School and Neighborhood Nutrition Environment and Their Association With Students' Nutrition Behaviors and Weight Status in Seoul, South Korea

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We examined the association between the school and neighborhood nutrition environments and adolescent nutrition behaviors and weight status. We conducted a cross-sectional survey with 1,342 fourth to ninth graders in 15 schools on their food-eating behaviors. Participants were randomly selected from eight predetermined districts in Seoul, South Korea. Height and weight data from the school annual health check-ups were obtained. Dietitians from each school completed questionnaires on the school nutrition environment. Types of food outlets in a 500-meter radius of the schools were recorded. Healthy eating index was created based on 10 questions on students' eating behaviors, such as breakfast skipping, fruit consumption, and ramen noodle consumption (possible score range 0-10). Generalized estimating equation method was used for statistical modeling. Higher density of supermarkets and traditional markets in the school neighborhoods was associated with a greater likelihood of child obesity after controlling for individual-level covariates (odds ratio = 1.37, 1.21-1.54). The school nutrition environment was not associated with student's healthy eating habits and weight status. Students who were younger, female, from more affluent families, who had less weekly screen time, or had stay-at-home mothers had higher scores on the healthy eating index. There was a gender difference in the associations between environmental factors and students' eating behaviors and obesity status. These findings suggest that the relationship between environmental factors and individual factors and weight status may be more complicated than previously reported in other parts of the world.