Walkability, Overweight, and Obesity in Adults: A Systematic Review of Observational Studies

Abstract

We conducted a systematic review to describe and summarize possible associations between the walkability index, overweight, and obesity. Systematic searches using seven electronic databases and reference lists were conducted to identify papers published until December 2017. Observational studies, describing associations using regression-based statistical methods, published in English and Portuguese, reporting markers of overweight and obesity, and involving adults (≥18 years) were included. Of the 2469 references initially retrieved, ten were used for the descriptive synthesis. Seven studies showed significant inverse associations between walkability and overweight and obesity, however, all were cross-sectional studies. High risk of bias scores were observed in “selection bias” and “withdrawals and dropouts”. All studies were published in high-income countries with sample sizes ranging among 75 to 649,513 participants. Weight and height as measures for determining BMI tended to be self-reported. Indicators of walkability, such as land-use mix, street connectivity and residential density were used as components of the indices. Based on this review, more studies should be conducted in low, middle, and middle-high income countries, using longitudinal designs that control neighborhood self-selection; other indicators of the neighborhood environment, such as food access, physical activity facilities, sidewalks, and safety and crime prevention should be considered.

A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study

“…A recent review of studies on neighborhood walkability and obesity among adults in high-income countries found cross-sectional study designs made up the majority of studies reporting an inverse relationship between objective walkability indices and markers of overweight/obesity [ 5 ]. No longitudinal studies in the review reported significant findings.…”

“…Despite this finding, Chandrabose et al [ 6 ] highlight the strength of association is weakened (though remains statistically significant) in studies of objective walkability. Although these two reviews differ in purpose and article inclusion criteria, both reviews emphasize the need for stronger longitudinal designs and methodologies to advance neighborhood walkability and obesity research [ 5 , 6 ].…”

Walkability and its association with walking/cycling and body mass index among adults in different regions of Germany: a cross-sectional analysis of pooled data from five German cohorts

“…However, not for all built environmental features positive associations were found, which limits the evidence 15 16 and indicates that different environmental features could have different associations with walking on the one and cycling on the other hand. 12 Additionally, although many studies on walkability and BMI indicate that BMI is lower the better walkability is, [17][18][19][20] there are also studies that did not found any or only very weak associations between BMI and walkability. [21][22][23] These inconsistencies could be due to the heterogeneity of walkability measures and methods used.…”

“…[21][22][23] These inconsistencies could be due to the heterogeneity of walkability measures and methods used. 22 23 Moreover, most studies used self-reported measures of weight and height, 17 resulting in a BMI that tends to be lower than the actual BMI. 24 25 Additionally, inconsistencies of the current findings may in part be due to little variability of walkability measures in some singlesite studies, which limits the generalisability of current results.…”

Association of the built environment and neighborhood resources with obesity-related health behaviors in older veterans with hypertension.

“…However, there have also been studies that did not find associations between neighborhood characteristics and BMI in older adults (Michael et al, 2013). Thus, neighborhood attributes may affect an individual’s exercise, eating habits and BMI; however, more research is needed (Ding & Gebel, 2012; Paulo Dos Anjos Souza Barbosa et al, 2019). These findings suggest that future research should consider additional neighborhood characteristics relevant to older adults, which this study aims to do.…”