Change in the Built Environment and its Association with Change in Walking and Obesity in Middle Age and Older Adults.

Abstract

The built environment, a subset of the physical environment that includes land-use patterns, transportation, and design, has been shown to influence walking and obesity. However, the majority of evidence is cross-sectional, providing little insight into the potential impact of changes in the built environment on changes in walking and obesity.

This dissertation uses longitudinal data from the Multi-ethnic Study of Atherosclerosis (MESA), to examine whether a) people who move to better built environments start walking more and lose more weight, b) people who have better built environments experience more positive trajectories in walking and weight, and c) people experiencing changes in the built environment around them experience changes in walking and obesity.

The first analysis found that participants who moved to a location with a higher walkability increased transport walking, had higher odds of meeting “Every Body Walk!” national campaign goals through transport walking, and had a reduction in Body Mass Index (BMI). The second analysis found that, among the entire cohort, a more supportive initial built environment and more positive changes in several specific built environment measures were associated with greater increases in transport walking over time. Similarly, the third analysis found that changes in the density of development towards a more walkable environment was associated with less pronounced increases or decreases in BMI and waist circumference over time. Together, these three findings indicate that changes in the built environment may be a viable option for increasing physical activity and decreasing obesity at the population level. A final analysis found that changes in the built environment are disproportionately spatially clustered in advantaged neighborhoods suggesting that urban planning policies should focus on equity in urban planning to ensure that changes do not have the unintended consequence of increased health disparities.

Collectively, this dissertation clarifies the mechanism linking built environments with health and encourages collaborative work across sectors to design and build healthy communities for all populations.