Running to the store? The relationship between neighborhood environments and the risk of obesity.

We expand the search for modifiable features of neighborhood environments that alter obesity risk in two ways. First, we examine residents' access to neighborhood retail food options in combination with neighborhood features that facilitate physical activity. Second, we evaluate neighborhood features for both low income and non-low income neighborhoods (bottom quartile of median neighborhood income versus the top three quartiles). Our analyses use data from the Utah Population Database merged with U.S. Census data and Dun & Bradstreet business data for Salt Lake County, Utah. Linear regressions for BMI and logistic regressions for the likelihood of being obese are estimated using various measures of the individual's neighborhood food options and walkability features. As expected, walkability indicators of older neighborhoods and neighborhoods where a higher fraction of the population walks to work is related to a lower BMI/obesity risk, although the strength of the effects varies by neighborhood income. Surprisingly, the walkability indicator of neighborhoods with higher intersection density was linked to higher BMI/obesity risk. The expected inverse relationship between the walkability indicator of population density and BMI/obesity risk is found only in low income neighborhoods. We find a strong association between neighborhood retail food options and BMI/obesity risk with the magnitude of the effects again varying by neighborhood income. For individuals living in non-low income neighborhoods, having one or more convenience stores, full-service restaurants, or fast food restaurants is associated with reduced BMI/obesity risk, compared to having no neighborhood food outlets. The presence of at least one healthy grocery option in low income neighborhoods is also associated with a reduction in BMI/obesity risk relative to no food outlets. Finally, multiple food options within a neighborhood reduce BMI/obesity risk, relative to no food options, for individuals living in either low-income or non-low neighborhoods.