Local food outlets, weight status, and dietary intake: associations in children aged 9-10 years

Background: The rising prevalence of childhood obesity is a key public health issue worldwide. Limited evidence suggests that there may be interactions between environmental factors at a neighborhood level and the development of obesity, with the availability and accessibility of food outlets being potentially important.

Purpose: To examine how the weight status and dietary intake of 1669 children aged 9-10 years was associated with neighborhood food outlets in a cross-sectional study.

Methods: Availability of food outlets was computed from GIS data for each child's unique neighborhood. Outlets were grouped into BMI-healthy, BMI-unhealthy, or BMI-intermediate categories according to food type sold. Weight status measurements were objectively collected, and food intake was recorded using 4-day food diaries. Data were collected in 2007 and analyzed in 2009.

Results: Availability of BMI-healthy outlets in neighborhoods was associated with lower body weight (1.3 kg, p=0.03); BMI (0.5 kg/m(2), p=0.02); BMI z-score (0.20, p=0.02); waist circumference (1.3 cm, p=0.02); and percentage body fat (1.1%, p=0.03) compared to no availability. In contrast, neighborhood availability of BMI-unhealthy outlets was inversely associated with body weight (1.3 kg, p=0.02); BMI (0.4 kg/m(2), p=0.05); BMI z-score (0.15, p=0.05); waist circumference (1.1 cm, p=0.04); and percentage body fat (1.0%, p=0.03). Unhealthy food intake (fizzy drinks 15.3%, p=0.04, and noncarbonated "fruit" drinks 11.8%, p=0.03) was also associated with availability of BMI-unhealthy food outlets.

Conclusions: Features of the built environment relating to food purchasing opportunities are correlated with weight status in children.