Higher walkability associated with increased physical activity and reduced obesity among United States adults

Abstract

Objective: This study examined associations among perceived neighborhood walkability, physical activity (PA), and obesity among United States adults.

Methods: Data from the 2020 National Health Interview Survey were analyzed. Walkability was assessed using a summative scale and was categorized as low, medium, or high. PA was categorized as insufficient (0-149 min/wk) or sufficient (150+ min/wk). Multivariable regressions estimated an association between obesity and BMI and PA/walkability. Mediation analysis was used to partition contribution of PA as a mediator. Effect modification by race and ethnicity in the association between walkability and BMI was explored.

Results: The sample included N = 31,568 adults. Compared with those in low-walkability neighborhoods, participants in high-walkability neighborhoods had increased odds of sufficient PA (odds ratio [OR] = 1.48; 95% CI: 1.30-1.69) and decreased obesity odds (OR = 0.76; 95% CI: 0.66-0.87). PA partially mediated the association between walkability and BMI (23.4%; 95% CI: 14.6%-62.7%). The association between walkability and BMI was modified by race and ethnicity (F_[5,567] = 2.75; p = 0.018). Among White, Black, Hispanic, and Asian adults, BMI decreased with increasing walkability; among American Indian/Alaska Native and multiracial/other adults, BMI increased with increasing walkability.

Conclusions: The findings highlight the importance of investing in the built environment to improve perceptions of walkability and promote PA and healthy weight, as well as developing interventions to target racial and ethnic disparities in these outcomes.

Figure 1.. Race/Ethnicity as an Effect Modifier in the Association between Perceived Walkability and Body Mass Index Note:

The estimated means (adjusted for all the other covariates) of body mass index along the perceived walkability scale is depicted by race/ethnicity. All estimates were statistically significant (p<0.05). While the estimates appear to have a strong magnitude for American Indian/Alaska Native and Non-Hispanic other race persons, those samples are considerably smaller. The 95% confidence intervals are not shown as they would obscure the interaction lines.