Abstract
BackgroundPrevious studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors.MethodsIn this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders.ResultsThe availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors.ConclusionIn this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.
Highlights
Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors
Once we identified the census tracts and corresponding data for each participant, these data were linked to the individuallevel data collected during the Look AHEAD trial
Of all the neighborhoods represented in the study, the mean % of those living below the federal poverty level was 11%
Summary
Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors. Neighborhood socioeconomic conditions are known to affect health even after controlling for individual-level socio-demographic factors [9,10,11]. Recent data suggests that the neighborhood environment may influence risk of chronic diseases such as cardiovascular disease, type 2 diabetes, and related health behaviors such as decreased levels of physical activity [12,13,14,15,16,17,18,19,20,21,22]. A few studies have demonstrated that living in neighborhoods with low socio-economic status (SES) is associated with an increased risk of obesity [23,24]. Investigating novel correlates of weight control is necessary given there is overwhelming evidence showing that weight loss is associated with marked improvement in health status, blood pressure and glucose control [25,26,27]
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