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The neighborhood energy balance equation: does neighborhood food retail environment + physical activity environment = obesity? The CARDIA study
University of Massachusetts Medical School Faculty Publications
  • Janne Boone-Heinonen, University of North Carolina
  • Ana V. Diez-Roux, University of Michigan
  • David C. Goff, Wake Forest University
  • Catherine M. Loria, National Heart, Lung, and Blood Institute
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Barry M. Popkin, University of North Carolina at Chapel Hill
  • Penny Gordon-Larsen, University of North Carolina
UMMS Affiliation
Department of Quantitative Health Sciences
Document Type

BACKGROUND: Recent obesity prevention initiatives focus on healthy neighborhood design, but most research examines neighborhood food retail and physical activity (PA) environments in isolation. We estimated joint, interactive, and cumulative impacts of neighborhood food retail and PA environment characteristics on body mass index (BMI) throughout early adulthood.

METHODS AND FINDINGS: We used cohort data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study [n=4,092; Year 7 (24-42 years, 1992-1993) followed over 5 exams through Year 25 (2010-2011); 12,921 person-exam observations], with linked time-varying geographic information system-derived neighborhood environment measures. Using regression with fixed effects for individuals, we modeled time-lagged BMI as a function of food and PA resource density (counts per population) and neighborhood development intensity (a composite density score). We controlled for neighborhood poverty, individual-level sociodemographics, and BMI in the prior exam; and included significant interactions between neighborhood measures and by sex. Using model coefficients, we simulated BMI reductions in response to single and combined neighborhood improvements. Simulated increase in supermarket density (from 25(th) to 75(th) percentile) predicted inter-exam reduction in BMI of 0.09 kg/m(2) [estimate (95% CI): -0.09 (-0.16, -0.02)]. Increasing commercial PA facility density predicted BMI reductions up to 0.22 kg/m(2) in men, with variation across other neighborhood features [estimate (95% CI) range: -0.14 (-0.29, 0.01) to -0.22 (-0.37, -0.08)]. Simultaneous increases in supermarket and commercial PA facility density predicted inter-exam BMI reductions up to 0.31 kg/m(2) in men [estimate (95% CI) range: -0.23 (-0.39, -0.06) to -0.31 (-0.47, -0.15)] but not women. Reduced fast food restaurant and convenience store density and increased public PA facility density and neighborhood development intensity did not predict reductions in BMI.

CONCLUSIONS: Findings suggest that improvements in neighborhood food retail or PA environments may accumulate to reduce BMI, but some neighborhood changes may be less beneficial to women.

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Citation: PLoS One. 2013 Dec 27;8(12):e85141. doi: 10.1371/journal.pone.0085141. Link to article on publisher's site
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Link to Article in PubMed
Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Janne Boone-Heinonen, Ana V. Diez-Roux, David C. Goff, Catherine M. Loria, et al.. "The neighborhood energy balance equation: does neighborhood food retail environment + physical activity environment = obesity? The CARDIA study" Vol. 8 Iss. 12 (2013) ISSN: 1932-6203 (Linking)
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