Epidemiologic Reviews Advance Access published online on May 28, 2007
Epidemiologic Reviews, doi:10.1093/epirev/mxm009
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The Built Environment and Obesity
1 Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD
2 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
3 Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
4 George W. Comstock Center for Public Health Research and Prevention, Johns Hopkins University, Hagerstown, MD
5 National Center for Smart Growth Research and Education, University of Maryland, College Park, MD
6 Prevention and Research Center, Women's Center for Health and Medicine, Mercy Hospital, Baltimore, MD
7 Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Correspondence to Dr. Mia A. Papas, Department of Pediatrics, University of Maryland School of Medicine, Room 163, 737 West Lombard Street, Baltimore, MD 21201 (e-mail: miapapas{at}gmail.com).
accepted for publication April 16, 2007.
Obesity results from a complex interaction between diet, physical activity, and the environment. The built environment encompasses a range of physical and social elements that make up the structure of a community and may influence obesity. This review summarizes existing empirical research relating the built environment to obesity. The Medline, PsychInfo, and Web of Science databases were searched using the keywords "obesity" or "overweight" and "neighborhood" or "built environment" or "environment." The search was restricted to English-language articles conducted in human populations between 1966 and 2007. To meet inclusion criteria, articles had to 1) have a direct measure of body weight and 2) have an objective measure of the built environment. A total of 1,506 abstracts were obtained, and 20 articles met the inclusion criteria. Most articles (84%) reported a statistically significant positive association between some aspect of the built environment and obesity. Several methodological issues were of concern, including the inconsistency of measurements of the built environment across studies, the cross-sectional design of most investigations, and the focus on aspects of either diet or physical activity but not both. Given the importance of the physical and social contexts of individual behavior and the limited success of individual-based interventions in long-term obesity prevention, more research on the impact of the built environment on obesity is needed.
environment design • obesity • residence characteristics • social environment
BMI, body mass indexCI, confidence intervalPR, prevalence ratio
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