Neighborhood and weight-related health behaviors in the Look AHEAD (Action for Health in Diabetes) Study
1 Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3 Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
4 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
5 Division of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
6 Department of Medicine, St. Luke's—Roosevelt Hospital Center, New York, NY, USA
7 Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
8 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
BMC Public Health 2010, 10:312 doi:10.1186/1471-2458-10-312Published: 4 June 2010
Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors.
In this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders.
The availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors.
In this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.