The relationships between aspects of the "built environment" and child and adolescent weight status are complex. Under particular conditions (which are not yet clearly identified in the research), for some children, certain aspects of the built environment may be associated with weight status. However, research is limited and further study of the role of the built environment is urgently needed as various aspects may influence the effectiveness of intervention strategies.

The lack of clear findings appears to be limited because of several issues:

• Research studies often defined the factors in different ways
• Different combinations of factors were included in multivariate models in different studies
• Effects of the built environment on weight status may be indirect and confounded by other social and environmental factors. 

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Accessibility of large chain supermarkets may be associated with a decreased risk of overweight or obesity but this relationship may be influenced by other characteristics (e.g., the relationship may hold for older children and adolescents but not younger children, and may be influenced by other factors such as race, income and geographic locale).

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

The available evidence does not support that density of and proximity to fast-food/full-service restaurants is associated with risk of pediatric obesity. Of note: None of these studies quantified actual patronage of fast-food/restaurant establishments.

These relationships appear to be multi-factorial and may be conditioned by other factors such as age, race, income or geographic locale.  

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.