Background: The prevalence of adolescent obesity is an ongoing public health concern. In the United States, 16.4 percent of children ages 10-17 are obese according to the 2007 National Survey of Children’s Health (NSCH). Adolescent obesity is influenced by physical and social attributes of both the proximal and the distal environment.

Objective: To test a conceptual model of proximal (home) and distal (neighborhood) environmental correlates of adolescent obesity.

Methods: This was a descriptive, cross-sectional study, using the 2007 NSCH, of 39,542 children ages 11-17. Structural equation modeling was used to test the fit of the model, identify direct and indirect effects of environmental correlates and determine reliabilities for latent constructs.

Results: The model fitted the data well (Root Mean Square Standard Error of Approximation, 0.038 (90% CI: 0.038 to 0.039), Comparative Fit Index, 0.950 and Tucker-Lewis Index, 0.934). Access to Physical Activity, Social Capital, Home Sedentary Behavior and Physical Activity had direct effects on obesity (- 0.053, p less than 0.001; 0.017, p less than 0.001; 0.110, p less than 0.001; - 0.119, p less than 0.001). Neighborhood Condition had indirect effects on obesity through Access to Physical Activity, Social Capital, and Home Sedentary Behavior (- 0.001, p equal to 0.009; 0.032, p less than 0.001; 0.044, p less than 0.001). Access to Physical Activity had indirect effects on obesity through Physical Activity, Social Capital and Home Sedentary Behavior (- 0.013, p less than 0.001; -0.005, p less than 0.001; - 0.005, p equals 0.003). Home Sedentary Behavior had indirect effect on obesity through Physical Activity (0.052, p less than 0.001).

Conclusions: Results of this model fit to US population-based data suggest that interventions should target not only sedentary behavior and physical activity, but also parent perceptions of safety, access to physical activity and the neighborhood condition.