Determinants of childhood obesity: What can we learn from built environment studies?

In the framework of the ELIANE (Environmental Links to physical Activity, Nutrition and hEalth) research project, we performed a systematic review of the associations between objective spatial measurements of the actual built environment and weight status in youth. The literature search identified 25 relevant papers (20 population studies). Eighteen of these reported at least one statistically significant relationship, although only 24 of the 63 associations tested were significant. Inverse relationships of weight with indices suggesting higher walkability were most consistently found to be significant (7 out of 9 papers). Weight was positively related to spatial accessibility to convenience store (3 out of 6 papers), and inversely to the spatial accessibility to recreational physical activity facilities (4 out of 9 papers). Relationships with parks, other food retail outlets and restaurants were inconsistent. Possible reasons for such discrepant results are discussed, and research avenues are presented. Better built environment measures are needed. A challenge lies in better understanding the complex pathways through which the built environment and the socio-economic context impact childhood weight status, taking into account collective social functioning and individual perceptions. (C) 2011 Elsevier Ltd. All rights reserved.