Abstract
Obesity and associated chronic conditions are endemic among the American population with rates disproportionately high among ethnic minorities and the economically disadvantaged. If current trends continue, every adult in the United States will be considered obese by the year 2030. Not only do overweight and obesity pose significant physical health risks, persons of overweight and obese status often encounter forms of bias, including stigma and appearance discrimination and are subject to negative myths and stereotyping. The causes of obesity are complex, and include biological, behavioral, and environmental factors. Historically, cultural and social mores have considered overweight and obese individuals the victims of faulty decision-making, impulsive behaviors, or flawed psychosocial development. However, obesogenic environments, or the physical settings that promote population-level obesity by encouraging increased food intake of non-healthful foods and physical inactivity are ubiquitous in the United States. The pervasive nature of obesogenic environments in the U.S. is evidenced by the fact that nearly seven out of every ten Americans are overweight. In fact, for most people, it is difficult NOT to become overweight. Minority, poor, and otherwise under-resourced communities share a disproportionate burden of obesogenic environments, including the phenomenon of food desserts, or areas with severely limited proximal or financial access to healthy foods. For example, fast-food restaurants tend to be more heavily concentrated in lower-income and minority neighborhoods than in high-income and predominantly White neighborhoods, and the availability of supermarkets in predominantly Black and Hispanic neighborhoods is lower than in predominantly White neighborhoods. This research study examines environmental sprawl, one facet related to obesogenic environments. Sprawl is a comprehensive measure of an area’s accessibility and has been shown to have significant associations with overweight and obesity. The purpose of this research study is to examine the effects of sprawl and energy intake on BMI while assessing the impact of demographic factors. The methods included traditional measures of association and correlation to describe the relationship between sprawl and BMI, as well linear regression methods to estimate the hypothesized predictive effect of sprawl score on BMI score and fruit and vegetable consumption. The sample consisted of adults living in the US who participated in the Behavioral Risk Factor Surveillance System survey and also resided in areas for which sprawl scores were calculated (n= 122,265). A total of 63% of respondents in the sample were overweight or obese, consistent with the current U.S. trends indicating a shift in the population weight distribution towards higher weight categories. Significant differences in BMI scores were noted based on education level, race, income, marital status, and sex, with minorities, and those with lower education and income levels having higher BMI scores and consuming fewer fruits and vegetables. In addition, a significant correlation exists between sprawl scores and BMI scores, with residents of more sprawling areas having higher BMI scores. The multivariate analyses also confirmed significant effects of sprawl and region of residence on BMI, even when accounting for the relationship of other significant variables.
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