The Associations between Neighborhood Characteristics and Childhood Overweight and Obesity in a National Dataset

Abstract

Background: National child obesity rates continue to climb. While neighborhood factors are known to influence childhood weight, more work is needed to further our understanding of these relationships and inform intervention and policy approaches reflective of complex real-world contexts.

Methods: To evaluate the associations between neighborhood components and childhood overweight/obesity, we analyzed sequential, cross-sectional data from the National Survey of Children's Health collected annually between 2016 and 2021. To characterize the complexity of children's neighborhood environments, several interrelated neighborhood factors were examined: amenities, detractions, support, and safety. We used ordinal logistic regression models to evaluate the associations between these exposures of interest and childhood weight status, adjusting for potential confounders.

Results: Our analytic sample contained 96,858 children representing a weighted population of 28,228,799 children ages 10-17 years. Child weight status was healthy in 66.5%, overweight in 16.8%, and obese in 17.2%. All four neighborhood factors were associated with child weight status. The odds of overweight or obesity generally increased with a decreasing number of amenities and increasing number of detractions, with the highest adjusted odds ratio seen with no amenities and all three possible detractions (1.71; 95% confidence interval [1.31, 2.11]).

Conclusions: Multiple factors within a child's neighborhood environment were associated with child weight status in this sample representative of the US population aged 10-17 years. This suggests the need for future research into how policies and programs can support multiple components of a healthy neighborhood environment simultaneously to reduce rates of childhood overweight/obesity.

Keywords: built environment; child obesity; child overweight; neighborhood; social environment.

Figure 1.

Record inclusion and exclusion flowchart.

Figure 2.

Odds of obesity or overweight by cumulative number of neighborhood amenities and detractions. NOTE: Each cell gives the adjusted odds ratio with 95% confidence interval. Each adjusted odds ratio gives the relative odds of being in a higher vs. lower weight category (obesity vs. overweight/healthy weight; or obesity/overweight vs. healthy weight) for the indicated numbers of amenities and detractions. All odds ratios are in reference to the “All four amenities, no detractions” neighborhood (bottom left).

Figure 3.

Model-based predicted probability of obesity by neighborhood factors – amenities, detractions, safety, and support. NOTE: The plot shows predicted probability point estimates with 95% confidence intervals by race and ethnicity category. The remaining covariates are set at the following for all models: special health care needs, no; year, 2019; age in years, 14; sex, female; highest adult education level, college degree or higher; food/cash assistance, no.