Academic journal article Canadian Journal of Public Health

Linking Childhood Obesity to the Built Environment: A Multi-Level Analysis of Home and School Neighbourhood Factors Associated with Body Mass Index

Academic journal article Canadian Journal of Public Health

Linking Childhood Obesity to the Built Environment: A Multi-Level Analysis of Home and School Neighbourhood Factors Associated with Body Mass Index

Article excerpt

ABSTRACT

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.

Key words: Obesity; child; adolescent; environment; diet; recreation

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2012;103(Suppl. 3):S15-S21.

Mots clés : obésité; enfant; adolescent; environnement; régime alimentaire; loisir

Childhood obesity has become a critical public health issue in Canada, as rates have tripled over the past three decades.1 Over one in four Canadian children are either overweight or obese (17% and 9% respectively).2 The increased prevalence of childhood obesity has been linked to the concurrent rise of physical health problems normally associated with adults, including Type 2 diabetes, hypertension, heart disease and pulmonary diseases, as well as socio-psychological afflictions such as discrimination, behavioural problems, negative self-esteem, anxiety and depression.3-6 A rapidly expanding avenue of research suggests that rising rates of obesity are due not only to individual-level factors (i.e., genetics), but also to characteristics of our local built environments that may be encouraging or discouraging the healthy diets or active lifestyles associated with healthy body weights.7-10

Previous research has confirmed that obesity is linked to the consumption of energy-rich, fast foods.11 Large-scale US studies have found that adult obesity rates are positively associated with the density of neighbourhood fast-food outlets12 and convenience stores.13 Much of the emphasis on the link between food and children's health focuses on advertising14 or food policies within schools;15-17 however, some policy-makers and public health professionals are shifting their focus to the food environments surrounding schools, as new research indicates that many children visit food retailers on their way to and from school, mostly filling up on high-sugar or high-fat, energy-dense foods.18 Several studies have shown that fast-food outlets are more prevalent near schools19,20 and in low-income neighbourhoods,21,22 suggesting that these vulnerable populations may be at heightened risk of developing poor eating habits as a result of increased exposure to unhealthy foods. …

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