (CAD) and cardiovascular risk factors (hypertension, high cholesterol, obesity, and diabetes), with census tract population-weighted national walkability index (NWI) from the US Environmental Protection Agency (EPA). We calculated the mean prevalence of each cardiovascular health indicator per quartile of the walkability score. We also fit a multivariable linear regression model to estimate the association between walkability index and the prevalence of CAD adjusting for age, sex, race, and the CDC'S social vulnerability index, an integrated metric of socioeconomic position. We additionally performed mediation analyses to understand the mediating effects of CAD risk factors on the relationship between NWI and CAD prevalence. A total of 70,123 census tracts were analyzed nationwide. Across walkability quartiles Q1 (least walkable) through Q4 (most walkable), we found statistically significant decrease in the prevalence of CAD (7.0% to 5.4%), and risk factors including hypertension (35.5% to 29.7%), high cholesterol (34.5% to 29.2%), obesity (35.0% to 30.2%), and diabetes (11.6% to 10.6%). After multivariable adjustment, continuous walkability index was negatively and significantly associated with the prevalence of CAD (β = -0.09, P<0.0001). The relationship between NWI and CAD is partially mediated by the risk factors. High cholesterol accounted for 45%, high blood pressure 41% and diabetes 10% of the total effect of walkability on CAD. While direct relationship between walkability and CAD accounted for 9% of the total effect. This nationwide analysis demonstrates that neighborhood walkability is associated with a lower prevalence of cardiovascular risk factors and CAD. The association between NWI and CAD seems to be partly mediated by prevalence of traditional risk factors.

Associations between area deprivation and changes in the digital food environment during the COVID-19 pandemic: Longitudinal analysis of three online food delivery platforms

Online food delivery services facilitate access to unhealthy foods and have proliferated during the COVID-19 pandemic. This study explores associations between neighbourhood deprivation and exposure to online food delivery services and changes in exposure by deprivation during the first year of the pandemic. Data on food outlets delivering to 661 postcode districts in London and the North of England in 2020 and 2021 were collected from three online delivery platforms. The association between area deprivation and overall exposure to online food delivery services was moderated by region, with evidence of a positive relationship between count of outlets and deprivation in the North of England, and a negative relationship in London. There was no association between area deprivation and growth of online food delivery services. Associations between neighbourhood deprivation and exposure to the digital food environment vary geographically. Consequently, policies aimed at the digital food environment need to be tailored to the local context.

Longitudinal association between density of retail food stores and body mass index in Mexican school children and adolescents

BACKGROUND

Obesity is rapidly increasing in Mexican children and adolescents, while food environments are rapidly changing. We evaluated the association between changes in retail food stores and change in body mass index (BMI) in Mexican children and adolescents.

METHODS

Data on 7507 participants aged 5-19 years old came from the Mexican Family Life Survey 2002-2012. Density of food stores at the municipal-level (number of food stores/area in km²) came from the Economic Censuses of 1999, 2004 and 2009. We categorized food stores as small food retail (small neighborhood stores, tiendas de abarrotes in Mexico), specialty foods, fruit/vegetables, convenience foods, and supermarkets. Associations between change in food stores and change in BMI were estimated using five longitudinal linear fixed-effects regression models (one per type of food store) adjusted for age, parental education, municipal-level socioeconomic deprivation and population density. Density of each food store type was operationalized as quartiles. Analyses were stratified by urbanization.

RESULTS

There was an inverse dose-response association between increases in fruit/vegetable store density and BMI (β = -0.455 kg/m², β = -0.733 kg/m², and β = -0.838 kg/m² in the second, third, and fourth quartile). In non-urban areas, children living in municipalities with the highest density of small food retail stores experienced a reduction in BMI (β = -0.840 kg/m²). In urban areas, there was an inverse association between specialty food stores with BMI (β = -0.789 kg/m² in third quartile, and β = -1.204 kg/m² in fourth quartile). We observed dynamic associations with age; results suggested stronger associations in adolescents.

CONCLUSIONS

The availability of fruit/vegetable stores may influence a reduction in children and adolescents BMI. These results indicate that policy approaches could be tailored by type of food store - with some consideration for level of urbanization and children's age.

Impact of educational attainment and economic globalization on obesity in adult females and males: Empirical evidence from BRICS economies

Obesity has considerably increased since 1980 and become a global epidemic. Obesity-related health problems and the negative social and economic implications of obesity have led international institutions and countries to combat it. This study investigates the role of educational attainment and economic globalization in the global prevalence of obesity in samples of adult females and males in BRICS economies for 1990-2016 through causality and cointegration tests. The results of the causality tests reveal that educational attainment and economic globalization have a significant influence on obesity in both adult females and males in the short run. Furthermore, cointegration analysis indicates a negative effect of educational attainment on obesity in all BRICS economies in the long run, but the influence of economic globalization on obesity differs among the BRICS economies. Furthermore, the negative influence of educational attainment on obesity is revealed to be relatively higher in females than males.

Effectiveness and Safety of Histamine H2 Receptor Antagonists: An Umbrella Review of Meta-Analyses

Histamine H2 receptor antagonists (H2RAs) were widely used to inhibit gastric acid secretion, but its association with adverse events remains controversial and unclear. We conducted an umbrella review of meta-analyses to systematically assess the quality and credibility of the correlations between H2RA use with the risk of adverse outcomes through searching 4 major databases from inception to April 30, 2022. Forty-six individual meta-analyses were identified, including 29 meta-analyses of observation studies with 32 unique outcomes and 19 meta-analyses of randomized controlled trials with 3 unique outcomes for comparing the H2RA versus non-H2RA group. A Measurement Tool to Assess Systematic Reviews 2 rating for the included meta-analyses showed that 4 of 46 meta-analyses were assigned as high scores, 3 were assigned as "moderate," and 25 were assigned as low scores. Grading of Recommendations Assessment, Development and Evaluation assessment for combined results demonstrated that 6 outcomes were rated as "moderate," 9 outcomes were rated as "low," and 17 outcomes were rated as "very low." We confirmed significant associations of H2RA use with pneumonia, peritonitis, necrotizing enterocolitis, Clostridium difficile infection, liver cancer, gastric cancer, and hip fracture diseases. No associations for colorectal cancer, melanoma, kidney cancer, lung cancer, or common reproductive system cancer or renal, neurological, and cardiovascular system diseases were observed. We found a variety of evidence for the associations between H2RAs and adverse outcomes, which would give clinicians more positive guidance on prescription of H2RAs in clinical practice.

The association of unhealthy and healthy food store accessibility with obesity prevalence among adults in the Netherlands: A spatial analysis

Introduction

Obesity prevalence has almost tripled in Europe since 1980, and the obesogenic (food) environment is hypothesised to be one of the main drivers. Still, empirical evidence is rare for Europe.

Objective

This ecological study explores spatial patterns of obesity prevalence of adults (aged 19+) in the Netherlands in 2016. It studies, in particular, its global associations with (un)healthy food store accessibility while assessing local differences and evaluating the importance of the immediate versus the wider food surroundings.

Methods

In our ecological study, we used small-area estimated obesity prevalence (adults, aged 19+) from 2836 neighbourhoods (six-digit postal codes, wijken) and combined this with measures from Statistics Netherlands on accessibility to (unhealthy) fast food and (healthy) fresh food. Spatial lag of X (SLX) models were estimated for the entire Netherlands to explore global associations. Separate models for urban, suburban, and rural neighbourhoods and a geographically weighted regression (GWR) were estimated to explore and visualise local variations in the associations. Total associations from the SLX models were then decomposed to yield contributions of the immediate and wider food surroundings.

Results

Regional clusters of high obesity were observed in selected areas in the north-east, the south-west, and south-east. Limited accessibility to unhealthy food was globally associated with lower obesity prevalence, whereas better accessibility to fresh food stores and supermarkets was not. The association regarding worse accessibility to unhealthy food was strongest for urban neighbourhoods, especially for the Randstad region. In urban settings, also better accessibility to fresh food stores proved relevant. The wider food surrounding proved more important than the immediate food surrounding, throughout.

Discussion

Public policies addressing obesity might be more effective when reducing the presence of unhealthy food rather than expanding healthy food supply. Moreover, they should focus on urban regions and high obesity clusters, thereby considering wider food surroundings.

Nutritional Status, Dietary Habits, and Physical Activity in Older Adults from Manta, Manabí

Defining the nutritional status and physical activity level of older adults makes it possible to guide them toward healthy lifestyles.

OBJECTIVE

The aim of this study was to evaluate dietary habits, nutritional status, and physical activity engagement in older adults living in the city of Manta, Manabí.

METHODS

An observational, descriptive, and cross-sectional study of 130 older adults was conducted to determine nutritional status via anthropometry, self-reported frequency of the consumption of foodstuffs, calculation of the healthy eating index (IAS), and physical activity patterns.

RESULTS

Average age was 71.62 ± 4.34 years, whilst 83.07% of participants were at nutritional risk due to being overweight or obese. Dietary habits in males were characterized by the consumption of three meals a day, as well as greater intake of cereals, roots, tubers, and milk and its derivatives, whilst females consumed more fruits and vegetables. Meat was widely consumed, although females consumed more fish and seafood than males. Eggs were hugely popular foods, in contrast to legumes. Pasta was a dietary staple in females. Visible fats and luncheon meats were consumed little. IAS values reflected the "need to change", whilst physical activity engagement was found to be low.

CONCLUSIONS

The nutritional status of the present study population was characterized by a tendency toward increasing overweight, particularly amongst females, with the predominance of class 1 obesity, low physical activity, and a healthy eating index requiring change toward more healthy habits.

Comparison of spatial approaches to assess the effect of residing in a 20-minute neighbourhood on body mass index

Beliefs that neighbourhood environments influence body mass index (BMI) assume people residing proximally have similar outcomes. However, spatial relationships are rarely examined. We considered spatial autocorrelation when estimating associations between neighbourhood environments and BMI in two Australian cities. Using cross-sectional data from 1329 participants (Melbourne = 637, Adelaide = 692), spatial autocorrelation in BMI was examined for different spatial weights definitions. Spatial and ordinary least squares regression were compared to assess how accounting for spatial autocorrelation influenced model findings. Geocoded household addresses were used to generate matrices based on distances between addresses. We found low positive spatial autocorrelation in BMI; magnitudes differed by matrix choice, highlighting the need for careful consideration of appropriate spatial weighting. Results indicated statistical evidence of spatial autocorrelation in Adelaide but not Melbourne. Model findings were comparable, with no residual spatial autocorrelation after adjustment for confounders. Future neighbourhoods and BMI research should examine spatial autocorrelation, accounting for this where necessary.

Built Environments and Cardiovascular Health: REVIEW AND IMPLICATIONS

PURPOSE

This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways.

REVIEW METHODS

We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate.

SUMMARY

Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.

The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults

BACKGROUND

Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project.

METHODS

This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously.

DISCUSSION

The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.

Validating a geospatial healthfulness index with self-reported chronic disease and health outcomes

Leveraging community engagement from past research may yield frameworks on which to build new inquiries. We previously integrated community voice into the development of a healthfulness index to increase awareness of social determinants of health in the built environment and inform deployment of public health interventions in the Flint (Michigan, USA) Center for Health Equity Solutions. Here we combine the healthfulness index with self-reported chronic disease and health outcomes (n = 12,279) from a community-based healthcare entity, the Genesee Health Plan. The healthfulness index purports to predict how health-promoting a neighborhood is based on many spatially varying characteristics; by linking our health plan data to this index, we validate the effectiveness of the healthfulness index. After geocoding all enrollees and joining their healthfulness scores, we conducted a series of logistic regressions to compare the relationship between self-reported outcomes and healthfulness. Matching the two intervention projects of our center (revolving around healthy eating & physical activity in project 1 and mental health sustainment & substance use prevention in project 2), our analyses also focused on classes of outcomes related to a) cardiovascular disease and b) mental health. In only select cases, higher (better) healthfulness scores from each project were independently associated with better cardiovascular and mental health outcomes, controlling for age, race, and sex. Generally, however, healthfulness did not add predictive strength to the association between health and sociodemographic covariates. Even so, the use of composite healthfulness indices to describe the health-promoting or degrading qualities of a neighborhood could be valuable in identifying differences in health outcomes. Future researchers could further explore healthcare claims datasets to increase understanding of the links between healthfulness and health outcomes. This and future work will be valuable in advocacy toward additional healthfulness indices to aid other communities in enriching understanding between the built environment and health.

The neighbourhood built environment and health-related fitness: a narrative systematic review

Background

There is increasing evidence demonstrating the importance of the neighbourhood built environment in supporting physical activity. Physical activity provides numerous health benefits including improvements in health-related fitness (i.e., muscular, cardiorespiratory, motor, and morphological fitness). Emerging evidence also suggests that the neighbourhood built environment is associated with health-related fitness. Our aim was to summarize evidence on the associations between the neighbourhood built environment and components of health-related fitness in adults.

Methods

We undertook a systematic review following PRISMA guidelines. Our data sources included electronic searches in MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, ProQuest Dissertations and Theses, and Transport Research International Documentation from inception to March 2021. Our eligibility criteria consisted of observational and experimental studies estimating associations between the neighbourhood built environment and health-related fitness among healthy adults (age ≥ 18 years). Eligible studies included objective or self-reported measures of the neighbourhood built environment and included either objective or self-reported measures of health-related fitness. Data extraction included study design, sample characteristics, measured neighbourhood built environment characteristics, and measured components of health-related fitness. We used individual Joanna Briggs Institute study checklists based on identified study designs. Our primary outcome measure was components of health-related fitness (muscular; cardiorespiratory; motor, and morphological fitness).

Results

Twenty-seven studies (sample sizes = 28 to 419,562; 2002 to 2020) met the eligibility criteria. Neighbourhood destinations were the most consistent built environment correlate across all components of health-related fitness. The greatest number of significant associations was found between the neighbourhood built environment and morphological fitness while the lowest number of associations was found for motor fitness. The neighbourhood built environment was consistently associated with health-related fitness in studies that adjusted for physical activity.

Conclusion

The neighbourhood built environment is associated with health-related fitness in adults and these associations may be independent of physical activity. Longitudinal studies that adjust for physical activity (including resistance training) and sedentary behaviour, and residential self-selection are needed to obtain rigorous causal evidence for the link between the neighbourhood built environment and health-related fitness.

Trial registration

Protocol registration: PROSPERO number CRD42020179807.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01359-0.

Associations between neighborhood built environment, residential property values, and adult BMI change: The Seattle Obesity Study III

Objective

To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI).

Methods

The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in Washington State. Measured heights and weights were obtained at baseline (n = 879), year 1 (n = 727), and year 2 (n = 679). Tax parcel residential property values served as proxies for individual socioeconomic status. Residential unit and road intersection density were captured using Euclidean-based SmartMaps at 800 m buffers. Counts of supermarket (0 versus. 1+) and fast-food restaurant availability (0, 1–3, 4+) were measured using network based SmartMaps at 1600 m buffers. Density measures and residential property values were categorized into tertiles. Linear mixed-effects models tested whether baseline BE variables and property values were associated with differential changes in BMI at year 1 or year 2, adjusting for age, gender, race/ethnicity, education, home ownership, and county of residence. These associations were then tested for potential disparities by age group, gender, race/ethnicity, and education.

Results

Road intersection density, access to food sources, and residential property values were inversely associated with BMI at baseline. At year 1, participants in the 3rd tertile of density metrics and with 4+ fast-food restaurants nearby showed less BMI gain compared to those in the 1st tertile or with 0 restaurants. At year 2, higher residential property values were predictive of lower BMI gain. There was evidence of differential associations by age group, gender, and education but not race/ethnicity.

Conclusion

Inverse associations between BE metrics and residential property values at baseline demonstrated mixed associations with 1- and 2-year BMI change. More work is needed to understand how individual-level sociodemographic factors moderate associations between the BE, property values, and BMI change.

•

Strong, inverse cross-sectional relationships between the built environment, residential property values (a proxy for individual socioeconomic status), and measured BMI were observed.

•

Measures of the built environment and residential property values showed modest and inconsistent associations with 1- and 2-year BMI change.

•

There was suggestive evidence that age may moderate the association between urban density and 1- and 2-year BMI change while education may moderate the association between residential property values and 2-year BMI change.

Measuring Obesogenicity and Assessing Its Impact on Child Obesity: A Cross-Sectional Ecological Study for England Neighbourhoods

Both major influences on changing obesity levels (diet and physical activity) may be mediated by the environment, with environments that promote higher weight being denoted obesogenic. However, while many conceptual descriptions and definitions of obesogenic environments are available, relatively few attempts have been made to quantify obesogenic environments (obesogenicity). The current study is an ecological study (using area units as observations) which has as its main objective to propose a methodology for obtaining a numeric index of obesogenic neighbourhoods, and assess this methodology in an application to a major national dataset. One challenge in such a task is that obesogenicity is a latent aspect, proxied by observed environment features, such as poor access to healthy food and recreation, as well as socio-demographic neighbourhood characteristics. Another is that obesogenicity is potentially spatially clustered, and this feature should be included in the methodology. Two alternative forms of measurement model (i.e., models representing a latent quantity using observed indicators) are considered in developing the obesogenic environment index, and under both approaches we find that both food and activity indicators are pertinent to measuring obesogenic environments (though with varying relevance), and that obesogenic environments are spatially clustered. We then consider the role of the obesogenic environment index in explaining obesity and overweight rates for children at ages 10-11 in English neighbourhoods, along with area deprivation, population ethnicity, crime levels, and a measure of urban-rural status. We find the index of obesogenic environments to have a significant effect in elevating rates of child obesity and overweight. As a major conclusion, we establish that obesogenic environments can be measured using appropriate methods, and that they play a part in explaining variations in child weight indicators; in short, area context is relevant.

The Nexus between Pollution and Obesity and the Magnifying Role of Media Consumption: International Evidence from GMM Systems Estimates

The aim of this paper is to uncover the associations between air pollution, media consumption, and the prevalence of obesity. Based on data availability, this study draws on an unbalanced panel of 28 countries and develops and extracts relationships through robust System-General Method of Moments (Sys-GMM) estimators that account for the dynamic nature and high persistence of the variables of interest. In light of previous findings, economic development, trade openness, and government consumption are included as controls in the dynamic panel models. The estimation results consistently indicate that pollution is a strong determinant of obesity, a link that remains robust through the alternative proxies for pollution (i.e., total greenhouse gas emissions (GHG) and carbon (CO₂) intensity of energy generation). However, CO₂ intensity shows the strongest association with obesity. Furthermore, the findings indicate that media consumption is an independent and significant driver of obesity, whilst its inclusion among regressors further magnifies the impact and significance of the pollution factor. Moreover, the combined effect of media consumption and pollution significantly contributes to spurring obesity in all model specifications. Thus, a vicious cycle emerges between air pollution, media consumption, and obesity, with synergistic detrimental health effects. The current findings highlight the importance of continuing and consistent efforts to mitigate pollution and reach related low-carbon policy targets. Moreover, for the sustainable reduction and prevention of obesity, these efforts should be complemented by policy interventions and public campaigns aimed at "healthy" media consumption, such as encouraging regular physical exercise and healthy nutrition.

Individual and environmental determinants of serum ferritin levels: A structural equation model

BACKGROUND AND OBJECTIVES

Serum ferritin levels are increasingly being used to assess iron stores. Considerable variation in ferritin levels within and between individuals has been observed, but our current understanding of factors that explain this variation is far from complete. We aim to combine multiple potential determinants in an integrative model, and investigate their relative importance and potential interactions.

METHODS

We use ferritin measurements collected by Sanquin Blood Bank on both prospective (N = 59 596) and active blood donors (N = 78 318) to fit a structural equation model with three latent constructs (individual characteristics, donation history, and environmental factors). Parameters were estimated separately by sex and donor status.

RESULTS

The model explained 25% of ferritin variance in prospective donors, and 40% in active donors. Individual characteristics and donation history were the most important determinants of ferritin levels in active donors. The association between environmental factors and ferritin was smaller but still substantial; higher exposure to air pollution was associated with higher ferritin levels, and this association was considerably stronger for active blood donors than for prospective donors.

DISCUSSION

In active donors, individual characteristics explain 20% (17%) of ferritin variation, donation history explains 14% (25%) and environmental factors explain 5% (4%) for women (men). Our model presents known ferritin determinants in a broader perspective, allowing for comparison with other determinants as well as between new and active donors, or between men and women.

Die „gesunde Kommune“ im Lichte „großer Wenden“ – ein sozialökologisch fundiertes Ziel kommunaler Gesundheitsförderung (KoGeFö)

Hintergrund

In Kommunen wird die Gesundheit der Bewohner*innen durch Lebensumstände geschützt, gefördert oder gefährdet. Kommunale Gesundheitsförderung (KoGeFö) findet in und mit der Kommune statt. In der Kommune konzentrieren sich Programme und Maßnahmen auf Endpunkte der Morbidität und Mortalität. Die Krankheitslast soll reduziert, sowie die individuelle Lebensqualität gestärkt werden. Mit der Kommune will Gesundheitsförderung die „gesunde Kommune“ entwickeln.

Fragestellung

Wann ist eine Kommune „gesund“? Welche Absichten werden in der Gesundheitsförderung mit der Kommune jenseits von Programmen verfolgt, die auf die Reduktion der Inzidenz und Prävalenz nicht-ansteckender Erkrankungen zielen, indem sie die Bewohner*innen motivieren und unterstützen, sich gesundheitsfördernd zu verhalten?

Material und Methoden

Vor dem Hintergrund „großer gesellschaftlicher Herausforderungen“ und mit Rückgriff auf sozialökologische Ansätze wird erörtert, was eine „gesunde Kommune“ ausmacht, worauf die Gesundheitsförderung mit der Kommune zielt.

Ergebnisse

Die „gesunde Kommune“ entwickelt sich in der intersektoralen Zusammenarbeit von Akteur*innen der Politik, von Verwaltungseinheiten, der Zivilgesellschaft und der Bewohner*innen. Die „gesunde Kommune“ ist als faire Umgebung gestaltet. Sie öffnet den Einzelnen Möglichkeitsräume für dessen Handeln und gewährt Verwirklichungschancen für persönlich wichtige Ziele.

Schlussfolgerung

Die bevorzugte sozialökologische Perspektive schärft den Blick für die dynamische Interaktion von Umwelt- und Personenfaktoren. Mit Fairness, Möglichkeitsräumen und Verwirklichungschancen sind drei Kriterien benannt, die sich als Gradmesser für den Endpunkt „gesunde Kommune“ einer Gesundheitsförderung mit der Kommune eignen.

The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.

Do sex and gender modify the association between green space and physical health? A systematic review

A growing literature shows that green space can have protective effects on human health. As a marginalized group, women often have worse life outcomes than men, including disparities in some health outcomes. Given their marginalization, women might have "more to gain" than men from living near green spaces. Yet, limited research has deliberately studied whether green space-health associations are stronger for women or men. We conducted a systematic review to synthesize empirical evidence on whether sex or gender modifies the protective associations between green space and seven physical health outcomes (cardiovascular disease, cancer, diabetes, general physical health, non-malignant respiratory disease, mortality, and obesity-related health outcomes). After searching five databases, we identified 62 articles (including 81 relevant analyses) examining whether such effect modification existed. We classified analyses based on whether green space-health were stronger for women, no sex/gender differences were detected, or such associations were stronger for men. Most analyses found that green space-physical health associations were stronger for women than for men when considering study results across all selected health outcomes. Also, women showed stronger protective associations with green space than men for obesity-related outcomes and mortality. Additionally, the protective green space-health associations were slightly stronger among women for green land cover (greenness, NDVI) than for public green space (parks), and women were also favored over men when green space was measured very close to one's home (0-500 m). Further, the green space-health associations were stronger for women than for men in Europe and North America, but not in other continents. As many government agencies and nongovernmental organizations worldwide work to advance gender equity, our review shows that green space could help reduce some gender-based health disparities. More robust empirical studies (e.g., experimental) are needed to contribute to this body of evidence.

Childhood obesity: an ecological perspective

OBJECTIVE

To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil.

DATA SOURCE

Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity.

DATA SYNTHESIS

Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control.

CONCLUSIONS

Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.

Machine learning approaches to characterize the obesogenic urban exposome

BACKGROUND

Characteristics of the urban environment may contain upstream drivers of obesity. However, research is lacking that considers the combination of environmental factors simultaneously.

OBJECTIVES

We aimed to explore what environmental factors of the urban exposome are related to body mass index (BMI), and evaluated the consistency of findings across multiple statistical approaches.

METHODS

A cross-sectional analysis was conducted using baseline data from 14,829 participants of the Occupational and Environmental Health Cohort study. BMI was obtained from self-reported height and weight. Geocoded exposures linked to individual home addresses (using 6-digit postcode) of 86 environmental factors were estimated, including air pollution, traffic noise, green-space, built environmental and neighborhood socio-demographic characteristics. Exposure-obesity associations were identified using the following approaches: sparse group Partial Least Squares, Bayesian Model Averaging, penalized regression using the Minimax Concave Penalty, Generalized Additive Model-based boosting Random Forest, Extreme Gradient Boosting, and Multiple Linear Regression, as the most conventional approach. The models were adjusted for individual socio-demographic variables. Environmental factors were ranked according to variable importance scores attributed by each approach and median ranks were calculated across these scores to identify the most consistent associations.

RESULTS

The most consistent environmental factors associated with BMI were the average neighborhood value of the homes, oxidative potential of particulate matter air pollution (OP), healthy food outlets in the neighborhood (5 km buffer), low-income neighborhoods, and one-person households in the neighborhood. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households and smaller amount of healthy food retailers. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households, smaller amounts of healthy food retailers and higher OP levels. Across the approaches, we observed consistent patterns of results based on model's capacity to incorporate linear or nonlinear associations.

DISCUSSION

The pluralistic analysis on environmental obesogens strengthens the existing evidence on the role of neighborhood socioeconomic position, urbanicity and air pollution.

Neighborhood Profiles and Body Mass Index Trajectory in Female Adolescents and Young Adults

PURPOSE

The purpose of this study is to identify distinct neighborhood profiles patterned by key structural, physical, and social characteristics and test whether living in different profiles are associated with body mass index trajectories during adolescence in racial/ethnic minority female youth.

METHODS

Participants were 1,328 sexually active female adolescents and young adults aged 14-23 years, predominately Hispanic and black, enrolled in an human papillomavirus type 4 vaccine (Gardasil) surveillance study at a large adolescent health clinic in New York City between 2007 and 2018. Body mass index was calculated from weight and height every 6 months. A comprehensive set of neighborhood structural, social, and physical characteristics from multiple national and state datasets was linked to each participant based on home address.

RESULTS

Latent profile analysis revealed five distinct neighborhood profiles in New York City: High Structural/High Social Advantage, Moderate Advantage/Low Crime, Low SES (Socioeconomic Status)/High Activity, Low SES/High Social Advantage, and High Disadvantage. Results from multilevel growth curve analysis revealed that living in Low SES/High Activity neighborhoods was associated with a lower BMI at age 22 (b = -1.32, 95% confidence interval -2.49, -.16), as well as a slower increase in BMI from age 14 to 22 years (b = -.22, 95% confidence interval -.46, .02), compared to the High Disadvantage profile.

CONCLUSIONS

Our findings suggest that improving neighborhood structural, social, and physical environments may help promote healthy weight and reduce health disparities during adolescence and young adulthood.

Socioeconomic inequalities in food outlet access through an online food delivery service in England: A cross-sectional descriptive analysis

Online food delivery services facilitate 'online' access to food outlets selling food prepared away-from-home. Online food outlet access has not previously been investigated in England or across an entire country. Systematic differences in online food outlet access could exacerbate existing health inequalities, which is a public health concern. However, this is not known. Across postcode districts in England (n = 2118), we identified and described the number of food outlets and unique cuisine types accessible online from the market leader (Just Eat). We investigated associations with area-level deprivation using adjusted negative binomial regression models. We also compared the number of food outlets accessible online with the number physically accessible in the neighbourhood (1600m Euclidean buffers of postcode district geographic centroids) and investigated associations with deprivation using an adjusted general linear model. For each outcome, we predicted means and 95% confidence intervals. In November 2019, 29,232 food outlets were registered to accept orders online. Overall, the median number of food outlets accessible online per postcode district was 63.5 (IQR; 16.0-156.0). For the number of food outlets accessible online as a percentage of the number accessible within the neighbourhood, the median was 63.4% (IQR; 35.6-96.5). Analysis using negative binomial regression showed that online food outlet access was highest in the most deprived postcode districts (n = 106.1; 95% CI: 91.9, 120.3). The number of food outlets accessible online as a percentage of those accessible within the neighbourhood was highest in the least deprived postcode districts (n = 86.2%; 95% CI: 78.6, 93.7). In England, online food outlet access is socioeconomically patterned. Further research is required to understand how online food outlet access is related to using online food delivery services.