HomeLifestyleHealth & FitnessNew Study Reveals Built Environment as Strongest Predictor of Adolescent Obesity

New Study Reveals Built Environment as Strongest Predictor of Adolescent Obesity

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How Does Built Environment Affect Adolescent Obesity?

A groundbreaking study published in The Obesity Society’s flagship journal, Obesity, has found that the built environment is a key predictor of adolescent obesity and related health behaviors.

The research, which provides the first quasi-experimental empirical evidence of its kind, challenges the prevailing notion that social and economic environments are the primary determinants of weight status and eating habits among young people.

Instead, the study’s findings suggest that factors such as neighborhood walkability, access to healthy food options, and availability of safe recreational spaces are the strongest indicators of adolescents’ body mass index (BMI) and related behaviors.

These findings have significant implications for public health policy and urban planning initiatives aimed at combating the obesity epidemic among youth.

This study “suggests that strategies for addressing childhood and adolescent obesity should focus on improving built environments more comprehensively,” remarks corresponding author Maria J. Prados.

Childhood and adolescent obesity has been recognized as a critical health concern of the 21st century.

“Adolescents represent an important target for potential health policy interventions because they are at an age when their health behaviors, preferences and interactions with the environments are evolving,” explains Prados.

According to literature reviews evaluating the impact of environments on childhood obesity, the majority of evidence available is from observational studies. However, these studies have produced somewhat inconsistent results regarding the significance of environments and their impact on certain groups. While studies such as the Moving to Opportunity housing experiment and other quasi- and natural experiments have the potential to examine causality, they have not yet directly assessed the independent roles of built, social, and economic environments on obesity. Rather, they have either focused on a limited set of environmental characteristics or analyzed the effects of place as a whole. Additionally, few well-designed studies have mainly been conducted among adults.

According to Prados, their study adds “a new dimension to the growing evidence that place matters by applying a more comprehensive approach to characterizing environments.”

In earlier research, the authors of this study utilized a natural experiment to evaluate the effects of place on obesity and obesity-related behaviors by examining the plausibly exogenous assignment of military service members and adolescents in their families to different locations. The study focused on a limited set of environmental factors, such as the neighborhood physical activity opportunities and food environment, or the combined influence of the environment as a whole, demonstrating that adolescents whose military parents were assigned to counties with higher obesity rates were more likely to have overweight or obesity. The present study builds on this earlier work by using the same natural experiment to simultaneously evaluate the impact of built, social, and economic environments on adolescent obesity and related behaviors. This experiment is based on the routine assignment of military personnel (and their families) to different installations in response to the Army’s needs.

The Military Teenagers Environments, Exercise and Nutrition Study was utilized by researchers to analyze data on adolescent obesity and related behaviors in military families. The co-hort study included 1,111 adolescents, of which 48% were female and aged between 12 and 14 years. The sample was ethnically diverse, with 41% non-Hispanic White, 22% non-Hispanic Black, 23% Hispanic, and 14% other. The study characterized 35 county-level environments based on 19 indicators and created three indices for the built, social, and economic environments. The analysis showed significant heterogeneity in exposure to the civilian environment, with 61% of families assigned to military installations for over two years and 54% living in the surrounding community rather than on military bases.

According to the study’s findings, longer exposure to a healthier built environment was linked to a lower probability of adolescent obesity and lower overweight or obesity status, although there was no effect on BMI z-scores. Specifically, after being exposed for more than two years, the likelihood of adolescent obesity was estimated to be 3.6 percentage points higher in a county with a built environment index at the 25th percentile, compared to a county at the 75th percentile. The same results were observed for adolescents who were not living on military bases. Additionally, more favorable built environments were associated with less consumption of unhealthy foods but not with increased physical activity. However, no association was found between social and economic environments and any outcomes. The data was drawn from the Military Teenagers Environments, Exercise and Nutrition Study, which collected information on adolescents’ BMI, overweight and obesity status, and self-reported diet and exercise.

“An interesting finding is that it was specifically the built environment that mattered – features like how close the adolescent lives to fast-food restaurants versus park and recreation facilities,” comments Amanda Staiano, PhD, associate professor, Louisiana State University’s Pennington Biomedical Research Center, who was not involved in the research.

According to the expert, social and economic environmental factors such as crime, social support, household income, and household education were found to be less important in this study, despite being very important for adolescents’ overall health. These factors were not directly linked to obesity risk or eating behaviors. However, these factors can be more challenging to modify than the built environment. On the other hand, the built environment can be improved through policy change and economic investment, such as incentivizing grocery stores to open in food deserts, limiting fast-food outlets near schools, implementing complete street policies to ensure pedestrian and cyclist safety, supporting the construction of safe playgrounds and parks, and enacting joint use agreements so families can use public facilities like school fields and courts on weekends.

According to Staiano, “putting concerted effort into improving the built environment is also essential both for obesity prevention and to assist those families who have obesity and are trying to develop healthier habits.”

She also emphasized that improving the built environment would require input and action from various stakeholders, including urban planners, elected officials, research scientists, and concerned community members.

The study’s authors suggest that more research is necessary to investigate whether social and economic environments may have a greater impact on adolescents and adults in non-military populations.

Image Credit: Michael S. Williamson/The Washington Post via Getty Images

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