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Is access to the outdoors associated with childhood overweight and obesity?
B.C. van der Zwaard1,2, A. Schalkwijk1,2, P.J.M. Elders1,2, G. Nijpels1,2, L. Platt3;
1
General practice and elderly care medicine, VU medical center, 2EMGO+ Institute for Health and Care
research, Amsterdam, Netherlands, 3Social Policy, London School of Economics and Political Science,
London, UK.
Background and aims: Overweight and obese children are at increased risk of becoming overweight and
obese adults and therefore an important risk factor for developing type 2 diabetes. Being overweight or
obese is associated with environmental, parental and socioeconomic status (SES) characteristics. The
aims of this study were to assess the association of environmental characteristics during ages 3-5 on being
overweight or obese at age 7. Furthermore we assessed if parental behaviors moderate or mediate this
influence. In the final stage of our analysis we assessed if the influence of SES on the derived model the
previous aims was assessed.
Materials and methods: The analysis used the Millennium Cohort Study; a nationally representative
study of around 19,000 children born in the UK between 2000-2001 who are followed over time. We use
measures from the surveys carried out at age 9 months, 3 years, 5 years and 7 years. Logistic regression
was used to test the initial association between the outcome measure overweight/obese (according to the
age specific Cole criteria) and determinants: amount of green space in the neighborhood, having access to
a garden and the condition (i.e. shabbiness) of the neighborhood. Subsequently, parental determinants
consisting of variables summarizing: food consumption, physical activity, rules and regularity were
evaluated as moderators or mediators of the initial association. Lastly SES related variables, namely
education level, housing tenure and poverty were tested as moderators or mediators of the associations.
Results: Statistically significant associations (p≤0.05) were found between low levels green space, not
having access to a garden, shabbiness of the neighborhood and childhood obesity (OR (95% CI)
respectively: 1,14 (1,02-1,27), 1,35 (1,16-1,58), 1,22 (1,05-1,42)). Parental determinants were related to
the environmental determinants and childhood overweight/obese but did not moderate or mediate the
association between the latter two. Therefore no parental variables were left in the model. For SES, the
highest level of education in the household did diminish the magnitude of the associations found between
the environmental determinants and being overweight/obese. In the final model the remaining significant
associations with childhood overweight/obese were no garden access for lower educated households and
shabbiness of the neighborhood for higher educated households (OR (95% CI) respectively: 1,41 (1,091,84), 1,38 (1,12-1,70)).
Conclusion: Not having access to a garden at age 3 - 5 for lower educated households increased
childhood overweight/obesity at age 7. Also the combination of a more dilapidated neighborhood and
higher education increased childhood overweight/obesity. To conclude, we showed that limits on access
to outdoors space is associated with future childhood overweight/obesity although moderated by
education level. More research is needed to see how we can deploy these findings in the prevention of
type 2 diabetes.