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Abstract

Various measures of the obesogenic environment have been proposed and used in childhood obesity research. The variety of measures poses methodological challenges to designing new research because methodological characteristics integral to developing the measures vary across studies. A systematic review has been conducted to examine the associations between different levels of obesogenic environmental measures (objective or perceived) and childhood obesity. The review includes all articles published in the Cochrane Library, PubMed, Web of Science and Scopus by 31 December 2018. A total of 339 associations in 101 studies have been identified from 18 countries, of which 78 are cross‐sectional. Overall, null associations are predominant. Among studies with non‐null associations, negative relationships between healthy food outlets in residential neighbourhoods and childhood obesity is found in seven studies; positive associations between unhealthy food outlets and childhood obesity are found in eight studies, whereas negative associations are found in three studies. Measures of recreational or physical activity facilities around the participants' home are also negatively correlated to childhood obesity in nine out of 15 studies. Results differ by the types of measurement, environmental indicators and geographic units used to characterize obesogenic environments in residential and school neighbourhoods. To improve the study quality and compare reported findings, a reporting standard for spatial epidemiological research should be adopted.

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... Another key consideration is the influence of shared home lifestyle on the mother-child cardiovascular risk profile. Indeed, a shared obesogenic diet and similar attitudes to physical exercise can importantly influence cardiovascular health of both mother and child, with such behavioural traits persisting into adulthood (17,18). Furthermore, the genetic inheritance of obesogenic traits is likely to play an additionally important role in driving poorer cardiovascular health in the offspring of mothers with obesity. ...
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Objective Obesity and cardiovascular disease are major global public health problems. Maternal obesity has been linked to multiple adverse health consequences for both mother and baby. Obesity during pregnancy may adversely alter the intrauterine environment, which has been hypothesised to predispose the offspring to poorer cardiovascular health throughout life. In this paper, we systematically review current literature examining the links between maternal obesity and offspring cardiovascular health. Methods This study is registered with PROSPERO (CRD42021278567) and was conducted in accordance with the PRISMA guidelines. A comprehensive systematic literature search was conducted, including two electronic databases (Ovid Medline, Embase), cross-referencing, author searching, and grey literature searches. We selected studies exploring the relationship between maternal obesity and offspring cardiovascular health, using pre-defined eligibility criteria. Studies were critically appraised using the ROBINS-I tool. Results From 1,214 results, 27 articles met the eligibility criteria. Multiple cardiovascular outcomes were considered, including congenital heart disease, cardiometabolic parameters, and cardiovascular diseases in neonates, children, and adults. In these studies, maternal obesity was consistently associated with congenital heart disease, several adverse cardiometabolic parameters throughout life including higher body mass index and insulin levels, and greater risk of cardiovascular disease in adulthood. Hypothesized underlying mechanisms are complex and multifactorial comprising genetic, environmental, and socioeconomic components, which can be difficult to quantify. Heterogeneity in study designs, highly selected study samples, and high risk of bias in some studies limit conclusions regarding causality. Conclusions We identified consistent evidence of links between maternal obesity and poorer offspring cardiovascular health throughout the lifecourse, extending from the neonatal period into adulthood. Although underlying mechanisms are unclear, our findings support consideration of targeted maternal obesity prevention for promotion of offspring cardiovascular health. This all-encompassing systematic review provides critical appraisal of the latest evidence, defines gaps and biases of existing literature, and may inform potential new public health strategies for cardiovascular disease prevention. Systematic Review Registration [ https://www.crd.york.ac.uk/prospero ], identifier PROSPERO (CRD42021278567).
... The study of obesity in the past decades has been key for understanding the underlying mechanisms and its effects on health as well as aspects that interact to define the overall body composition of an individual, including environmental, epigenetic and early development factors [57][58][59]. Hence, energy balance studies, while complex, could add valuable information to identifying the actions can be taken from a comprehensive perspective that includes the multiple factors implied in achieving EB. ...
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Overweight and obesity are often explained by an imbalance between energy intake and ex- penditure. This, in addition to metabolic effects, makes it difficult to assess the real state of individual energy balance. This study aims to analyze the energy gaps between intake and expenditure in the adult population of Latin America, as well as its relationships with sociodemographic variables and nutrition status, to draw an epidemiological perspective based on the trends observed. The energy imbalance gap was used to this end. The difference between energy intake and expenditure can be applied as a reference to explain whether weight equilibrium can prevent weight gain. Moreover, the energy imbalance gap allows for a better understanding of the design of public health policies. Using data from the Latin American Study of Nutrition and Health, the energy imbalance gap in adult population from eight Latin-American countries was assessed in 5994 subjects aged from 19–65. Usual dietary intake was measured using two non-consecutive 24 h dietary recalls. The sociodemographic questionnaire was supplemented by anthropometric measurements. Physical activity was measured through the long International Physical Activity Questionnaire. Energy expenditure was obtained using the basal metabolic rate. For the overall sample, the mean energy intake was 1939.1 kcal (95% CI: 1926.9; 1951.3), the mean of energy expenditure was 1915.7 kcal (95% CI: 1906.4; 1924.9), and the mean of energy imbalance gap was 23.4 kcal (95% CI: 11.9; 35.0). Results show that energy intake and expenditure were higher in men. Moreover, subjects aged 19–34, of high socioeconomic level, who completed high school, were mestizos and were of normal weight consumed the highest number of calories. Overall, a positive energy imbalance gap was observed. Overweight and obese fromArgentina, Costa Rica, Ecuador, Peru, and Venezuela showed a significantly lower energy imbalance gap than underweight subjects. These findings confirm the high variability of energy imbalance gap and the accompanying correlates of energy intake and expenditure. Further research is needed to specifically address interventions in low and middle-income countries such as many in Latin America, to help reduce the prevalence of obesity and eradicate undernutrition.
... Children's diets may also be influenced by general contextual factors, namely conditions and life opportunities that promote obesity (i. e., the obesogenic environment), such as proximity to supermarkets and fast-food restaurants (Mei et al., 2020), and media exposure, such as unhealthy food advertising on TV (Russell et al., 2019). Still, a significant determinant of children's eating habits is the family environment. ...
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Excessive sugar intake is one of the factors contributing to the alarming rates of childhood obesity and overweight in Portugal. Children's preferences and food consumption patterns are largely determined by the foods that are more familiar to them. Parents and caregivers are responsible for shaping children's eating habits since they are the ones who choose the food available in the household. The present study explores parental perceptions about sugar and sugar intake and its consequences on children's health. Moreover, we also examined the practices that parents use to regulate their children's diet, namely, to promote the consumption of desired foods (e.g., vegetables) and limit the intake of undesired food (e.g., sweets), and the perceived barriers and facilitators of sugar intake regulation. To this end, 42 interviews were conducted with parents of school-aged children (ages 6–10 years). A thematic analysis revealed that parents perceive sugar as highly negative (e.g., “evil”, “poison”, “addiction”) and its consumption as harmful (e.g., hyperactivity; overweight). Nonetheless, the view that sugary food consumption is not necessarily problematic was also common. Indeed, most parents considered that sugar intake should be regulated but not forbidden. To control the intake of sugary foods (e.g., sodas, cookies), they reported using strategies such as restriction, explanation, or negotiation. Several barriers to sugar intake regulation were identified (e.g., birthday parties, parents' lack of knowledge), but also a few facilitators (e.g., bringing food from home to school). Our findings may inform the development of interventions or policies to promote healthier eating habits in school-age children.
... 35 Finally, most, if not all, of the basic obesogenic environmental measures used in youth obesity research are summarized and compared from a methodological perspective. 36 Theoretically, all the built environmental factors mentioned above, except speed limit and urban sprawl, are negatively associated with youth obesity by encouraging their physical activity while discouraging their sedentary behaviours; the access to all the aforementioned food venues, except convenience stores and fast-food restaurants, is negatively associated with youth obesity by encouraging their healthy eating behaviours. According to the findings of the OBECHO project, although most associations between built/food environments and weight-related behaviours and outcomes were mixed, mainly owing to different study designs, populations and areas, there are some globally consistent findings independent of those factors. ...
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The increasing prevalence of obesity in youth has contributed to the growing global burden of chronic diseases (e.g. diabetes, cardiovascular diseases and cancers), which has been largely accounted for by obesogenic behaviours and environments. Previous studies have focused on the influences on obesity of multidimensional environmental indicators, which have mixed effects, for example, built environmental factors, food environmental factors and neighbourhood safety. After a thorough search of all databases, I found a limited body of reviews on the associations of basic environmental factors. A basic environmental factor, from a perspective of geographic information systems, is an indicator constructed by only one‐step spatial function, without ambiguous effects on obesity. In contrast to basic obesogenic environmental factors, an example of mixed environmental factor is neighbourhood safety, which is a complex measure of night light, crime rate, traffic volume, speed limit, smoothness of roads and many other factors of injury. Without a sufficient, up‐to‐date understanding of the roles of basic obesogenic environmental factors in obesity, the uncertainties will propagate and lead to more uncertainties in the association between indicators and obesity.
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The project ‘Obesogenic Environment and Childhood Obesity’ (OBECHO), carried out under the leadership of the International Institute of Spatial Lifecourse Epidemiology (ISLE), has reviewed all sufficiently reported studies of obesogenic environmental determinants published prior to 1 January 2019. Findings of the OBECHO project have formed the unprecedentedly inclusive evidence for policy‐making and the establishment of the future research agenda regarding the obesogenic environment. Furthermore, the outbreak of the coronavirus disease 2019 (COVID‐19) pandemic has made this evidence become an important benchmark record of how youths have interacted with the obesogenic environment in the pre‐COVID‐19 era. The implementation of lockdown measures worldwide for curbing COVID‐19 transmission has been affecting not mere youth's lifestyle behaviours and weight status but, more fundamentally, obesogenic environments and hence youth‐environment interaction patterns. However, COVID‐19, although causing unfavoured changes, will speed up the transformation of the research landscape from traditional to modern modes for more reliable evidence. We should closely track and study those abnormalities caused by COVID‐19 and the accompanying interventions.
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Triglycerides, HDL, and their ratio are associated with metabolic disorders and diseases. Gender is known to have a relationship with these factors, but not consistent. This study wanted to see the relationship between gender and triglyceride levels, HDL levels, and the triglyceride / HDL ratio in secondary school teachers in Makassar City. The study was conducted with a cross-sectional approach in 6 junior high schools and 6 senior high schools with a total population of 200 teachers and involved 122 samples of teachers from secondary schools in Makassar City. Sampling using a stratified random sampling technique. The measurement of triglyceride and HDL levels was carried out by the Prodia laboratory. Data analysis was performed using the chi-square test. The results showed that there was a relationship between gender and triglyceride levels (p = 0.004). However, no relationship was found between HDL levels (p = 0.856) and the triglyceride / HDL ratio (p = 0.959) among secondary school teachers in Makassar City. Interventions to improve triglyceride levels must consider gender aspects primarily by paying more attention to male teachers.
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The prevalence of obesity is still rising among Chinese adults and may be attributed to environmental factors, which, however, has only been examined in western countries before. This study aimed to estimate associations between obesogenic environments and adult obesity in China, on the basis of the official 2013-4 nationally representative survey. General and abdominal obesity were defined by body mass index and waist circumference, respectively, according to both the Chinese and international criteria. The mean summer/winter temperature in provinces, the mean fine particulate matter (PM2.5) concentration, gross domestic product per capita, and education level in districts/counties, and the densities of fast-food restaurants, full-service restaurants, grocery stores, and supermarkets in subdistricts/towns were calculated. Five-level logistic regression models were used to estimate their associations with obesity, also in urban and rural regions separately. Both general and abdominal obesity in men were associated with the highest PM2.5 concentration, summer temperature, and density of full-service restaurants and grocery stores, as well as the lowest winter temperature. These associations were also observed in women except for summer temperature and density of full-service restaurants with abdominal obesity. Some associations varied by urban-rural regions. Also, the higher regional education level was associated with general and abdominal obesity in men. Additionally, obesity was associated with the increasing number of coexisting obesogenic environmental factors. Our findings call for more attention to citizens living in certain environments in China, such as cold winters and with more full-service restaurants and grocery stores. This is the first national, comprehensive obesogenic environment study in China, which generated evidence-based hypotheses for future longitudinal research and interventions on obesogenic environments in China.
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Spatial lifecourse epidemiology is an interdisciplinary field that utilizes advanced spatial, location-based, and artificial intelligence technologies to investigate the long-term effects of environmental, behavioural, psychosocial, and biological factors on health-related states and events and the underlying mechanisms. With the growing number of studies reporting findings from this field and the critical need for public health and policy decisions to be based on the strongest science possible, transparency and clarity in reporting in spatial lifecourse epidemiologic studies is essential. A task force supported by the International Initiative on Spatial Lifecourse Epidemiology (ISLE) identified a need for guidance in this area and developed a Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) Statement. The aim is to provide a checklist of recommendations to improve and make more consistent reporting of spatial lifecourse epidemiologic studies. The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cohort studies was identified as an appropriate starting point to provide initial items to consider for inclusion. Reporting standards for spatial data and methods were then integrated to form a single comprehensive checklist of reporting recommendations. The strength of our approach has been our international and multidisciplinary team of content experts and contributors who represent a wide range of relevant scientific conventions, and our adherence to international norms for the development of reporting guidelines. As spatial, location-based, and artificial intelligence technologies used in spatial lifecourse epidemiology continue to evolve at a rapid pace, it will be necessary to revisit and adapt the ISLE-ReSt at least every 2–3 years from its release.
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The International Initiative on Spatial Lifecourse Epidemiology (ISLE) convened its first International Symposium on Lifecourse Epidemiology and Spatial Science at the Lorentz Center in Leiden, Netherlands, 16-20 July 2018. Its aim was to further an emerging transdisciplinary field: Spatial Lifecourse Epidemiology. This field draws from a broad perspective of scientific disciplines including lifecourse epidemiology, environmental epidemiology, community health, spatial science, health geography, biostatistics, spatial statistics, environmental science, climate change, exposure science, health economics, evidence-based public health, and landscape ecology. The participants, spanning 30 institutions in 10 countries, sought to identify the key issues and research priorities in spatial lifecourse epidemiology. The results published here are a synthesis of the top 10 list that emerged out of the discussion by a panel of leading experts, reflecting a set of grand challenges for spatial lifecourse epidemiology in the coming years. https://doi.org/10.1289/EHP4868.
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Background: The built environment is an important contributor to childhood obesity; however, large-scale and longitudinal studies designed to examine their associations remain limited. This study aimed to examine whether walkable neighborhoods were associated with childhood obesity risk over a 9-year period. Methods: We used data collected in the US nationally representative Early Childhood Longitudinal Study - Kindergarten (ECLS-K) Cohort, with 9440 kindergarteners followed up until their 8th grade (1998-2007). Four built environmental variables, street intersection density, residential density, fitness facility density, and recreational facility density, were calculated from national census, business, and road network datasets, and then matched with ECLS-K samples. Mixed-effect models were performed to estimate associations between built environments and child weight status. Results: Children who experienced increased intersection density during 1998-2007 had a lower BMI in 2007 (β = -0.49, p < 0.01), especially girls (β = -0.79, p < 0.01) and suburban children (β = -0.66, p < 0.05). They also had lower obesity risk in 2007 (OR = 0.79 [95% CI = 0.66-0.94]), especially girls (OR = 0.68 [95% CI = 0.52-0.88]). Girls and boys who lived in neighborhoods with the higher (but not highest) residential density in 1998 showed lower obesity risk (OR = 0.54 [95% CI = 0.30-0.98]) and overweight risk (OR = 0.54 [95% CI = 0.30-0.95]) in 2007, respectively. Conclusions: National data indicate that in the US greater walkability in residential neighborhoods may lead to lower child BMI and obesity risk after nine years, and the association was stronger among girls and in suburban regions. This provides useful evidence for future obesity prevention and urban planning.
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Background Effects of food environments (FEs) on childhood obesity are mixed. Objectives To examine the association of residential FEs with childhood obesity and variation of the association across gender and urbanicity. Methods We used the US Early Childhood Longitudinal Study—Kindergarten Cohort data, with 9440 kindergarteners followed up from 1998 to 2007. The Dun and Bradstreet commercial datasets in 1998 and 2007 were used to construct 12 FE measures of children, ie, changes in the food outlet mix and density of supermarkets, convenience stores, full‐service restaurants, fast‐food restaurants, retail bakery, dairy‐product stores, health/dietetic food stores, confectionery stores, fruit/vegetable markets, meat/fish markets, and beverage stores. Two‐level mixed‐effect and cluster robust logistic regression models were fitted to examine associations. Results Decreased exposures to full‐service restaurants, retail bakeries, fruit/vegetable markets, and beverage stores were generally obesogenic, while decreased exposure to dairy‐product stores was generally obesoprotective; the magnitude and statistical significance of these associations varied by gender and urbanicity of residence. Higher obesity risk was associated with increased exposure to full‐service restaurants among girls, and with decreased exposures to fruit/vegetable markets in urban children, to beverage stores in suburban children, and to health/dietetic food stores in rural children. Mixed findings existed between genders on the associations of fruit/vegetable markets with child weight status. Conclusion In the United States, exposure to different FEs seemed to lead to different childhood obesity risks during 1998 to 2007; the association varied across gender and urbanicity. This study has important implications for future urban design and community‐based interventions in fighting the obesity epidemic.
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Background School neighborhood food environment is recognized as an important contributor to childhood obesity; however, large-scale and longitudinal studies remain limited. This study aimed to examine this association and its variation across gender and urbanicity at multiple geographic scales. Methods We used the US nationally representative Early Childhood Longitudinal Study–Kindergarten cohort data and included 7530 kindergarteners followed up from 1998 to 2007. The Census, road network, and Dun and Bradstreet commercial datasets were used to construct time-varying measurements of 11 types of food outlet within 800-m straight-line and road-network buffer zones of schools and school ZIP codes, including supermarket, convenience store, full-service restaurant, fast-food restaurant, retail bakery, dairy product store, health/dietetic food store, candy store, fruit/vegetable market, meat/fish market, and beverage store. Two-level mixed-effect and cluster-robust logistic regression models were performed to examine the association. Results A higher body mass index (BMI) in 2007 was observed among children experiencing an increase of convenience stores in school neighborhoods during 1998–2007 (β = 0.39, p < 0.05), especially among girls (β = 0.50) and urban schoolchildren (β = 0.41), as well as among children with a decrease of dairy product stores (β = 0.39, p < 0.05), especially among boys (β = 1.86) and urban schoolchildren (β = 0.92). The higher obesity risk was associated with the increase of fast-food restaurants in urban schoolchildren (OR = 1.27 [95% CI = 1.02–1.59]) and of convenience stores in girls (OR = 1.41 [95% CI = 1.09–1.82]) and non-urban schoolchildren (OR = 1.60 [95% CI = 1.10–2.33]). The increase of full-service restaurants was related to lower obesity risk in boys (OR = 0.74 [95% CI = 0.57–0.95]). The decrease of dairy product stores was associated with the higher obesity risk (OR = 1.68 [95% CI = 1.07–2.65]), especially boys (OR = 2.92 [95% CI = 1.58–5.40]) and urban schoolchildren (OR = 1.67 [95% CI = 1.07–2.61]). The schoolchildren exposed to the decrease of meat/fish markets showed the lower obesity risk (OR = 0.57 [95% CI = 0.35–0.91]), especially urban schoolchildren (OR = 0.53 [95% CI = 0.32–0.87]). Results from analyses within 800-m straight-line buffer zones of schools were more consistent with our theory-based hypotheses than those from analyses within 800-m road-network buffer zones of schools and school ZIP codes. Conclusions National data in the USA suggest that long-term exposure to the food environment around schools could affect childhood obesity risk; this association varied across gender and urbanicity. This study has important public health implications for future school-based dietary intervention design and urban planning. Electronic supplementary material The online version of this article (10.1186/s12916-019-1329-2) contains supplementary material, which is available to authorized users.
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The United Nations has called on all nations to take immediate actions to fight noncommunicable diseases (NCDs), which have become an increasingly significant burden to public health systems around the world. NCDs tend to be more common in developed countries but are also becoming of growing concern in low- and middle-income countries. Earth observation (EO) technologies have been used in many infectious disease studies but have been less commonly employed in NCD studies. This review discusses the roles that EO data and technologies can play in NCD research, including (a) integrating natural and built environment factors into NCD research, (b) explaining individual-environment interactions, (c) scaling up local studies and interventions, (d) providing repeated measurements for longitudinal studies including cohorts, and (e) advancing methodologies in NCD research. Such extensions hold great potential for overcoming the challenges of inaccurate and infrequent measurements of environmental exposure at the level of both the individual and the population, which is of great importance to NCD research, practice, and policy.
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Background Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. Methods Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size. ResultsOut of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. Conclusions Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. Trial registrationRegistered in PROSPERO: CRD42016033252
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School environments may contribute to adolescent behavior, reproductive physiology and body composition (BC). The Nutritional and Health Survey in Taiwan (2010) for 1458 junior high school students was geo-mapped for 30 school environs. Facilities for physical activity (fitness centers, gymnasia and sports stadiums, activity centers and parks), sedentary activities (reading material rental shops (RMRS), internet cafes) and food and beverage outlets (FBOs) were calculated as weighted numbers within 1000m of schools. Multiple linear regressions were used to predict BC variable z-scores. For boys, higher fitness center densities and, for girls, gymnasia and sports stadiums were associated with less abdominal fatness. For girls, body mass index, waist circumference (WC) and triceps skinfold thickness (TSF) were greater when RMRS density was higher as was TSF with internet café density. Where there were no FBOs, boys’ WC and TSF were less with more parks, but girls were shorter and WC more adverse. With greater RMRS density and no FBOs, girls still had increased WC/Hip ratio, and less mid-arm muscle circumference. Boys’ findings were more evident after considering puberty. Physical activity facilities (differently by gender), food and beverage outlets absence for boys and low reading material rental shop density for girls increase the likelihood of healthier body composition. © 2017 Chiang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Childhood obesity has been linked to cardiovascular disease (CVD) risk in adulthood. Of great concern is the expected increase in the population's CVD burden in relation to childhood obesity. This is compounded by the risk related to chronic hyperglycemia exposure in youth with type 2 diabetes. We herein provide an overview of the spectrum of early cardiovascular disease manifestation in youth with obesity and type 2 diabetes, in particular abnormalities in cardiac structure and function. Cardiac remodeling and adverse target organ damage is already evident in the pediatric age group in children with obesity and type 2 diabetes. This supports the importance of intensifying obesity prevention efforts and early intervention to treat comorbidities of obesity in the pediatric age group to prevent cardiac events in early adulthood.
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Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease among children. Lifestyle interventions, such as diet and exercise, are frequently recommended. Children with NAFLD have a distinct physiology that is different from obesity alone and has the potential to influence lifestyle treatments. Studies of diet alone in the treatment of pediatric NAFLD have focused on sugar and carbohydrate, but did not indicate any one dietary approach that was superior to another. For children who are obese and have NAFLD, weight loss may have a beneficial effect regardless of the diet used. Exercise is widely believed to improve NAFLD because a sedentary lifestyle, poor aerobic fitness, and low muscle mass are all risk factors for NAFLD. However, there have been no randomized controlled trials of exercise as a treatment for children with NAFLD. Studies of the combination of diet and exercise suggest a potential for improvement in serum alanine aminotransferase activity and/or magnetic resonance imaging liver fat fraction with intervention. There is also enthusiasm for the use of dietary supplements; however, studies in children have shown inconsistent effects of vitamin E, fish oil, and probiotics. This review presents the available data from studies of lifestyle intervention and dietary supplements published to date and highlights challenges that must be addressed in order to advance the evidence base for the treatment of pediatric NAFLD.
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In recent years, childhood overweight and obesity have become an increasing and challenging phenomenon in Western cities. A lot of studies have focused on the analysis of factors such as individual dispositions and nutrition balances, among others. However, little is known about the intra-urban spatial patterns of childhood overweight and its associations with influencing factors that stretch from an individual to a neighbourhood level. The aim of this paper is to analyse the spatial patterns of childhood obesity in Berlin, and also to explore and test for associations with a complex set of risk factors at the individual, household and neighbourhood levels. We use data from a survey of 5–6 year-olds that includes health status, height, and weight, as well as several socioeconomic and other risk variables. In addition, we use a set of neighbourhood variables, such as distance, and density measures of parks or fast food restaurants. Our outcome variable is the percentage of children of 5–6 years who were reported overweight or obese in 2012. The aggregated data is available for 60 areas in Berlin. We first analyse the outcome and risk factor data descriptively, and subsequently apply a set of regression analyses to test for associations between reported overweight and obesity, and also individual, household and neighbourhood characteristics. Our analysis returned a distinct spatial distribution of childhood overweight in Berlin with highest shares in the city centre. Moreover, we were able to identify significant effects regarding the social index, and the percentage of non-German children being obese or overweight; additionally, we identified fast food restaurant density as a possible influencing factor. For the other variables, including the neighbourhood variables, we could not identify a significant association on this aggregated level of analysis. Our findings confirm the results of earlier studies, in which the social status and percentage of non-German children is very important in terms of the association with childhood overweight and obesity. Unlike many studies conducted in North America, this study did not reveal an influence of neighbourhood variables. We argue that European urban structures differ from North American structures and highlight the need for a more detailed analysis of the association between the neighbourhood environment and the physical activity of children in urban setting.
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Purpose Little is known about the relationship between changes in food store environment and children's obesity risk in the United States. This study examines children's weight status associated with the changes in the quantity of food stores in their neighborhoods. Methods A nationally representative cohort of schoolchildren in the United States was followed from fifth grade in 2004 to eighth grade in 2007 (n = 7,090). In 2004 and 2007, children's body mass index (BMI) was directly measured in schools. ZIP Code Business Patterns data from the Census Bureau in 2004 and 2007 characterized the numbers of food stores in every ZIP code area by type of store: supermarkets, limited-service restaurants, small-size grocery, and convenience stores. Baseline and change in the numbers of stores were the major exposures of interest. Results Girls living in neighborhoods with three or more supermarkets had a lower BMI 3 years later (by -.62 kg/m2; 95% confidence interval = -1.05 to -.18) than did those living in neighborhoods without any supermarkets. Girls living in neighborhoods with many limited-service restaurants had a greater BMI 3 years later (by 1.02 kg/m2; 95% confidence interval =.36-1.68) than did those living in neighborhoods with less than or equal to one limited-service restaurant. Exposure to a decreased quantity of small-size grocery stores in neighborhoods was associated with girls' lower BMI by eighth grade. Conclusions The longitudinal association between neighborhood food environment and children's BMI differed by gender. For girls, supermarkets in neighborhoods seemed protective against obesity, whereas small-size grocery stores and limited-service restaurants in neighborhoods increased obesity risk. There was no significant longitudinal finding for boys. © 2016 Society for Adolescent Health and Medicine. All rights reserved.
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Introduction: Researchers and policy-makers are interested in the influence that food retailing around schools may have on child obesity risk. Most previous research comes from North America, uses data aggregated at the school-level and focuses on associations between fast food outlets and school obesity rates. This study examines associations between food retailing and BMI among a large sample of primary school students in Berkshire, England. By controlling for individual, school and home characteristics and stratifying results across the primary school years, we aimed to identify if the food environment around schools had an effect on BMI, independent of socio-economic variables. Methods: We measured the densities of fast food outlets and food stores found within schoolchildren's home and school environments using Geographic Information Systems (GIS) and data from local councils. We linked these data to measures from the 2010/11 National Child Measurement Programme and used a cross-classified multi-level approach to examine associations between food retailing and BMI z-scores. Analyses were stratified among Reception (aged 4-5) and Year 6 (aged 10-11) students to measure associations across the primary school years. Results: Our multilevel model had three levels to account for individual (n = 16,956), home neighbourhood (n = 664) and school (n = 268) factors. After controlling for confounders, there were no significant associations between retailing near schools and student BMI, but significant positive associations between fast food outlets in home neighbourhood and BMI z-scores. Year 6 students living in areas with the highest density of fast food outlets had an average BMI z-score that was 0.12 (95% CI: 0.04, 0.20) higher than those living in areas with none. Discussion: We found little evidence to suggest that food retailing around schools influences student BMI. There is some evidence to suggest that fast food outlet densities in a child's home neighbourhood may have an effect on BMI, particularly among girls, but more research is needed to inform effective policies targeting the effects of the retail environment on child obesity.
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To identify longitudinal individual, social and environmental predictors of adiposity (BMI z-score), and of resilience to unhealthy weight gain, in healthy weight children and adolescents. Two hundred healthy weight children aged 5-12 years at baseline and their parents living in socio-economically disadvantaged neighborhoods were surveyed at baseline and three years later. Children's height and weight were objectively measured, parents completed a detailed questionnaire that examined the home, social and neighborhood environments, and objective measures of the neighborhood environment were assessed using geographic information system data. Children classified as healthy weight at baseline who had small or medium increases in their BMI z-score between baseline and three year follow up (those in the bottom and middle tertiles) were categorized as 'resilient to unhealthy weight gain'. Where applicable, fully adjusted multivariable regression models were employed to determine baseline intrapersonal, social and environmental predictors of child BMI z-scores at follow-up, and resilience to unhealthy weight gain at follow-up. Maternal efficacy for preventing their child from engaging in sedentary behaviors (B = -0.03, 95 % CI: -0.06, 0.00) was associated with lower child BMI z-score at follow up. Rules to limit sedentary behaviors (OR = 1.14, 95 % CI: 1.03, 1.25) was a predictor of being resilient to unhealthy weight gain. The findings suggest that strategies to support parents to limit their children's sedentary behavior may be important in preventing unhealthy weight gain in socioeconomically disadvantaged communities.
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Objectives: This study examines environmental factors associated with BMI (body mass index) levels among adolescents with the aim of identifying potential interventions for reducing childhood obesity. Methods: Students (n=1,048) aged 10-14 years at 28 schools in London, ON, completed a survey providing information on age, sex, height, weight, home address, etc., which was used to construct age-sex adjusted BMI z-scores. The presence of recreation opportunities, fast-food outlets and convenience stores was assessed using four areal units around each participant's home and school neighbourhood: "circular buffers" encompassing territory within a straight-line distance of 500 m and 1000 m; and "network buffers" of 500 m and 1000 m measured along the street network. School neighbourhoods were also assessed using school-specific "walksheds". Multilevel structural equation modeling techniques were employed to simultaneously test the effects of school-environment (Level 2) and home-environment (Level 1) predictors on BMI z-scores. Results: Most participants (71%) had a normal BMI, 16.9% were overweight, 7.6% were obese, and 4.6% were considered underweight. Multilevel analyses indicated that built environment characteristics around children's homes and schools had a modest but significant effect on their BMI. The presence of public recreation opportunities within a 500 m network distance of home was associated with lower BMI z-scores (p<0.05), and fast-food outlets within the school walkshed was associated with higher BMI z-scores (p<0.05). Conclusion: Interventions and policies that improve children's access to publicly provided recreation opportunities near home and that mitigate the concentration of fast-food outlets close to schools may be key to promoting healthy lifestyles and reducing childhood obesity.
Article
Geographic Information Systems (GIS), Global Positioning Systems (GPS), and remote sensing (RS) are revolutionizing obesity-related research. The primary applications of GIS have included visualizing obesity outcomes and risk factors, constructing obesogenic environmental indicators, and detecting geographical patterns of obesity prevalence and obesogenic environmental features. GPS was mainly used to delineate individual activity space and combined with other devices to measure obesogenic behaviors. RS has been understated for its role as important sources of data about natural and built environments. These spatial technologies, collectively called the 3S technologies, will be useful in measuring more facets of obesogenic environments and individual environmental exposure at finer levels and studying obesity etiology and interventions.
Article
Objective The goal of this study was to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. Methods Data were obtained from the National Household Food Acquisition and Purchase Survey (2012‐2013; n = 3,748 children aged 2 to 18 years). Logistic regression was used to examine associations between neighborhood retail food access (≤1 mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible nonparticipants, 1,575 SNAP ineligible). Store types included supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non–fast food restaurants. Results Odds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03‐1.17]) and for children in SNAP (1.14 [1.05‐1.24]). Eligible non‐SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04‐1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non‐SNAP: 7.7%, SNAP ineligible: 5.5%). Conclusions Greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
Article
This paper examined prospective associations between built environment features assessed at baseline using direct audits and adiposity outcomes two years later in Montreal, Canada. Data stem from the Quebec Adipose and Lifestyle Investigation in Youth study of 630 children aged 8-10 years with a parental history of obesity. Baseline measurements took place between 2005 and 2008. Follow-up took place between 2008 and 2011. Built environment features were assessed at baseline in up to 10 contiguous street segments around participants' residential addresses using on-site audits. Analyses were restricted to participants who reported the same address both at baseline and follow-up. Prospective associations between adiposity outcomes at follow-up (BMI z-score and waist-height ratio) and built environment features at baseline (traffic-calming features, pedestrian aids, disorder, physical activity facilities, convenience stores, and fast-food restaurants) were examined using multivariable regression models. 391 children were included in the analyses. In fully-adjusted models, children living in residential areas with presence of pedestrian aids had lower BMI z-score, and lower waist-height ratio. Also, children residing in residential areas with at least one convenience store had lower BMI z-score, and lower waist-height ratio at follow-up. Findings provide evidence of the potential role of street-level urban design features in shaping childhood adiposity. To better inform policy and intervention, future research should explore the possibility of reducing obesogenic neighbourhoods by enhancing street-level design features.
Article
Introduction: The study examined the association of neighborhood walkability to multiple activity-related outcomes and BMI among adolescents and evaluated socioeconomic status as an effect modifier. Method: Cross-sectional study, with adolescents recruited from neighborhoods that met criteria for a 2 × 2 matrix defined by high/low GIS-defined walkability and high/low median income. Adolescents aged 12-16 years (n = 928) were recruited from selected neighborhoods in Maryland and King County, Washington regions in 2009-2011. There were 50.4% girls, and 66.3% were non-Hispanic white, with no medical restrictions on physical activity (PA) or diets. Total PA and sedentary time was assessed by 7 days of accelerometer monitoring. Adolescents self-reported active transport, time spent on 6 sedentary behaviors, and height and weight, used to compute BMI percentiles. Mixed model linear and logistic regressions examined outcomes for association with walkability and income, adjusting for demographic covariates and clustering within block groups. Results: Walkability was positively and significantly related to objectively-measured PA (p < .001) and more frequent walking for transportation (p < .001). Total self-reported total sedentary time (p = .048) and TV time (p < .007) were negatively related to walkability. Time in vehicles was negatively related to walkability only among higher-income adolescents. Conclusions: Neighborhood walkability was strongly and consistently associated with adolescents' objectively-assessed total physical activity and reported active transportation. A novel finding was that adolescents living in walkable neighborhoods reported less television time and less time in vehicles. Most results were similar across income categories. Results strengthen the rationale for recommendations to improve walkability.
Article
To examine the influence of neighborhood environment on childhood overweight and obesity in Shelby County Schools, Tennessee, and whether and to what extent that influence varies by age, gender, and the specific environment characteristics. 41,283 students were surveyed covering both individual-level covariates and several objective measures of neighborhood environment. Multilevel logistic regressions were used to examine the influence of neighborhood-level variables on overweight+obesity and obesity with adjustment of individual-level covariates. Further, a stratified analysis for each of the six groups by school level and gender. For both overweight+obesity and obesity, younger children were less sensitive to neighborhood characteristics than older children, and boys are less sensitive than girls. For girls in middle and high schools, the risk of overweight+obesity and obesity were positively associated with population density, and negatively associated with percent of poverty and percent of unhealthy food. Boys' risk of overweight+obesity and obesity were positively associated with distance to park. Neighborhood environment plays an important role in childhood overweight and obesity, and the effects vary by age, gender, and the specific neighborhood characteristic. Intervention programs tailored to specific groups may be more effective than ones targeted to children as a whole.
Article
Objectives: One third of school-aged children in New York State (NYS) are overweight or obese, with large geographic disparities across local regions. We used NYS student obesity surveillance data to assess whether these geographical variations are attributable to the built environment. Method: We combined NYS Student Weight Status Category Reporting System 2010-2012 data with other government publicly available data. Ordinary least squares regression models identified key determinants of school district-level student obesity rates for elementary and middle/high schools. Geographical weighted regression models explored spatial variations in local coefficients of the built environment predictors. Results: From ordinary least squares models, higher farmers' market density was only significantly associated with lower obesity rates among elementary school students (b = -0.116; p < .01). Higher fast-food restaurant density was significantly associated with higher obesity rates (b = 0.014; p < .05), and higher land use mix was only significantly associated with lower obesity rates (b = -0.054; p < .01) among middle/high school students. In geographical weighted regression analyses, the inverse association between market density and obesity rates among elementary school students was more pronounced in the eastern portion of the state. The relationship between higher fast-food restaurant density and higher obesity rates among middle/high school students was found in the southeastern portion of the state. Conclusions: Different patterns of food consumption may explain varying determinants of obesity between younger and older students. Regional variations in local associations between the built environment variables and obesity may suggest differences in how healthy food sources are accessed locally.
Article
Background: Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective. Aims: The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets. Methods: A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child's residence to quantify access to fast food. Results: The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets. Conclusions: This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood.
Article
Background Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective. Aims The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets. Methods A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child’s residence to quantify access to fast food. Results The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets. Conclusions This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood.
Article
The study aim was to examine associations of neighborhood built environment and neighborhood socio-economic status (SES) with multiple physical activity (PA) behaviors, sedentary time, and obesity indicators among adolescents. Cross-sectional study of 325 adolescents aged 14–18 years recruited from schools in Valencia, Spain. Participants' home neighborhoods were classified according to walkability and SES levels. Walkability was defined as an index of three built environment characteristics (i.e., residential density, land use mix, and street connectivity) based on geographic information system data. Moderate-vigorous PA (MVPA) and sedentary time were assessed using accelerometers. Active commuting to school, leisure-time PA, and time in specific sedentary activities were evaluated by questionnaire. Objectively measured weight and height were used to calculate body mass index, and percent body fat was analyzed by bioelectrical impedance. Data were collected in 2013–15. Mixed model regression analyses were performed. Analyses showed an SES-by-walkability interaction for MVPA on weekends. MVPA was highest in high-SES/high-walkable neighborhoods. Another SES-by-walkability interaction was found for sedentary minutes per weekend day. The lowest average sedentary minutes were found in high-SES/high-walkable areas. Neighborhood SES was positively related to participation in sports teams/PA classes and, negatively to time spent in sedentary behaviors. Adolescents living in lower-SES neighborhoods spent more time watching TV and had more obesity and body fat. Present findings strengthen the rationale for targeting neighborhood built and SES environments as health promotion interventions for adolescents.
Article
Background: Childhood obesity is a global issue. Understanding associated factors is essential in designing interventions to reduce its prevalence. There are knowledge gaps concerning the leptogenic potential of play areas for very young children and particularly whether there is an association between levels of childhood obesity and play area quality. Methods: A cross-sectional observational study was conducted to investigate whether spatial access to play areas had an association with healthy weight status of 4-5-year-old children. Data from the English National Childhood Measurement Programme 2012/13 was used to measure healthy weight status and a geographic information system was used to calculate (a) the number of purposefully constructed play areas within 1km (density), and (b) the distance to nearest play area (proximity), from child's residential postcode. A play area quality score was included in predictive models. Multilevel modelling was used to adjust for the clustering of observations by school. Adjustment was also made for the effects of gender and deprivation. Results: 77% of children had a healthy weight status (≥2nd and <85th centile). In a fully adjusted multilevel model there was no statistically significant association between healthy weight status and density or proximity measures, with or without inclusion of a play area quality score, or when accounting for the effects of gender and deprivation. Conclusions: Among 4-5-year-old children attending school, there was no association between healthy weight status and spatial access to play areas. Reasons may include under-utilisation of play areas by reception age children, their minimal leptogenic influence or non-spatial influences affecting play area choice.
Article
Among the causes of obesity, environmental factors have also been studied, in addition to genetic, social, psychological, and hormonal factors. The distribution of food outlets, facilitating or hindering food acquisition, can promote body weight control by encouraging healthier food habits. The objective of this study was to investigate associations between environmental availability and utilization of food outlets and overweight/obesity in 7 to 14-year-old schoolchildren in Florianópolis, in the South of Brazil. A logistic regression analysis identified a positive association between overweight/obesity in 2195 schoolchildren and the presence of restaurants in the vicinity of their homes (buffer = 400 meters). Being a member of a family that utilizes public markets/greengrocers was also positively associated with overweight/obesity in the sample investigated. Identifying the distribution of these establishments in the vicinity of the homes of schoolchildren in middle-income countries is an important element in understanding the role played by the food environment in weight gain in a variety of different settings.
Article
Geographic information systems (GIS) data/methods offer good promise for public health programs including obesity-related research. This study systematically examined their applications and identified gaps and limitations in current obesity-related research. A systematic search of PubMed for studies published before 20 May 2016, utilizing synonyms for GIS in combination with synonyms for obesity as search terms, identified 121 studies that met our inclusion criteria. We found primary applications of GIS data/methods in obesity-related research included (i) visualization of spatial distribution of obesity and obesity-related phenomena, and basic obesogenic environmental features, and (ii) construction of advanced obesogenic environmental indicators. We found high spatial heterogeneity in obesity prevalence/risk and obesogenic environmental factors. Also, study design and characteristics varied considerably across studies because of lack of established guidance and protocols in the field, which may also have contributed to the mixed findings about environmental impacts on obesity. Existing findings regarding built environment are more robust than those regarding food environment. Applications of GIS data/methods in obesity research are still limited, and related research faces many challenges. More and better GIS data and more friendly analysis methods are needed to expand future GIS applications in obesity-related research.
Article
Parks and park features are important for promoting physical activity and healthy weight, especially for low-income and racial/ethnic minority youth who have disproportionately high obesity rates. This study 1) examined associations between neighborhood park and playground availability and youth obesity, and 2) assessed whether these associations were moderated by youth race/ethnicity and socioeconomic status (SES). In 2013, objectively measured height and weight were collected for all 3rd-5th grade youth (n = 13,469) in a southeastern US county to determine body mass index (BMI) percentiles. Enumeration and audits of the county’s parks (n = 103) were concurrently conducted. Neighborhood park and playground availability were calculated as the number of each facility within or intersecting each youth’s Census block group. Multilevel linear regression models were utilized to examine study objectives. For boys, no main effects were detected; however, SES moderated associations such that higher park availability was associated with lower BMI percentile for low-SES youth but higher BMI percentile for high-SES youth. For girls, the number of parks and playgrounds were significantly associated with lower BMI (b =-2.2,b =-1.1,p < 0.05, respectively) and race/ethnicity and SES moderated associations between playground availability and BMI percentile. Higher playground availability was associated with lower BMI percentile for White and high-SES girls but higher BMI percentile for African American and low-SES girls. Considerable variation was detected in associations between park and playground availability and youth obesity by SES and race/ethnicity, highlighting the importance of studying the intersection of these characteristics when exploring associations between built environment features and obesity.
Article
Background and objectives: Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries. Methods and study design: The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured. Results: Our longitudinal analysis suggested boys in the 2nd quartile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as compared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile. Conclusions: Food environment may affect children's BMI in China, while the association is inconsistent with previous studies. Further research is needed.
Article
Background: Structural factors of neighbourhood environments in which children live have attracted increasing attention in epidemiological research. This study investigated whether neighbourhood socioeconomic position (SEP), public playground and park space, and perceived environmental exposures were independently associated with overweight in preschool aged children while simultaneously considering individual child and family factors. Methods: Body-Mass-Index (BMI) data from 3499 children (53% boys and 47% girls) from three surveys between 2004 and 2007 from 18 school enrolment zones in the city of Munich, Germany, were analysed with hierarchical logistic regression models. An index of neighbourhood SEP was calculated with principal component analysis. Individual socioeconomic data, parental BMI, birth weight, housing characteristics, and perceived annoyance due to exposures to noise, air pollution, lack of greenspace, and traffic were collected with parental questionnaires. Measures of age-specific playground space and availability of park space derived from Geographic Information System were additionally weighted with age-specific population data. Results: In bivariate analysis perceived annoyance due to exposures to noise or lack of greenspace, high frequency of lorries, traffic jam, living in a multiple dwelling or next to a main road, low neighbourhood SEP, and low playground space were significantly associated with overweight. However, in multivariate analysis only living in a multiple dwelling was independently associated with overweight. From the considered individual child and family factors low parental education, parental overweight or obesity, and a high birthweight showed an independent relation to overweight. Conclusions: Our study identified individual child and parental factors, and living in a multiple dwelling as the strongest predictors for overweight in preschool aged children. However, perceived annoyance to built environmental exposures additionally explained overweight variance between neighbourhoods. Based on our findings interventions and policies addressing overweight prevention in young children should focus on parental behaviours and the immediate home environment.
Article
Introduction: The childhood obesity epidemic is a global concern. There is limited evidence in Mexico linking the local food environment to obesity. The purpose of this study is to describe the links between the local food environment around elementary schools and schoolchildren's BMI in two Mexican cities. Methods: Cross-sectional surveys were conducted in 60 elementary schools in two Mexican cities (i.e., Cuernavaca and Guadalajara) in 2012-2013. Anthropometric measurements on schoolchildren were collected, as well as environmental direct audits and observations in a 100-m buffer around schools. Children's BMI was evaluated according to WHO-recommended procedures. In BMI models, the explanatory variable was the number of retail food sources. These models were adjusted for child's characteristics, schools' socioeconomic background, compliance with federal guidelines concerning unhealthy foods within schools' facilities, and corresponding city. Analysis was conducted in 2014. Results: The number of mobile food vendors was higher around public schools than outside private schools (p<0.05). Linear regression procedures showed a significant positive statistical association between children's BMI and the number of mobile food vendors around schools. Schoolchildren from the highest tertile of mobile food vendors showed 6.8% higher BMI units than those from the lowest tertile. Children attending schools within the highest tertile of food stores also had 4.7% higher BMI units than children from schools in the lowest tertile. Conclusions: Health policy in Mexico should target the obesogenic environment surrounding elementary schools, where children may be more exposed to unhealthy foods.
Article
Reducing socioeconomic disparities in weight-related health is a public health priority. The purpose of this paper was to examine 10-year longitudinal patterns in overweight and weight-related behaviors from adolescence to young adulthood as a function of family-level socioeconomic status (SES) and educational attainment. Project EAT (Eating and Activity in Teens and Young Adults) followed a diverse sample of 2,287 adolescents from 1999 to 2009. Mixed-effects regression tested longitudinal trends in overweight, fast food, breakfast skipping, physical inactivity, and screen use by family-level SES. The influence of subsequent educational attainment in young adulthood was examined. Results revealed that the prevalence of overweight increased significantly from adolescence to young adulthood with the greatest change seen in those from low SES (mean change = 30.7%, 95% CI = 25.6%-35.9%) as compared to high SES families (mean change = 21.7%, 95% CI = 18.2% to 25.1%). Behavioral changes from adolescence to young adulthood also differed by SES background; the prevalence of frequent fast food intake (≥ 3 times/wk) increased most dramatically in those from low SES (mean change = 6%, 95% CI = 0.5%-11%) as compared to high SES families (mean change = -1.2%, 95% CI = -5.2%-2.9%). Overall trends suggest that a higher educational attainment mitigates the negative impacts of a low SES background. These findings suggest that continued effort is needed to ensure that public health strategies addressing obesity and related behaviors reach adolescents and young adults from low SES backgrounds and do not contribute to widening socioeconomic gaps in weight-related health.
Article
Objectives: To determine whether proximity to a supermarket modified the effects of an obesity intervention. Methods: We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included a computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. Results: Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls. Conclusions: Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention. (Am J Public Health. Published online ahead of print January 21, 2016: e1-e6. doi:10.2105/AJPH.2015.302986).
Article
This article is the sixth in a series of the comorbidities of childhood obesity and reviews psychosocial aspects with a focus on weight-based victimization and discrimination stemming from weight bias and stigma. Outcomes from these bullying and discriminatory experiences are pervasive and impact youth across all settings, including school. Lastly, this article provides recommendations on how to reduce bias and stigma to better serve these students in the school environment.
Article
Built environment factors constrain individual level behaviors and choices, and thus are receiving increasing attention to assess their influence on health. Traditional regression methods have been widely used to examine associations between built environment measures and health outcomes, where a fixed, prespecified spatial scale (e.g., 1 mile buffer) is used to construct environment measures. However, the spatial scale for these associations remains largely unknown and misspecifying it introduces bias. We propose the use of distributed lag models (DLMs) to describe the association between built environment features and health as a function of distance from the locations of interest and circumvent a-priori selection of a spatial scale. Based on simulation studies, we demonstrate that traditional regression models produce associations biased away from the null when there is spatial correlation among the built environment features. Inference based on DLMs is robust under a range of scenarios of the built environment. We use this innovative application of DLMs to examine the association between the availability of convenience stores near California public schools, which may affect children’s dietary choices both through direct access to junk food and exposure to advertisement, and children’s body mass index z scores.
Article
Existing research evidence indicates that children and adolescents of parents with a low socioeconomic position spend more time on sedentary behaviour than their counterparts. However, the mechanisms driving these differences remain poorly understood. The main aim of this systematic review was to summarize the evidence regarding the association between socioeconomic position and correlates of sedentary behaviour among youth (0-18 years) from developed countries. The literature search was conducted using MEDLINE, Embase, CINAHL and PsycINFO. A total of 37 studies were included. All but three studies examined screen-based sedentary behaviours only. Methodological quality ranged from low to moderate. Education was the most commonly used indicator of socioeconomic position, followed by income. Socioeconomic position was inversely related to the presence of a TV in the child's bedroom, parental modelling for TV viewing, parental co-viewing and eating meals in front of the TV. We found no/indeterminate evidence for an association between socioeconomic position and rules and regulations about screen time. The findings suggest possible factors that could be targeted in future intervention studies to decrease screen-based sedentary behaviour in lower socioeconomic groups in particular. © 2015 World Obesity.
Article
The study determined the association between body mass index (BMI) z score and fruit and vegetable intake, frequency and ratio of fast food outlets and grocery stores in concentric areas around the child's residence, outdoor play and total crime index. Data from 78 Louisiana pre-school children were analyzed using Pearson's correlation and multiple regression analysis. Parental-reported fruit intake was linearly associated with increased number of grocery store counts in concentric areas around the child's residence (P = 0.0406, P = 0.0281). Vegetable intake was inversely (P = 0.04) and the ratio of fast food outlets to grocery stores in a 2-mile concentric area around the child's residence was positively (P = 0.05) associated to BMI z score after applying Best Model regression analysis (F = 3.06, P = 0.0346). Children residing in neighbourhoods with greater access to fast foods and lower access to fruits and vegetables may be at higher risk for developing obesity during pre-school years. © 2015 World Obesity.
Article
We examined the uncertainty of the contextual influences on food access through an analytic framework of the uncertain geographic context problem (UGCoP). We first examined the compounding effects of two kinds of spatiotemporal uncertainties on people's everyday efforts to procure food and then outlined three key dimensions (food access in real time, temporality of the food environment, and perceived nutrition environment) in which research on food access must improve to better represent the contributing environmental influences that operate at the individual level. Guidelines to address the UGCoP in future food access research are provided to account for the multidimensional influences of the food environment on dietary behaviors. (Am J Public Health. Published online ahead of print July 16, 2015: e1-e4. doi:10.2105/AJPH.2015.302792).
Article
To examine the relationship between local food environments and obesity and assess the quality of studies reviewed. Systematic keyword searches identified studies from US and Canada that assessed the relationship of obesity to local food environments. We applied a quality metric based on design, exposure and outcome measurement, and analysis. We identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross-sectional. Associations between food outlet availability and obesity were predominantly null. Among non-null associations, we saw a trend toward inverse associations between supermarket availability and obesity (22 negative, 4 positive, 67 null) and direct associations between fast food and obesity (29 positive, 6 negative, 71 null) in adults. We saw direct associations between fast food availability and obesity in lower income children (12 positive, 7 null). Indices including multiple food outlets were most consistently associated with obesity in adults (18 expected, 1 not expected, 17 null). Limiting to higher quality studies did not affect results. Despite the large number of studies, we found limited evidence for associations between local food environments and obesity. The predominantly null associations should be interpreted cautiously due to the low quality of available studies. © 2015 The Obesity Society.