Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways

Abstract

BackgroundThe built environment (BE) is said to influence local obesity rates. Few studies have explored causal pathways between home-neighborhood BE variables and health outcomes such as obesity. Such pathways are likely to involve both physical activity and diet.MethodsThe Seattle Obesity Study (SOS II) was a longitudinal cohort of 440 adult residents of King Co, WA. Home addresses were geocoded. Home-neighborhood BE measures were framed as counts and densities of food sources and physical activity locations. Tax parcel property values were obtained from County tax assessor. Healthy Eating Index (HEI 2010) scores were constructed using data from food frequency questionnaires. Physical activity (PA) was obtained by self-report. Weights and heights were measured at baseline and following 12 months’ exposure. Multivariable regressions examined the associations among BE measures at baseline, health behaviors (HEI-2010 and physical activity) at baseline, and health outcome both cross-sectionally and longitudinally.ResultsNone of the conventional neighborhood BE metrics were associated either with diet quality, or with meeting PA guidelines. Only higher property values did predict better diets and more physical activity. Better diets and more physical activity were associated with lower obesity prevalence at baseline and 12 mo, but did not predict weight change.ConclusionAny links between the BE and health outcomes critically depend on establishing appropriate behavioral pathways. In this study, home-centric BE measures, were not related to physical activity or to diet. Further studies will need to consider a broader range of BE attributes that may be related to diets and health.

Obesity and the Built Environment: A Reappraisal

“…The built environment (BE) has been defined as the human‐modified space in which people conduct their daily lives . Measuring and quantifying human exposure to the neighborhood BE have been accomplished in a variety of ways . Current studies on obesity and the BE owe much to the development of geographic information systems (GIS) and the widespread use of global positioning system (GPS) devices .…”

“…By contrast, measures of diet quality, PA, and health have not followed suit. Standard methods of dietary intake assessment, such as food recalls or food frequency questionnaires, have generally not been used . Instead, the frequency of consuming “healthy” and “unhealthy” foods per day has been one proxy for diet quality .…”

“…Standard methods of dietary intake assessment, such as food recalls or food frequency questionnaires, have generally not been used . Instead, the frequency of consuming “healthy” and “unhealthy” foods per day has been one proxy for diet quality . Health outcomes, when included in BE studies, have been limited to body weight, with only a few studies examining diabetes or cardiovascular outcomes .…”

Spousal metabolic risk factors and incident hypertension: A longitudinal cohort study in Iran

“…The respondent had higher values for baseline SBP, DBP, and age; therefore, the incidence of hypertension may be biased toward an overestimation. Third, since there was no information on some important confounders such as the built environment, access to care, diet quality, 43 duration of marriage, and duration of the comorbidities of DM, hypertension, and dislipidemia, we could not examine their effect on our results. And last but not least, we included the baseline measures of risk factors in our analysis; these factors might have changed during the study period.…”

Growing Healthy Communities Initiative

“…The current challenges to derive any significant correlation, or, for that matter, inference to a causal pathway between built physical environments and positive health outcomes do exist. They point to intermediary variables such as associations between diet, physical activity and built environments (Drewnowski et al, 2016), high income vs. middle income countries (Blay, Schulz, & Mentz, 2015), younger populations vs. older populations (Siu, Lambert, Fu, Hillier, Bosworth, & Michael, 2012). Hence, it has become extremely important that in addition to choosing specific built environment variables, better tools need to be designed and implemented which could assess large amounts of spatial data covering wider geographic extent (Kroeger, Messer, Edwards, & Miranda, 2012).…”