A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study

Abstract

Background Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes. Methods This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships. Results The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC. Conclusion People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.

Neighbourhood Walkability and Its Influence on Physical Activity and Cardiometabolic Disease: A Cross-Sectional Study in a Caribbean Small Island Developing State

“…The concept of walkability as an upstream determinant of cardiovascular health is likely to be the result of a walkable environment leading to increased PA. This in turn may limit age-related weight gain, reduce body fat, waist circumference, and BMI, and may improve blood pressure and insulin resistance, all factors that drive cardiovascular risk during later life [ 21 , 53 , 54 ]. Our findings suggest that enhancing neighborhood walkability should be considered as an enabling factor in designing environmental interventions aimed at reducing the burden of CVD.…”

Aging in Rural Communities

“…Despite the more natural physical environment, rural areas have significantly lower walkability than urban areas [127•]. Walkability has been shown to be an independent risk factor for obesity and related cardiovascular disease (CVD) [128], which has substantial implications for the health of rural older adults.…”

Walkability Indicators in the Aftermath of the COVID-19 Pandemic: A Systematic Review

“…[26][27][28][63][64][65][66]. Another topic of general interest for Public Health is people's physical health, manifested through obesity, overweight and frailty, and generally calculated using the Body Mass Index (BMI) or Waist Circumference (WC) [67][68][69][70][71]. Other studies focus on the correlation between walkability and prevalence of diseases or health complications, such as cancer [72,73], hypertension [30,74], cardiovascular problems [29,75,76], diabetes [32] and dementia [31].…”

“…Most studies analyzed resort to well-established indicators from the literature on walkability, either using already known values of an indicator, for areas where previous work with that indicator was developed, or employing the indicator's formulas and methodologies, sometimes with small adjustments, to calculate walkability for new areas of analysis. Health is people's physical health, manifested through obesity, overweight and frailty, and generally calculated using the Body Mass Index (BMI) or Waist Circumference (WC) [67][68][69][70][71]. Other studies focus on the correlation between walkability and prevalence of diseases or health complications, such as cancer [72,73], hypertension [30,74], cardiovascular problems [29,75,76], diabetes [32] and dementia [31].…”