Residential Density Is Associated With BMI Trajectories in Children and Adolescents: Findings From the Moving to Health Study

Paula Maria Lozano; Jennifer F Bobb; Flavia P Kapos; Maricela Cruz; Stephen J Mooney; Philip M Hurvitz; Jane Anau; Mary Kay Theis; Andrea Cook; Anne Vernez Moudon; David E Arterburn; Adam Drewnowski

doi:10.1016/j.focus.2024.100225

Residential Density Is Associated With BMI Trajectories in Children and Adolescents: Findings From the Moving to Health Study

AJPM Focus. 2024 Mar 15;3(3):100225. doi: 10.1016/j.focus.2024.100225. eCollection 2024 Jun.

Authors

Paula Maria Lozano¹, Jennifer F Bobb^{1

2}, Flavia P Kapos^{3

4}, Maricela Cruz^{1

2}, Stephen J Mooney^{5

6}, Philip M Hurvitz^{7

8}, Jane Anau¹, Mary Kay Theis¹, Andrea Cook^{1

2}, Anne Vernez Moudon⁷, David E Arterburn¹, Adam Drewnowski^{5

9}

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
² Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington.
³ Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke School of Medicine, Durham, North Carolina.
⁴ Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.
⁵ Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
⁶ Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington.
⁷ Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, Washington.
⁸ Center for Studies in Demography & Ecology, University of Washington, Seattle, Washington.
⁹ Center for Public Health Nutrition, University of Washington, Seattle, Washington.

Abstract

Introduction: This study investigates the associations between built environment features and 3-year BMI trajectories in children and adolescents.

Methods: This retrospective cohort study utilized electronic health records of individuals aged 5-18 years living in King County, Washington, from 2005 to 2017. Built environment features such as residential density; counts of supermarkets, fast-food restaurants, and parks; and park area were measured using SmartMaps at 1,600-meter buffers. Linear mixed-effects models performed in 2022 tested whether built environment variables at baseline were associated with BMI change within age cohorts (5, 9, and 13 years), adjusting for sex, age, race/ethnicity, Medicaid, BMI, and residential property values (SES measure).

Results: At 3-year follow-up, higher residential density was associated with lower BMI increase for girls across all age cohorts and for boys in age cohorts of 5 and 13 years but not for the age cohort of 9 years. Presence of fast food was associated with higher BMI increase for boys in the age cohort of 5 years and for girls in the age cohort of 9 years. There were no significant associations between BMI change and counts of parks, and park area was only significantly associated with BMI change among boys in the age cohort of 5 years.

Conclusions: Higher residential density was associated with lower BMI increase in children and adolescents. The effect was small but may accumulate over the life course. Built environment factors have limited independent impact on 3-year BMI trajectories in children and adolescents.

Keywords: Built environment; adolescent; child; geographic information systems; natural experiment; obesity.