ARS | Publication request: The built environment moderates effects of family-based childhood obesity treatment over two years

Submitted to: Annals of Behavioral Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: March 27, 2012
Publication Date: October 18, 2012
Citation: Epstein, L.H., Raja, S., Oluyomi, T., Paluch, R.A., Wilfley, D.E., Saelens, B.E., Roemmich, J.N. 2012. The built environment moderates effects of family-based childhood obesity treatment over two years. Annals of Behavioral Medicine. 44:248-258.

Interpretive Summary: Aspects of the neighborhood built environment such as the proximity or distance to parks and food outlets can influence child activity and eating. These built environment factors influence usual behaviors, but may also influence behaviors during weight control therapy. Thus, the built environment could aid or hinder pediatric weight loss efforts. This study tested whether the built environment is related to effectiveness of standardized family-based behavioral treatments on overweight children’s weight loss. The zBMI (overweight) change data for 212 children (8-12 years old) who participated in four randomized trials to treat obesity were related to built environment variables related to physical activity or food purchasing. Living in neighborhoods with greater parkland, larger average block sizes and fewer supermarkets were protective and associated with greater zBMI reductions at 2 years. Girls and older children with low access to convenience stores had better success at 2 years. Having no access to neighborhood parks within areas of low block size was associated with poorer treatment outcome. Neighborhood park availability had no additional benefit on maintaining a lower zBMI if the child lived in a neighborhood with larger blocks. Thus, aspects of the neighborhood built environment are associated with child success in behavioral treatments for obesity, and efficacy may be improved by individualizing treatments based on characteristics of the built environment.

Technical Abstract: Background: Research suggests the built environment can influence child activity and eating. Purpose: Test whether the built environment is related to effectiveness of standardized family-based behavioral treatments on overweight children’s weight loss. Method: zBMI changes for 212 children (8-12 years old) who participated in four randomized trials to treat obesity were related to built environment related to physical activity or food purchasing. Results: Parkland, larger average block size and fewer supermarkets were associated with greater zBMI change at 2 years. Girls and older children with low access to convenience stores had better success at 2 years, while interactions of no parkland with low block size, high number of supermarkets or convenience stores were related to reduced long-term zBMI change. Conclusions: Built environment is associated with child success in behavioral treatments for obesity, and efficacy may be improved by individualizing treatments based on characteristics of the built environment.