Does change in the neighborhood environment prevent obesity in older women?
Introduction
The impact of neighborhood environmental determinants on health may increase as adults age. As retirees spend more time near home, physical and mental health decline, and social supports decrease (Johnson and Troll, 1994, Shaw et al., 2007), older adults may grow increasingly dependent on their residential neighborhood. A review of the literature on neighborhood effects among older adults suggested that neighborhood environment can be a primary influence on older adults' health and functioning (Yen, Michael, & Perdue, 2009).
Increasingly, research is investigating the role of neighborhood built environment in physical activity and obesity (Ding & Gebel, 2012). Results from studies conducted in the general adult population suggest a protective effect of walkable neighborhood environments on obesity although interpretation is complicated by limitations in the design and execution of the studies (Feng, Glass, Curriero, Stewart, & Schwartz, 2010). Research specific to older adults is more limited (Kerr, Rosenberg, & Frank, 2012). While prior cross-sectional studies evaluating environmental correlates of obesity in samples of older adults support a significant association between neighborhood environment and BMI or other measures of obesity (Berke et al., 2007, Eisenstein et al., 2011, Frank et al., 2010, Grafova et al., 2008, James et al., 2013, King et al., 2011; Lee et al., 2009, Li et al., 2008), results from longitudinal studies are mixed, with studies suggesting no association, a positive association, and a negative association between BMI and characteristics of the built environment (Lee et al., 2009, Li et al., 2009, Michael et al., 2013, Sarkar et al., 2013).
Any study examining weight change in a cohort of older adults (in our study, adults 72–85 years) must consider two different outcomes: obesity and weight loss. Walkable neighborhood environments may prevent obesity. Approximately 35% of Americans aged 60 years and older are now overweight or obese (Flegal, Carroll, Ogden, & Curtin, 2010), and older women are more likely to be obese (13%) than are older men (12%) (Flegal et al., 2010). The prevalence of obesity in adults aged 60 and over increased about 35% between 1990 and 2000 (Arterburn et al., 2004, Villareal et al., 2005); since 2000 the increase has stabilized in older women, but continues to rise in older men (Flegal et al., 2010). Unhealthy body weight is strongly linked to poor health outcomes in older adults (Colditz et al., 2004, Grundy, 2000), including increased risk of chronic diseases such as diabetes mellitus (Apovian et al., 2002), coronary heart disease (Grundy, 2000, Vincent et al., 2010), and breast cancer (Colditz et al., 2004). Obesity also increases the risk of disability (Vincent et al., 2010) and is associated with lower overall quality of life among older adults (Yan et al., 2004).
Alternatively, neighborhood walkability may result in attenuation of weight loss in older adults. Despite the increased prevalence of obesity among older adults, weight and BMI generally increase until age 60 and then remain stable (Villareal et al., 2005). Over age 75, weight loss is a marker of frailty (Fried, Ferrucci, Darer, Williamson, & Anderson, 2004). Modest levels of physical activity may attenuate aging-related weight loss because exercise for this age group keeps them stronger and healthier, rather than reducing BMI (Dziura et al., 2004, Stephen and Janssen, 2010). A recent study found that modest amounts of physical activity attenuated age-related weight loss by approximately 25% in a normal healthy cohort of adults aged 65 years and older (Stephen & Janssen, 2010).
Another major challenge related to interpreting evidence of the influence of the neighborhood environment on weight change is the difficulty in establishing a causal association (Ding & Gebel, 2012). Cross-sectional studies represent the most common source of evidence and do not account for temporal precedence. Neither do these studies generally consider competing explanations of the built environment–physical activity relationship, most importantly neighborhood self-selection: as people may select their residence based on a preference to be active, residential selection may inflate or over-estimate the causal influence of neighborhood features on residents' BMI (Smith et al., 2011, Zick et al., 2013).
Evaluation of natural experiments, including opportunistic evaluations of environmental interventions, are recommended to enhance causal inference (Ding & Gebel, 2012). While some studies have evaluated changes in neighborhood environment as a result of individuals moving, these studies have methodological limitations including self-selection, small samples of movers, short follow-up periods, and focus on movers to new housing developments (Giles-Corti et al., 2013; Lee et al., 2009). Studies examining impacts of changes to neighborhood design provide a stronger test of the influence on obesity (Durand, Andalib, Dunton, Wolch, & Pentz, 2011).
Over the past 30 years, the Portland region and the state of Oregon have made significant investments in plans, regulatory structures, and public facilities to reduce sprawl. The region is governed by Metro, a chartered regional government with elected officials. In December 1994 Metro adopted the Metro 2040 Growth Concept, in which city and county growth plans were required to incorporate such strategies as: (1) compact growth centers, (2) affordable housing, (3) open space development, and (4) transit-oriented development approaches. The light rail system in Portland, significantly expanded during the past decade, is intended not so much as a replacement for cars but as an intervention to increase active modes of transportation, including walking. Additionally, a system of green spaces was developed to protect open space resources within the urban area. These policy developments resulted in measurable changes in the built environment characteristics since the early 1990s (Jun, 2008).
We sought to capitalize on the changes in the Portland region's physical environment. Using Metro's comprehensive regional spatial data and a large cohort study of older women residing in the Portland metropolitan region with longitudinal measures of body size and other health factors, we assessed whether change in the neighborhood environment is associated with change in adiposity, measured by BMI, in older women over an 18-year period.
Section snippets
Study design
We employed a retrospective cohort design examining concurrent change in BMI and neighborhood built environment over an 18-year period among a sample of older women living in Portland, Oregon. We used geographic information system (GIS) tools to merge historical individual-level and neighborhood data from several sources.
Study population
The Portland cohort of the Study for Osteoporotic Fractures (SOF) in women was the source of participant data. The design, enrollment process, and inclusion criteria have been
Descriptive statistics
Of the 2003 women in this analysis at baseline, 1729 (86%) completed 4 visits and contributed an average of six years of follow-up data, 1369 (68%) completed six visits and contributed an average of 10 years of data, and 700 (35%) completed seven visits and contributed an average of 15 years of data. Similar to other cohorts of older adults, death was the primary reason for loss to follow-up (Hardy, Allore, & Studenski, 2009). Compared to women who were alive at the end of the study (n = 987),
Discussion
We observed no association between neighborhood built environment, or change in built environment, and change in BMI over time among a cohort of older, white, community-dwelling women. The population in this study was overweight at baseline but BMI decreased over the follow-up period. BMI may decrease with age, especially among older adults with complex morbidities (Dziura et al., 2004). Increased neighborhood SES at baseline was independently associated with healthier BMI at baseline and
Conclusion
Our results contribute to the understanding of the association between changes in the built environment and changes in BMI in older women. Our findings do not support an association between improvements in the neighborhood built environment and BMI in older, white women over an 18-year period. Importantly this study addresses many of the limitations of prior research through the linkage of repeated objective measures of standard environmental characteristics with repeated objective measures of
Acknowledgments
This research was supported by U.S. National Institute of Aging grant R01 AG028254 awarded to the first author. Study infrastructure, data collection, and follow-up of study participants were supported by the National Institute of Aging and National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576). The sponsor had no role in the preparation, review, or approval of the manuscript for
References (70)
- et al.
Longitudinal assessment of urban form and weight gain in African–American women
American Journal of Preventive Medicine
(2011) - et al.
Methods for incorporating death into health-related variables in longitudinal studies
Journal of Clinical Epidemiology
(2005) - et al.
Built environment, physical activity, and obesity: what have we learned from reviewing the literature?
Health & Place
(2012) - et al.
The built environment and obesity: a systematic review of the epidemiologic evidence
Health & Place
(2010) - et al.
“Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician
Journal of Psychiatric Research
(1975) - et al.
Obesity relationships with community design, physical activity, and time spent in cars
American Journal of Preventive Medicine
(2004) - et al.
Neighborhood characteristics favorable to outdoor physical activity: disparities by socioeconomic and racial/ethnic composition
Health & Place
(2010) - et al.
The influence of urban design on neighbourhood walking following residential relocation: longitudinal results from the RESIDE study
Social Science & Medicine
(2013) Structural equations modeling: fit indices, sample size, and advanced topics
Journal of Consumer Psychology
(2010)- et al.
Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults
Social Science & Medicine
(2011)
The built environment and physical activity levels: the Harvard alumni health study
American Journal of Preventive Medicine
Built environment, adiposity, and physical activity in adults aged 50–75
American Journal of Preventive Medicine
Built environment and change in body mass index in older women
Health & Place
Neighborhood design and active aging
Health & Place
Built environment configuration and change in body mass index: the Caerphilly Prospective Study (CaPS)
Health & Place
Effects of neighborhood walkability on healthy weight: assessing selection and causal influences
Social Science Research
Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the obesity society
American Journal of Clinical Nutrition
The built environment and risk of obesity in the United States: Racial-ethnic disparities
Health & Place
Neighborhood environment in studies of health of older adults: a systematic review
American Journal of Preventive Medicine
Body mass index and physical function in older women
Obesity Research
The coming epidemic of obesity in elderly Americans
Journal of the American Geriatrics Society
Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis)
Obesity
Association of the built environment with physical activity and obesity in older persons
American Journal of Public Health
Association of walkability with obesity in Baltimore city, Maryland
American Journal of Public Health
The role of the built environment in the disablement process
American Journal of Public Health
Risk factors for breast cancer according to estrogen and progesterone receptor status
Journal of the National Cancer Institute
Prospective study of urban form and physical activity in the Black Women's Health Study
American Journal of Epidemiology
The women's health initiative: the food environment, neighborhood socioeconomic status, BMI, and blood pressure
Obesity
A systematic review of built environment factors related to physical activity and obesity risk: implications for smart growth urban planning
Obesity Reviews
Can physical activity attenuate aging-related weight loss in older people?: The Yale health and aging study, 1982–1994
American Journal of Epidemiology
Environmental correlates of overweight and obesity in community residing older adults
Journal of Aging and Health
Applied missing data analysis
Missing not at random models for latent growth curve analyses
Psychological Methods
Travel and the built environment: a meta-analysis
Journal of the American Planning Association
Prevalence and trends in obesity among US adults, 1999–2008
Journal of the American Medical Association
Cited by (45)
Machine-learning-assisted Investigation into the Relationship between the Built Environment, Behavior, and Physical Health of the Elderly in China
2023, Biomedical and Environmental SciencesHow daily activities and built environment affect health? A latent segmentation-based random parameter logit modeling approach
2023, Travel Behaviour and SocietyAir pollution, greenness and risk of overweight among middle-aged and older adults: A cohort study in China
2023, Environmental ResearchHow greenway exposure reduces body weight: A natural experiment in China
2022, Landscape and Urban PlanningThe social determinants of health influencing obesity for the aged in the Pakpoon community context: A qualitative study
2022, International Journal of Nursing SciencesCitation Excerpt :Living in a neighborhood with a high density of fast-food restaurants is significantly associated with obesity [8,13]. In contrast, the better the access to healthy food is, the healthier local aging populations are [14]. A compounding issue is that people who have fewer healthy food choices locally are more likely to be obese than many healthy food choices [15].
Establishing associations between residential greenness and markers of adiposity among middle-aged and older Chinese adults through multilevel structural equation models
2020, International Journal of Hygiene and Environmental HealthCitation Excerpt :However, results from an Ireland study have questioned whether the greenness–overweight/obesity association is linear and suggested a u-shaped association, whereby those living in neighbourhoods with the lowest and highest levels of green space were more likely to be obese (Dempsey et al., 2018). In addition, a study among older women in Portland, USA, suggested that access to parks was not associated with BMI (Michael et al., 2014). Consistent with previous evidence on adults (Huang et al., 2019b; Persson et al., 2018; Sarkar, 2017), we found a significant negative association between greenness and the prevalence of abdominal adiposity among middle-aged or older adults.