Neighborhood-Level Analysis on the Impact of Accessibility to Fast Food and Open Green Spaces on the Prevalence of Obesity

Background: The complex epidemiology of obesity includes environmental factors. We examined how accessibility to fast food restaurants and green spaces is associated with obesity. Methods: We used geocoded body mass index values of 20,927 subjects that visited the largest statewide health care network in Rhode Island. Spatial analysis and logistic regression were used to examine the association of obesity at the individual level, and obesity hot and cold spots with the accessibility to fast food restaurants and green space areas. Results: The age-adjusted prevalence of obesity in our sample was 33%. Obese subjects were less likely to live in neighborhoods with the highest accessibility to green space areas (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.81-0.97), compared with neighborhoods with low accessibility. Obese subjects were more likely to live in neighborhoods with medium or high accessibility to fast food restaurants (OR 1.22; 95% CI, 1.14-1.31; OR 1.20; 95% CI, 1.10-1.32, respectively). Looking at obesity clustering, hot spots were 18% and 21% less likely to be located in neighborhoods with medium and high accessibility to green space areas, respectively (OR 0.82; 95% CI, 0.76-0.88; OR 0.79; 95% CI, 0.71-0.86). In contrast, hot spots were 1.65 and 4.81 times more likely to be located in neighborhoods with medium and high accessibility to fast food restaurants, respectively (OR 1.65; 95% CI, 1.53-1.77; OR 4.81; 95% CI, 4.39-5.27, respectively). Conclusions: Accessibility to fast food restaurants is positively associated with the presence of obesity hot spots, while access to green space areas is associated with decreased neighborhood obesity rates.