Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways

Background: The built environment ( BE) is said to influence local obesity rates. Few studies have explored causal pathways between home-neighborhood BE variables and health outcomes such as obesity. Such pathways are likely to involve both physical activity and diet. Methods: The Seattle Obesity Study ( SOS II) was a longitudinal cohort of 440 adult residents of King Co, WA. Home addresses were geocoded. Home-neighborhood BE measures were framed as counts and densities of food sources and physical activity locations. Tax parcel property values were obtained from County tax assessor. Healthy Eating Index ( HEI 2010) scores were constructed using data from food frequency questionnaires. Physical activity ( PA) was obtained by self-report. Weights and heights were measured at baseline and following 12 months' exposure. Multivariable regressions examined the associations among BE measures at baseline, health behaviors ( HEI-2010 and physical activity) at baseline, and health outcome both cross-sectionally and longitudinally. Results: None of the conventional neighborhood BE metrics were associated either with diet quality, or with meeting PA guidelines. Only higher property values did predict better diets and more physical activity. Better diets and more physical activity were associated with lower obesity prevalence at baseline and 12 mo, but did not predict weight change. Conclusion: Any links between the BE and health outcomes critically depend on establishing appropriate behavioral pathways. In this study, home-centric BE measures, were not related to physical activity or to diet. Further studies will need to consider a broader range of BE attributes that may be related to diets and health.