589 - Multilevel Associations of the Food Environment with Child Body Mass Index and Obesity

Publication Number: 4577.589

Izzuddin M. Aris, Harvard Medical School, Boston, MA, United States; Man Luo, MassGeneral Hospital for Children, C, MA, United States; Tien-Yu Lee, Boston Children's Hospital, Brookline, MA, United States; Lauren Fiechtner, MassGeneral Hospital for Children, Boston, MA, United States; Elsie Taveras, MassGeneral Hospital for Children, Chestnut Hill, MA, United States; Allison Wu, Boston Children's Hospital, Boston, MA, United States

Background: Food insecurity in households with children is widespread and increasing in the U.S. Household food insecurity and neighborhood vulnerability are social factors associated with childhood obesity. Most prior studies have been cross-sectional or examined the exposures of household food insecurity and neighborhood food access in isolation.

Objective: To examine the multilevel and longitudinal associations between neighborhood food access and household food security with childhood obesity prevalence.

Design/Methods: We conducted a retrospective study of children seeking primary care from 11 Mass General Brigham affiliate sites between 2019 and 2024. We included children aged 2-11 years with either residential addresses or data on household food security at baseline (2019) and at least one measure of body mass index (BMI) at baseline and follow-up (2020-2024). We geocoded addresses using ArcGIS and linked them to data from the Food Access Research Atlas (FARA). In urban settings, FARA defines low food access as a low-income census tract where >100 housing units do not have a vehicle (LILV) and >0.5 mile from the nearest supermarket. We used mixed-effects models to examine associations of LILV neighborhoods and household food insecurity at baseline with BMI z-scores and risk of obesity across follow-up, adjusting for insurance type. Our study did not meet criteria for human subjects research by the institution’s IRB.

Results: Among 13,832 children between ages 2-11 years with neighborhood food access data, 26% (n=3,616) resided in LILV neighborhoods (Table 1). After adjusting for insurance type (public vs. private), residence in LILV neighborhoods at baseline was associated with higher mean BMI z-score and obesity probability trajectories across follow-up (Figure 1). Specifically, children who resided in LILV (vs. non-LILV) neighborhoods had higher mean BMI z-score (β 0.14; 95% CI 0.05, 0.22) and higher risk of obesity (RR 1.83; 95% CI 1.08, 3.11) at age 10. Among 3,903 children with household food security data, 22% (n=856) reported food insecurity. In adjusted models, children in food insecure (vs. food secure) households had higher mean BMI z-score (β 0.15; 95% CI 0.05, 0.26) and higher obesity risk (RR 1.88; 95% CI 1.11, 3.19) at age 10.

Conclusion(s): Childhood residence in LILV neighborhoods and food insecure households are associated with higher BMI trajectories and obesity risk. Our findings are timely given tightening restrictions on federal food policies and nutrition security programs. Comprehensive strategies to improve the multilevel food environment for childhood obesity prevention are warranted.

Figure 1. Child Body Mass Index (BMI) z-score and Probability of BMI ≥95th Percentile by A) Neighborhood Food Access and B) Household Food Security
PAS_Figure1_251103.pdfAdjusted for insurance type in 2019. LILV indicates low-income, low-food access tract using vehicle status.

Table 1. Characteristics of Children According to Neighborhood Food Access and Household Food Security in 2019
PAS_Abstract_Table_FINAL.pdf