Childhood obesity affects more than 18% of children in the United States and continues to be a significant health issue throughout the country. “Achieving and maintaining healthy weight, nutrition, and physical fitness are critical to optimizing child health,” says Patrick M. Vivier, MD, PhD. “The data on childhood obesity is highly concerning both on a national level as well as in the state of Rhode Island.” In Rhode Island, the prevalence of children who are classified as overweight or obese is 31%, but the rate is higher than 43% in some of the state’s core cities.

Assessing Physical Activity Environments

In addition to diet, genetics, family environment, and psychological factors, studies have shown that physical activity environments play an important role in a child’s development of overweight and obesity. For a study published in the Rhode Island Medical Journal, Dr. Vivier and colleagues sought to better understand the relationship between the physical activity environment and child overweight and obesity in Rhode Island. Using geographic information systems, the researchers calculated distances from every residence in Rhode Island to the closest physical activity location to assess the relationship of distance with childhood overweight and obesity.

“We wanted to determine if families had access to public basketball courts, tennis courts, fields, pools, ice rinks, skate parks, playgrounds, and tracks,” Dr. Vivier explains. “In particular, we explored if the presence of these facilities varied by neighborhood characteristics and whether this was related to childhood obesity rates. These data are important to gaining a clearer understanding of whether families have access to environments that can foster physical activity. While it’s helpful to recommend exercise, it’s also important to know if families in high-risk areas have access to facilities for physical activity.”

Childhood Overweight & Obesity Is Complex

According to the study results, the average distance to the closest physical activity location in high-risk towns ranged from 0.61 to 3.15 miles. For low-risk towns, the average distance to the closest physical activity resources ranged from 1.25 to 7.43 miles.

“Residences in high-risk neighborhoods were closer to physical activity locations than those in low-risk neighborhoods,” says Dr. Vivier. “In our adjusted model, the presence of physical activities was not protective against childhood obesity (Table). These findings are important because they show that the problem is not that people living in high-risk areas had to travel further to reach a field or court. The reality is that they live in closer proximity to these resources. This finding serves as an important reminder that the issue of childhood overweight and obesity is complex. Other factors can play a critical role, such as awareness of physical activity resources, having reliable transportation to these facilities, and the safety of these facilities.”

The Importance of Engaging With Families

Dr. Vivier notes that the findings serve as a reminder to physicians that it is critically important to engage with parents. “As clinicians, we need to collaborate with parents to discover potentially limiting factors to accessing physical activity facilities for their children and determine how we can help,” he notes. “At the Hassenfeld Child Health Innovation Institute, we’re building a website to inform families where physical activity facilities are located. We’re assessing other initiatives to encourage use of our existing facilities. From a policy perspective, building new facilities may not be enough to impact this important health issue. We need to look at more complex factors, because on its own, proximity to physical activity resources is not a significant predictor of child overweight and obesity.”

The study team noted that future research should examine the quality of physical activity environments and resources, as well as actual usage patterns by children in the community. “We also need to engage with families to identify factors that impact access to healthy lifestyles,” says Dr. Vivier. “In addition, we must continue to assess new interventions that aim to promote healthy weight, nutrition, and physical fitness to reduce the burden of childhood overweight and obesity.”

References

Flanagan S, Rogers ML, Carlson L, Jelalian E, Vivier PM. Childhood overweight/obesity and the physical activity environment in Rhode Island. R I Med J. 2021;104:42-46. Available at: http://rimed.org/rimedicaljournal/2021/02/2021-02-42-contribution-flanagan.pdf.

Cerin E, Saelens BE, Sallis JF, Frank LD. Neighborhood Environment Walkability Scale: validity and development of a short form. Med Sci Sports Exerc. 2006;38(9):1682-1691.

Casey R, Oppert J-M, Weber C, et al. Determinants of childhood obesity: what can we learn from built environment studies? Food Qual Pref. 2014;31:164-172.

Duncan DT, Castro MC, Gortmaker SL, Aldstadt J, Melly SJ, Bennett GG. Racial differences in the built environment—body mass index relationship? A geospatial analysis of adolescents in urban neighborhoods. Int J Health Geogr. 2012;11(1):11.

Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE. Neighborhood environment and physical activity among youth: a review. Am J Prev Med. 2011;41(4):442-455.