PWM: Environment (2012)
Aspects of the built environment in which individual patients live and work can seem so far removed from dietetics practice that RDs may wonder why it is important to be aware of the state of the research on topics such as:
- Neighborhood safety,
- Physical activity resources, or
- Residential density.
Two key aspects of dietetics practice argue for the importance of the RD being aware of this research.
Informed Dietetics Practice
For instance, an overweight child who lives in an unsafe neighborhood with few parks or physical activity resources available in the immediate vicinity may find it substantially more difficult to meet a recommendation to increase the time spent each week in moderate or vigorous physical activity. Thus, a health professional who makes such a recommendation without being aware of the impact of the individual’s built environment risks making irrelevant recommendations.First, as outlined in the International Dietetics and Nutrition Terminology (IDNT) manual (3rd Ed.), nutrition assessment involves identifying all data relevant for identifying the nutrition related problem and formulating nutrition intervention goals (p.13). Without a clear understanding of the built environment in which a child lives, a nutrition intervention goal may be unrealistic or insensitive given the patient’s situation.
In short, without some knowledge of the built environment that may be associated with childhood overweight and obesity and RD risks making ineffective recommendations.
RD Community Responsibility
Because of these arguments, the Work Group on Pediatric Overweight determined that RDs should be made aware of different aspects of the built environment that may affect pediatric overweight and obesity. While this is a new area of research and firm conclusions elusive, the practicing RD should be aware of this research and factor it into his or her practice.Second, RDs live in communities, and as such, have a responsibility to advocate for health promoting living situations. In order to advocate for health promoting aspects of neighborhoods, schools, municipalities and state and federal policy, the RD must be aware of the best research on the relationship between aspects of the built environment and health.
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Assessment
What is the relationship between built environment and childhood obesity and overweight?
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Conclusion
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.
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Grade: III
- 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.
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Evidence Summary: Childhood Obesity and the Built Environment
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results,
click here.
- Worksheets
- Bell JF, Wilson JS, Liu GC. Neighborhood Greeness and 2 Year Changes in Body Mass Index of Children and Youth. Am J Prev Med. 2008 (Dec); 35 (6): 547-553.
- Burdette HL, Whitaker RC. Neighborhood playgrounds, fast food restaurants, and crime: Relationships to overweight in low-income preschool children. Prev Med. 2004: 38; 57-63.
- Cutts BB, Darby KJ, Boone CG, Brewis A. City structure, obesity and environmental justice: An integrated analysis of physical and social barriers to walkable streets and park access. Social Science & Medicine, 2009; 69: 1,314-1,322.
- Duncan DT, Johnson RM, Molnar BE , Azrael D. Association between neighborhood safety and overweight status among urban adolescents. BMC Public Health. 2009; 9: 289.
- Evenson KR, Scott MM, Cohen DA, Voorhees CC. Girls Perception of Neighborhood Factors on Physical Activity, Sedentary Behavior and Body Mass Index. Obesity, 2007 (Feb); 15 (2): 430-445.
- Ewing R, Brownson RC, Berrigan D. Relationship Between Urban Sprawl and Weight of United States Youth. Am J Prev Med 2006 (Dec); 31 (6): 464-474.
- Franzini L, Elliott MN, Cuccaro P, Schuster M, Gilliland J, Grunbaum J, Franklin F, Tortolero SR. Influences of physical and social neighborhood environments on children's physical activity and obesity. Am J Pub Health. 2009; 99: 271-278.
- Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and environment. Pediatrics. 2006; 117: 417-424.
- Klingerman M, Sallis JF, Ryan S, Frank L, Nader PR. Association of neighborhood design and recreation environment variables with physical activity and body mass index in adolescents. Am J Health Promot 2007; 21 (4): 274-277.
- Liu GC, Cunningham C, Downs SM, Marrero DG, Fineberg N. A spatial analysis of obesogenic environments for children. Proc AMIA Symp 2002; 459-463.
- Nelson MC, Gordon-Larsen P, Song Y, Popkin BM. Built and Social Environments: Associations with Adolescent Overweight and Activity. American Journal of Preventative Medicine, 2006; 31 (2): 109-117.
- Oreskovic NM, Winickoff JP, Kuhlthau KA, Romm D, Perrin JM. Obesity and the Built Environment Among Massachusetts Children. Clin Pediatrics 2009; 48: (9); 904-912.
- Romero AJ, Robinson TN, Kraemer HC, Erickson SJ, Haydel KF, Mendoza F, Killen JD. Are Precieved Neighborhood Hazards a Barrier to Physical Activity in Children? Arch Pediatr Adolesc Med. 2001; 155: 1,143-1,148.
- Scott MM, Cohen DA, Evenson KR, Elder J, Catellier D, Ashwood JS, Overton A. Weekend schoolyard accessibility, physical activity and obesity: The Trial of Activity in Adolescent Girls (TAAG) Study. Prev Med. 2007 (May); 44 (5): 398-403.
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Search Plan and Results: Built or food environment systematic reviews 2009
What is the relationship between the availability of retail food stores and childhood obesity and overweight?
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Conclusion
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).
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Grade: II
- 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.
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Evidence Summary: Pediatric Obesity and Accessibility of Retail Food Stores
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results,
click here.
- Worksheets
- Liu GC, Wilson JS, Rong Q, Ying J. Green neighborhoods, food retail and childhood overweight: Differences by population density. Am J Health Prom; 2007. 21 (Supp): 317-325.
- Powell LM, Auld C, Chaloupka FJ, O'Malley PM, Johnston LD. Associations between access to food stores and adolescent body mass index. Am J Prev Med. 2007; 33 (4S): S301-S307.
- Sturm R, Datar A. Body mass index in elementary school children, metropolitan area food prices and food outlet density. Public Health 2005; 119: 1,059-1,068.
What is the relationship between the accessibility of fast-food/full-service restaurants and childhood obesity and overweight?
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Conclusion
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.
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Grade: III
- 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.
-
Evidence Summary: Pediatric Obesity and Accessibility of Fast Food and Full-Service Restaurants
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results,
click here.
- Worksheets
- Burdette HL, Whitaker RC. Neighborhood playgrounds, fast food restaurants, and crime: Relationships to overweight in low-income preschool children. Prev Med. 2004: 38; 57-63.
- Crawford DA, Timperio AF, Salmon JA, Baur L, Giles-Corti B, Roberts RJ, Jackson ML, Andrianopoulos N, Ball K. Neighbourhood fast food outlets and obesity in children and adults: The CLAN study. Int J Ped Obesity. 2008: 3; 249-256.
- Liu GC, Wilson JS, Rong Q, Ying J. Green neighborhoods, food retail and childhood overweight: Differences by population density. Am J Health Prom; 2007. 21 (Supp): 317-325.
- Oreskovic NM, Winickoff JP, Kuhlthau KA, Romm D, Perrin JM. Obesity and the Built Environment Among Massachusetts Children. Clin Pediatrics 2009; 48: (9); 904-912.
- Sturm R, Datar A. Body mass index in elementary school children, metropolitan area food prices and food outlet density. Public Health 2005; 119: 1,059-1,068.