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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Adam Drewnowski, Anju Aggarwal, Wesley Tang, Philip M. Hurvitz, Jason Scully, Orion Stewart, Anne Vernez Moudon

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

The 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.

Methods

The 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.

Results

None 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.

Conclusion

Any 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.
Appendix
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Literature
1.
2.
Michimi A, Wimberly MC. Associations of supermarket accessibility with obesity and fruit and vegetable consumption in the conterminous United States. Int J Health Geogr. 2010;9:49.CrossRefPubMedPubMedCentral
3.
Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006;30(4):333–9.CrossRefPubMed
4.
Sturm R, Cohen DA. Zoning for health? The year-old ban on new fast-food restaurants in South LA. Health Aff (Millwood). 2009;28(6):w1088–1097.CrossRef
5.
Black JL, Macinko J. Neighborhoods and obesity. Nutrition Rev. 2008;66(1):2–20.CrossRef
6.
Ding D, Gebel K. Built environment, physical activity, and obesity: what have we learned from reviewing the literature? Health Place. 2012;18(1):100–5.CrossRefPubMed
7.
8.
Duncan MJ, Spence JC, Mummery WK. Perceived environment and physical activity: a meta-analysis of selected environmental characteristics. Int J Behav Nutr Phys Act. 2005;2(1):11.CrossRefPubMedPubMedCentral
9.
Rehm CD, Moudon AV, Hurvitz PM, Drewnowski A. Residential property values are associated with obesity among women in King County, WA, USA. Soc Sci Med. 2012;75(3):491–5.CrossRefPubMedPubMedCentral
10.
Nelson NM, Woods CB. Obesogenic environments: Are neighbourhood environments that limit physical activity obesogenic? Health Place. 2009;15(4):917–24.CrossRefPubMed
11.
Ploeg MV. Access to affordable, nutritious food is limited in “food deserts”. Amber Waves. 2010;8(1):20–7.
12.
Babey SH, Diamant A, Hastert TA, Goldstein H, et al. Designed for disease: The link between local food environments and obesity and diabetes. 2008.
13.
Treuhaft S, Karpyn A. The Grocery Gap: Who has access to healthy food and why it matters. Oakland and Philadelphia: PolicyLink and The Food Trust; 2010.
14.
Morland K, Wing S, Diez RA. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92(11):1761–7.CrossRefPubMedPubMedCentral
15.
Charreire H, Casey R, Salze P, Simon C, Chaix B, Banos A, et al. Measuring the food environment using geographical information systems: a methodological review. Public Health Nutr. 2010;13(11):1773–85.CrossRefPubMed
16.
Powell LM, Han E, Chaloupka FJ. Economic contextual factors, food consumption, and obesity among US adolescents. J Nutr. 2010;140(6):1175–80.CrossRefPubMed
17.
Laraia BA, Siega-Riz AM, Kaufman JS, Jones SJ. Proximity of supermarkets is positively associated with diet quality index for pregnancy. Prev Med. 2004;39(5):869–75.CrossRefPubMed
18.
Gibson DM. The neighborhood food environment and adult weight status: estimates from longitudinal data. Am J Pub Health. 2011;101(1):71–8.CrossRef
19.
Laska MN, Hearst MO, Forsyth A, Pasch KE, Lytle L. Neighbourhood food environments: are they associated with adolescent dietary intake, food purchases and weight status? Public Health Nutr. 2010;13(11):1757–63.CrossRefPubMedPubMedCentral
20.
Moore LV, Roux AVD, Nettleton JA, Jacobs DR. Associations of the local food environment with diet quality—a comparison of assessments based on surveys and geographic information systems the multi-ethnic study of atherosclerosis. Am J Epidemol. 2008;167(8):917–24.CrossRef
21.
Leal C, Chaix B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obesity Rev. 2011;12:217–30.CrossRef
22.
Franco M, Diez-Roux AV, Nettleton JA, Lazo M, Brancati F, Caballero B, et al. Availability of healthy foods and dietary patterns: The Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2009;89:897–904.CrossRefPubMedPubMedCentral
23.
24.
Rundle A, Quinn J, Lovasi G, Bader MD, Yousefzadeh P, Weiss C, et al. Associations between body mass index and park proximity, size, cleanliness, and recreational facilities. Am J Health Promot. 2013;27(4):262–9.CrossRefPubMedPubMedCentral
25.
Giles-Corti B, Macintyre S, Clarkson JP, Pikora T, Donovan RJ. Environmental and lifestyle factors associated with overweight and obesity in Perth, Australia. Am J Health Promot. 2003;18(1):93–102.CrossRefPubMed
26.
Stafford M, Cummins S, Ellaway A, Sacker A, Wiggins RD, Macintyre S. Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Soc Sci Med. 2007;65(9):1882–97.CrossRefPubMed
27.
Hoehner CM, Brennan Ramirez LK, Elliott MB, Handy SL, Brownson RC. Perceived and objective environmental measures and physical activity among urban adults. Am J Prev Med. 2005;28:105–16.CrossRefPubMed
28.
Humpel N, Owen N, Leslie E. Environmental factors associated with adults’ participation in physical activity: a review. Am J Prev Med. 2002;22(3):188–99.CrossRefPubMed
29.
Larsen K, Gilliland J. Mapping the evolution of ‘food deserts’ in a Canadian city: supermarket accessibility in London, Ontario, 1961–2005. Int J Health Geogr. 2008;7:16.CrossRefPubMedPubMedCentral
30.
O’Dwyer LA, Coveney J. Scoping supermarket availability and accessibility by socio-economic status in Adelaide. Health Promot J Austr. 2006;17(3):240–6.PubMed
31.
Sharkey JR, Horel S. Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area. J Nutr. 2008;138(3):620–7.PubMed
32.
Apparicio P, Cloutier MS, Shearmur R. The case of Montreal’s missing food deserts: evaluation of accessibility to food supermarkets. Int J Health Geogr. 2007;6:4.CrossRefPubMedPubMedCentral
33.
Smoyer-Tomic K, Spence J, Amrhein C. Food Deserts in the Prairies? Supermarket Accessibility and Neighborhood Need in Edmonton, Canada. Prof Geogr. 2006;58(3):307–26.CrossRef
34.
Bodor JN, Rose D, Farley TA, Swalm C, Scott SK. Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment. Public Health Nutr. 2008;11:413–20.CrossRefPubMed
35.
Jago R, Baranowski T, Baranowski JC, Cullen KW, Thompson D. Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects. Int J Behav Nutr Phys Act. 2007;4:35.CrossRefPubMedPubMedCentral
36.
Edwards NJ, Giles-Corti B, Larson A, Beesley B. The effect of proximity on park and beach use and physical activity among rural adolescents. J Phys Act Health. 2014;11(5):977–84.CrossRefPubMed
37.
Van Cauwenberg J, Cerin E, Timperio A, Salmon J, Deforche B, Veitch J. Park proximity, quality and recreational physical activity among mid-older aged adults: moderating effects of individual factors and area of residence. Int J Behav Nutr Phys Act. 2015;12:46.CrossRefPubMedPubMedCentral
38.
Kaczynski AT, Besenyi GM, Stanis SA, Koohsari MJ, Oestman KB, Bergstrom R, et al. Are park proximity and park features related to park use and park-based physical activity among adults? Variations by multiple socio-demographic characteristics. Int J Behav Nutr Phys Act. 2014;11:146.CrossRefPubMedPubMedCentral
39.
Cohen D, Sehgal A, Williamson S, Strum R, McKenzie TL, Lara R, et al. Park use and physical activity in a sample of public parks in the city of Los Angeles. 2006.
40.
Cohen DA, Ashwood JS, Scott MM, Overton A, Evenson KR, Staten LK, et al. Public parks and physical activity among adolescent girls. Pediatrics. 2006;118(5):e1381–9.CrossRefPubMedPubMedCentral
41.
Burdette HL, Whitaker RC. Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev Med. 2004;38(1):57–63.CrossRefPubMed
42.
Yan AF, Voorhees CC, Clifton K, Burnier C. “Do you see what I see?” - correlates of multidimensional measures of neighborhood types and perceived physical activity-related neighborhood barriers and facilitators for urban youth. Prev Med. 2010;50 Suppl 1:S18–23.CrossRefPubMed
43.
Saelens BE, Sallis JF, Black JB, Chen D. Neighborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health. 2003;93(9):1552–8.CrossRefPubMedPubMedCentral
44.
45.
Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, Shikany JM, Lewis CE, Popkin BM. Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study. Arch Intern Med. 2011;171(13):1162–70.CrossRefPubMedPubMedCentral
46.
47.
Aggarwal A, Cook AJ, Jiao J, Seguin RA, Vernez Moudon A, Hurvitz PM, et al. Access to supermarkets and fruit and vegetable consumption. Am J Public Health. 2014;104(5):917–23.CrossRefPubMedPubMedCentral
48.
Fiechtner L, Block J, Duncan DT, Gillman MW, Gortmaker SL, Melly SJ, et al. Proximity to supermarkets associated with higher body mass index among overweight and obese preschool-age children. Prev Med. 2013;56(3–4):218–21.CrossRefPubMed
49.
Drewnowski A, Aggarwal A, Hurvitz PM, Monsivais P, Moudon AV. Obesity and Supermarket Access: Proximity or Price? Am J Public Health. 2012;102(8):e74–80.CrossRefPubMedPubMedCentral
50.
Morland KB, Evenson KR. Obesity prevalence and the local food environment. Health Place. 2009;15(2):491–5.CrossRefPubMed
51.
Powell LM, Auld MC, Chaloupka FJ, O’Malley PM, Johnston LD. Associations between access to food stores and adolescent body mass index. Am J Prev Med. 2007;33(4 Suppl):S301–307.CrossRefPubMed
52.
Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, et al. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect. 2009;117(3):442–7.CrossRefPubMed
53.
Gase LN, DeFosset AR, Smith LV, Kuo T. The association between self-reported grocery store access, fruit and vegetable intake, sugar-sweetened beverage consumption, and obesity in a racially diverse, low-income population. Front Public Health. 2014;2:229.CrossRefPubMedPubMedCentral
54.
Mellor JM, Dolan CB, Rapoport RB. Child body mass index, obesity, and proximity to fast food restaurants. Int J Pediatr Obes. 2011;6(1):60–8.CrossRefPubMed
55.
Fraser LK, Edwards KL. The association between the geography of fast food outlets and childhood obesity rates in Leeds, UK. Health Place. 2010;16(6):1124–8.CrossRefPubMed
56.
Hickson DA, Diez Roux AV, Smith AE, Tucker KL, Gore LD, Zhang L, et al. Associations of fast food restaurant availability with dietary intake and weight among African Americans in the Jackson Heart Study, 2000–2004. Am J Public Health. 2011;101 Suppl 1:S301–309.CrossRefPubMedPubMedCentral
57.
Leung CW, Laraia BA, Kelly M, Nickleach D, Adler NE, Kushi LH, et al. The influence of neighborhood food stores on change in young girls’ body mass index. Am J Prev Med. 2011;41(1):43–51.CrossRefPubMedPubMedCentral
58.
59.
Neuhouser ML, Kristal AR, McLerran D, Patterson RE, Atkinson J. Validity of short food frequency questionnaires used in cancer chemoprevention trials: results from the Prostate Cancer Prevention Trial. Cancer Epidemiol Biomarkers Prev. 1999;8(8):721–5.PubMed
60.
Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol. 1999;9(3):178–87.CrossRefPubMed
61.
Monsivais P, Drewnowski A. Lower-energy-density diets are associated with higher monetary costs per kilocalorie and are consumed by women of higher socioeconomic status. J Am Diet Assoc. 2009;109(5):814–22.CrossRefPubMedPubMedCentral
62.
Rehm CD, Monsivais P, Drewnowski A. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007–2010. Prev Med. 2015;73:70–5.CrossRefPubMedPubMedCentral
63.
James P, Berrigan D, Hart JE, Hipp JA, Hoehner CM, Kerr J, et al. Effects of buffer size and shape on associations between the built environment and energy balance. Health Place. 2014;27:162–70.CrossRefPubMedPubMedCentral
64.
Vernez Moudon A, Drewnowski A, Duncan GE, Hurvitz PM, Saelens BE, Scharnhorst E. Characterizing the food environment: pitfalls and future directions. Public Health Nutr. 2013;16(7):1238–43.CrossRefPubMedPubMedCentral
65.
Owen N, Humpel N, Leslie E, Bauman A, Sallis JF. Understanding environmental influences on walking; Review and research agenda. Am J Prev Med. 2004;27(1):67–76.CrossRefPubMed
66.
Stewart OT, Moudon AV, Fesinmeyer MD, Zhou C, Saelens BE. The association between park visitation and physical activity measured with accelerometer, GPS, and travel diary. Health Place. 2016;38:82–8.CrossRefPubMed
67.
Berrigan D, Pickle LW, Dill J. Associations between street connectivity and active transportation. Int J Health Geogr. 2010;9(1):1–18.CrossRef
68.
McCormack GR, Shiell A, Giles-Corti B, Begg S, Veerman JL, Geelhoed E, et al. The association between sidewalk length and walking for different purposes in established neighborhoods. Int J Behav Nutr Phys Act. 2012;9:92.CrossRefPubMedPubMedCentral
69.
Kang B, Scully J, Stewart O, Hurvitz P, Moudon AV. Split-Match Aggregate (SMA) algorithm: intergrating sidewalk data with transportation network data in GIS. Int J Geogr Inf Sci. 2015;29(3):440–53.CrossRef
70.
Duffey KJ, Gordon-Larsen P, Jacobs Jr DR, Williams OD, Popkin BM. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. Am J Clin Nutr. 2007;85(1):201–8.PubMed
71.
Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D, Moore JM, et al. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009;169(4):401–8.CrossRefPubMedPubMedCentral
72.
73.
Simmons D, McKenzie A, Eaton S, Cox N, Khan MA, Shaw J, et al. Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia. Int J Obes. 2005;29(6):703–10.CrossRef
74.
Gary-Webb TL, Baptiste-Roberts K, Pham L, Wesche-Thobaben J, Patricio J, Pi-Sunyer FX, et al. Neighborhood and weight-related health behaviors in the Look AHEAD (Action for Health in Diabetes) study. BMC Public Health. 2010;10(312):1471–2458.
75.
Carlson A, Gerrior S. Food source makes a difference in diet quality. J Nutr Educ Behav. 2006;38:238–43.CrossRefPubMed
76.
Zenk SN, Lachance LL, Schulz AJ, Mentz G, Kannan S, Ridella W. Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population. Am J Health Promot. 2009;23:255–64.CrossRefPubMedPubMedCentral
77.
Mejia N, Lightstone AS, Basurto-Davila R, Morales DM, Sturm R. Neighborhood food environment, diet, and obesity among Los Angeles County adults, 2011. Prev Chronic Dis. 2015;12:E143.CrossRefPubMedPubMedCentral
78.
Spoon C. Infographic: the role of parks and recreation in promoting physical activity. In: Active Living Research. 2012.
79.
Alexander DS, Huber LRB, Piper CR, Tanner AE. The association between recreational parks, facilities and childhood obesity: a cross-sectional study of the 2007 National Survey of Children’s Health. J Epidemiol Comm Health. 2013. doi:10.​1136/​jech-2012-201301.
80.
Duncan GE, Cash SW, Horn EE, Turkheimer E. Quasi-causal associations of physical activity and neighborhood walkability with body mass index: a twin study. Prev Med. 2015;70:90–5.CrossRefPubMed
81.
Horn EE, Turkheimer E, Strachan E, Duncan GE. Behavioral and environmental modification of the genetic influence on body mass index: A twin study. Behav Genet. 2015;45(4):409–26.CrossRefPubMedPubMedCentral
82.
Caspi CE, Kawachi I, Subramanian SV, Adamkiewicz G, Sorensen G. The relationship between diet and perceived and objective access to supermarkets among low-income housing residents. Soc Sci Med. 2012;75(7):1254–62.CrossRefPubMedPubMedCentral
83.
84.
Potestio ML, Patel AB, Powell CD, McNeil DA, Jacobson RD, McLaren L. Is there an association between spatial access to parks/green space and childhood overweight/obesity in Calgary, Canada? Int J Behav Nutr Phys Act. 2009;6(1):1–10.CrossRef
85.
Hurvitz PM, Moudon AV, Kang B, Saelens BE, Duncan GE. Emerging technologies for assessing physical activity behaviors in space and time. Front Public Health. 2014;2:2.CrossRefPubMedPubMedCentral
86.
Chaix B, Kestens Y, Perchoux C, Karusisi N, Merlo J, Labadi K. An interactive mapping tool to assess individual mobility patterns in neighborhood studies. Am J Prev Med. 2012;43(4):440–50.CrossRefPubMed
87.
Almanza E, Jerrett M, Dunton G, Seto E, Pentz MA. A study of community design, greenness, and physical activity in children using satellite, GPS and accelerometer data. Health Place. 2012;18(1):46–54.CrossRefPubMed
88.
Rundle AG, Sheehan DM, Quinn JW, Bartley K, Eisenhower D, Bader MM, et al. Using GPS data to study neighborhood walkability and physical activity. Am J Prev Med. 2016;50(3):e65–72.CrossRefPubMed
89.
Rodríguez DA, Cho G-H, Evenson KR, Conway TL, Cohen D, Ghosh-Dastidar B, et al. Out and about: Association of the built environment with physical activity behaviors of adolescent females. Health Place. 2012;18(1):55–62.CrossRefPubMed
90.
Wheeler BW, Cooper AR, Page AS, Jago R. Greenspace and children’s physical activity: a GPS/GIS analysis of the PEACH project. Prev Med. 2010;51(2):148–52.CrossRefPubMed
91.
Zenk SN, Schulz AJ, Matthews SA, Odoms-Young A, Wilbur J, Wegrzyn L, et al. Activity space environment and dietary and physical activity behaviors: a pilot study. Health Place. 2011;17:1150–61.CrossRefPubMedPubMedCentral
92.
Shearer C, Rainham D, Blanchard C, Dummer T, Lyons R, Kirk S. Measuring food availability and accessibility among adolescents: Moving beyond the neighbourhood boundary. Soc Sci Med. 2015;133:322–30.CrossRefPubMed
93.
Sallis JF, Cerin E, Conway TL, Adams MA, Frank LD, Pratt M, et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet. 2016;387(10034):2207–17.CrossRefPubMed
94.
Hunter RF, Christian H, Veitch J, Astell-Burt T, Hipp JA, Schipperijn J. The impact of interventions to promote physical activity in urban green space: a systematic review and recommendations for future research. Soc Sci Med. 2015;124:246–56.CrossRefPubMed
95.
Drewnowski A, Aggarwal A, Tang W, Moudon AV. Residential property values predict prevalent obesity but do not predict 1 year weight change. Obesity. 2015;23(3):671–6.CrossRefPubMedPubMedCentral
96.
Handbury J, Rahkovsky I, Schnell M. What drives nutritional disparities? Retail access and food purchases across the socioeconomic spectrum. 2015.CrossRef
Metadata
Title
Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways
Authors
Adam Drewnowski
Anju Aggarwal
Wesley Tang
Philip M. Hurvitz
Jason Scully
Orion Stewart
Anne Vernez Moudon
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3798-y

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