Childhood obesity and the built environment

Department of Preventive Medicine, University of California, San Francisco, California, USA.
Current opinion in pediatrics (Impact Factor: 2.53). 04/2010; 22(2):202-7. DOI: 10.1097/MOP.0b013e328336eb6f
Source: PubMed


Neighborhood factors are increasingly examined for their role in the childhood obesity epidemic. Whereas studies on the impacts of neighborhood factors on adult obesity are relatively common, studies examining these same factors on childhood obesity are far fewer.
Using the Ecological Systems Theory (EST) as a model, we sought to examine the strength of the literature with respect to neighborhood factors as outlined in EST. This includes factors related to the family and the school, which are embedded in larger social contexts of the community and society. These factors are often referred to in the literature as the 'built environment' which encompasses the entire range of structural elements in a residential setting including, for example, housing mix, transportation networks, public resources, and presence of sidewalks or trails.
Whereas progress has been made with respect to the body of evidence supporting the role of neighborhood factors on childhood obesity and obesity-related behaviors, much work remains to be done to enhance our understanding of neighborhood level factors. As the body of evidence grows, these studies will inform multilevel interventions which are urgently needed to tackle the growing epidemic of childhood obesity in the US.

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Available from: Irene H Yen, May 21, 2014
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    • "Studies indicate that the built environment is one of the main sources of factors shaping physical activity and sedentary behaviour in youth [7,8]. Built environments particularly important to youth activity habits include schools and the residential neighbourhood [9-14]. "
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    ABSTRACT: Background: Physical activity and sedentary behaviour are important contributors to adolescents' health. These behaviours may be affected by the school and neighbourhood built environments. However, current evidence on such effects is mainly limited to Western countries. The International Physical Activity and the Environment Network (IPEN)-Adolescent study aims to examine associations of the built environment with adolescent physical activity and sedentary behaviour across five continents.We report on the repeatability of measures of in-school and out-of school physical activity, plus measures of out-of-school sedentary and travel behaviours adopted by the IPEN - Adolescent study and adapted for Chinese-speaking Hong Kong adolescents participating in the international Healthy environments and active living in teenagers-(Hong Kong) [iHealt(H)] study, which is part of IPEN-Adolescent. Methods: Items gauging in-school physical activity and out-of-school physical activity, and out-of-school sedentary and travel behaviours developed for the IPEN - Adolescent study were translated from English into Chinese, adapted, and pilot tested. Sixty-eight Chinese-speaking 12-17 year old secondary school students (36 boys; 32 girls) residing in areas of Hong Kong differing in transport-related walkability were recruited. They self-completed the survey items twice, 8-16 days apart. Test-retest reliability was assessed for the whole sample and by gender using one-way random effects intra-class correlation coefficients (ICC). Test-retest reliability of items with restricted variability was assessed using percentage agreement. Results: Overall test-retest reliability of items and scales was moderate to excellent (ICC = 0.47-0.92). Items with restricted variability in responses had a high percentage agreement (92%-100%). Test-retest reliability was similar in girls and boys, with the exception of daily hours of homework (reliability higher in girls) and number of school-based sports teams or after-school physical activity classes (reliability higher in boys). Conclusions: The translated and adapted self-report measures of physical activity, sedentary and travel behaviours used in the iHealt(H) study are sufficiently reliable. Levels of reliability are comparable or slightly higher than those observed for the original measures.
    Full-text · Article · Jun 2014 · BMC Pediatrics
    • "Only one association was found between variables related to perceived safety and BMI z-score. A systematic review found that studies pertaining to safety are characterized by different exposures of interest, population groups and study designs (Galvez et al., 2010). The authors noted that neighborhood safety constitutes a unique factor because it can be placed in both the social or built environment. "
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    ABSTRACT: Background Maternal smoking during pregnancy is associated with childhood overweight, but the association with fat distribution is not clear. Objective To explore the longitudinal association between smoking during pregnancy and childhood overweight and fat distribution. Methods In the KOALA Birth Cohort Study, repeated questionnaires were administered to 2698 mother-child pairs, including questions on smoking at 14 and 34 weeks of pregnancy. Main outcomes were birth weight, weight gain in the first year, body mass index (BMI) z-scores and overweight (BMI 85th percentile) at 1, 2, 4-5 and 6-7 years (n=1730) and waist circumference and four skinfold thicknesses measured at home visits at age 6-7 years in a subgroup (n=418). We used multivariable linear and logistic regression, with generalized estimating equations (GEE) for repeated measurements. ResultsMaternal smoking was associated with lower birth weight, higher weight gain in the first year and increasing overweight after infancy (change with age P=0.02 in the GEE). Maternal smoking vs. non-smoking during pregnancy was associated with a higher risk of the child exceeding the 85th percentile of BMI (adjusted odds ratio [aOR] 3.72; 95% CI 1.33-10.4), waist circumference (aOR 2.65; 95% CI 1.06-6.59) and sum of skinfold thicknesses (aOR 4.45; 95% CI 1.63-12.2) at the age of 6-7 years. Conclusions Maternal smoking during pregnancy is associated with lower birth weight, weight catch-up and development of overweight into childhood.
    No preview · Article · Jan 2013 · Pediatric Obesity
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    • "This systematic review was, therefore, developed to examine the effect of the school built environment during the period of primary education. Given the range of study designs that previous reviews (Dunton et al., 2009; Feng et al., 2010; Galvez et al., 2010; Papas et al., 2007) have encountered, this systematic review was designed to be able to incorporate both experimental and observational studies. The search strategy was designed to be sensitive to identify any studies which examined the school built environment rather than specific to certain elements of the built environment (Box 2). "
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    ABSTRACT: This systematic review considers current literature on the association between childhood overweight and obesity and the primary school built environment. Bibliographic databases from the fields of medicine, social science, exercise science and education were systematically searched. The following elements of the built environment were found to have been investigated: playground availability and adequacy; gymnasium availability and adequacy; school field, showers and covered playground availability. One intervention study was identified which utilized the built environment as an adjunct to a behavior change intervention. This systematic review identified minimal research upon the association between the school built environment and weight status and the current results are inconclusive.
    Full-text · Article · Feb 2012 · Health & Place
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